Antidepressants May Provide Some Relief for Lower Back Pain

Researchers say taking antidepressants can provide some short-term relief for your aching back. There are other steps you can take, too.

Physical activity and ergonomics are two ways to try to get some relief from chronic lower back pain. Getty Images
Doctors often prescribe anti-inflammatory medications and recommend physical therapy in order to treat back pain.

But what about antidepressants?

A recent study authored by doctors in Australia and the Netherlands found that the antidepressant amitriptyline was effective at reducing lower back pain on a short-term basis.

But there’s a catch.

While the antidepressant was effective at the three-month mark, its positive effects were less significant after six months.

The study authors note that although a larger-scale study would be helpful, their findings indicate that an antidepressant medication can be beneficial for lower back pain — and is certainly less harmful than treatment with opioids.

“This study is saying that when patients are treated with antidepressants, they’re not bothered by the pain as much,” explained Dr. Charla Fischer, associate professor of orthopedic surgery at New York University’s School of Medicine. “So the pain scores remain the same, but it’s more the mental outlook of not being so bothered by the pain that’s different.”

Stress and back pain
While the physical source of lower back pain can often be identified through testing, the mental and emotional toll of stress and depression tends to exacerbate the problem.

In short, back pain isn’t all in your head. But what’s in your head can have a way of making things worse.

Fischer says one of her first steps in talking to a patient is unpacking their day-to-day life to identify possible stressors.

“I usually talk to them about how they get to work, what kind of work they do, whether they like it, and how it’s going in general,” she said. “That opens the door into other issues that may be bothering them and gives a sense of their activities in relation to what can cause back pain.”

The fact that many people work sedentary jobs that have them sitting during their daily commute, then sitting at their desk for the day — often while staring at a computer monitor — is a recipe for stress.

“All of those things are physically stressful, and then there’s the emotional stress,” Fischer told Healthline. “Some people carry stress in their stomach and they get IBS, some people get anxiety, and some people get back pain. It all depends on the individual.”

When it comes to a diagnosis, a simple MRI or X-ray can give doctors an idea of the physical factors — whether they’re degenerative, traumatic, or related to deformity — that are contributing to back pain.

But it’s difficult to parse just how much of the pain is from these physical factors and how much is from stress.

“If you’ve got something going on that we can see on an MRI or X-ray and can point to, having any kind of depression or anxiety diagnosis compounds that,” explained Fischer. “We don’t see many patients where we can diagnose that it’s more mental than physical. It’s really hard to tease out. Is stress a component? It usually is, so we tend to treat everything together with the physical therapy and the anti-inflammatory treating their muscle injury.”

Ergonomics and physical activity
Most of us don’t have the luxury of being able to quit a stressful job, but there are ways to make things more bearable.

Fischer says she encourages patients to make small but meaningful changes to improve their comfort levels throughout the day, starting with their morning commute.

“I start out with making sure that they’re comfortable in their commute,” she said. “I also make sure that their bag that they carry to work or school isn’t too heavy, because those can be additional triggers of pain. Once they’re at work, there are certain ergonomics that I talk to them about to make sure that their back and neck are in good alignment.”

She says it’s fine to sit down to get work done, but problems can arise when there’s too much uninterrupted sitting in a workday.

“It’s not necessarily that sitting is so terrible, but it’s sitting for 10 hours at a time, straight through, that is really destructive and can lead to spasms and pain,” she said. “So I talk to patients about taking a break or working at a standing desk.”

To break the cycle of sitting, Fischer recommends standing up every hour or so and drinking some water.

Another way to reduce stress, and eyestrain, is to simply look outside.

“Look at something natural that’s in the distance,” Fischer said. “Workers can get problems related to eyestrain from staring at a monitor all day. So if they change their focus and look far away, that can help relax the eyes, which also decreases chances of headache and neck pain.”

It’s also important to take advantage of the time allotted during breaks and lunchtime.

Fischer says that socializing with co-workers provides valuable social stimulation and feedback. Breaks are also a great chance to go for a walk.

“Get up and walk around,” Fischer said. “Getting out of the office for lunch is always good. Getting some fresh air and sunlight helps not just your back, but everything. It’s a good, gentle exercise for your back muscles. I’m a big proponent of walking.”

The bottom line
Antidepressants can be effective at treating lower back pain on a short-term basis.

A new study concluded that taking antidepressants can help relieve pain or better manage pain over a three-month period.

However, for long-term preventive care, it’s best to focus on ergonomics, physical activity, and self-care.