Back Pain = Major Depression and Major Depression = Back Pain

A new study by Yang, et al., explores the “Bidirectional Comorbid Associations Between Back Pain and Major Depression in US Adults.” Funded by a grant from the NCMIC Foundation, this is the first population-based study on the bidirectional comorbid association between these two globally recognized key health problems.¹

The goal of the study: “to explore the cross-sectional and longitudinal comorbid associations between major depression and back pain in a national sample of adults in the U.S.” using data from the Midlife in the United States Survey (MIDUS). Back pain patients were defined as patients who had experienced back pain “almost every day” or “several times a week” in the previous 30 days.

The study found that “major depression is likely to be prospectively associated with back pain, and that back pain is linked to subsequent major depression.” This bidirectional association between back pain and major depression is consistent with findings from previous research.^2-3 The study also found that “age was inversely related to major depression” and that “there was a higher proportion of female participants with major depression (24.1%) and a higher proportion of female participants with back pain (14.1%).”

Needless to say, these comorbid and bidirectional associations between back pain and major depression may have implications for the management of patients with both ailments. As both cause high levels of disability, there is likely a benefit to managing patients with depression by examining their back pain and vice versa. Addressing both complaints simultaneously has the potential to be much more effective than focusing on a single ailment.

According to the NIH National Institute of Mental Health, in the past year “an estimated 21.0 million adults in the United States had at least one major depressive episode. This number represented 8.4% of all U.S. adults.⁴ The Yang, et al., findings set the stage for doctors of chiropractic to reach out to mental health care providers in an effort to collaborate with and co-manage patients who suffer from both back pain and depression. The likely result: significant improvements in overall patient care, as well as a better clinical understanding among providers of how major depression and back pain are related.

References

1. Yang H, Hurwitz EL, Li J, et al. Bidirectional comorbid associations between back pain and major depression in US adults. Int J Environ Res Publ Health, 2023;20(5):4217.
2. Bener AA, Verjee M, Dafeeah EE, et al. Psychological factors: anxiety, depression, and somatization symptoms in low back pain patients. J Pain Res, 2013;6:95-101.
3. Hurwitz EL, Morgenstern H, Yu F. Cross-sectional and longitudinal associations of low-back pain and related disability with psychological distress among patients enrolled in the UCLA Low-Back Pain Study. J Clin Epidemiol, 2003;56:463-471.
4. Major Depression. NIH National Institute of Mental Health: www.nimh.nih.gov/health/statistics/major-depression.