People with chronic pain have high rates of depression and anxiety

Chronic pain plagues millions of individuals across the globe, but its influence extends beyond the physical symptoms. A recent review of over 375 published studies has uncovered a remarkably strong link between chronic pain and mental illness.

The researchers found that 40% of adults living with chronic pain have clinically significant depression and anxiety – a result that is of particular concern considering the absence of comprehensive treatment for both conditions.

The study, led by researchers at Johns Hopkins Medicine, emphasizes the need for regular screening for depression and anxiety in individuals with persistent pain conditions.

The research showed that women, younger adults, and individuals with fibromyalgia were most at risk of suffering mental illness associated with chronic pain.

Chronic pain and mental health

For many years, studies have shown that chronic pain and mental health disorders often occur together. But according to this new research, the link is actually stronger than it was initially believed to be.

The results reinforce the need for mental health treatment to become a routine aspect of managing chronic pain, which is defined as pain that lasts more than three months. Ongoing pain can be disabling, often impacting an individual’s capacity to work, sleep, and participate in daily activities.

According to the Centers for Disease Control and Prevention (CDC), approximately 51.6 million U.S. adults – about 21% of the population – suffered from chronic pain in 2021. Among these individuals, between 20% and 40% also experience depression and anxiety.

Dr. Rachel Aaron, the first author of the study, is an assistant professor of physical medicine and rehabilitation at the Johns Hopkins University School of Medicine.

“Right now, we have effective psychological treatments for depression and anxiety, and effective psychological treatments for chronic pain, but these treatments are often siloed,” explained Dr. Aaron.

“In fact, many studies exclude people with chronic pain who have depression or anxiety from clinical trials. We need integrated treatments that address chronic pain and mental health together.”

Comprehensive analysis of global data

In an attempt to assess the magnitude of the problem, the researchers examined data from 376 studies that were carried out between 2013 and 2023. These studies involved 347,468 adult patients from 50 nations, with a mean participant age of 52.

The aim was to provide an estimate of how prevalent depression and anxiety are among individuals who suffer from chronic pain, and to compare their frequencies to those who live without persistent pain conditions.

The study incorporated clinical symptoms from medical histories, diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and many demographic variables such as age, gender, location, and pain duration.

Depression, anxiety, and chronic pain

Among the seven key symptoms of depression and anxiety disorders, the researchers found that patients with chronic pain exhibited the highest rates in clinical depression (39%) and clinical anxiety (40%).

Major depressive disorder was present in 37% of individuals, while 6% experienced persistent depressive disorder.

Generalized anxiety disorder affected 17% of individuals, while 8% had panic disorder. Social anxiety disorder was less common, with a rate of two percent.

The findings suggest that the psychological distress experienced by the patients is more than just a reaction to discomfort.

The data supports the theory that adverse life experiences and emotional distress can increase the risk of chronic nociplastic pain – a condition linked to changes in the way the brain and spinal cord process pain signals.

The need for better screening

Despite the strong link between chronic pain and mental health, screening for depression and anxiety is not a routine part of chronic pain treatment.

Many chronic pain patients with depression or anxiety struggle to find specialized care, and some are even excluded from clinical trials designed to test new pain treatments. The lack of access to integrated care leaves them in a cycle of untreated symptoms.

“People who have chronic pain are more likely than those who don’t to have depression and anxiety. This is a significant public health problem that should be addressed with routine screening of depression and anxiety in clinical settings, and the development of novel treatments that target their comorbidity,” noted Dr. Aaron.

“At the same time, this is also a story of resilience. Most people with chronic pain do not have depression or anxiety. These results challenge the ableist narrative that chronic pain is inherently depressing, and remind us that people with chronic pain can and do lead psychologically healthy, fulfilling lives.”

Rethinking pain management

The study’s findings highlight the need for a shift in how we treat chronic pain and mental health. Instead of being treated as separate issues, medical professionals should develop new strategies that address both simultaneously.

This could include integrated therapy programs, improved screening in clinical settings, and broader inclusion criteria in research trials.

Recognizing the link between chronic pain and mental illness is the first step toward real change – one that could improve the lives of those living with persistent pain and the mental health challenges that often accompany it.

The full study was published in the journal JAMA Network Open.

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