Top

Chiropractic & Manual Therapies

Published in:

Open Access 01-12-2005 | Review

Are chronic low back pain outcomes improved with co-management of concurrent depression?

Authors: Peter Middleton, Henry Pollard

Published in: Chiropractic & Manual Therapies | Issue 1/2005

Abstract

Objective

To discuss the role of depression in chronic lower back pain and comment on appropriate methods of screening and co-management.

Data Sources

The current scientific literature was investigated using the online web databases CINAHL, Medline/PUBMED, Proquest, Meditext and from manual library searches.

Data Extraction

Databases 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 synthesis

Pain 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.

Conclusion

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. 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.

Ehrlich G: Back pain. J Rheumatology. 2003, 26-31. Suppl 67

Portenoy R, Kanner R: Definition and assessment of pain. Pain management: theory and practice. Edited by: Portenoy RK, Kanner RM. 1996, Philadelphia: FA Davis, 3-18.

IASP Task Force on Taxonomy: Pain terms: a current list with definitions and notes on usage. Classification of Chronic Pain. Edited by: Merskey H, Bogduk N. 1994, IASP Press, Seattle, 207-213. 2

Engel G: The need for a new medical model: a challenge for biomedicine. Science. 1977, 196: 129-136.CrossRefPubMed

van Tulder M, Becker A, Bekkering T, Breen A, Gil del Real, Hutchinson A, et al: European guidelines for the management of active non-specific low back pain in primary care. Proceedings of the 5th Interdisciplinary World Congress on Low back and pelvic pain. Edited by: Vleeming A, Mooney V, Hodges P, Lee D, McGill S, Ostgaard HC. 2004, Melbourne, Australia, 56-79. Nov.10–13 2004

Deyo R, Rainville J, Kent D: What can the history and physical examination tell us about low back pain?. JAMA. 1992, 268: 760-5. 10.1001/jama.268.6.760.CrossRefPubMed

Andersson G: The epidemiology of spinal disorders. The adult spine: Principles and practice. Edited by: Frymoyer JW. 1997, New York: Raven Press, 93-141. 2

Andersson GB: Low back pain. J Rehabil Res Dev. 1997, 34 (4): ix-x.PubMed

Frymoyer J: Back pain and sciatica. N Engl J Med. 1988, 318: 291-300.CrossRefPubMed

10.

Suarez-Almazor ME, Belseck E, Russell AS, Mackel JV: Use of lumbar radiographs for the early diagnosis of low back pain. Proposed guidelines would increase utilization. JAMA. 1997, 11 (277(22)): 1782-6. 10.1001/jama.277.22.1782.CrossRef

11.

Hollingworth W, Todd CJ, King H, Males T, Dixon AK, Karia KR, Kinmonth AL: Primary care referrals for lumbar spine radiography: diagnostic yield and clinical guidelines. Br J Gen Pract. 2002, 52 (479): 475-80.PubMedCentralPubMed

12.

Royal College of General Practitioners: Clinical guidelines for the management of acute low back pain. 1999, London, Royal College of General Practitioners,

13.

Kendall N, Linton S, Main C: Guide to assessing psychosocial yellow flags in acute low back pain: risk factors for long term disability and work loss. 1997, Accident Rehabilitation & Compensation Insurance Commission of New Zealand and the National Health Committee, Wellington, New Zealand,

14.

Mersky H: Pain terms: a list with definitions and notes on usage recommendated by the IASP Subcommittee on Taxonomy. Pain. 1979, 6: 249-252.

15.

Mersky H, Bogduk N, eds: Classification of Chronic Pain,. 1994, IASP Press, Seattle, 164-6. 2

16.

Moseley GL: Evidence for a direct relationship between cognitive and physical change during an education intervention in people with chronic low back pain. Eur J Pain. 2004, 8 (1): 39-45. 10.1016/S1090-3801(03)00063-6.CrossRefPubMed

17.

Atkinson J, Slater M, Patterson T, Grant I, Garfin S: Prevalence, onset and risk of psychiatric disorders in men with chronic low back pain: a controlled study. Pain. 1991, 45: 111-21. 10.1016/0304-3959(91)90175-W.CrossRefPubMed

18.

Romano J, Turner J: Chronic pain and depression: does the evidence support a relationship?. Psychology Bulletin. 1985, 97: 18-34. 10.1037//0033-2909.97.1.18.CrossRef

19.

Kramlinger K, Swanson D, Maruta T: Are patients with chronic pain depressed?. Am J Psychiatry. 1983, 140: 747-9.CrossRefPubMed

20.

Dworkin R, Richlin D, Handlin D, Brand C: Predicting treatment response in depressed and non-depressed chronic pain patients. Pain. 1986, 24: 343-53. 10.1016/0304-3959(86)90120-X.CrossRefPubMed

21.

Haley W, Turner L, Romano L: Depression in chronic pain patients: relation to pain, activity and sex differences. Pain. 1985, 46: 177-84.

22.

Weikgenant A, Slater M, Patterson T, Atkinson J, Grant I, Garfin S: Coping activities in chronic low back pain: relationship with depression. Pain. 1993, 53: 95-103. 10.1016/0304-3959(93)90061-S.CrossRef

23.

Aaum P, Leino I, Magni G: Depressive and distress symptoms as predictors of low back pain, neck-shoulder pain, and other musculoskeletal morbidity: a 10-year follow-up of metal industry employees. Pain. 1993, 53 (1): 89-94. 10.1016/0304-3959(93)90060-3.CrossRef

24.

Magni G, Moreschi C, Rigatti-Luchini S, Merskey H: Prospective study on the relationship between depressive symptoms and chronic musculoskeletal pain. Pain. 1994, 56: 289-297. 10.1016/0304-3959(94)90167-8.CrossRefPubMed

25.

Croft P, Papageorgiou A, Ferry S, Thomas E, Jayson M, Silman A: Psychologic distress and low back pain. Spine. 1996, 20: 2731-7.CrossRef

26.

Deyo R, Diehl A: Psychological predictors of disability in patients with low back pain. J Rheumatology. 1988, 27: 483-9.CrossRef

27.

Nyiendo J, Haas M, Goldberg B, Sexton G: Pain, disability, and satisfaction outcomes and predictors of outcomes: A practice-based study of chronic low back pain patients attending primary care and chiropractic physicians. J Manipulative Physiol Ther. 2001, 24 (7): 433-9. 10.1067/mmt.2001.117091.CrossRefPubMed

28.

Price D, McGrath P, Rafii A, Buckingham B: The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain. 1983, 17: 45-56. 10.1016/0304-3959(83)90126-4.CrossRefPubMed

29.

Newton-John TR, Spence SH, Schotte D: Cognitive-behavioural therapy versus EMG biofeedback in the treatment of chronic low back pain. Behav Res Ther. 1995, 33 (6): 691-7. 10.1016/0005-7967(95)00008-L.CrossRefPubMed

30.

Turner JA, Jensen MP: Efficacy of cognitive therapy for chronic low back pain. Pain. 1993, 52 (2): 169-77. 10.1016/0304-3959(93)90128-C.CrossRefPubMed

31.

Vlaeyen JW, Haazen IW, Schuerman JA, Kole-Snijders AM, van Eek H: Behavioural rehabilitation of chronic low back pain: comparison of an operant treatment, an operant-cognitive treatment and an operant-respondent treatment. Br J Clin Psychol. 1995, 34 (1): 95-118.CrossRefPubMed

32.

Tait R, Chibnall I, Margolis R: Pain extent: relations with psychological state, pain severity, pain history and disability. Pain. 1990, 41: 295-301. 10.1016/0304-3959(90)90006-Y.CrossRefPubMed

33.

Jayson M: Back pain. Bri Med J. 1996, 313: 355-8.CrossRef

34.

Spinhoven P, Ter Kuile M, Kole-Snijders AM, Hutten Mansfeld M, Den Ouden DJ, Vlaeyen JW: Catastrophizing and internal pain control as mediators of outcome in the multidisciplinary treatment of chronic low back pain. Eur J Pain. 2004, 8 (3): 211-9. 10.1016/j.ejpain.2003.08.003.CrossRefPubMed

35.

Olason M: Outcome of an interdisciplinary pain management program in a rehabilitation clinic. Work. 2004, 22 (1): 9-15.PubMed

36.

McCracken LM, Gross RT, Eccleston C: Multimethod assessment of treatment process in chronic low back pain: comparison of reported pain-related anxiety with directly measured physical capacity. Behav Res Ther. 2002, 40 (5): 585-94. 10.1016/S0005-7967(01)00074-2.CrossRefPubMed

37.

Clarke D, Smith G: Somatisation: what is it?. Aust Family Physician. 2000, 29 (2): 109-13.

38.

Nickel R, Egle U, Rompe J, Eysel P, Hoffmann S: Somatisation predicts the outcome of treatment in patients with low back pain. J Bone Joint Surgery. 2002, 84 (2): 189-95. 10.1302/0301-620X.84B2.12235.CrossRef

39.

Lipowski Z, Somatisation: The concept and its clinical application. Am J Psychiatry. 1988, 145: 1358-68.CrossRefPubMed

40.

BenDebba M, Torgerson W, Long D: Personality traits, pain duration and severity, functional impairment and psychological distress in patients with persistent low back pain. Pain. 1997, 72 (1–2): 115-25. 10.1016/S0304-3959(97)00020-1.CrossRefPubMed

41.

Seaman D, Cleveland C, Spinal pain syndromes: Nociceptive, neuropathic, and psychologic mechanisms. J Manipulative Physiol Ther. 1999, 22 (7): 458-72.CrossRefPubMed

42.

Pincus T, Williams A: Models and measurements of depression in chronic pain. J Psychosom Res. 1999, 47 (3): 211-9. 10.1016/S0022-3999(99)00045-8.CrossRefPubMed

43.

Fernandez E, Turk DC: The scope and significance of anger in the experience of chronic pain. Pain. 1995, 61: 165-175. 10.1016/0304-3959(95)00192-U.CrossRefPubMed

44.

Banks SM, Kerns RD: Explaining high rates of depression in chronic pain: a diathesis-stress framework. Psychol Bull. 1996, 199: 95-110.CrossRef

45.

Fairbank J, Couper J, Davies J, O'Brian J: The Oswestry Low Back Pain Disability Questionnaire. Physiotherapy. 1980, 66: 271-3.PubMed

46.

Roland M, Morris R: A study of the natural history of low back pain. Part 1. Development of a reliable and sensitive measure of disability in low back pain. Spine. 1983, 8: 141-4.CrossRefPubMed

47.

Fairbank J, Pynsent P: The Oswestry Disability Index. Spine. 2000, 25 (22): 2940-53. 10.1097/00007632-200011150-00017.CrossRefPubMed

48.

Maire J: Evaluating the effectiveness of care in neck and back pain. Pain and functional status as outcome measures. Australasian Chiropractic Osteopathy. 2002, 10 (1): 16-20.PubMedCentralPubMed

49.

Slover J, Abdu W, Lurie J, Hanscom B, Weinstein J: General versus spine-specific health surveys, do comorbidities influence baseline results?. Spine J. 2002, 2 (5 Suppl 1): 63-10.1016/S1529-9430(02)00302-9.CrossRef

50.

Haas M, Jacobs G, Raphael R, Petzing K: Low back pain outcome measurement assessment in chiropractic teaching clinics: responsiveness and applicability of two functional disability questionnaires. J Manipulative Physiol Ther. 1995, 18 (2): 79-87.PubMed

51.

Beck A, Steer R, Garbin N: Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clin Psychol Rev. 1988, 8: 77-100. 10.1016/0272-7358(88)90050-5.CrossRef

52.

Pincus T, Williams AC, Vogel S, Field A: The development and testing of the depression, anxiety, and positive outlook scale (DAPOS). Pain. 2004, 109 (1–2): 181-8. 10.1016/j.pain.2004.02.004.CrossRefPubMed

53.

Pedersen P: Prognostic indicators in low back pain. J Coll Gen Pract. 1981, 31: 209-16.

54.

Waddell G, Newton M, Henderson I, Somerville D, Main CJ: A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain. 1993, 52 (2): 157-68. 10.1016/0304-3959(93)90127-B.CrossRefPubMed

55.

Main CJ, Wood PL, Hollis S, Spanswick CC, Waddell G: The Distress and Risk Assessment Method. A simple patient classification to identify distress and evaluate the risk of poor outcome. Spine. 1992, 17 (1): 42-52.CrossRefPubMed

56.

Trief PM, Grant W, Fredrickson B: A prospective study of psychological predictors of lumbar surgery outcome. Spine. 2000, 25 (20): 2616-21. 10.1097/00007632-200010150-00012.CrossRefPubMed

57.

Sullivan M, Reesorb K, Mikailc S, Fisherd R: The treatment of depression in chronic low back pain: review and recommendations. Pain. 1992, 50 (1): 5-13. 10.1016/0304-3959(92)90107-M.CrossRefPubMed

58.

Jamison J: Stress: the chiropractic patients' self-perceptions. J Manipulative Physiol Ther. 1999, 22 (6): 395-8.CrossRefPubMed

59.

Pfingsten M, Hildebrandt J, Leibing E, Franz C, Saur P: Effectiveness of a multimodal treatment program for chronic low-back pain. Pain. 1997, 73 (1): 77-85. 10.1016/S0304-3959(97)00083-3.CrossRefPubMed

60.

Burton AK, Waddell G, Tillotson KM, Summerton N: Information and advice to patients with back pain can have a positive effect. A randomized controlled trial of a novel educational booklet in primary care. Spine. 1999, 24 (23): 2484-91. 10.1097/00007632-199912010-00010.CrossRefPubMed

61.

Metagenics: Practitioner Technical Data Manual. Nervine relaxant herbs. 2000, Health World Ltd, 127-30.

62.

Linde K, Mulrow CD: St John's wort for depression. Cochrane Database Syst Rev. 2000, CD000448-2

63.

Muller D, Pfeil T, von den Driesch V: Treating depression comorbid with anxiety – results of an open, practice-oriented study with St John's wort WS 5572 and valerian extract in high doses. Phytomedicine. 2003, 10 (Suppl 4): 25-30.CrossRefPubMed

64.

Shelton RC, Keller MB, Gelenberg A, Dunner DL, Hirschfeld R, Thase ME, et al: Effectiveness of St John's wort in major depression: a randomized controlled trial. JAMA. 2001, 285 (15): 1978-86. 10.1001/jama.285.15.1978.CrossRefPubMed

65.

Kroenke K: Cognitive behavioural therapy for somatatization and symptom syndromes: a critical review of controlled clinical trials. Psychotherapy Psychosom. 2000, 69 (4): 205-15. 10.1159/000012395.CrossRef

66.

Hoffmann B: Back to basics: Confronting psychological issues in patients with low back pain. Topics Clinical Chiropractic. 1999, 6 (2): 1-7.

67.

Licciardone JC, Stoll ST, Fulda KG, Russo DP, Siu J, Winn W, Swift J: Osteopathic manipulative treatment for chronic low back pain: a randomized controlled trial. Spine. 2003, 28 (13): 1355-62. 10.1097/00007632-200307010-00002.PubMed

68.

Burton AK, McClune TD, Clarke RD, Main CJ: Long-term follow-up of patients with low back pain attending for manipulative care: outcomes and predictors. Man Ther. 2004, 9 (1): 30-5. 10.1016/S1356-689X(03)00052-3.CrossRefPubMed

Title: Are chronic low back pain outcomes improved with co-management of concurrent depression?
Authors: Peter Middleton
Henry Pollard
Publication date: 01-12-2005
Publisher: BioMed Central
Published in: Chiropractic & Manual Therapies / Issue 1/2005
Electronic ISSN: 2045-709X
DOI: https://doi.org/10.1186/1746-1340-13-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Are chronic low back pain outcomes improved with co-management of concurrent depression?

Abstract

Objective

Data Sources

Data Extraction

Data synthesis

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Data Sources

Data Extraction

Data synthesis

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2005

The establishment of the Chiropractic & Osteopathic College of Australasia in Queensland (1996–2002)

Chiropractic & Osteopathy. A new journal

Trunk muscle activity during bridging exercises on and off a Swissball

Subluxation: dogma or science?

The biopsychosocial model and hypothyroidism

Cervical stenosis in a professional rugby league football player: a case report