Research results just released from the University of Sydney shows that depression can cause back pain. This new research uncovers a deeper level of the relationship between pain and depression – it is old news that nearly half of back pain patients experience depressive symptoms; we can all understand that persons suffering chronic pain would feel mental distress.

Now, this research has medical practitioners wondering, which came first – the chicken, or the egg? 

The research was conducted by analysing data from 11 international studies drawing on an massive pool of 23, 000 participants. In Australia, it is estimated that around 61, 000 people who experience low back pain can attribute the cause to their depression. Since costs associated with treatment are 2.8 times higher where patients encounter both conditions at the same time there is an added financial imperative to find treatments that work.

Marina Pinheiro is the lead author of the study and also a physiotherapist. She said that “once people have both conditions they are much harder to manage.” Co-author Paulo Ferreira supported her statement: “when patients come to us with both back pain and depression their cases are much more complex. They don’t respond to treatment in the same way as patients who only experience back pain — they take much longer to recover and treatment can be expensive.”

Treating both conditions at the same time is likely to be necessary, requiring collaboration between physiotherapists and psychotherapists as they work with a patient. As greater knowledge of the relationship between mind and body is accumulated we can hope that better treatments will be developed that work towards a speedier recovery time. Unfortunately the study was not able to conclude exactly how the depression to back pain mechanism works – that topic will be investigated in future research. For the moment researchers can only hypothesise about how this mysterious link works. Pinheiro suggests that “It could be because people with depression often have lower levels of physical activity and poor sleep, or due to issues with neurotransmitters which impact both mood and pain thresholds.”

The complex relationship between depression and back pain is affecting more people. The severity of depression is higher too when the patient is experiencing back pain simultaneously. Traditionally low back pain affects 40 – 50 year olds but in recent years an ever increasing number of people in their teens, 20s and 30s are reporting symptoms. Complicating matters further, young people with depression have increased chances of developing back pain as they age. While this study poses as many questions as it answers it has been eye-opening, changing the way we understand conditions that were previously assumed to be independent of each other.