- Depression in the leading non-fatal cause of disability in the developed world
- Depression and chronic pain are common co-morbid conditions and 1 out of 3 people with chronic pain are also estimated to have depression.
- People with orthopedic pain who are depressed are at a greater risk for having elevated levels of pain intensity and prolonged work disability compared to those
- who are not depressed.
- Research shows that different forms of physical exercise can have a significant benefit on the severity of depressive symptoms: participation in regular exercise over 12 weeks was associated with a 47% improvement in the severity of depressive symptoms.
We all experience feelings of sadness, loneliness and depression at times; in individuals who have chronic pain, mild to severe symptoms of depression are even more common. Some symptoms of depression include difficulty concentrating or making decisions, fatigue, decreased energy, insomnia, loss of interest in activities or hobbies, overeating or appetite loss, persistent aches, pains or headaches etc. Feelings of depression may be associated with an acute muscle or joint injury and tend to be more prevalent and more severe in those with chronic conditions. Often times it is difficult to determine if these feelings of depression are a result of the pain or from some other issue. Though as physical therapists we focus on improving musculoskeletal impairments, depressive symptoms may improve as pain decreases and function improves. Some patients may require more specialized treatment for their depression symptoms along with PT to improve their functional abilities; this is especially true for those whose pain has not resolved, depressive feelings have persisted and for those who have been unable to return to work (either at all or at their previous capacity). A study published last year in JOSPT (Journal of Orthopedic and Sports Physical Therapy) looked at the change in feelings or thoughts of depression during physical therapy and how it relates to a person's work status one year later.
This study looked at 106 patients who sustained back or neck injuries in work related incidents. Out of the 235 subjects who qualified for the study (subjects between the ages of 18-65 who had sustained a work related back or neck injury within the past 3-12 weeks, were not currently working and were receiving worker's compensation benefits AND scored at a certain level on a depression index) there were 124 who met all of the inclusion criteria. Therefore approximately half of patients with work related musculoskeletal pain conditions started PT with clinically significant levels of depression. The subjects who met the inclusion criteria underwent a course of physical therapy (3x/week for 7 weeks) and were assessed during their course of physical therapy, after PT and 1 year following the completion of PT. Several measures were looked at to determine successful results from physical therapy: pain intensity, depression symptoms from the Beck Depression Index, Pain Catastrophizing scale, fear of movement and pain self-efficacy (a measure of the level of self-confidence). Feelings or thoughts of depression decreased in approximately 40% of these patients following physical therapy that addressed improving their back or neck pain and improving their function. Those patients with depressive symptoms who are less likely to recover over the course of PT include: patients with higher levels of pretreatment depressive and pain catastrophizing levels and patients who did not show early treatment improvements in their levels of depressive symptoms or pain self-efficacy. Those patients who did not show improvements during PT were less likely to have returned to work.
In summary, feelings or thoughts of depression can be associated with work related injuries and can improve following PT to regain mobility and strength and decrease pain. Others may require more assistance from other healthcare providers who specialize in diagnosing and treating these depressed thoughts and feelings. It is important that you share these thoughts and feelings with your healthcare providers so that you can get all the help and support needed!
Adapted from JOSPT Patient Perspectives. J Orthop Sports Phys Ther 2012;42(11):957-967