Recently, researchers analyzed data from a survey of roughly 5,400 people between 2004 and 2009. They found that patients suffering from back pain who were also diagnosed with depression were twice as likely to be prescribed opioid pain medication. The data also showed that these individuals often received twice the usual dose for their symptoms. The point to analyzing data and publishing the survey in the journal Pain Reports, was to help health care professionals better understand the opioid epidemic that plagues our country. Sadly, there are a great number of people today who suffer from both depression and back pain, and who also may be at risk for developing a painkiller addiction.
Opioids for the Treatment of Back Pain
Lower back pain is the leading cause of disability in the United States. It is also one of the most common reasons that doctor’s prescribe pain medication. However, more recently, many physicians and health care professionals are discovering that prescribing pain medication to manage pain, even for those who experience chronic pain, may be causing more harm than good. In fact, those taking pain medications over a long period of time, may find that in some cases, the negative consequences might outweigh the benefits. Research published by NCBI (National Center for Biotechnology Information) shows that the following side effects can occur with long-term use of pain medication:
- increased risk for overdose
- opioid abuse
- fractures
- heart attack
- possible sexual dysfunction
Although we need more research to fully understand these effects, studies do show that higher doses can increase risks. Furthermore, other research published in the Journal of American Medical Association (JAMA) reveals that pain medication often leads to short-term benefits which are not significant.
Perhaps, at one point, opioid medication may have appeared to be the best solution for someone suffering from back pain. Now, individuals may have to look for other options in order to avoid all of the risks and side effects of opioid painkillers.
While there are many over-the-counter medications that can address back pain, the two most common are acetaminophen-based (or a non-steroidal anti-inflammatory). In addition, activities such as yoga, physical therapy, and acupuncture can promote spinal health.
Depression, Back Pain, and Opioids
Life gets more troubling when it’s not only the body that’s causing pain but also one’s thoughts and feelings. As many people know, pain medication not only helps to manage pain, but it also creates the pleasant side effect of feeling good emotionally. This is why someone who experiences back pain and depression may be at the greatest risk for addiction to pain medication. Here are a few reasons why depression and back pain may overlap:
- Physical pain often provokes an emotional response, including anxiety, irritability, and anger.
- People whose pain limits their independence or ability to work are especially likely to get depressed.
- One of the symptoms of depression can be bodily pain, which can also aggravate any preexisting pain condition.
- Those who experience the difficulties of living with chronic pain are more susceptible to develop depression.
- Studies have shown, that more than half of individuals who experience chronic pain issues, also suffer from depression.
- Research indicates that 65% of those who are depressed also report physical pain.
To make matters worse, depression in those who experience chronic pain often goes untreated, and untreated depression can lead to serious consequences. These include suicidal thoughts and attempts, which might result in loss of life. When comparing those with chronic pain versus those who suffer from both chronic pain and depression results show that the ones that suffered from both conditions tended to:
- Report more intense discomfort as a result of pain
- Feel less control over their well-being
- Choose more unhealthy coping strategies
Steven Feinberg, MD, adjunct associate clinical professor at Stanford University School of Medicine commented that:
Chronic pain and depression go hand in hand. You almost have to assume a person with chronic pain is depressed and begin there.
Non-Opioid Alternatives
As mentioned above, in some cases, there are safer alternatives to taking prescription pain medication. However, it’s important to discuss the following options with your doctor first:
Antidepressants: Interestingly, the same neurotransmitters and nerves that affect chronic pain are the same that are affected when someone has depression. For this reason, when someone takes antidepressants, it is expected that their level of physical pain will also likely decrease. For some, antidepressants may be a preferred alternative opioid-based medications. Doctors are now prescribing a new type of antidepressant that are working well for both depression and chronic pain. This new approach has been working for many patients and carries much less risks of addiction and overdose.
Exercise: Although it might be difficult to exercise if you also experience pain, doctors suggest that gentle, regular exercise can actually produce more endorphins which help minimize pain. Furthermore, exercise can actually help prevent and decrease symptoms of depression.
Cognitive Therapy: Although it’s hard to believe that pain is also in your head, the truth is that much of it is. Therefore, some doctors suggest cognitive therapy for those with chronic pain and depression. This form of therapy helps a person identify their negative thoughts and feelings, especially as it relates to pain. Over time, a person might still notice those same negative thoughts and feelings, but they can control it. As their thoughts and feelings change from negative to positive, a person can eventually develop a more fulfilling life.
Keep in mind that these are suggestions to help avoid the risk of addiction to prescription pain medication. However, before trying one of the above, have a discussion with your doctor about these alternatives. Depending on your unique needs and circumstances, these may or may not work for you.
Chronic Pain and Depression
Chronic pain and depression often occur simultaneously. When someone is yearning to feel better both physically and emotionally, opioid medication might be an attractive option. However, as discussed above, its risks may outweigh the benefits. Consequently, it is always important to consult with your medical care provider and discuss options that will provide the best quality of life.
