40% of adults with chronic pain could have anxiety, depression: Study

New Delhi: About 40 per cent of adults experiencing chronic, persistent pain could also have anxiety or depression, a review has found.

Women, young adults and those with conditions such as fibromyalgia are most likely to have anxiety and depression, it observed.

Fibromyalgia is a condition marked by widespread body ache and tenderness, despite no physical injury such as tissue damage.

For the review published in the Journal of the American Medical Association (JAMA) Network Open, the researchers analysed 376 studies, involving nearly 3.5 lakh people from across 50 countries. The participants were aged about 50 years on average, and about 70 per cent were women.

The most commonly reported chronic pain conditions in the study included fibromyalgia, low back pain and rheumatoid arthritis (inflammation of joints). Pain is said to be chronic if it persists beyond a maximum of three months.

"In this systematic review and meta-analysis of depression and anxiety among individuals with chronic pain, approximately 40 per cent of adults had clinically significant depression and anxiety," the authors wrote.

Therefore, a mental health screening of patients with chronic pain is critical, they said.

While acute pain can be caused by an injury or surgery, its transition to chronic pain has psychological undertones, according to the biopsychosocial model of pain.

Developed in the 1970s, the model suggests that one's experience of pain in response to an external trigger is a complex interplay of biological, psychological, social and cultural factors.

Women are considered especially vulnerable to chronic pain, owing to varied factors, including hormonal cycles and heightened emotional responses.

Further, "women, younger people, and people with nociplastic pain (arising from changes in how one perceives pain) were most likely to have depression and anxiety," the authors wrote.

According to a 2023 round-up article on pain research in The Lancet journal, the biopsychosocial risk factors of poor sleep, despondency, tiredness, stress and a Body Mass Index of over 30 were the most important reasons for localised pain progressing into chronic pain.

While treatments commonly involve anti-inflammatory drugs and prescription medicines, such as antidepressants and opioids, experts strongly recommend psychotherapy sessions as well.

"Treatments for the most common types of chronic pain (Examples: fibromyalgia, chronic low back pain) have limited impact on pain intensity, meaning many people will live with their pain long-term," said Dr Bronwyn Thompson, senior lecturer, department of orthopaedic surgery and musculoskeletal medicine, University of Otago, New Zealand. He was not involved in the study.

Dr Debbie Bean, a health psychologist and senior lecturer, Auckland University of Technology, New Zealand, said living with chronic pain can affect many aspects of one's life, including work and social relationships.

"People with chronic pain can also experience stigma, where others don't take their pain seriously, or they may even feel disbelieved or judged for their pain. So, it is not just the pain itself but the effects it has on a person's life that mean that chronic pain can lead to both anxiety and depression," said Dr Bean, who was not involved in the review.

Further, given that depression and anxiety can influence how body's nervous system responds to painful experiences, the two problems — chronic pain and poor mental health — can become a vicious cycle, Dr Bean said.