“From my clinical experience,” Dr. DeStefano says, “patients with CLBP reach a degree of hopelessness when their pain is not addressed despite multiple therapies. Often it causes them to seek more and more care and therapies out of desperation. This makes them feel vulnerable and desperate and feeds their hopelessness.”
“It is very important to address patients’ fears about loss of function while simultaneously defining the individual etiology of low back pain in the acute setting,” she advises, adding, “it is important to manage low back pain as any chronic illness, reducing the frequency of exacerbations. This will not only lessen anxiety and depression, it will also decrease cost of care.”
Dr. William E. Gusa, vice chair of pain management at the University of Mississippi Medical Center in Jackson, says by email, “Unfortunately, insurance coverage for mental health in the United States is variable and patients frequently don’t buy in to that concept. Once they hear you recommend treatment for anxiety and depression, they jump to the conclusion that you believe it is only in their head.”
“If these results would make it into the non-medical word, maybe patients would be more open to mental health interventions in conjunction with pain treatments,” says Dr. Gusa, who was not involved in the study.
The authors recommend more individualized intensive CP management for these patients, possibly before or along with other interventions. And they recommend further research to explore how generalizable these results might be to patients with other CP conditions, to identify other predictive factors, and to develop screening tools.
The corresponding author did not respond to requests for comment.
- Oliveira DS, Vélia Ferreira Mendonça L, Sofia Monteiro Sampaio R, et al. The impact of anxiety and depression on the outcomes of chronic low back pain multidisciplinary pain management—a multicenter prospective cohort study in pain clinics with one-year follow-up. Pain Med. 2018 Jul 11. doi: 10.1093/pm/pny128. [Epub ahead of print]