Why Treating Chronic Pain Means Treating Mental Health

Chronic pain affects one in five adults in the United States. Defined as pain that lasts longer than three months, chronic pain can disrupt a person’s life, making everyday tasks exhausting, work unpredictable, and relationships challenging to maintain. It upends routines, sleep, and movement. And, for many people, both physical and mental health are disrupted.  

Mental health and chronic pain are deeply intertwined. When these conditions occur at the same time, they often reinforce one another. Depression and anxiety can be a response to pain. They are also strong predictors of who develops chronic pain in the first place and how severe it becomes. But current pain management approaches don’t generally take that into account. Estimates of how chronic pain, depression, and anxiety co-occur vary widely, but understanding the overlap is crucial for designing effective treatment and support.

A new study offers clarity. Rachel Aaron and colleagues conducted a meta-analysis of 376 studies of chronic pain and its association with depression and anxiety, published between 2013 and 2023. Together, these studies included nearly 350,000 people with chronic pain across 50 countries, along with comparison groups made up of people with other medical conditions and the general population.

The meta-analysis found that about 40% of adults living with chronic pain had clinically significant depression and anxiety, compared to about 15% of people without chronic pain. Depression and anxiety were highest among younger adults and women. These groups are also more likely to have their pain underestimated or attributed to psychological causes, and are less likely to be referred to pain specialists or receive adequate pain treatment, even when reporting similar symptoms. And this is especially true for people of color.

These problems persist together, in part, because experiencing depression or anxiety can make it more difficult for people with chronic pain to access care.

The authors also noted that depression and anxiety were particularly high among people with pain conditions that originate in the central nervous system without any physical injury or tissue damage, such as complex regional pain syndrome, fibromyalgia, and temporomandibular disorder. This type of pain, which is often stigmatized, develops when pain signals from the body become amplified and distorted in the brain, increasing pain sensitivity.

These problems persist together, in part, because experiencing depression or anxiety can make it more difficult for people with chronic pain to access care. Mental health diagnoses can lead clinicians to downplay physical symptoms, which can discourage patients from seeking treatment for either the pain or the mental health symptoms, particularly if they have been repeatedly dismissed.

Furthermore, very few treatment options are available specifically for people experiencing chronic pain and depression or anxiety.  Evidence shows that psychological treatments improve physical symptoms, but they don’t necessarily improve mental ones. Thirty-seven percent of U.S. adults with chronic pain experienced depression and anxiety even after receiving mental health treatment, more than twice the proportion of those without chronic pain. These patients need new, targeted treatments.

Chronic pain cannot be treated effectively if mental health is treated as a separate issue.

Ideally, mental health screening should be routine in pain care, and pain treatment should be integrated with mental health services. This approach already exists in some settings. Interdisciplinary pain clinics are staffed by physicians, psychologists, and physical therapists, and are designed to address both physical pain and the mental health symptoms that often accompany it. Such clinics can reduce disability and depression, while improving long-term function and quality of life. The Department of Veterans Affairs, for example, has Interdisciplinary Pain Management Centers across the country that use this approach and consistently see positive results.

However, this model is not widely available because health care delivery is siloed into specialties, which delegate pain treatment and mental health care to different clinicians who are unlikely to be working together.

The authors argue that chronic pain cannot be treated effectively if mental health is treated as a separate issue. Meaningful progress will require coordinated, interdisciplinary approaches that treat physical and emotional pain together, reduce dismissal of patients with mental health conditions, and expand care models designed specifically for people living with both chronic pain and depression or anxiety.