While musculoskeletal conditions that affect the body are often thought of in terms of pain and disability, it’s not uncommon for psychological factors to be present, which can complicate matters and prolong the patient’s suffering. For example, in a 2019 study that included 252 patients with chronic low back pain, researchers observed that those with psychological factors (mental distress) not only experienced more painful days over the course of the year, but also required more doctor visits.

In an effort to help doctors of chiropractic and other healthcare professionals determine when a referral to a mental health professional is advisable, experts have reviewed the relevant research involving musculoskeletal disorders with co-occurring psychological issues to uncover “yellow flags” that could prolong recovery. These factors can include:

• Fear-avoidance behavior— Unnecessarily restricting movement has been shown to prolong pain and disability.
• Catastrophizing — The tendency of a patient to describe their pain in more negative and exaggerated terms due to a poor understanding of their condition or disease.
• Poor coping skills — The patient seeks to ignore their pain, reinterpret their pain as something else, and divert attention away from their pain rather than engaging in proactive strategies to manage their pain and recovery.
• Mood disorders — Research has shown that depression, anxiety, and other mental health disorders increase the risk of chronicity.

To illustrate how this can play out, a 2022 study looked at the health histories of three spinal pain patients in the Veterans Affairs healthcare system with co-occurring mental health conditions (depression, anxiety, and/or suicide ideation). Following a referral for care that included cognitive behavioral therapy, mindfulness therapy, and/or psychiatric treatment, each patient experienced greater improvements with respect to both pain and function. The authors of the study also note that chiropractic offers an excellent frontline, guideline-recommended treatment approach, highlighting that patients are significantly less likely to receive a subsequent prescription for opioids and other serious medications that can lead to poor long-term outcomes.

If you are struggling with chronic musculoskeletal pain and it’s affecting your quality of life, don’t be afraid or embarrassed to share this information with your doctor of chiropractic as coordinated care with an allied healthcare professional may be necessary to provide the best possible treatment result in the shortest period of time with the least suffering in the interim.