Unfortunately, there is a bit of the “chicken or the egg” analogy in terms of the association of depression and chronic pain. By definition (NIH) chronic pain is a continuous constant pain that is more than three months in duration. Pain, in the acute setting, is a very important response. While not pleasant (understatement, I know), acute pain functions to let our body know there is a problem, and we should investigate to prevent further harm, or change activities to initiate healing. Chronic pain, however, no longer is as useful for feedback and can cause unintended negative situations for the body as well as the mind. One of the negative reactions is development of depression. Depression can be a serious mental illness manifesting with feelings of hopelessness, fatigue, irritability, insomnia, lack of concentration, or even contemplation of suicide. In addition, it also manifests in aches, pains that do not improve despite medical treatments.
As you can see, chronic pain, and depression are inter-related, and poses a difficult problem, especially when trying to predict a successful outcome with surgery.
In terms of Depression and Spine Surgery, unfortunately, the science has not been supportive of having Spine Surgery when depressed. Recently, at the North American Spine Society Meeting (San Fransisco, November 2014), Miller et al Presented “The Impact of Preoperative Depression on Quality of Life Outcomes Following Lumbar Surgery”. There was a retrospective look at patients who had lumbar decompression or fusion from 2008 and 2012. Preoperative pain and depression measures were compared.
The study concluded that worse preoperative pain and depression are associated with less improvement in the quality of life following the Spine Surgery.
This is not new information, and confirms what we already know.
If you have depression, and are contemplating spine surgery, please be evaluated for depression. Sometimes, moderating or curing your depression will also cure your chronic back pain. After treatment, you should feel mentally better. More importantly, you may also be able to avoid surgery, or have a better outcome if you have surgery.
- Mccubbin T, Dimidjian S, Kempe K, Glassey MS, Ross C, Beck A. Mindfulness-based stress reduction in an integrated care delivery system: one-year impacts on patient-centered outcomes and health care utilization. Perm J. 2014 Fall;18(4):4-9. PubMed PMID: 25662520