Back Pain and Depression: What's the Link?

Feelings of depression are significantly more common in people with chronic back pain. Find out more about how to manage your pain and your emotions.

Chronic pain and depression are two of the most common health problems Americans face. What's more, studies have found that these two conditions are often linked, afflicting the same sufferers.

Close to 6 million American adults report suffering from back pain, and studies have shown that depression is four times greater in people with chronic back pain than in those without. Similarly, a 2004 study published in the journal PAIN showed that the rate of depression is often directly proportional to pain severity.

Why Are Back Pain and Depression Linked?

* In the brain. A normal brain works in a state of equilibrium. When one part of the brain is active, the others slow down. In the case of chronic pain sufferers, the region of the brain mostly associated with emotion never slows down regardless of other brain activity, according to a February 2008 study by Northwestern University's Feinberg School of Medicine. This imbalance can result in the feelings of depression often associated with back pain.
* In the body. When a person experiences constant pain, it sets off a domino effect that results in symptoms related to depression. The same Feinberg School study reported that pain often makes it difficult to sleep, which can lead to fatigue and irritability during the day. In addition, a person with back pain may find it hard keep up with everyday movements ultimately resulting in lack of participation in enjoyable activities.

What Can You Do About Back Pain and Depression?
Coping with pain or depression is an on-going battle. Although your doctor can provide medical treatments, there are a few ways to manage your symptoms day to day.

Document it. Keep track of your physical and/or emotional pain in a journal so that, if you need to, you can accurately communicate your symptoms with a doctor.
Be active. Plan activities to help you gain a feeling of contribution. By completing small tasks, you will realize that you can be of help, despite any pain you may be experiencing.
Get support. Joining an online community may help you become conscious of the fact that you are not alone.
Enjoy life. Make a list of the things you know you can do and try to do one of those things each day. In addition, look for new hobbies, games, or people to associate yourself with.

Tips to Help Manage IBS

Follow these steps to help ease the symptoms of irritable bowel syndrome.

Irritable bowel syndrome (IBS) affects up to 20 percent of the general population, according to the National Digestive Diseases Information Clearinghouse (NDDIC). And for those living with it, the condition can be uncomfortable, inconvenient, and even embarrassing. If you think you may have IBS, it's important to consult with a doctor so that you can get an accurate diagnosis and treatment suggestions. In addition, the following self-care tips may help ease your symptoms and prevent flare-ups.

Stay hydrated. Drinking enough water every day helps to keep your digestive system working efficiently by preventing constipation and diarrhea. The NDDIC recommends aiming for six to eight glasses a day.
Up your soluble fiber intake. Soluble fiber can help to prevent spasms and reduce IBS symptoms by keeping the colon distended. The fiber also absorbs water, which helps prevent stools from becoming too hard and consequently difficult to pass. Good sources of soluble fiber include oatmeal, most types of beans, and citrus fruit.
Avoid dairy products. The lactose contained in dairy products causes many problems for digestion and often irritates IBS symptoms. Try alternative products, such as soy milk and cheeses, and if you must eat dairy, take lactase (the enzyme that breaks down lactose) in pill form before consuming it. Lactase pills can be purchases over the counter.
Eat smaller meals. Although most people will feel bloated after eating a large meal, the feeling is usually more intense for those with IBS. Try consuming five smaller meals a day, instead of three large meals, to reduce symptoms.
Avoid using laxatives. Even if you think they may help, laxatives can potentially weaken your intestines and disrupt your body's natural digestive cycle, resulting in dependency.
Exercise regularly. Not only does regular exercise help you maintain a healthy weight and prevent disease; it also helps aid digestion and relieve constipation. Try going for a short 20-minute walk every day or doing activities like swimming or yoga.
Bust the bubbles. Carbonated beverages, such as soda, can often result in increased intestinal gas and bloating, reports the National Women's Health Information Center. Avoid them when possible.
Practice stress reduction. Although it is a myth that IBS can actually be caused by stress, feelings of anxiety can aggravate symptoms. Try yoga, walking, or breathing techniques to help keep yourself calm.
Avoid coffee. Coffee is an infamous bowel irritant. The caffeine it contains speeds up every system in the body, including the colon, which can cause diarrhea.
Cut back on the fat. Not only can consuming too much fat cause weight gain and health problems; for people with IBS, it can also lead to uncomfortable, painful, and sometimes even more frequent bowel movements.

A Guide to Antidepressants

If you're among the 17 million Americans suffering from depression, a condition in which prolonged feelings of sadness and hopelessness interfere with the ability to function normally, you may be feeling overwhelmed by the alphabet soup of medications--SSRIs, SNRIs, NDRIs, TCAs, MAOIs--from which to choose. How can you determine which one is right for you? The first, most important step is to consult with a medical professional, who will not only help you decide and write a prescription, but also offer additional treatment if needed. Before you visit a doctor, here's a summary of the four primary classes of antidepressants.

Selective Serotonin
Reuptake Inhibitors (SSRIs).
Because they trigger fewer side effects, SSRIs are the most prescribed antidepressants, according to the National Institutes of Mental Health (NIMH). They prevent the reabsorption of serotonin by the nerve cells that send messages, making the neurotransmitter more available to the synapse and the recipient cells and thus stimulating them. Most commonly known by the names Paxil, Prozac, and Zoloft, SSRIs can also trigger some side effects, such as anxiety, insomnia, nausea, decreased sex drive, and headaches.

Atypical Antidepressants.
Atypical antidepressants, which act much like SSRIs by suppressing reuptake activity in the nerve cells, include both serotonin-norepinephrine reuptake inhibitors (SNRIs), such as Effexor, and norepinephrine-dopamine reuptake inhibitors (NDRIs), such as Wellbutrin. The newest group of depression medications, they allow for greater levels of norepinephrine and serotonin or norepinephrine and dopamine in the brain. Raising the availability of all three neurotransmitters has been shown to help alleviate the symptoms of depression.

Tricyclic Antidepressants (TCAs).
First prescribed in the 1950s to treat depression, TCAs also curb the reuptake process but are much more apt to produce side effects such as drowsiness, dry mouth, constipation, and blurred vision. They're often prescribed when treatments with SSRIs and atypical antidepressants prove ineffective.

Monoamine Oxidase Inhibitors (MAOIs).
The oldest class of antidepressants, which stop the breakdown of monoamine neurotransmitters, MAOIs are often the last medication doctors turn to because of their powerful interaction with food and beverages containing tryamine, such as wine, chocolate, and several types of cheeses. Consuming such items while taking an MAOI can lead to sudden spike in blood pressure, putting you at a greater risk for a heart attack or stroke.

The Next Steps

Once you and your doctor have determined the best course of pharmacological treatment, it's important to keep a list of the drug's side effects on hand, take careful note of changes in your eating or sleeping habits, and contact your doctor immediately if you start to have any suicidal thoughts. About 60 percent of people diagnosed with depression will have success with the first antidepressant they try, according to the NIMH. If you're not among them, don't get discouraged: Additional NIMH-funded research has established that those who did not get well after taking one antidepressant increased their chances of relieving their symptoms when they switched to a different medication or combined it with another.

Since many antidepressants require anywhere from two to six weeks to take effect, patience is key, as is an open line of communication with your doctor; in addition to any side effects you may experience, he or she should also be aware of all prescriptions and over-the-counter supplements or medicines you might be taking (e.g., serotonin syndrome can occur when some antidepressants are mixed with triptan-based migraine medications or herbal supplements). Most importantly, you should combine whatever form of medication you choose with a method of talk therapy. A University of Pennsylvania study published in 2005 found that when medication and cognitive therapy were used in tandem to treat depression, the relapse rate significantly decreased.

Understanding IBS

Irritable bowel syndrome affects up to 20 percent of the U.S. adult population, and the disorder has no known cause. Here, a look at IBS, from symptoms to treatment

Imagine not being able to make dinner plans with your friends or not eating your favorite foods for fear that it will send you running for the bathroom. For people who suffer from irritable bowel syndrome (IBS), these scenarios may sound all too familiar. Because the disorder is commonly characterized by cramping, abdominal pain, bloating, constipation, and diarrhea, some IBS patients report that they can never be far from a bathroom.

Who Gets IBS and Why?

Symptoms of IBS affect up to 20 percent of the U.S. adult population, according to the National Digestive Diseases Information Clearinghouse (NDDIC), a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Approximately 60 to 65 percent of IBS sufferers are female, and the condition can affect people of all ages, even children.

Researchers have yet to discover any specific cause for IBS. One theory is that people who suffer from IBS have particularly sensitive colons that are highly reactive to certain foods and stress. The immune system, which fights infection, may also be involved. What doctors and researchers do know is that IBS is not a disease; it's a functional disorder in which the bowel does not work correctly.

IBS Symptoms

Many people are able to control their symptoms with diet, stress management, and prescribed medications. But for some, IBS can be disabling, keeping them from their jobs and social events. According to the American Academy of Family Physicians, symptoms of IBS may include:

* Bloating and gas;
* Abdominal cramping and pain;
* Mucus in the stool;
* Constipation;
* Diarrhea, especially after eating, or first thing in the morning;
* Urge to have a bowel movement immediately after having one.


Certain factors may cause symptoms to worsen, such as excessive stress or an improper diet. In women, the symptoms of IBS may be more frequent during their menstrual periods. Some people find that their symptoms subside for a few months and then return, while others report a constant worsening of symptoms over time.

Diagnosing IBS

If you think you may have IBS, seeing your doctor is the first step toward treatment. Although there is no specific test for IBS, your doctor will carefully study your medical history and perform diagnostic tests to rule out other problems. These tests may include blood and stool sample tests, X-rays, and a colonoscopy, which allows your doctor to see the inside of your colon. Even if your test results are negative, your doctor may still diagnose you with IBS based on the severity and frequency of your symptoms.

Treating IBS

There is no known cure for IBS, but many options are available to treat the symptoms. Unfortunately, many people suffer from IBS for a long time before seeking help. In fact, up to 70 percent of people with IBS are not receiving medical care for their symptoms, according to the NDDIC. Getting help is very important, though. A careful combination of diet, stress management, and medication helps many IBS sufferers to keep their condition under control.

Diet.
Careful eating can often help to reduce IBS symptoms. Before drastically changing your diet, try keeping a journal of everything you eat, noting the foods that seem to cause distress. Then discuss these findings with your doctor, who may recommend that you consult with a registered dietitian to help you develop an appropriate meal plan.

The following may worsen IBS symptoms, according to the International Foundation for Functional Gastrointestinal Disorders (IFFGD).

* Fried or fatty foods;
* Certain high-fiber foods;
* Dairy products;
* Vegetables such as beans, cabbage, legumes, cauliflower, and broccoli;
* Coffee;
* Caffeine;
* Alcohol.


In some cases, dietary fiber (in foods such as fruits, vegetables, and whole-grain cereals and breads) may relieve IBS symptoms, particularly constipation. However, fiber may also increase instances of gas, bloating, and diarrhea. Doctors usually recommend a diet with an appropriate balance of fiber to produce soft, painless bowel movements.

Stress Management.
The colon has many nerves that connect it to the brain. These nerves control the normal contractions of the colon and can cause abdominal spasms during stressful times. As a result, people with IBS often experience cramps or "butterflies" when they are nervous or upset. Stress management is, therefore, an important part of managing your condition. People with IBS are advised to get adequate sleep; seek counseling, if needed; and engage in stress-reducing activities, such as walking or yoga.

Medication.
Doctors often prescribe fiber supplements or laxatives for constipation as well as medications to decrease diarrhea. An antispasmodic is commonly prescribed, which may help to control colon muscle spasms and reduce abdominal pain. With any medication and even over-the-counter laxatives and fiber supplements, it's important to follow your doctor's instructions carefully. Some IBS sufferers report a worsening in abdominal bloating and gas from increased fiber intake--and laxatives can be habit forming if they are used too frequently.

Most Fattening Ballpark Food

There was a time when the national pastime was synonymous with peanuts and cracker jacks. Now, the ballpark menu has expanded—to include one fattening item after another. Stadiums often serve foods made famous by their hometowns (such as cheesesteaks in Philly, crabcakes in Baltimore, or pierogies in Pittsburgh), but many of them should come with an exercise plan on the side.

Chili cheese dog. To begin with, most hot dogs contain several grams of saturated fat (the kind of fat that causes high cholesterol, according to the American Heart Association). Add to it the greasy, gooey cheese and loads of spicy chili (and if it's Cincinnati's famous Skyline chili, served at the Great American Ball Park, there may be some chocolate added). The final caloric score of these treats? Somewhere in the ballpark of 400 calories.

Pretzel dog. Maybe they're going to for a triple play here: high in fat, high in sodium, and high in carbs. It's not like the hot dog is a health food to begin with, but wrapping a 200-plus-calorie pretzel around it is just adding insult to injury. If a pretzel dog isn't your thing, but you still want all the fatty goodness of the pretzel and sausage, you can order the bratzel (a bratwurst wrapped in a pretzel) the next time you're at a St. Louis Cardinals home game. But beware: You'll be consuming a quarter of your daily calorie intake.

Beer. It's technically not a food, but a cold brew is a ubiquitous ballpark staple nonetheless. In fact, the vendors are everywhere, shouting, "Get your beer, here," into the stands. Whether you're having a cold one at Miller Park or Coors Field or any of the other fields not named after beers, each eight-ounce glass weighs in at approximately 100 calories. Light beers could save you about 25 to 30 calories a glass, but they'll still cost an arm and a leg.

Garlic fries. These specialty French fries are such a hit, they can be found in multiple stadiums, particularly on the West Coast, including Bank One Ballpark (home of the Arizona Diamondbacks), PETCO Park (home of the San Diego Padres), and AT&T Park (home of the San Francisco Giants). With these fries, you'll be batting 500-calories, that is.

Italian sausages. It doesn't matter if you top your sandwich with the hottest peppers or the sweet kind, Italian sausages are a strikeout, for sure. Although the caloric count and fat grams vary widely depending on where you're ordering, they're never low, sometimes swinging as high as 700 calories and more than 40 grams of fat.

Anything smothered in barbecue sauce. Pick your poison: the barbecue pork ribs in Atlanta, the barbecue beef sandwich while watching the Royals play at home, or some of Manny's barbecue pit beef in Pittsburgh's PNC Park. To be fair, it's not the sauce that will wreak havoc on your waistline; it's everything underneath it.

Cuban sandwich. You can get a Cuban while rooting for the Tampa Bay Rays, the Boston Red Sox, or the Cleveland Indians. Regardless of who they're playing, one pre-game prediction is sure to be true: At about 700 calories a sandwich, this ballpark food will ruin your diet.

Cheesesteak. It's no surprise that they serve this famous Philadelphia staple at Citizen's Bank Park where the Phillies play. While Geno's Steaks and Pat's King of Steaks continue to battle across the street from each other for dominance in the Philly cheesesteak market, whether you grab one of those or the kind at the park, one thing is clear: You're going to need to loosen your belt after you finish eating it.

Pizza. Two slices of Little Caesar's pepperoni pizza stack up to 780 calories. And if that's not enough to convince you to steer clear, consider this the next time you're at a Detroit Tigers home game: Mike Ilitch owns both the team and the pizza franchise, which has made him enough money to earn a spot on the Forbes Richest Americans list. Maybe you should save your money.

Chocolate-covered cheesecake. As if the other foods haven't already done enough harm, the final inning brings dessert. And at the Great American Ballpark in Cincinnati, that means chocolate-covered cheesecake, which is sure to issue to the final blow to your waistline.