4 in 10 adults with chronic pain face mental health woes

Chronic pain is accompanied by depression and anxiety in 40 percent of adults, according to the results of a meta-analysis.

Pooled data from 376 studies showed that 39.3 percent (95 percent confidence interval [CI], 37.3–41.1; I²=98.9 percent) of people with chronic pain had clinical symptoms of depression and 40.2 percent (95 percent CI, 38.0–42.4 percent; I²=99.0 percent) had clinical symptoms of anxiety. Younger people and women were most likely to have co-occurring depression and anxiety. [JAMA Netw Open 2025;8:e250268]

“The prevalence of clinical symptoms of depression and anxiety was highest among individuals with pain conditions associated with nociplastic mechanisms (ie, pain due to altered nociception in the absence of tissue damage), including fibromyalgia, complex regional pain syndrome, and temporal mandibular disorder,” the authors said.

For instance, more than half of individuals with fibromyalgia had depression (54.0 percent, 95 percent CI, 48.5–59.4) and anxiety (55.5 percent, 95 percent CI, 50.4–60.4).

“In contrast, people with pain conditions with greater nociceptive or neuropathic involvement, including various types of arthritis, had the lowest prevalence of depression (22.1–29.1 percent) and anxiety (17.5–26.3 percent),” they added.

Chronic pain is defined as pain that persists for more than 3 months and is frequently associated with psychological distress, including symptoms of depression and anxiety. [Pain 2015;156:1003-1007; J Pain 2016;17:T21-T49]

The present data point to a significant public health problem that should be addressed with routine screening for depression and anxiety in clinical settings in which chronic pain is treated, according to first study author Dr Rachel Aaron from the Johns Hopkins University School of Medicine in Baltimore, Maryland, US.

“Right now, we have effective psychological treatments for depression and anxiety, and effective psychological treatments for chronic pain, but these treatments are often siloed. In fact, many studies exclude people with chronic pain who have depression or anxiety from clinical trials. We need integrated treatments that address chronic pain and mental health together,” Aaron continued.

At the same time, the author acknowledged the resilience of other people with chronic pain who do not have depression or anxiety. “These results challenge the ableist narrative that chronic pain is inherently depressing and remind us that people with chronic pain can and do lead psychologically healthy, fulfilling, lives.”

The studies included in the meta-analysis represented 50 countries and involved 347,468 adults with chronic pain (mean age 51.3 years, 70.0 percent female) and 160,564 control participants. The most common chronic pain conditions included mixed (K=142), fibromyalgia (K=85), chronic low back pain (K=37), and rheumatoid arthritis (K=20).