Ravi thought he was coping well with his back pain. He had gotten used to having pain most days since he hurt his back in college while playing rugby. He figured some amount of pain would always be part of his life.
But over a couple of months, Ravi stopped going out with friends after work. He didn’t go on bike rides with his son the way he used to. He snapped at his wife in a way he never had before.
"I started feeling sad and angry a lot," Ravi recalls. "I didn’t want to do anything. My back was hurting more. I was having trouble focusing on my work. My life just started feeling smaller and smaller."
Ravi had slipped into depression.
Link between depression and back pain
"My wife begged me to see my doctor, because she saw all these changes in my personality," Ravi says. "When my doctor told me I was depressed, I saw it as a flaw in my character. And I didn't want to take any medicine. I thought it was something I could just power through, like I had powered through my back pain for the past 20 years."
Ravi's doctor convinced him to take antidepressants. "He told me it could take a month or more for the medicine to work. He suggested that in the meantime I see a counselor to talk about how I was feeling. I was even less excited about that than I was about the medicine," he says with a laugh.
But the counselor helped him see the link between his back pain and depression. "She said living with pain all the time can wear you down and make you depressed. And the depression can actually make your pain worse. That is true for me. The more down I get, the worse my back feels."
The counselor made a guided imagery recording that Ravi could use to help him relax when he felt upset or anxious. Ravi noticed that when he got upset, his muscles would tighten and increase his pain.