Tackling the Complex Connection Between Musculoskeletal Pain & Mental Health

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February 23, 2023
The MSK pain and mental health connection

Chronic pain and depression are the silent killers of productivity in the workplace.

Clinical studies have long demonstrated a strong association between chronic musculoskeletal (MSK) pain and depression. Patients who suffer from chronic pain are more likely to be depressed, and patients with depression are more likely to report symptoms of chronic pain. It’s a vicious cycle that helps explain why MSK pain and mental health are consistently top concerns for employers—and among their biggest sources of medical spend.

Affecting as many as 1 in 2 adult Americans, MSK conditions are one of the top two drivers of healthcare costs for large employers, according to the Business Group on Health’s survey of benefit leaders. Meanwhile, nearly 1 in 10 adults and almost 1 in 5 adolescents and young adults will experience a major depressive episode in any given year, studies show. Depression also leads to a staggering 200 million lost workdays each year, costing employers up to $44 billion annually, according to figures cited by the CDC.

How these extremely prevalent and debilitating conditions intertwine and feed off each other has been the subject of a growing body of medical literature. Here’s what we know:

  • The majority of people who struggle with depression also have chronic pain, and a close majority of people with chronic pain will experience depression—65% and 50%, respectively. This means that more often than not, a patient with one condition will also exhibit symptoms of the other.

  • Depression interacts with chronic pain to increase the prevalence of pain symptoms in people with depression—and vice versa. For instance, studies have shown that patients with multiple pain symptoms such as back pain, headache, and abdominal pain are 3 to 5 times more likely to be depressed than patients without pain.

Beyond the fact that MSK disorders or depression on their own will lead to greater medical costs, increased worker absenteeism, and lower productivity, the combination of the two is especially concerning to employers for two reasons:

  • The first is that pain and depression complicate and hinder the recovery process for patients because they appear to each increase the severity of the other condition. Pain slows recovery from depression, and depression makes pain more difficult to treat. For instance, the onset of major depression may cause patients to drop out of pain rehabilitation programs.

This means employees with MSK pain will take longer to recover if they exhibit comorbid depression, and thus it behooves companies to choose solutions that are able to effectively take a “whole-body” approach to MSK treatment. Sword is a perfect example of a company that treats both the pain and the comorbid depression.

  • The second point is closely related to the fact that MSK patients with accompanying depression are often more difficult to treat. People suffering from chronic pain who also exhibit depressive symptoms become very heavy consumers of medical services, even if they don’t report other underlying conditions or illnesses.

In fact, medical costs for people with chronic pain who are also depressed are significantly higher for patients with either condition alone. A 2009 study found that for patients with both major depressive disorder and disabling chronic pain total annual costs were more than 37% higher than for patients with major depressive disorder and no chronic pain.

Fortunately, a digital health solution like Sword Health can tackle both MSK pain and mental health, driving down medical spend while improving health outcomes. In a peer-reviewed study published last year in the Journal of Medical Internet Research, researchers at Sword showed that our multimodal digital care programs can produce substantial improvements in both mental health (anxiety and depression scores) and productivity—even in members with significant depression at baseline.

The clinical study included 7,785 participants who were divided into three groups: patients showing mild or no depression (group 1), mild depression (group 2), and moderate depression (group 3). Significant improvements in depression and anxiety scores were observed in groups 2 and 3—respectively 51% and 29% improvement in depression scores; 41% and 21% improvement in anxiety scores.

All three groups reported significant reductions in productivity impairment, amounting to an average decline of 48%:

  • 38% in group 1
  • 62% in group 2
  • 44% in group 3

Across all of our programs and sessions, Sword members see an average 62% reduction in pain levels, and a 52% decline in both depression and anxiety. Members also see other health improvements such as better sleep, lower weight, and increased physical activity—all of which contribute to their mental and emotional wellbeing (which, in turn, makes it easier for them to achieve lasting pain relief.) It’s a virtuous cycle.

At Sword, we know that many people suffer silently with pain, even as it affects so many areas of their life. By combining convenient, on-demand physical therapy treatment with ongoing education and cognitive behavioral health therapy, Sword enables members to overcome both their physical and mental challenges to improve their quality of life at home and their productivity at work.

Request a demo to see how Sword can help your people become pain free, improve their sleep and mental health, and increase workplace productivity—all with best-in-class ROI and clinical outcomes.


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