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depressive symptoms

The Impact of Depressive Symptoms: Considerations for Clinicians Treating Patients with Low Back Pain

Teaser: 

Jessica Wong, DC, MPH,1
Linda Carroll, PhD, 2
Pierre Côté, DC, PhD, 3

1 Research Associate, UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC).
2Professor Emeritus, School of Public Health, University of Alberta.
3 Professor and Canada Research Chair in Disability Prevention and Rehabilitation, Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT); Director, UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC).

CLINICAL TOOLS

Abstract: A considerable proportion of patients with low back pain (LBP) experience depressive symptoms. A clinical case is used to highlight potential steps that clinicians can take to help manage depressive symptoms in these patients: 1) Assess for depressive symptoms using a valid and reliable questionnaire; 2) Provide education, reassurance, and self-management strategies to initiate the program of care; 3) Adjust care plans if patients also present with depressive symptoms (e.g., ongoing support and education); and 4) Provide ongoing assessment of depressive symptoms, and consider referrals to a specialist or other health care providers (e.g., counselors, clinical psychologists, or psychiatrists) for further evaluation if symptoms are worsening.
Key Words: Low back pain, depressive symptoms, depression, depressive disorder.

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A considerable proportion of patients with low back pain present with depressive symptoms
Depressive symptomatology includes depression that has not been formally diagnosed and symptoms that do not meet the criteria for depression
The presence of depression may indicate poorer recovery from low back pain
Patients experiencing low back pain and concomitant depressive symptoms may benefit from ongoing assessments, education, reassurance, and self-management strategies
Assess for depressive symptoms in patients with LBP using a valid and reliable questionnaire (e.g., Patient Health Questionnaire-9)
Provide education, reassurance, and self-management strategies to all patients with LBP to initiate the program of care
Adjust the care plan accordingly if patients also present with depressive symptoms, including additional support and education (e.g., addressing misconceptions, encouraging activity) on an ongoing basis
Provide ongoing assessment of depressive symptoms, and consider referrals for further evaluation if symptoms are worsening
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