Chronic back pain and mental health issues both make a significant impact on employees. Mental illness and back pain in the workplace are the top two contributors to presenteeism – when employees are at work but unable to focus. Together, they cost millions of dollars in lost productivity. Major depression also follows only low back pain in years lost to disability.

Unfortunately, these two common, debilitating conditions often go hand-in-hand. And workplace stress, especially during these challenging times, can make both worse.

In fact, chronic pain and depression occur together 30 to 50% of the time. When together, they raise healthcare costs by 79%. Added to those numbers, since the pandemic, employees have seen a 64% increase in depression and a 47% increase in anxiety.

The comorbidity between mental health issues and back pain can impact employees in a few different ways. Understanding how these two common conditions influence each other is the first step toward finding an accessible solution that can help address both.

1. Workplace stress specifically makes back pain worse.

When we get stressed out, the body naturally goes into “fight or flight” mode. The muscles around your spine tense and spasm, and the body releases the stress hormone cortisol.

Any kind of stress can make back pain worse. However, recent research found that workplace stress poses a particular threat. Several work-related factors are correlated with chronic low back pain, the most prevalent chronic pain condition and severe musculoskeletal condition. High workload, low job control, and low social support are all key risks.

2. Chronic pain can lead to depression, and vice versa.

Pain is a risk factor for depression, and depression is a risk factor for pain. Sixty-five percent of people with depression also report chronic musculoskeletal pain. People with chronic back pain are three times more likely to experience a depressive episode.

Researchers are still working to understand everything about this connection. We do know that both chronic pain and depression lead to changes in the brain that overlap with each other. Research has shown that sensory pathways in the brain related to pain share the same brain regions involved in mood management.

3. Anxiety and depression make pain feel worse. 

Anxious feelings in people with chronic pain are common, and can impact recovery. One common thinking pattern in chronic pain is catastrophizing. Expecting the worst result makes pain feel worse, research has found.

Hypervigilance, when patients have a difficult time focusing on anything but pain, is also common and can exacerbate the pain experience. With time, heightened anticipation of pain can make even low-intensity sensations, such as being brushed against, feel painful.

In fear avoidance, another common anxiety-related behavior, people in pain avoid exercise and movement, for fear it will make their pain worse. Fear avoidance in particular can slow recovery by preventing chronic back pain sufferers from trying the recommended first-line treatment, physical therapy.

4. Exercise requires more of an effort with chronic back pain and depression – but it helps both.

Both depression and chronic back pain can drain energy levels and make it more difficult to get moving, but exercise also improves symptoms for both.

The evidence that exercise reduces depression symptoms is well established. Some studies have even found that depression is just as effective as antidepressants in managing symptoms.

Exercise therapy is the recommended first-line treatment for back pain. Despite this, research has found that many patients don’t have the chance to try physical therapy, and instead receive invasive and costly care. Up to 39% of those who ultimately receive surgery never had physical therapy.

5. Access is an issue for chronic back pain and mental health.

Employees struggle to find the right treatments for both chronic back pain and mental health issues even under normal circumstances. Sixty percent of counties in the U.S. don’t have a single psychiatrist. Seventy-five percent of employers with workforces of 5,000 people or more say access to behavioral health care is an issue in some or all of their locations.

Cognitive behavioral therapy is effective in treating back pain. However, most low back pain patients aren’t directed to this option. Despite treatment guidelines, only 8% of patients are prescribed cognitive behavioral therapy for back pain.

Accessing a physical therapist for back pain can also be challenging, especially as employees continue to put off care during the pandemic.

How can employers help?

Chronic pain and depression occur together up to 50% of the time. Even if someone with chronic pain isn’t clinically depressed, negative thought patterns and anxiety can still slow recovery.

As the pandemic stretches on, many employees still have limited access to in-person care for mental and physical health. To help, employers can support employees with chronic pain and depression by offering a holistic solution that addresses pain from a psychologically-informed perspective.

The Fern Health digital musculoskeletal pain employer program brings together exercise therapy, pain neuroscience education, skill building, and one-on-one coaching to reduce functional musculoskeletal pain symptoms and improve mental health.

Want to learn more about offering a holistic approach to chronic MSK pain to your employees? Get in touch below.