When suffering from back pain, most people’s first response is to take an over-the-counter pain medication. If that doesn’t reduce the pain, a physician can prescribe a stronger medication, a physical therapist can suggest specific exercises, or trained specialists can do various types of alternative therapies, like chiropractic adjustment or acupuncture.
However, there’s another type of treatment that might significantly reduce back pain, but it isn’t commonly thought of as a way to reduce physical pain: counseling. Also called psychotherapy or talk therapy, counseling comes in many shapes and forms, each one a little different.
Although there are many different types of counseling, all of them are focused on finding ways to help people improve their quality of life.
A few of the specialized types of counseling include:
- Grief counseling
- Child/pediatric counseling
- School counseling
- Marriage counseling
- Career counseling
- Mental health counseling
The counselors specializing in each of these fields will focus on different ways in which they can help improve their patients’ lives. When chronic pain, such as back pain, is involved, perhaps the most appropriate type of talk therapy is mental health counseling.
The term mental health counseling is quite broad, so it can encompass multiple types of counseling. For instance, a mental health specialist might also offer suicide intervention, depression, or grief counseling, or there may be other counselors who specialize in these specific sub-sets of mental health.
Additionally, different types of counseling professionals have different names, depending on how much education they’ve had. A psychiatrist is a medical doctor who, after completing medical school, spent at least four years getting specialized training and practical experience. Since psychiatrists are medical doctors, they are able to prescribe medications. A psychologist is someone with a doctorate in psychology and two years of field training. Psychologists are unable to prescribe medications. Licensed professional counselors have completed a Master’s degree or higher in counseling, plus 3,000 hours of supervised clinical practice and a state certification exam.
Back pain and mood disorders are closely connected, which is why treating mood disorders with counseling can prevent or reduce back pain.
The relationship between chronic pain and depression is well-established. Feeling pain constantly is upsetting and stressful and can lead to withdrawal from people and activities. This, in turn, can encourage the development of depression.
Not only can chronic pain lead to depression, but depression can lead to chronic pain. In some people, depression causes unexplained, persistent physical pain. This may sometimes be the only symptom of depression.
The two conditions – chronic pain and depression – create a vicious cycle. When depressed, people interpret physical pain more emotionally, which makes it feel more severe. The more severe the pain is, the more upset and depressed people can become, which leads to an even more emotional interpretation of pain.
It’s not yet entirely clear why pain and depression go together so often, but there are a few theories.
Obviously, one of the reasons that back pain and depression go hand in hand is described above. Pain is depressing, and depression makes pain feel worse. In addition to this, it’s also possible that inflammation is involved in both processes, as explained by the National Institute of Mental Health, which states:
“According to recent research, people with depression have higher than normal levels of proteins called cytokines. Cytokines send messages to cells that affect how the immune system responds to infection and disease, including the strength and length of the response. In this way, cytokines can trigger pain by promoting inflammation, which is the body’s response to infection or injury.”
Potentially compounding this is the tendency of people with depression to deal with pain passively. Passively dealing with pain involves things like withdrawing from activities, wishing for more effective pain medications, or hoping that the pain will go away on its own. Actively dealing with pain, on the other hand, involves exercise, staying busy, and other ways of actively pursuing pain relief.
Some researchers are considering the possibility that people with severe depression use passive coping methods to deal with what is, initially, fairly mild pain. With no aggressive pain management, and with the pain exacerbated by depression, the pain continues to worsen, which begins the cycle of worsening depression and pain. This could potentially be part of the reason why people with depression are vulnerable to chronic pain.
Depression isn’t the only mood disorder that can afflict people with chronic pain. After screening 250 chronic pain patients at Veterans Medical Center, researchers found that 45% were positive for at least one common anxiety disorder. Additionally, those who tested positive for anxiety also reported worse pain and a lower quality of life.
The good news is that counseling can successfully treat both depression and anxiety disorders and, by extension, chronic pain.
Counselors are trained to diagnose mood disorders, so they’ll be able to tell the difference between depression and anxiety. Treatment can then be adjusted and personalized to yield the best possible results. As the mood disorder begins to improve, pain levels might improve, too.
A good sign that mood disorders might be involved in your chronic back pain is ineffectiveness of strong pain medications. Research has shown that people with mood disorders, like depression and anxiety, experience 50% less improvement from opioid use for back pain. People with mood disorders can also experience more side effects from opioids, as well as a higher likelihood for opioid abuse.
If your back pain isn’t being managed effectively and you suspect you may have a mood disorder, discuss it with your physician. He or she should be able to offer suggestions, as well as refer you to a counselor.
Have you been diagnosed with a mood disorder, in addition to back pain?
Image by Fechi Fajardo via Flickr