Depression and Anxiety Affect 40% of Chronic Pain Patients
/By Pat Anson
About 40% of adults with chronic pain have clinical symptoms of depression or anxiety, according to a large new study that calls for the routine screening of pain patients for mental health issues.
Researchers conducted a systematic review and meta-analysis of 376 studies involving nearly 350,000 people with chronic pain around the world. Their findings, published in JAMA Network Open, show that pain patients with fibromyalgia had the highest rates of depression and anxiety, along with those who are younger and female.
“To address this significant public health concern, it is essential to routinely screen for mental health symptoms in clinical settings where people with chronic pain are treated,” wrote lead author Rachel Aaron, PhD, a clinical psychologist at Johns Hopkins University School of Medicine
Aaron and her colleagues found that people with fibromyalgia, complex regional pain syndrome (CPRS) and other types of nociplastic pain -- persistent nerve pain that occurs without tissue damage – were most likely to have depression and anxiety; while those with arthritis, post-surgical pain and other conditions with documented tissue damage were less likely to have mental health issues.
Chronic Pain Condition Depression Anxiety
Fibromyalgia 54% 55.5%
CPRS 47.4% n/a
TMJ 39.2% 32.4%
Neuropathy 37.5% 33.8%
Pelvic Pain 36.3% 51.8%
Low Back Pain 33.3% 32.1%
Back Pain 33.3% n/a
Musculoskeletal Pain 29.2% n/a
Osteoarthritis 29.1% 17.5%
Spondyloarthritis 29% n/a
Rheumatoid Arthritis 27.2% 26.3%
Post-surgical Pain 22.5% n/a
Many patients resent the idea that their pain is “all in their head,” but researchers think emotional stress and trauma may play a causal role in the development of chronic pain.
“The overall pattern of findings aligns with evidence that psychological distress and adverse life experiences increase the risk for chronic nociplastic pain,” researchers said. “The present findings underscore the need for innovative treatment development to address these prevalent comorbidities, particularly for nociplastic pain.
“For physicians treating individuals with chronic pain in primary care and specialty practice, systematic screening of depression and anxiety is critical, as is having a network of mental health referral sources when a positive screening result is detected. Short-term, cost-effective, and remotely delivered psychological treatments for chronic pain are becoming increasingly available and can be recommended to individuals with chronic pain.”
Previous studies have also found an association between chronic pain, anxiety and depression.
Researchers at McGill University found that people who experienced physical, sexual or emotional abuse as children were 45% more likely to report chronic pain in adulthood. Childhood trauma has also been linked to an increased risk of fibromyalgia, migraine and lupus, as well as mood and sleep problems.
A 2023 study estimates that 12 million adults with chronic pain in the U.S. have anxiety or depression so severe that it limits their ability to work, socialize and complete daily tasks. That study also recommends that pain patients be routinely evaluated for anxiety and depression.
