Experts agree there is a connection between anxiety, depression, and musculoskeletal (MSK) pain.

The latest research shows there is a connection between anxiety, depression, and musculoskeletal (MSK) pain. 

More than 1.71 billion people suffer from MSK conditions around the world. In the U.S. anxiety disorders are one of the most common mental illnesses, affecting more than 40 million adults

Establishing the correlation between human mental health and generalized back pain gives us another weapon in the fight against MSK pain. When work matters, it’s important to keep employees’ minds and bodies healthy. 

This article will look at the latest research establishing the connection between back pain, anxiety, and depression.

What is the Pain-Anxiety-Depression Connection?

Research shows our mental health affects our perception of pain. Harvard Medical School says, “People suffering from depression, for example, tend to experience more severe and long-lasting pain than other people.” 

Additional studies indicate that overlapping depression and anxiety has a particular effect on diseases such as irritable bowel syndrome, fibromyalgia, and low back pain. In the past, researchers believed that the pain from these diseases was, literally, all in the patient’s head, meaning, these illnesses stemmed not from physical dysfunction but from psychological issues. 

What we’ve come to learn over time is that there is a complex relationship between our mental and physical health. Focusing on pain alone may miss the underlying mental illness contributing to the decline in the person’s physical health.

The latest research shows there is a connection between anxiety, depression, and musculoskeletal (MSK) pain.

How Does Mental Health Affect MSK Pain?

The link between mental and physical health has been established for decades. Patients with anxiety and depression often have lower pain thresholds and their quality of life is negatively impacted. Pain and depression often go hand-in-hand. This can complicate outcomes for both chronic pain sufferers and those with mental illness. A 2008 study reaffirmed earlier findings that patients who report chronic pain symptoms suffer greater levels of depression and anxiety. 

MSK pain is one of the most common disorders today, causing a wide range of degenerative inflammatory conditions of the muscles, ligaments, tendons, joints, nerves, and blood vessels. It affects people of all ages and from all walks of life.

A 2021 study published in Middle East Current Psychiatry looked at 450-patients suffering from MSK pain. They determined, “When depression and pain co-occur, both disorders can have an additive adverse effect on health and its management.” The study also found that MSK pain causes insomnia that contributes to the depressive state of the patient.

In the study, researchers administered several standard psychiatric tests, including the Goldberg depression scale and the Beck Anxiety Inventory. The goal was to “evaluate the association between anxiety, depression, and insomnia with MSK pain source.” They determined: 

  • 39.4% of the participants had severe depression
  • 31.1% of the patients also had severe anxiety
  • 32.9% also suffered from insomnia

Ultimately the researchers noted there was a statistically significant correlation between anxiety and depression and MSK pain. They cited some of the earlier studies that paved the way for their work, including: 

  • 2016 Archives of Environmental & Occupational Health research tracked migrant farmworkers in North Carolina and found depressive symptoms were significantly associated with neck and shoulder pain.
  • 2012 European Journal of Pain research determined that a heightened depressed mood has an adverse effect on how MSK pain impacts the patient.
  • 2009 General Hospital Psychiatry research tracked 500 primary care patients with MSK pain. They concluded, “Both anxiety and psychosocial stress should be considered in the assessment and treatment of patients with MSK pain and depression.”
  • 2011 Scandinavian Journal of Pain research found that depression is not only associated with the development of chronic pain but also adverse patient health treatment outcomes.

A 2018 BMC Public Health article was by far the largest group studied; 6,572 Danish female healthcare workers participated. The study found that not only were depression and MSK pain correlated, when these two illnesses were comorbid, they increased the risk that the workers would experience long term sickness absence (LTSA). 

Interestingly, the COVID-19 quarantine may have contributed significantly to the problem of mental and MSK issues. We know that the social isolation during the pandemic has led to more cases of depression. What we don’t know yet is whether there have been a corresponding set of MSK injuries to contend with as well. However, one 2020 study in the British Journal of Pain suggests that lockdown restrictions may have increased both chronic pain symptoms, depression, and anxiety. 

Given the baseline data that shows a correlation as well, the chances are high that a retrospective look back at this time period will show an increase in both ailments.

What is the connection between anxiety, depression, and musculoskeletal (MSK) pain?

What is the Solution for MSK and Mental Health?

Employers have a vested interest in understanding the body/mind health connection. Both depression and MSK pain are significant cost centers and a key reason for absenteeism in the American workplace.  

We don’t completely understand the correlation. We know, however, that when a person experiences depression their emotional ability to manage it is lowered and their perception of their pain threshold is skewed. It’s a vicious circle; the patient has pain and can’t sleep and the pain makes them limit their physical activities which leads to a sedentary lifestyle—and more depression. The pain itself invokes stress and anxiety. Even the absence of pain can make you anxious, wondering when will it return? These feelings of stress can lead to other emotional problems such as depression over time.

Medically speaking, this makes sense. Chronic MSK pain and depression share some of the same neurotransmitters and nerve pathways in the brain and spinal cord. What doesn’t make sense is that more healthcare providers focus on the “loudest” MSK complaint, possibly missing the underlying depression contributing to the pain. 

It seems clear that employers and healthcare providers should consider three evidence-based approaches to tackling both mental and physical disorders. Physical therapy must be combined with mental health treatment, as well as patient education to improve the outcomes of patients experiencing depression and MSK comorbidity. Taking a “whole approach” to the art and science of care and caring for the patient is clearly the best way to improve the quality of their lives.

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