by Jason Holden – Physiotherapist
Clinical research sometimes has some unexpected findings. More recently in the course of my research the number of people with low back pain presenting with worryingly high levels of depression came as a surprise to me and many of my colleagues.
What do we know?
Meta-analytic data consistently shows a correlation between low back pain and depression. But does a person with depression develop chronic low back pain or does the low back pain cause depression? This is less clear cut.
Why it is important
People with depressive symptoms can be very very good at hiding their symptoms. The stigma around clinical depression, particularly in males, continues to be a barrier to people seeking treatment. On the other hand, low back pain can be hard for people to cope with. Work, leisure, travel, family and many other daily activities we all take for granted are impacted by low back pain and this can take an unexpected toll.
Clinical Implications
It is important for therapists to have an awareness of this link. Asking patients how they are coping and how they are feeling, while acknowledging that the literature tells us this can be an issue may help people open up about their struggles and facilitate them to seek help. Australia in particular has government funded programs available to patients through their GP and it is vital for therapists to maintain an open dialogue with the patient’s GP (with their consent).
Clinical Measures
The DASS-21 is a validated screening tool to aid in basic screening for Depression, anxiety and stress and may be a useful adjunct to assessment.