Can psychiatric illness cause back pain and body pain, and what is the treatment for the same?

Psychiatric Illness and Back/Body Pain: Relationship and Treatment

Yes, psychiatric illnesses can cause back pain and body pain, and treatment should include a multimodal approach with psychological therapies, physical therapies, and appropriate pharmacological interventions based on pain type and psychiatric comorbidities. 1

Relationship Between Psychiatric Illness and Pain

Psychiatric Conditions Associated with Pain

• Psychiatric disorders often precede chronic back pain, with studies showing that 77% of chronic low back pain patients meet lifetime diagnostic criteria for at least one psychiatric diagnosis 2
• Common psychiatric conditions associated with pain include:
  • Major depression
  • Anxiety disorders
  • Substance abuse disorders
  • Somatic symptom disorders 3, 2
• Research indicates that 54% of patients with depression, 94% with substance abuse, and 95% with anxiety disorders experienced these conditions before the onset of their back pain 2

Pain Mechanisms in Psychiatric Illness

• Psychosocial factors significantly contribute to generating disability from back pain 3
• Pain catastrophizing (tendency to magnify or exaggerate pain sensations) and negative expectancy are common psychological mechanisms 3
• Pain acceptance (ability to tolerate discomfort) and psychological flexibility affect pain perception and disability 3

Assessment Approach

Screening Tools

• The STarT Back tool helps identify patients at low, medium, or high risk for developing persistent disabling pain 3, 1
• Leeds General Depression Scale and Beck Depression Inventory are effective screening instruments for psychiatric illness in pain clinic populations 4

Risk Stratification

Risk Level	Characteristics	Management Approach
Low risk	Minimal psychosocial factors	Self-management strategies
Medium risk	Some psychosocial factors	Physiotherapy with patient-centered plan
High risk	Significant psychosocial factors	Comprehensive biopsychosocial assessment [3,1]

Treatment Recommendations

Psychological Interventions

1. First-line psychological treatments:

   • Cognitive behavioral therapy (CBT) - provides relief of back pain for periods ranging from 4 weeks to 2 years (Category A2 evidence) 3
   • Biofeedback and relaxation training 3
   • Mindfulness-based stress reduction 3

2. Additional psychological approaches:

   • Supportive psychotherapy and group therapy 3
   • Psychophysiologic symptom relief therapy (PSRT) - shows promising results with 63.6% of patients reporting being pain-free at 26 weeks in one study 5

Pharmacological Management

1. For neuropathic pain components:

   • Anticonvulsants (α-2-delta calcium-channel antagonists, sodium-channel antagonists) 3
   • Serotonin-norepinephrine reuptake inhibitors (SNRIs) like duloxetine 3, 1
   • Tricyclic antidepressants (TCAs) 3

2. For non-neuropathic pain:

   • NSAIDs (for up to one week) 1
   • Acetaminophen 1
   • Muscle relaxants for muscle spasm (short-term use) 1

3. Psychotropic medications for pain modulation:

   • Low-dose TCAs and SNRIs have the most proven efficacy 3
   • Higher doses of SSRIs or bupropion for patients with significant psychiatric comorbidity 3
   • Avoid mood stabilizers and atypical antipsychotics unless under psychiatric consultation 3

Physical and Rehabilitative Approaches

• Physical therapy with focus on active interventions rather than passive treatments 1
• Heat therapy - provides moderate improvement in pain relief 1
• Massage for subacute back pain 1
• Encourage continued activity rather than bed rest 1

Multidisciplinary Rehabilitation

• Two levels of psychological therapy for back pain:
  1. Low intensity - provided by a single professional following a treatment manual
  2. High intensity - delivered by a specialist pain team 3
• Multidisciplinary rehabilitation shows moderate reduction in short-term pain intensity and disability compared with usual care 1

Special Considerations

When to Refer

• Refer for specialized care if:
  • Pain persists after 3 months of standard therapies 1
  • Severe radicular pain with neurological deficits is present 1
  • Red flag symptoms are identified 1
  • Significant psychiatric comorbidity requiring specialized mental health intervention 3

Common Pitfalls to Avoid

• Overreliance on opioids - should only be prescribed as a last resort and for very limited duration 1
• Prescribing bed rest - can prolong recovery and worsen outcomes 1
• Premature imaging - only warranted with evidence of underlying pathology or severe symptoms that don't improve after 6-8 weeks 1
• Neglecting patient education - crucial for effective management 1
• Failing to recognize psychiatric comorbidities - can significantly impact treatment outcomes 2

By addressing both the physical and psychological aspects of pain through this comprehensive approach, patients with psychiatric illness-related back and body pain can achieve significant improvements in pain management and quality of life.