Association between chronic backache and depression and anxiety , role of prolotherapy

      In new research, a multi-national study led by the University of Sydney found a significant

association between chronic low back pain and increased risk of depression or anxiety. This agrees

with another new study which tells doctors to recognized anxiety and depression in back pain

patients so they could treat them better.

This is can be a complicated subject for some doctors in so far that it can be difficult to determine

if depression is causing back pain, or if back pain is causing depression. One this shown is that

people with depression are more prone to have episodes of low back pain.3 Further compounding this

research is another study that questions if opioid pain killers are effective for patients with

depression and anxiety. Worse patients with depression and anxiety are more prone to prescription

abuse.

Patients suffering from back pain related to depression or intensified because of depression SHOULD

NOT be recommended to spinal surgery

In a new study published in December 2016, doctors found that preoperative life dissatisfaction and

the long-term life dissatisfaction burden were associated with poorer 10-year surgical outcomes.

In recent research investigators strongly suggest that patients suffering from back pain related to

depression or intensified because of depression not be recommended to spinal surgery.

Here is what they said:

Depressive symptoms are very common in chronic pain patients.

Studies have reported prevalence of 30-80% of patients with some depressive symptoms and 20% of

patients who fulfill the criteria for a true major depressive disorder.

There is increasing evidence that the fear of pain, along with the fear of hurt or harm, are major

influences. They note that “yellow flags” indicating diverse psychosocial prognostic factors for the

development of disability following the onset of musculoskeletal pain are often present.

Additionally, depression and psychosomatic disorders are common in patients receiving

multidisciplinary pain programs.

Therefore, with the existence of these risk factors, surgical intervention is not recommended due

to the increased incidence of developing postoperative pain and chronic problems.

In the journal Nature – doctors said: “Over the past few decades, there has been a paradigm shift in

our understanding of chronic low back pain. Nowadays, this condition is accepted as a biopsychosocial

phenomenon in which anatomical injury interplays with psychosocial factors.

The considerable progress made in discovering the true source of patient’s pain and the sharp

increase in related health-care costs have not translated into a decreased prevalence of chronic

low back pain or the development of therapies with markedly improved efficacy and safety.

Classic medical–technical interventions(surgery et al.) for for chronic low back pain always need to

be placed in a broader therapeutic framework comprising physical, psychosocial and behavioural

strategies, and must address the patient’s welfare in a holistic context.

Antidepressants for back pain?

Recently, researchers from the Harvard Medical School and Beth Israel Deaconess Medical Center sought

to examine the safety and effectiveness of opioids (pain-killers), nonsteroidal anti-inflammatory

drugs (NSAIDs), and antidepressants for treatment of chronic low back pain.

In addition to assessing the effectiveness of these drugs, they also evaluated whether certain people

respond more favorably to pharmacological management.

The researchers acknowledged that medications are a mainstay of low back pain management, but there

is uncertainty as to the optimal use of commonly prescribed medications such as opioids,

antidepressants, and NSAIDS.

After examining the medical literature, these are the conclusions they reached:

1. Opioids and NSAIDs are effective for chronic low back pain, while antidepressants have no

meaningful clinical benefit.

2. Based on the significant rate of side effects with opioids and the lack of convincing superiority

over NSAIDs, opioids are not recommended as a treatment for chronic low back pain.

Here are their recommendations:

1: NSAIDs should be considered as a treatment of chronic low back pain. There is evidence

demonstrating favorable effectiveness, but also significant side effects that may have meaningful

clinical consequences.

2: Opioids may be considered in the treatment of chronic low back pain but should be avoided if

possible. There is evidence demonstrating favorable effectiveness compared to placebo, similar

effectiveness compared to NSAIDs, and with significant side effects including decreasing

effectiveness related to habituation when used long-term.

3: Antidepressants should not be routinely used for the treatment of chronic low back pain. There

is evidence that they are not more effective than placebo with respect to pain, functional status,

or depression.

And they conclude that based on the hypothesis that chronic low back pain is a symptom reflective of

a heterogeneous group of disorders, categorization of certain patient specific subgroups may be

helpful in guiding future treatment decision making.

As we read through the article, we basically see a lot of contradiction. Use NSAIDs but only if

necessary because the side effects are great. Opioids and painkillers: consider them, but in

reality avoid them if you can. The one thing that is not contradictory is antidepressants – don’t use

them.

Anxiety’s role in chronic pain

Anxiety is a common byproduct of chronic pain and new research is suggesting that patients coping

with chronic pain should be evaluated for anxiety disorders. Researchers evaluated 250 patients

with moderate to severe chronic joint or back pain for which pain medications were not helping.

They tested for the following conditions:

generalized anxiety, characterized by persistent worry;

panic, or sudden, repeated attacks of fear;

social anxiety, characterized by overwhelming anxiety in everyday social interactions;

post-traumatic stress, or a repeated feeling of danger after a stressful event;

obsessive-compulsive disorder, characterized by repeated thoughts or rituals that interfere with

daily life.

They also evaluated health-related quality of life issues, ie fatigue, sleep habits, and work

productivity. The results showed that 45% of the patients tested positive for at least one or more

of these common anxiety disorders. Many of these were present in combination with depression.

Patients with anxiety disorders also presented with more pain and worse quality of life issues.

Addressing the cause of chronic pain

In many of these cases, researchers pointed out that patients may not necessarily need treatment

for the anxiety as they may just have the symptoms related to the disorder, although they did predict

that one in five patients may have an anxiety disorder.

This research shows that the source of anxiety is chronic pain.

The standard treatment of pain medications was not working so it’s clear that an effective treatment

of the

chronic pain is warranted. Prolotherapy is a treatment that addresses chronic joint and back pain,

attacking the origin of pain that is ligament and tendon injury or laxity. Patients who choose

Prolotherapy no longer have to cope with pain, or the byproducts that come with it. They find a

permanent cure, ceasing the anxiety, depression, fatigue, sleeplessness and decreased productivity

that accompany chronic pain.

Back pain – treating the whole patient

It is always important to realize the significance of a patient’s anxiety, depression and overall

disability as a human being and not treat them as a “spine.” Researchers in the Journal of Orthopedic

Science also looked at these factors in trying to predict which patients with lumbar back pain would

be “disabled” by the pain.

Researchers in the Journal of Orthopedic Science also looked at these factors in trying to predict

which patients with lumbar back pain would be “disabled” by the pain.

Here is what they said: “Lumbar disc herniation may influence patients’ daily activities and social

interactions; however, no predictive models of disability could be found for patients with lumbar

disc herniation.”

So they went looking for those quality of life aspects that would predict “disability” in these

patients: What they found was “the most influential factor affecting the disability level was the

pain level, followed by the fatigue level, and depression level.

The depression level was directly affected by the fatigue level and the pain level. The fatigue

level was directly affected by the pain level, and the pain level was directly affected by age

and previous surgery.

Low back pain: quality of life

Writing in the medical journal Pain Medicine researchers, not surprisingly, noted that when low back

pain was not resolved – patients had catastrophizing thoughts, state anxiety, anger, and depressive

symptoms. Mostly a lot of anger, especially after failed back surgery.

This is the challenge that faces many Prolotherapy doctors. A patient that visits a Prolotherapy

doctor can express the symptoms of anger, depression, fatigue and exhaustion from their pain. The

Prolotherapy doctor was not the first choice but the fifth, sixth, seventh choice and only after a

failed regiment of pain-killers, epidurals, spiraling back pain, and failed surgical expectations.

These patients are of course very skeptical of the medical profession on all levels.

Can Prolotherapy heal all these patients? No. If the pain source is not being generated by ligament

and tendon weakness and instability, then the realistic goals of Prolotherapy should be immediately

discussed with the patient. Can Prolotherapy help many of these patients? In my experience YES!

This is supported by other independent Prolotherapy research that found that pain and disability

problems significantly improved after Prolotherapy treatment.

Effective Treatment for Chronic Low Back Pain is effective treatment for depression and anxiety

An interesting note here is that the researchers state low back pain is a symptom reflective of a

heterogeneous group of disorders. In other words, back pain is not simplistic of a single diagnosis.

You can be diagnosed with a herniated disc, but it may be ligament damage that is causing your pain.

You could be diagnosed with spinal stenosis, but that may not be what is generating the pain. This is

in agreement with a philosophy of many Prolotherapy doctors who practice comprehensive Prolotherapy.

Prolotherapy in my opinion is not one injection of one ingredient at one spot. Back pain is diffuse

and as such needs to be treated with multiple injections at multiple sites.