"It's not just the pain that's getting me down. I don't feel like myself any more. I can't do the things I'd normally do - I feel so helpless; I feel like I'm a burden on everyone around me."
"I'm scared that it's not going to get better, and I'll be stuck like this. What if it stays this bad forever?"
"It feels like I'm going crazy. I don't know whether it's the medication I'm taking or something else. The other day I just couldn't stop crying. This isn't like me."
"My doctor blames everything on my depression. He won't take my back pain seriously - he says it's all in my head."
Being in pain can be tough - sometimes really tough. When I talk to my patients about how they're coping, I often hear things like this. I try to reassure them that no, they're not going crazy, that it's common for people to feel like this, and that even though things are bad right now, it will get better (in the vast majority of cases). Most of all, though, I take the time to listen.
For many people, the pain isn't even the worst bit; it's what the pain stops them from doing - whether that's their job, exercising and getting outdoors, taking care of their family, socialising with friends or simply getting a good night's sleep.
Mental health and physical health are inseparable. Studies have shown a link between back pain and mental health conditions, It seems likely that this link works in both directions: stress and anxiety may increase a person's risk of suffering from back pain, for example; whereas chronic pain conditions can trigger sleep disturbances and depression.
Patients sometimes worry that if they mention being depressed, their physical symptoms may be dismissed as being "all in their head". It's important for us to be clear that the association between mental and physical health is more complicated than that, and that physical pain should always be taken seriously.
For some patients, just being able to talk about how they're feeling can be a relief. Others may need more help. We sometimes suggest that patients talk to their doctor (if they prefer, we can write a letter to their GP), or recommend a psychologist who can help with specific issues that they're facing. There are also a number of organisations that offer support and advice to people who are struggling with mental health difficulties, including http://mind.org.uk.
If you need urgent help, then Mind's website also has details of where to go for support during a mental health crisis.
The important thing is to remember that you're not alone and that help is available.