New research from the University of Arizona Health Sciences published in the journal PAIN found that nearly 1 in 20 adults in the US experience the coexistence of chronic pain and anxiety or depression, resulting in functional limitations in daily life.
Co-occurrence of chronic pain and anxiety/depression symptoms in US adults: Prevalence, functional impacts, and opportunities. Summary The coexistence of chronic pain and clinically significant symptoms of anxiety and/or depression is regularly observed in the literature. However, little is known empirically about the population prevalence of co-occurring symptoms, nor whether people with co-occurring symptoms constitute a distinct subpopulation within US adults living with chronic pain or US adults living with symptoms of anxiety and/or depression. (A/D). To address this gap, this study analyzes data from the 2019 National Health Interview Survey, a representative annual survey of self-reported health status and treatment use in the United States (n = 31,997). Approximately 12 million American adults, or 4.9% of the adult population, suffer from chronic pain and co-occurring A/D symptoms. Unremitted A/D symptoms coexisted in 23.9% of US adults with chronic pain, compared with an A/D prevalence of 4.9% among those without chronic pain. In contrast, chronic pain occurred simultaneously in the majority (55.6%) of US adults with non-remitting A/D symptoms, compared to a chronic pain prevalence of 17.1% among those without A/D symptoms. . The likelihood of experiencing functional limitations in daily life was higher among those who experienced concurrent symptoms, compared with those who experienced chronic pain alone or A/D symptoms alone. Among those with co-occurring symptoms, 69.4% reported that work was limited due to a health problem, 43.7% reported difficulty running errands alone, and 55.7% reported difficulty participating in social activities. These data point to the need for targeted investment to improve functional outcomes for the nearly 1 in 20 US adults living with co-occurring chronic pain and clinically significant A/D symptoms. |
Visualize the prevalence of chronic pain alone, anxiety and/or depression symptoms alone, and their coexistence. Data source: National Center for Health Statistics, National Health Interview Survey, 2019. A/D, anxiety/depression; CP, chronic pain.
Comments
Previous research has shown that chronic pain along with symptoms of anxiety or depression are biologically related . This study is one of the few to examine the national prevalence of chronic pain with symptoms of anxiety or depression in adults. The results shed light on the fact that millions of people may be experiencing symptoms that may limit their ability to work, complete daily tasks, and socialize.
"The study findings highlight an underappreciated health care and population need: the interdependence between mental health and chronic pain needs to be considered," said the paper’s lead author, Jennifer S. De La Rosa, PhD, director of strategy of the Comprehensive Pain and Addiction Unit of Health Sciences at the University of Arizona. Center, which funded the study. "This work is very exciting because it offers the opportunity to use interdisciplinary, team-based approaches to medicine, leveraging what is known across disciplines to meet the needs of these individuals."
The study, "Co-occurrence of chronic pain and anxiety/depression symptoms in US adults: Prevalence, functional impacts, and opportunities," found that approximately 12 million people, or 4.9% of the US adult population, have concurrent chronic pain conditions and symptoms of anxiety or depression.
The research team analyzed data from 31,997 people who participated in the National Health Interview Survey, which has been identified as the best source for chronic pain surveillance.
Adults with chronic pain were approximately five times more likely to report symptoms of anxiety or depression compared to those without chronic pain. And, among all American adults living with ongoing anxiety or depression today, the majority (55.6%) are people who also suffer from chronic pain.
Additionally, the effects of co-occurring symptoms of anxiety or depression and chronic pain negatively affected daily activities more than either condition alone. Nearly 70% of people with co-occurring symptoms reported limitations at work, more than 55% reported difficulty participating in social activities, and nearly 44% were more likely to have difficulty running errands alone.
"I was surprised by the magnitude of the effect with functional limitations," said De La Rosa, who is also a research assistant professor at the University of Arizona College of Medicine, Tucson Department of Family and Community Medicine. "Across all areas of functional life activity, we saw a huge jump in people living with both conditions. These are people who are at high risk for functional limitation, which will disrupt their quality of life."
Future studies could look at whether those receiving pain treatment receive mental health care and whether that care relieves symptoms.
"When someone experiences chronic pain and symptoms of anxiety or depression, achieving positive health outcomes can be more difficult," said senior author Todd Vanderah, PhD, director of the Comprehensive Pain and Addiction Center, professor and chair of the Department of Pharmacology. at the Tucson School of Medicine and a member of the BIO5 Institute. "This study gives us another avenue to explore in our continued effort to find new ways to treat chronic pain."
Conclusions
Prioritizing the health and functional outcomes of people with chronic pain and co-occurring anxiety/depression symptoms would benefit everyone affected by chronic pain or anxiety/depression . Translational and reverse translational research on coexistence may present an opportunity to develop interventions that, if effective in improving outcomes in the context of coexistence, can be fully implemented to benefit both clinical populations.
Overall, the evidence is consistent with the narrative that the coexistence of chronic pain and A/D symptoms makes achieving positive health outcomes for one or both conditions more challenging. The clinical literature suggests that comprehensive physical and mental health treatment is the best treatment approach for patients with co-occurring symptoms.
However, little is known about the use of A/D treatment and the effectiveness of A/D treatment in controlling A/D symptoms and improving function among patients who have chronic pain and mental health needs. Additional research should clarify the existing dynamics of treatment referral, use, and effectiveness of mental health treatment for patients with chronic pain. Additional research should accurately identify and address systemic disparities in treatment and associated outcomes among those living with co-occurring symptoms.
To improve the profound functional impacts associated with the coexistence of chronic pain and mental health symptoms, research must be prioritized to address unmet needs and improve outcomes. Emphasizing function, in the case of chronic pain and anxiety/depression, may be an avenue to better meet patients where they are, rather than focusing exclusively on symptom management per se .
In the literature review, commonalities were observed in chronic pain and anxiety/depression in both clinical and preclinical research. In the authors’ opinion, co-occurrence is not a contamination or complication for chronic pain or mental health research and should not be treated as such. Instead, the coexistence of chronic pain and A/D symptoms should be viewed as a timely research target with the potential to produce synergistic advances in the areas of chronic pain and mental illness prevention, treatment, education, and policy.
The global coronavirus pandemic of 2020 to 2022 may have lastingly altered the national prevalence of chronic pain and anxiety/depression since 2019. Numerous surveys were initiated during the pandemic to understand trends and changes in chronic pain and health mental health associated with Covid-19. This study can serve as a benchmark for pandemic-related comparative research on mental health, chronic pain, and co-occurrence.
Other co-authors from the UArizona Health Sciences Comprehensive Pain and Addiction Center include Associate Director of Medical Affairs Mohab M. Ibrahim, PhD, MD, professor of anesthesiology at the UArizona College of Medicine - Tucson and director of the UArizona Health Sciences Comprehensive Pain and Addiction Center. Chronic Pain Management; Deputy Director of Operations Alyssa R. Padilla, MPH; and Benjamin R. Brady, DrPH, adjunct research assistant professor at the Mel and Enid Zuckerman School of Public Health. Additional co-authors are Katherine E. Herder, MPH, doctoral student at the Zuckerman School of Public Health; and Jessica S. Wallace, program evaluator, Department of Family and Community Medicine, Tucson School of Medicine.
