Chronic back pain often leads to varying degrees of depression. Chronic pain and depression are two of the most common health problems that physicians deal within practice. Depression is more commonly experienced by those with chronic back pain than acute or short duration back pain. The relationship between depression and back pain will vary from individual to individual. In some cases chronic or severe back pain will lead to a secondary or reactive form of depression.  In other cases depression may precede the onset of low back pain rendering the individual more susceptible to a lower tolerance or threshold for pain.  

There are many reasons why chronic low back pain may lead to or cause depression Some of the reasons are listed below.

• Back pain often makes it difficult to sleep, leading to fatigue and irritability during the day.
• Social isolation and lack of participation in enjoyable activities.
• Lack of gainful employment which leads to financial problems which impact the whole family.
• The development of secondary symptoms due the use of medications. This may include gastrointestinal distress and impairment of cognitive function.
• Impairment of memory and concentration secondary to pain and related sleep deprivation.
• Loss of libido and/or inability to have sex

The presence of one or more of the above situations combined with unremitting back pain can lead to feelings of despair, hopelessness and other symptoms of depression. Back pain can increase family stress from financial strain. The person with back pain may unable to contribute as much to the household and parental responsibilities thus straining the martial relationship.

Symptoms of depression include:

• Recurrent bouts of anger and frustration
• Lose of weight not associated with diet or exercise
• Taking risks such as reckless driving and extreme sports
• Loss of concentration
• Isolation from family and friends
• Avoiding pleasurable activities
• Chronic fatigue
• Loss of interest in work and hobbies
• Alcohol or substance abuse
• Suicidal thoughts
• Social isolation
• Unable to make critical decisions
• Changes in sleep patterns (sleep too much or cannot sleep)
• Uncontrollable bouts of crying without proportionate cause
• Violent behavior
• Feelings of sadness and hopelessness
• Thoughts of death and dieing

Depression may also present with physical symptoms such as back pain, headaches, digestive problems, and chronic pain.

The precise cause of depression is not known. In most cases multiple causes may be present. The severity and duration of depression is influenced by genetics, self image, your state of health and the environment. Everyone is susceptible to depression in the wake of major stress such as that which occurs with the loss of a loved one, after the end of an important relationship, with a major job change, after a move or with longstanding financial problems.

Job stress can pay an important role in the development of chronic pain and depression. Some of the job factors which might contribute include the following.

• Lack of control over job responsibilities
• Too much time away from home
• Unreasonable demands for work performance
• Repetitive activity or lifting which leads to daily discomfort or pain
• Frequent conflicts with supervisors or co-workers
• Lack of job security
• Night-shift work
• Frequent job shift changes
• Excessive overtime
• Perception of being underpaid for experience or performance

Depression can also adversely affect your overall health thus having additional negative impact on a spine problem. For example, it can cause an elevation of various stress hormones, which can damage the organs including the heart. Depression increases the likelihood of a person engaging in self-destructive behavior such as careless activities, over-indulging and driving recklessly.

Individuals with back pain and depression need to incorporate different self-help strategies to help manage their conditions. Some simple strategies are listed below.

Set realistic goals and prioritize tasks

• Spend more time with supportive family and friends
• Participate in a regular back care related exercise progam with individuals who have overcome or learned to mange their back pain.
• Avoid isolation and engage in activities you enjoy that do not increase back symptoms. 

If you suspect you have depression, schedule a physical examination with your family doctor or primary health care professional. There are numerous medical conditions which cause signs and symptoms similar to primary depression. Examples of these conditions include sleep deprivation, viral infection, and a low testosterone level can produce symptoms similar to male depression. If your attending doctor rules out an underlying medical condition further assessment may include a depression screening. The treatment of moderate to severe depression may require the use of medication and psychotherapy. Mild depression often resolves with proper nutritional supplementation and lifestyle modification.