Chronic Pain and Mental Health Often Interconnected
Chronic pain and mental health disorders often occur together. In fact, research suggests that chronic pain and mental health problems can contribute to and exacerbate the other.
People living with chronic pain are at heightened risk for mental health problems, including depression, anxiety, and substance use disorders. Chronic pain can affect sleep, increase stress levels and contribute to depression. An estimated 35% to 45% of people with chronic pain experience depression.1 Pain can also be a common symptom among people with an anxiety disorder, particularly generalized anxiety disorder, according to the Anxiety and Depression Association of America (ADAA). Anxiety, depression, and other mood disorders commonly occur at the same time as chronic pain from conditions like fibromyalgia, back problems, migraines and arthritis.
Research using functional imaging suggests that mental health disorders and chronic pain share biological mechanisms, which contributes to the interconnection.2 One example of the interconnection is that depression can make a person more sensitive to pain.
In a new report, Mental Health America used data from its online mental health screening program to analyze the intersection between mental health and chronic pain. Between 2015 and 2019, more than 160,000 individuals who used the Mental Health America screening program self-identified as living with arthritis or other chronic pain. People who reported having arthritis or chronic pain were more likely to have several mental health conditions, including severe anxiety, severe depression, bipolar and PTSD. For example, among people taking the screening for depression, 47% of those with chronic pain screened positive for severe depression compared to 36% of those without chronic pain.
The study found that older people more frequently reported chronic pain—about 60% of those age 65 and over reported they had chronic pain compared to 26% of those age 18 to 24. Among the population groups examined in the study, veterans and active duty military members and caregivers were more likely than others to have chronic pain.
Based on its analysis, Mental Health America provided a series of recommendations for improving care of these commonly co-occurring conditions. Among the recommendations:
- Primary care physicians should proactively initiate conversations about mental health and chronic pain with patients rather than waiting for patients to report symptoms.
- Care should be patient-centered and include the use of shared decision-making tools. The needs, goals and preferences of each individual patient must be recognized and included in the treatment plan.
- Bringing together peer support specialists, community health workers, and others into care teams could create more effective pain management.
When chronic pain and mental health disorders occur together, it is important to treat both conditions, according to mental health experts. Some treatments and approaches may help both mental health and pain conditions, including psychotherapy and relaxation techniques. Medications, including some antidepressants and some anticonvulsants, can be useful in treating both conditions. Lifestyle changes, such as exercise, good nutrition and sufficient sleep, can also be helpful for both managing pain and improving mental health symptoms.
- Vadivelu, Nalini, et al. (2017). Pain and Psychology-A Reciprocal Relationship. The Ochsner Journal, 17(2): 173-180.
- Hooten, WM. Chronic Pain and Mental Health Disorders; Shared Neural Mechanisms, Epidemiology, and Treatment. Mayo Clin Proc. 2016 Jul;91(7):955-70.
- Mental Health America. Early, Equitable and Trauma Responsive Care for Chronic Pain and Mental Health 2020.
- Harvard Health Publishing. The Pain-Anxiety-Depression Connection.