Coping with Back Pain & Depression After a Work Injury

I found a great article today ( on dealing with chronic pain and depression.  Sadly many injured workers who have suffered a serious injury can end up dealing with one or both of these conditions.  I wanted to pass along Dr. Deardorff’s article in hopes that this information may help some of my clients dealing with these adverse situations.


As always, this is not intended as medical advice, simply information to keep my clients well informed and hopefully help them to address these issues with their doctor.


4 Tips to Help Cope With Chronic Pain and Depression

By: William W. Deardorff, PhD, ABPP

It is not uncommon for those who suffer from chronic pain to feel stressed and depressed at times. This is no surprise, given the fact that “chronic pain” usually means pain that lasts more than three to six months. Prolonged pain appears to set up a pathway in the nervous system that sends pain signals to the brain, even in the absence of an underlying anatomical problem.


Some chronic pain may be due to a diagnosable anatomical problem, such as degenerative disc disease or spinal stenosis, that can cause continual pain until successfully treated. More often, the chronic pain has no clear anatomical cause, as in failed back surgery syndrome or chronic back pain without an identified pain generator. In such cases, the pain is itself the disease. Click here for more Depression Symptoms


For some people, the stress and depression resulting from chronic pain can become consuming, and can even worsen and prolong the pain. Increased pain can, in turn, lead to increased stress and depression, creating a cycle of depression and pain that can be difficult to break. There are things a person with pain can do, however, to prevent or manage the chronic pain and depression that may develop:


1) Minimize the chances of developing chronic pain

Talking to a physician about symptoms of depression or stress, or a history of depression, while still in the acute pain phase can alert a physician to the need for consideration of both conditions in creating a treatment plan for the patient’s spine health. While one patient may demonstrate a full recovery from the initial injury, a patient who is more prone to depression and stress, shows signs of depression and/or stress, or who has a history of clinical depression may be more vulnerable to developing a chronic pain problem that persists beyond the initial acute pain complaint. An informed physician can suggest a treatment plan early on that treats the patient’s mental state as well as their physical pain, minimizing the chances of the patient developing a chronic pain problem.


It is advisable for patients to talk with their doctors if they experience any of the following common symptoms of depression:

*Changes in sleep patterns

*Changes in appetite

*Feelings of anxiety.


Stress can manifest itself in several ways Patients should talk with their doctors if they believe they exhibit symptoms characteristic of stress-related back pain, which are similar to those of fibromyalgia:


*Back pain and/or neck pain

*Diffuse muscle aches

*Muscle tender points

*Sleep disturbance and fatigue

*In many stress-related back pain cases, patients complain of the pain “moving around”


Chronic pain can also be exacerbated by things such as physical de-conditioning due to lack of exercise and a person’s thoughts about the pain. Patients can help thwart their pain from developing into or minimizing chronic pain by engaging in an appropriate exercise program and practicing distraction, guided imagery and other cognitive techniques.


2) Identify stress triggers that can increase chronic pain

“Patients can monitor how their own stress and anxiety affects their back pain by keeping a diary of when their back pain changes and what kinds of stress could be triggering the pain. This exercise can redirect a patient’s focus from the pain to the elements in their life that affect their pain. Identifying stress triggers or emotional triggers that affect the pain will give the patient the opportunity for better pain relief through avoiding or eliminating these stress triggers. Recognizing how depression and stress affect their pain can lessen anxiety by giving patients more control over their chronic pain problem.”


3) Communicate about depression

“Depression and an emotional reaction to chronic pain are normal. Many patients do not speak to their physicians about their depression because they believe that once the initial pain problem is resolved, the depression, anxiety, and stress they are feeling will go away. However, secondary losses from a chronic pain problem, such as changes in the ability to do favorite activities, disrupted family relationships, financial stress, or the loss of a job, can continue to contribute to feelings of hopelessness and depression.


“Talking to a physician about feelings of depression will keep the physician better informed and better able to provide appropriate care. Depression can affect the frequency and intensity of pain symptoms, and the healing rate. Getting simultaneous back pain treatment and depression treatment will give the patient a better chance of a full recovery.””


4) Seek multi-disciplinary care for pain and depression

“Informing a physician of depression can create an opportunity for a multi-disciplinary course of treatment involving both a physician and a mental health professional. With a team approach, both the pain problem and the depression are monitored simultaneously, and both doctors can communicate about how each area affects the other. It’s important for physicians to understand that changes in the physical symptoms of pain can also be related to changes in a patient’s mental state.


In addition, some common treatments for pain, including opioid pain medication, can actually make depression worse. This worsening depression can then affect the physical presentation of the pain. If both physical and mental well-being are being monitored closely by medical experts, treatment and medication recommendations, including antidepressants, can be made that take both the physical pain and the emotional health of the patient into account.”


For more information on Virginia Workers Compensation, order my book, “The Ultimate Guide to Workers’ Compensation in Virginia” by clicking this link, or call our office today (804) 755-7755.


Michele Lewane, Esq.

Depression and Chronic Back Pain After a Work Injury

I have represented a lot of injured workers who suffered a back injury at work and sometimes, these injuries can lead to other conditions, like depression or chronic pain.  While depression and chronic pain are very common after a serious back injury, there is still a lot that medical professionals are examining to better understand the relationship between chronic pain and depression.


I wanted to pass on Dr. Deardorff’s article (taken from explaining some of the links between chronic pain and depression so you can be informed and possibly have a better understanding of some things you might be dealing with.


Depression and Chronic Back Pain

By: William W. Deardorff, PhD, ABPP

“Depression is by far the most common emotion associated with chronic back pain. The type of depression that often accompanies chronic pain is referred to as major depression or clinical depression. This type of depression goes beyond what would be considered normal sadness or feeling “down for a few days”.


The symptoms of a major depression occur daily for at least two weeks and include at least 5 of the following (DSM-IV, 1994):


*A predominant mood that is depressed, sad, blue, hopeless, low, or irritable, which may include periodic crying spells

*Poor appetite or significant weight loss or increased appetite or weight gain

*Sleep problem of either too much (hypersomnia) or too little (hyposomnia) sleep

*Feeling agitated (restless) or sluggish (low energy or fatigue)

*Loss of interest or pleasure in usual activities

*Decreased sex drive

*Feeling of worthlessness and/or guilt

*Problems with concentration or memory

*Thoughts of death, suicide, or wishing to be dead


Chronic pain and depression are two of the most common health problems that health professionals encounter, yet only a handful of studies have investigated the relationship between these conditions in the general population (Currie and Wang, 2004).


Major depression is thought to be four times greater in people with chronic back pain than in the general population (Sullivan, Reesor, Mikail & Fisher, 1992). In research studies on depression in chronic low back pain patients seeking treatment at pain clinics, prevalence rates are even higher. 32 to 82 percent of patients show some type of depression or depressive problem, with an average of 62 percent (Sinel, Deardorff & Goldstein, 1996). In a recent study it was found that the rate of major depression increased in a linear fashion with greater pain severity (Currie and Wang, 2004). It was also found that the combination of chronic back pain and depression was associated with greater disability than either depression or chronic back pain alone.”


Depression is Common for Those with Chronic Back Pain

“Depression is more commonly seen in patients with chronic back pain problems than in patients with pain that is of an acute, short-term nature. How does depression develop in these cases? This can be understood by looking at the host of symptoms often experienced by the person with chronic back pain or other spine-related pain.


*The pain often makes it difficult to sleep, leading to fatigue and irritability during the day.

*Then, during the day, because patients with back pain have difficulty with most movement they often move slowly and carefully, spending most of their time at home away from others. This leads to social isolation and a lack of enjoyable activities.

*Due to the inability to work, there may also be financial difficulties that begin to impact the entire family.

*Beyond the pain itself, there may be gastrointestinal distress caused by anti-inflammatory medication and a general feeling of mental dullness from the pain medications.

*The pain is distracting, leading to memory and concentration difficulties.

*Sexual activity is often the last thing on the person’s mind and this causes more stress in the patient’s relationships.


Understandably, these symptoms accompanying chronic back pain or neck pain may lead to feelings of despair, hopelessness and other symptoms of a major depression or clinical depression.


A recent study by Strunin and Boden (2004) investigated the family consequences of chronic back pain. Patients reported a wide range of limitations on family and social roles including: physical limitation that hampered patients’ ability to do household chores, take care of the children, and engage in leisure activities with their spouses. Spouses and children often took over family responsibilities once carried out by the individual with back pain. These changes in the family often led to depression and anger among the back pain patients and to stress and strain in family relationships.”


I believe that depression can be a “silent destroyer” because too many people fail to recognize the signs or, they fail to get treatment for their condition even if the depression seems to be slowly breaking down the fabric of their lives.  I don’t want to see anyone suffer needlessly, there is help available.


While I NEVER give medical advice or a medical opinion, if you feel that the information in this article reflects on your situation, you need to address this with your doctor right away.


For more information on Virginia Workers Compensation, order my book, “The Ultimate Guide to Workers’ Compensation in Virginia” by clicking this link, or call our office today (804) 755-7755.


Michele Lewane, Esq.


Self Help for Depression

I found some tips from the National Institute of Mental Health for “self help” for people who may be suffering from depression.


To Help Yourself                                                                    (

*Do not wait too long to get evaluated or treated. There is research showing the longer one waits, the greater the impairment can be down the road. Try to see a professional as soon as possible.

*Try to be active and exercise. Go to a movie, a ballgame, or another event or activity that you once enjoyed.

*Set realistic goals for yourself.

*Break up large tasks into small ones, set some priorities and do what you can as you can.

*Try to spend time with other people and confide in a trusted friend or relative. *Try not to isolate yourself, and let others help you.

*Expect your mood to improve gradually, not immediately. Do not expect to suddenly “snap out of” your depression. Often during treatment for depression, sleep and appetite will begin to improve before your depressed mood lifts.

*Postpone important decisions, such as getting married or divorced or changing jobs, until you feel better. Discuss decisions with others who know you well and have a more objective view of your situation.

*Remember that positive thinking will replace negative thoughts as your depression responds to treatment.

*Continue to educate yourself about depression.


This information is NOT meant to be medical advice or a medical opinion.


I understand that not all of these items may apply or help with your particular situation but a positive attitude goes a long way in dealing with any life changing event.  Of all the people I have represented over the last 20+ years, the people who make an effort to maintain a positive outlook seem to have the best recovery and the best outlook on their future after dealing with a work injury.


If you are dealing with depression related to your work injury, make sure you discuss this information with your doctor.


For more information on work injuries and Virginia Workers Compensation, order my book, “The Ultimate Guide to Workers’ Compensation in Virginia” by clicking this link, or call our office today (804) 755-7755.


Michele Lewane, Esq.


Depression Can Affect Men, Women and Older Adults Differently

Often times, people who have been injured at work find themselves facing circumstances that can lead to depression (loss of ability to things they did before the injury, loss of income, loss of employment, chronic pain and so on) and many other biological factors can also play a role in leading to a person suffering from depression.  Many of us may not realize it, but according to this article (taken from the National Institute of Mental Health), depression can affect men, women  and older adults in different ways and for several different reasons.


How do women experience depression?                   (

Depression is more common among women than among men. Biological, life cycle, hormonal, and psychosocial factors that women experience may be linked to women’s higher depression rate. Researchers have shown that hormones directly affect the brain chemistry that controls emotions and mood. For example, women are especially vulnerable to developing postpartum depression after giving birth, when hormonal and physical changes and the new responsibility of caring for a newborn can be overwhelming.

Some women may also have a severe form of premenstrual syndrome (PMS) called premenstrual dysphoric disorder (PMDD). PMDD is associated with the hormonal changes that typically occur around ovulation and before menstruation begins.

During the transition into menopause, some women experience an increased risk for depression. In addition, osteoporosis—bone thinning or loss—may be associated with depression.11 Scientists are exploring all of these potential connections and how the cyclical rise and fall of estrogen and other hormones may affect a woman’s brain chemistry.12

Finally, many women face the additional stresses of work and home responsibilities, caring for children and aging parents, abuse, poverty, and relationship strains. It is still unclear, though, why some women faced with enormous challenges develop depression, while others with similar challenges do not.

How do men experience depression?

Men often experience depression differently than women. While women with depression are more likely to have feelings of sadness, worthlessness, and excessive guilt, men are more likely to be very tired, irritable, lose interest in once-pleasurable activities, and have difficulty sleeping.13,14

Men may be more likely than women to turn to alcohol or drugs when they are depressed. They also may become frustrated, discouraged, irritable, angry, and sometimes abusive. Some men throw themselves into their work to avoid talking about their depression with family or friends, or behave recklessly. And although more women attempt suicide, many more men die by suicide in the United States.15

How do older adults experience depression?

Depression is not a normal part of aging. Studies show that most seniors feel satisfied with their lives, despite having more illnesses or physical problems. However, when older adults do have depression, it may be overlooked because seniors may show different, less obvious symptoms. They may be less likely to experience or admit to feelings of sadness or grief.16

Sometimes it can be difficult to distinguish grief from major depression. Grief after loss of a loved one is a normal reaction to the loss and generally does not require professional mental health treatment. However, grief that is complicated and lasts for a very long time following a loss may require treatment. Researchers continue to study the relationship between complicated grief and major depression.17

Older adults also may have more medical conditions such as heart disease, stroke, or cancer, which may cause depressive symptoms. Or they may be taking medications with side effects that contribute to depression. Some older adults may experience what doctors call vascular depression, also called arteriosclerotic depression or subcortical ischemic depression. Vascular depression may result when blood vessels become less flexible and harden over time, becoming constricted. Such hardening of vessels prevents normal blood flow to the body’s organs, including the brain. Those with vascular depression may have, or be at risk for, co-existing heart disease or stroke.18

Although many people assume that the highest rates of suicide are among young people, older white males age 85 and older actually have the highest suicide rate in the United States. Many have a depressive illness that their doctors are not aware of, even though many of these suicide victims visit their doctors within 1 month of their deaths.19

Most older adults with depression improve when they receive treatment with an antidepressant, psychotherapy, or a combination of both.20 Research has shown that medication alone and combination treatment are both effective in reducing depression in older adults.21 Psychotherapy alone also can be effective in helping older adults stay free of depression, especially among those with minor depression. Psychotherapy is particularly useful for those who are unable or unwilling to take antidepressant medication.22,23

If you are dealing with depression related to your work injury, make sure you discuss this information with your doctor.

For more information on work injuries and Virginia Workers Compensation, order my book, “The Ultimate Guide to Workers’ Compensation in Virginia” by clicking this link, or call our office today (804) 755-7755.


Michele Lewane, Esq.

Signs of Depression After a Work Injury

Many people who have suffered the misfortune of a workplace injury face the prospect of being out for work for an extended period of time. Being out of work for a long period of time can lead to other challenges (loss of income, lack of physical activity, inability to pay bills, prolonged periods of pain, anxiety, and so on). One of the big problems injured workers in these situations face is the increased likely hood that they could become depressed.

I have done some research on the internet and found several lists of signs to look for if you believe you or someone you know might be depressed. The first list is taken from the National Institute of Mental Health ( and the second list is taken from The Mayo Clinic (

I wanted to pass this information on to you so that you can hopefully recognize when you or someone you know may need help.

Signs and symptoms include: (
*Persistent sad, anxious, or “empty” feelings
*Feelings of hopelessness or pessimism
*Feelings of guilt, worthlessness, or helplessness
*Irritability, restlessness
*Loss of interest in activities or hobbies once pleasurable, including sex
*Fatigue and decreased energy
*Difficulty concentrating, remembering details, and making decisions
*Insomnia, early-morning wakefulness, or excessive sleeping
*Overeating, or appetite loss
*Thoughts of suicide, suicide attempts
*Aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment.

Depression symptoms include: (
*Feelings of sadness or unhappiness
*Irritability or frustration, even over small matters
*Loss of interest or pleasure in normal activities
*Reduced sex drive
*Insomnia or excessive sleeping
*Changes in appetite — depression often causes decreased appetite and weight loss, but in some people it causes increased cravings for food and weight gain
*Agitation or restlessness — for example, pacing, hand-wringing or an *inability to sit still
*Irritability or angry outbursts
*Slowed thinking, speaking or body movements
*Indecisiveness, distractibility and decreased concentration
*Fatigue, tiredness and loss of energy — even small tasks may seem to require a lot of effort
*Feelings of worthlessness or guilt, fixating on past failures or blaming yourself when things aren’t going right
*Trouble thinking, concentrating, making decisions and remembering things
*Frequent thoughts of death, dying or suicide
*Crying spells for no apparent reason
*Unexplained physical problems, such as back pain or headaches

For some people, depression symptoms are so severe that it’s obvious something isn’t right. Other people feel generally miserable or unhappy without really knowing why.

Depression affects each person in different ways, so symptoms caused by depression vary from person to person. Inherited traits, age, gender and cultural background all play a role in how depression may affect you

If you are dealing with depression related to your work injury, make sure you discuss this information with your doctor.

For more information on work injuries and Virginia Workers Compensation, order my book, “The Ultimate Guide to Workers’ Compensation in Virginia” by clicking this link, or call our office today (804) 755-7755.
Michele Lewane, Esq.