Is Low Back Pain in Young Adults Linked to Depression? The Shocking Truth | Podcast Ep. 322

Foreign hello and welcome to the Evidence Based Chiropractor. I am your host, Dr. Jeff Langmaid. And on today's episode, we're diving deep into some research. This is a study that came out in 2017, and if you see younger people in your practice, you're going to want to pay attention. This study was titled Associations between Low Back Pain and Depression and Somatization in a Canadian Emerging Adult Population. It's the first study I've seen really analyzing this in a emerging adult population, meaning 18 to 26 years old. A lot of good clinical pearls in this one. We'll break it down in more on today's episode. Before we get started, I'm gonna say a few words about the smart chiropractor. The smart chiropractor can power your patient journey to provide you with more qualified leads, more new patients, better retention, consistent reactivations, all without spending any money on advertising. This is about content, this is about consistency, and this is about communication. We believe and have seen when you teach and invite consistently, you can keep your schedule full without having to resort to deep discount advertising or demographic targeting and then hoping to convert somebody, quote, unquote, once they come in your front doors. That's all@the smartchiropractor.com, so head over there and check it out. But on today's episode, we're talking research study came out in 2017. Basics are this. We all know low back pain is one of the most common conditions, musculoskeletal, neuromusculoskeletal conditions in the world. The lifetime prevalence is sky high. Almost everybody, as I like to say, is gonna have back pain at some point in their life. And the point prevalence is about 30% of the population at any given time. Some of the challenges associated with this is low back pain is the leading cause of years lived with disability and is associated with quality of life issues. When you have low back pain, it makes a big impact in your quality of life. This is going to tie into a lot of the psychological component that we talk about on today's episode. This is one of the first studies to tackle that emerging adulthood category. They defined it in the research as 18 to 26 years old. Now this is a super important time for quite a few reasons. One is that everybody has more responsibility, more independence regarding lifestyle choices as they talk about in this study and establishing behaviors for good and for bad that'll last the rest of their lives. Typically around this age, people are getting into the workforce, going to college, whatever it might be. For those individuals, they're going to have more responsibility on them day in and day out again, more independence in terms of what they're choosing. You know, I guess their mother and father aren't cooking for them anymore. So they're making decisions in terms of how they move, how they eat, how they engage with the healthcare system and their daily wellness and health habits, or lack thereof. And often this is a critical junction point between what's been played in your head, on the tapes, in your head, so to speak, as a child, what's been ingrained in you, and what's to become second nature as you go through the rest of your life as an adult. Not that change can't happen, but this is an interesting transitional period. And behaviors during this period have been linked and may be linked to chronic disease later in life. But the catch 22, the benefit is at this age, a lot of those behaviors are still malleable. They can still be changed. So this is an important junction point. It sets up the next 30, 40, 50, 60 years of life. And I think all of us, if we're a chiropractor, as you are listening, we see people come in with pain, whether they're a teenager, whether they're a young adult. And sometimes it can be difficult to deal with and challenging to really nail down a true diagnosis. Because a lot of what we'll talk about right now, and that key word is somatization. I hadn't heard that before. I hope I'm pronouncing it correctly. But this is defined as a complex array of behaviors characterized by an abundant usage of body expressions and language to, to convey feelings or personal complaint and social distress, amplifying or distorting sometimes subtle physiological changes. So this is, I immediately think of that slumped posture, that depressed type posture, shoulders rolled forward, hyperkyphosis, we know that that plays a role due to previous studies that we've cited on this podcast that has maybe not causation, but certainly correlation with mental state. And they found that there's no question that there is co occurrence between depressive and somatoform disorders. So when somatization is occurring, there's a link there to mood, to depressive disorders, and that's a key part of this. And when you throw low back pain into it, you, you start to really develop a challenging situation, but also one, in my opinion, that we can help tremendously as the advocates, as the doctors, as the educators, teachers and guides for these young people coming into our practices. So this study, they took and looked at a university population, 18 to 26 years old. Right. A total of a little bit above 1,000 students. And they ran a bunch of questionnaires and surveys to determine what's going on. And one of those was to grade low back pain. Grading scale was 0, 1, 2 and 3. And this was to estimate the frequency and intensity. And grade zero was none or a single episode with mild intensity. Grade 2 was intermittent or chronic episodes with mild intensity. Grade 2, did I say Grade 2 there? Grade 1 was intermittent or chronic episodes with mild Intensity. Grade 2 was single episode of moderate to severe intensity. And grade three was intermittent or chronic episodes with moderate to severe intensity. So this was how they graded things to really stratify and better understand, okay, what's going on with this patient population? What are the correlations and how are these things playing out? So the analysis showed that people in the at risk category of depression were more likely than the people in the normal depression category to be classified as having low back pain. Probably no surprises. There are significant associations were observed for the at risk depression category in grades two and three low back pain, whereas individuals in the at risk depression category were 2 times, a little bit over, 2 times more likely to be classified with grade 2 and 1.8 times more likely to be classified with Grade 3 low back pain than those in the normal depression category. So there's no question there was a correlation here. There was an association between a depressive category, an at risk category, and the frequency and intensity of low back pain, which is important because we've seen this in adult populations time and time again. But this is one of the first times it's really been explored in a younger population that emerging adulthood. So they said their findings demonstrate that both depression and somatization are positively associated with low back pain, with both independently and co occurring, and that the results of this study support the evidence that low back pain is quite prevalent in an emerging adult population, with over half the participants reporting current or past low and back pain across all the grades. Subjects in this study were most commonly reported experiencing back pain in the lowest grade category. That's good. Nearly 25% recording intermittent or chronic episodes of mild intensity and about 21% intermittent or chronic with moderate to severe intensity. And thankfully only 5% a single episode of moderate to severe intensity. So I look at that and there's a couple key takeaways. One is that intermittent or chronic in mild or moderate accounted for almost 50% of the people. So I know we think of that, you know, 40 years old to 60, 45 to 65 as the hotbed of disc and low back pain issues, but it's creeping downward in age. You probably see that in your practice. But this study reinforces that idea. And we've seen time and time again throughout the research that low back pain and depression are associated and they can be cyclical as well. And it's been suggested that people experiencing depression are 60% more likely to develop back pain in their lifetime versus non depressed people. That's big. When you think about low back pain being number one cause of disability worldwide, costing how many billions or trillions of dollars in care? And we see that mental health is playing a huge role in, I wouldn't say cause. I don't know if it's cause or correlation. I think these two things play together, but these are big deals. And when you combine depressive features, depressive moods, depressive mental states with low back pain, this is a challenging equation. And it's something all of us as providers need to be aware of. Because how we speak to a patient, how we empower that patient, how we're going through our report of findings day in and day out table talk. How are we communicating with these individuals? Are we showing empathy? Are we staying positive? Are we laying that foundation of improvement is so, so, so important because we also know that the presence of depression has been shown to have a negative effect on recovery. So not only is makes it more likely that low back pain comes about, but it makes it harder to get away. And that's a big deal. And we know it's cyclical because persistent low back pain non ironically increases the likelihood of depressive symptoms. Your quality of life goes down. You're unable to really do those things you love with the people you love. A big life effect, right? We talked about it on this podcast quite a few times. People don't come in due to pain. They come in because the life effect, they come in because the pain has gotten bad enough that it's prevented them from doing something they love. And you know this because we asked the question how long? Oh, okay. You know Jonathan, great to meet you. You're going through your report. Excuse me, your present history, history of present illness. And how long have you been dealing with this? Three months, three years, 30 years. Right. People deal with stuff forever. It's just when it gets to the point where they're unable to do the things that they love that they begin to take action. And understanding these psychological factors, I guess embedding that understanding into your care is so, so important. Why we've seen previous Studies, there's pain, catastrophizing, there's fear, avoidance, behavior, that heightened somatic awareness. These are all challenges that can really ramp up that pain and disability. And they are a big, big deal. And I can't overstate that on this podcast. Not all of us, many of us, are never going to be psychiatrists, psychologists, but I think we all can appreciate the fact that being mindful of these factors during care and treatment is so important. The tone that you utilize, the space that you create, even visually in your practice, can play a role. And, you know, we shouldn't take any of this lightly. I know a lot of times, you know, it's like low back pain. Low back pain. All right, we know, we know, we know about low back pain. It seems almost boring. But I want to caution you against glazing over it because this is something that affects tens of millions of people. And quite frankly, if chiropractors, you know, doubled their market share in terms of how people with low back pain that were taken care of, there wouldn't be a chiropractor out there that would want for new patients. That doesn't mean that would be all you have to do. But what I'm saying is that this is such a epidemic that there are hundreds of millions of people worldwide, billions worldwide, technically, dealing with this day in and day out. And the more tools you can have in your tool belt to help people get the results they desire, the more that you help them, the more that they'll help you, the more referrals you'll get in, the better relationships you'll build and develop with other healthcare providers in your community, and the better you'll be able to guide people on their unique journeys of health. So important to keep in mind that not only is depression and low back pain associated in adults, but it's also associated in younger individuals. And, and here's where I'm going to put this kind of into action for you. We've all had people come in, teenagers, quote, unquote, come in that have, you know, kind of undefined back pain. And, you know, it's. You look at their posture and their posture stinks. It difficult to get them to talk and tell you anything. You know, sometimes this might be your own child, but there's no question that we've seen this in practice all of the time. So being empathetic to the fact that there might be other things going on in their life is really, really important. And helping guide that process, being that beacon of positive health, encouraging, also tying back to the beginning of this encouraging healthy behaviors. When we think about individuals in this transitional emerging adulthood phase of 18 to 26, again, habits are pretty malleable. So emphasizing and showcasing the importance of movement, segmental movement, regional movement, whole body movement, exercise, highlighting the fact that their body is resilient and can get, well, you know, talking about, you know, diet, nutrition, you don't need to overwhelm somebody with all of this in a single visit, but highlighting it, they might not be hearing it anywhere else. And you know, sometimes as chiropractors we kind of live in our bubble where it's like, well, most people probably think the way we think and it's just not true. Many people have no idea how their body works. They have absolutely no idea how to navigate the healthcare system and they clearly have no idea about the proactive steps they can take to improve their resilience, to improve their overall function, to improve their overall quality of life. Many people, most people, an overwhelming majority of people are totally flying blind in relation to these super important things that really define not to be too hoity toity here, but really define our human experience. So the more that you can be an understanding ear, the more that you can have positive encouragement, the more that you can showcase those positive steps in meaningful bite sized ways. By meeting your patients where they're at, helping them gain those small improvements, taking them the next step, your practice is going to be so much better for it. The people's lives that you touch are going to be so much more greatly improved and you're just going to be being the best doctor slash teacher you can possibly be. And I don't think there's anything better that we can be than that. Final component of this that I'll talk about is relative to referral relationships with other healthcare providers and just the medical model, quite frankly, I, you know, when, when a doc goes in, a pain management doc's in with somebody for 90 seconds, they're not getting this information. And a primary care doctor in and out in 90 seconds for that history, they're not gaining. And this is not every primary care doctor, not every pain management doctor. But by and large we know the story here, they're not getting this information. And when somebody's going down the route of medication, advanced imaging, potentially surgical intervention, and there's really at the heart of this, this is about a mental state just as much as it's about the musculoskeletal issue. That person is really being set up for failure long term. So you know, getting out there bridging the gap, building those relationship and being sensitive to this is going to help you stand out as a provider. And the longer you do it, the more you're going to stand out. So get out there, keep up, you know, keep up the fantastic work. And before we close today, I'll say a few words about Chiro Matchmakers. If you are looking to build, grow or expand your team with a chiropractic assistant or an associate doctor, please head over to chiromatchmakers.com we have helped hundreds docs place hundreds of chiropractic associates and thousands of chiropractic assistants. This is not just about finding any anybody to be in your practice. We all know that those relationships go south sooner rather than later. This is about using behavioral assessments. This is about matching people based upon their behavior, their goals and your practice culture to ensure a fantastic fit long term. Now if you're on the other side of that equation and you are somebody out there looking for your next opportunity, we have over a hundred open positions right now, most paying $85,000 base salary and above. You can check us out@cairomatchmakers.com docs. I hope you have a fantastic week in practice and I will talk to you soon.

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