By: Hinge Health
Depression and chronic musculoskeletal (MSK) pain are deeply connected and together they create a cycle that has profound impacts on the daily lives of employees.
"I've battled with depression. It's a vicious cycle of pain and stiffness and isolation." - Lenell H., chronic knee pain
Lenell, a 45-year-old County Clerk in Florida, frequently practiced Tae Kwon Do with her 2 kids, living by the mantra that a family that kicks together, sticks together. Then she injured her knee and developed chronic knee pain that made it difficult for her to stand for even 5 minutes without pain. Unable to socialize with friends and family without pain, she began to feel alone, hopeless, and desperate to resolve her pain.
Lenell's case isn't unique. One in two Americans suffer from musculoskeletal (MSK) pain and over 16 million adults in the United States have at least one major depressive episode in a given year. These two conditions account for two of the top five reasons for absenteeism. Given the high comorbidity of depression and MSK pain, employers are increasingly looking to holistic interventions to break the cycle of member's physical and emotional pain.
The Vicious Cycle of Pain and Depression
Chronic pain and depression share neural pathways and affect the same regions of the brain. This creates a feedback loop known as the depression-pain dyad, where depression increases the severity and intensity of pain, and chronic MSK pain increases the risk for depression. Of people who live with depression, 65% also have chronic pain² and of people who have chronic pain, 27% will experience depression.¹
When someone is depressed, both the perception of pain and the emotional ability to manage the pain is disrupted. Pain also blunts the effects of anti-depression medication. 95% of patients who have depression that does not improve after 12 months of treatment have an underlying chronic pain condition. Essentially, difficult to treat depression is a chronic pain problem.
Pain and Depression Negatively Impact the Workplace
Chronic MSK pain and depression are the top reasons that employees take time off. Employees that continue working at a reduced ability are also at greater risk for job errors and work injuries, indirectly cost their employer 3 times more than those who call in sick.³
Healthcare costs for an average employee who seeks treatment for major depressive disorder exceed $2,000 per year⁴, while treatment for chronic pain can add $2,300⁵. The average short-term disability claim for chronic back pain costs employers about $10,000 in benefits and wage replacement, and long-term disability increases that to about $35,000.⁶
Holistically Treating Pain and Depression in Your Workforce
Health and benefit executives at leading employers recognize that comprehensive, holistic interventions are needed to achieve better clinical outcomes for the co-morbid conditions of chronic MSK pain and depression. A comprehensive approach is supported by multiple research publications. Global Spine Journal states, "cognitive behavioral therapy has been shown to be just as effective as surgery for chronic low back pain".⁷ Research from the Archives of General Psychiatry reported, "improved lower back pain at 7 weeks and 2 years were associated with significantly fewer depressive symptoms."⁸
Case Study: Reducing Pain and Depression Without Surgery or Drugs
For Lenell's employer, Manatee County Government, MSK was a top 3 medical cost driver. Medications for depression and anxiety were also in their top 10 areas of spend. Given that public sector employees tend to have long tenures, it was critical to address both chronic pain and mental health. While reducing medical spending was a priority for Manatee County, long-term employee engagement and well-being were essential.
Human Resources Director, Kim Stroud, has a background in mental health and was aware of the link between mental health and chronic MSK pain. Her team implemented an MSK care program with a holistic approach to pain care, including mental health screening, cognitive behavioral therapy, and 1-on-1 health coaches trained in motivational interviewing, behavioral change, and the Patient Activation Model.
Through a benefits program that addressed both chronic pain and behavioral health, her workforce was able to break the cycle of pain and depression. Clinical outcomes for Manatee County Government included: 73% reduction in pain (over 4X better than the average opioid pain reduction of 15%)⁹ which led to 2 out of 3 surgeries avoided, 78% reduction in anxiety, 30% reduction in depression, and 44% reduction in lost workdays. Lenell participated in the program and not only is she now pain-free, she escaped the cycle of isolation and depression that pain brought with it.
"Being able to walk without pain has given me back my freedom and happiness." - Lenell H.
By understanding the connection between mental health and chronic pain benefits leaders can help reduce employee pain, improve workplace productivity, and lower medical spend. Employers looking to address mental health and chronic MSK pain should prioritize solutions that take a comprehensive approach to treat the whole person.
Resources
¹Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and Pain Comorbidity; A Literature Review. Arch Intern Med. 2003;163(20): 2433–2445. doi:10.1001/archinte.163.20.2433.B
²Katon W, Schulberg H. Epidemiology of depression in primary care. Gen Hosp Psychiatry. 1992;14(4):237-247.
³Stewart WF et al.; Lost Productive Time and Cost Due to Common Pain Conditions in the US Workforce. JAMA. 2003; 290(18): 2443–2454.
⁴Greenberg, PE et al.; The Economic Burden of Adults With Major Depressive Disorder in the United States (2005 and 2010). J Clin Psychiatry 2015;76(2):155–162.
⁵Integrated Benefits Institute. Health and Productivity Impact of Chronic Conditions: Back Pain. San Francisco, CA. 2017.
⁶Veronese N, Stubbs B, et al; association between lower limb osteoarthritis and incidence of depressive symptoms: data from the osteoarthritis initiative. Age Ageing 2017; 46 (3): 470–476.
⁷Hanscom DA, Brox JI, Bunnage R; Defining the Role of Cognitive Behavioral Therapy in Treating Chronic Low Back Pain: An Overview. Global Spine J. 2015 Dec; 5(6): 496–504.
⁸Von Korff M, Ormel J, Katon W, Lin EHB. Disability and Depression Among High utilizers of Health Care. A Longitudinal Analysis. Arch Gen Psychiatry. 1992 Feb;49(2):91–100.
⁹Expert Rev Neurother. 2013;13(11):1201-1220
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