Although patients and healthcare professionals tend to focus on the location of the injury, what the patient experiences mentally often determines their perception of pain and how well they cope.

Functional MRI scan studies show that chronic low back pain can actually rewire neural circuitry in the brain.

Depression is known to increase the risk for chronic pain. Likewise, chronic pain tends to make depression and other psychiatric disorders more persistent.

Older people in particular tend to experience depression as physical symptoms, including fatigue, insomnia, and chronic pain.

Depression syndromes that display minimal feelings of sadness are often termed "masked depression."

And acute low back pain can be particularly stressful. A recent analysis of more than 10,000 medical records showed higher levels of depression in people suffering acute back pain.

A meta-analysis of systematic studies also found that symptoms of depression predicted worse low back pain outcomes.

Another review of studies indicated depression symptoms increase the risk for a future episode of low back pain — and the more severe the depression, the higher the risk of a future pain episode.

Chronic back pain victims experience a variety of negative emotions. They may sense a loss of control. Others believe their condition indicates a sign of weakness. Many feel helpless because they must turn to others for assistance.

Because many patients are unable to get relief from their symptoms, they may feel anger and resentment toward the healthcare professionals that failed to cure them. Their discouragement can lead them to pursue unproven treatments that may cause harm and prolong their pain.

Chronic pain can also lead to anxiety. Low back pain is the most common cause of missed work; as a result, many patients feel stress about future finances.

Anxiety may also stem from misunderstandings about the underlying cause of pain. Patients may feel panic or dread when a doctor diagnoses them with a ruptured disc or nerve damage.

Erroneous beliefs about the meaning and severity of these terms may lead to fear of future physical disabilities.

Chronic pain not only increases risk of depression, it can also impair memory and thinking. For a study published in the American Journal of Internal Medicine, Dr. Elizabeth Whitlock and her associates at the University of California, San Francisco, interviewed more than 10,000 people ages 62 and older over the course of a decade.

The researchers found that those who complained of chronic pain at baseline and after a decade went on to experience 9 percent more rapid memory decline than those with no pain issues.

Although the study didn’t prove cause and effect, the results suggest that chronic pain diverts attention from other mental tasks, leading to poor memory.