Abstract
ObjectiveTo discuss the role of depression in chronic lower back pain and comment on appropriate methods of screening and co-management.Data SourcesThe current scientific literature was investigated using the online web databases CINAHL, Medline/PUBMED, Proquest, Meditext and from manual library searches.Data ExtractionDatabases were searched from 1980 to the present (2005). Articles were searched with the key words "depression" and "low back pain". Over three hundred articles were sourced and articles were then selected on their relevance to the chronic spinal pain states that present to manual therapy practitioners.Data synthesisPain is a subjective awareness of peripheral nociceptive stimulation, projected from the thalamus to the cerebral cortex with each individual's pain experience being mediated by his or her psychological state. Thus a psychological component will often be associated with any painful experience. A number of studies suggest (among other things) that the incidence of depression predicts chronicity in lower back pain syndromes but that chronic lower back pain does not have the reciprocal action to predict depression.ConclusionThe aetiology of chronic pain is multifactorial. There is sufficient evidence in the literature to demonstrate a requirement to draw treatment options from many sources in order to achieve a favourable pain relief outcome. The treatment should be multimodal, including mental and emotional support, counseling and herbal advice. While a strong correlation between depression and chronic low back pain can be demonstrated, an apparent paucity of literature that specifically addresses the patient response to chiropractic treatment and concurrent psychotherapy identifies the need for prospective studies of this nature to be undertaken. It is likely that multimodal/multidisciplinary treatment approaches should be encouraged to deal with these chronic lower back pain syndromes.
Highlights
Specific causes for acute back pain, such as infections, tumours, osteoporosis, spondyloarthropathies, and trauma represent a minority of pain syndromes requiring specific therapeutic approaches [1]
While a strong correlation between depression and chronic low back pain can be demonstrated, an apparent paucity of literature that addresses the patient response to chiropractic treatment and concurrent psychotherapy identifies the need for prospective studies of this nature to be undertaken
Is depression predictive of chronic low back pain? It has been suggested that the presence of depressive symptoms predicts future musculoskeletal disorders, but not vice versa [23]
Summary
The aetiology of chronic pain is multifactorial. There is sufficient evidence in the literature to demonstrate a requirement to draw treatment options from many sources in order to achieve a favourable pain relief outcome. Treatments administered should be multimodal with a need to include mental and emotional support, counseling and natural remedy advice (in particular St. John's Wort and possibly Valerian). While a strong correlation between depression and chronic low back pain can be demonstrated, an apparent paucity of literature that addresses the patient response to chiropractic treatment and concurrent psychotherapy identifies the need for prospective studies of http://www.chiroandosteo.com/content/13/1/8 this nature to be undertaken. Future studies should focus on effectiveness and the dose response characteristics of these interventions in isolation and in combination
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