Co-occurrence of chronic pain and anxiety/depression symptoms in U.S. adults: prevalence, functional impacts, and opportunities

Chronic Pain Resilience Across Clinical Populations: A Concept Analysis

BACKGROUND

Chronic pain resilience is a concept that is frequently used in research but lacks theoretical clarity. Understanding chronic pain resilience is germane to developing interventions to improve it and the overall quality of life among individuals with chronic pain.

AIMS

To uncover and clarify the unique characteristics of the concept of chronic pain resilience.

DESIGN

A concept analysis using Rodgers' evolutionary method.

METHODS

Full-text articles published after 2000 in English were used to inform the concept analysis. Scopus, PubMed, PsychINFO, Embase, and CINAHL Plus with Full Text were utilized for literature searches. Rodgers' evolutionary approach was used to clarify the attributes, antecedents, and consequences.

RESULTS

The search yielded 31 articles that were used in the analysis. The key attributes of chronic pain resilience included engagement in meaningful activities despite pain, maintaining positive psychological homeostasis, buffering against negative mental outcomes, seeking support, and self-empowerment. After considering surrogate terms, antecedents, attributes, and consequences, chronic pain resilience may be defined as the development of the capacity to successfully adapt to chronic pain. This adaptation results in a move toward optimal social, physical, mental, and behavioral functioning by balancing negative and positive psychosocial factors, despite the additional challenges brought about by living with chronic pain.

Examining the Relationship Between Chronic Pain and Mortality in U.S. Adults

Chronic pain (CP) significantly impacts quality of life and increases noncommunicable disease risk, with recent U.S. data showing a 6.3% incidence rate, surpassing diabetes, depression, and hypertension. International studies suggest higher mortality in CP populations, yet prior U.S. data are inconclusive. To investigate CP's mortality risk, we analyzed National Health Interview Survey and National Death Index data. We hypothesized that individuals with CP and high-impact CP (HICP [≥1 activity limitation]) would exhibit higher mortality rates. National Health Interview Survey provided demographics, pain reporting, lifestyle, and psychosocial data matched with National Death Index mortality records. Chi-square analyses explored the relationships between CP/HICP and demographics, lifestyle factors, psychosocial variables, and mortality. Cox proportional hazards models assessed mortality risk between groups. The weighted sample was 245,899,776; 20% reported CP and 8% HICP, both groups exhibiting higher mortality rates than pain-free individuals (CP: 5.55%, HICP: 8.79%, total: 2.82%). Hazard ratios indicated nearly double the mortality risk for CP and 2.5 times higher risk for HICP compared to those without these conditions. Adjusting for lifestyle and psychosocial factors reduced mortality risk but remained elevated compared with non-CP individuals. Heart disease, malignant neoplasms, and chronic lower respiratory diseases accounted for a higher percentage of deaths in CP cases. CP individuals showed higher rates of smoking, alcohol consumption, obesity, inactivity, depression, anxiety, emotional problems, and sleep disturbances. CP and HICP significantly influence mortality outcomes, leading to excess deaths compared with pain-free individuals. Given the relationship between pain, lifestyle, psychosocial variables, and mortality, further investigations are needed into CP causation and prevention strategies. PERSPECTIVE: This article presents evidence regarding the relationship between CP, HICP, and mortality. Additional findings are discussed regarding the impact of demographics, lifestyle, and psychosocial variables on mortality in those with versus without CP and HICP. These findings are crucial for informing future research, prevention, and healthcare management strategies.

Using Multimodal Assessments to Reevaluate Depression Designations for Spine Surgery Candidates

BACKGROUND

Depression is common in spine surgery candidates and may influence postoperative outcomes. Ecological momentary assessments (EMAs) can overcome limitations of existing depression screening methods (e.g., recall bias, inaccuracy of historical diagnoses) by longitudinally monitoring depression symptoms in daily life. In this study, we compared EMA-based depression assessment with retrospective self-report (a 9-item Patient Health Questionnaire [PHQ-9]) and chart-based depression diagnosis in lumbar spine surgery candidates. We further examined the associations of each depression assessment method with surgical outcomes.

METHODS

Adult patients undergoing lumbar spine surgery (n = 122) completed EMAs quantifying depressive symptoms up to 5 times daily for 3 weeks preoperatively. Correlations (rank-biserial or Spearman) among EMA means, a chart-based depression history, and 1-time preoperative depression surveys (PHQ-9 and Psychache Scale) were analyzed. Confirmatory factor analysis was used to categorize PHQ-9 questions as somatic or non-somatic; subscores were compared with a propensity score-matched general population cohort. The associations of each screening modality with 6-month surgical outcomes (pain, disability, physical function, pain interference) were analyzed with multivariable regression.

RESULTS

The association between EMA Depression scores and a depression history was weak (r rb = 0.34 [95% confidence interval (CI), 0.14 to 0.52]). Moderate correlations with EMA-measured depression symptoms were observed for the PHQ-9 (r s = 0.51 [95% CI, 0.37 to 0.63]) and the Psychache Scale (r s = 0.68 [95% CI, 0.57 to 0.76]). Compared with the matched general population cohort, spine surgery candidates endorsed similar non-somatic symptoms but significantly greater somatic symptoms on the PHQ-9. EMA Depression scores had a stronger association with 6-month surgical outcomes than the other depression screening modalities did.

CONCLUSIONS

A history of depression in the medical record is not a reliable indication of preoperative depression symptom severity. Cross-sectional depression assessments such as PHQ-9 have stronger associations with daily depression symptoms but may conflate somatic depression symptoms with spine-related disability. As an alternative to these methods, mobile health technology and EMAs provide an opportunity to collect real-time, longitudinal data on depression symptom severity, potentially improving prognostic accuracy.

LEVEL OF EVIDENCE

Diagnostic Level III . See Instructions for Authors for a complete description of levels of evidence.

Assessing suicide risk in chronic pain management: a narrative review across drug classes

INTRODUCTION

Chronic pain presents a multifaceted challenge in clinical practice, necessitating a nuanced understanding of pharmacological interventions to optimize treatment outcomes. This review provides an outline of various pharmacological agents commonly used in chronic pain management and highlights their safety considerations, particularly regarding suicide risk.

AREAS COVERED

This review discusses the role of antidepressants, anticonvulsants, GABA receptor agonists, NMDA receptor antagonists, corticosteroids, cannabis and cannabinoids, bisphosphonates, calcitonin, and alpha-2 adrenergic receptor agonists in chronic pain management. It assesses their therapeutic benefits, potential for misuse, and psychiatric adverse effects, including the risk of suicide. Each pharmacological class is evaluated in terms of its efficacy, safety profile, and considerations for clinical practice. We searched peer-reviewed English literature on the topic using the MEDLINE database without time restrictions.

EXPERT OPINION

While pharmacological interventions offer promise in alleviating chronic pain, healthcare providers must carefully weigh their benefits against potential risks, including the risk of exacerbating psychiatric symptoms and increasing suicide risk. Individualized treatment approaches, close monitoring, and multidisciplinary collaboration are essential for optimizing pain management strategies while mitigating adverse effects. Ongoing research efforts are crucial for advancing our understanding of these pharmacological interventions and refining pain management practices.

Factors associated with depression in patients undergoing rehabilitation for chronic pain: a cross-sectional analytical study at a referral hospital in Peru

Despite the well-known impact of depression on patients with chronic pain and its association, few studies have evaluated its related factors in Physical Medicine and Rehabilitation settings. The objective of the present study was to assess the factors associated with depression in adult patients undergoing rehabilitation for chronic pain at Hospital Rebagliati (HNERM) in Peru. A cross-sectional analytical study was conducted between June and August 2023, involving 212 adult patients with chronic pain undergoing rehabilitation at HNERM. Data were collected through a survey, including sociodemographic information, pain characteristics, and depression assessment using the Patient Health Questionnaire-9 (PHQ-9). Statistical analysis included descriptive statistics and generalized linear models to identify factors associated with depression. Among 212 participants, 17.9% had a depression diagnosis based on the PHQ-9 (cutoff score: 10 points). Factors associated with a higher frequency of depression included a time since pain diagnosis of 3-6 months [adjusted prevalence ratios (aPR): 1.15, 95% confidence interval (CI): 1.04-1.27], severe pain (aPR: 1.17, 95% CI: 1.04-1.32), comorbidities (for 1: aPR: 1.21, 95% CI: 1.08-1.35; for 2: aPR: 1.17, 95% CI: 1.06-1.29; for ≥3: aPR: 1.27, 95% CI: 1.10-1.47), use of ≥2 medications for pain management (aPR: 1.27, 95% CI: 1.13-1.42), and receipt of psychological therapy (aPR: 1.26, 95% CI: 1.09-1.46). Nonpharmacological interventions did not show an association with an increased prevalence of depression. These findings underscore the significance of adopting a comprehensive approach to chronic pain management, including the screening, assessment, and treatment of associated depression.

The unmet mental health needs of U.S. adults living with chronic pain

ABSTRACT

Previous research suggests that individuals with mental health needs and chronic pain may be less likely to use mental health treatment compared with those with mental health needs only. Yet, few studies have investigated the existence of population-level differences in mental health treatment use. We analyzed data from the National Health Interview Survey (n = 31,997) to address this question. We found that chronic pain was associated with end-to-end disparities in the mental health journeys of U.S. adults: (1) Those living with chronic pain are overrepresented among U.S. adults with mental health needs; (2) among U.S. adults with mental health needs, those living with chronic pain had a lower prevalence of mental health treatment use; (3) among U.S. adults who used mental health treatment, those living with chronic pain had a higher prevalence of screening positive for unremitted anxiety or depression; (4) among U.S. adults living with both chronic pain and mental health needs, suboptimal mental health experiences were more common than otherwise-just 44.4% of those living with mental health needs and co-occurring chronic pain reported use of mental health treatment and screened negative for unremitted anxiety and depression, compared with 71.5% among those with mental health needs only. Overall, our results suggest that U.S. adults with chronic pain constitute an underrecognized majority of those living with unremitted anxiety/depression symptoms and that the U.S. healthcare system is not yet adequately equipped to educate, screen, navigate to care, and successfully address their unmet mental health needs.

Psychometric Properties of the Arabic Version of the Pain Resilience Scale among Lebanese Adults with Chronic Musculoskeletal Pain

Background

The Pain Resilience Scale (PRS), which measures behavioral perseverance and the ability to regulate emotions and cognition despite ongoing pain, lacks an Arabic version.

Objectives

This study aimed to translate, culturally adapt, and validate an Arabic version of the Pain Resilience Scale (PRS-A) among Lebanese adults.

Methods

Phase 1 involved translation and cross-cultural adaptation of the PRS into Arabic. Phase 2 examined the reliability and validity of the PRS-A. A convenience sample of 154 Lebanese adults with chronic musculoskeletal pain completed the PRS-A and self-report measures of pain catastrophizing, pain self-efficacy, pain intensity and interference, depression and anxiety, and quality of life.

Results

The PRS-A yielded a two-factor structure with factor 1 representing "cognitive/affective positivity" and factor 2 representing "behavioral perseverance," accounting for 41.93% and 15.15% of the variance in pain resilience, respectively. Total PRS-A score (M = 33.20 and SD = 9.90) showed significant correlations with pain catastrophizing (M = 27.65, SD = 13.03, and r = -0.52), pain self-efficacy (median = 9.00, IQR = 4, and rho = 0.61), pain intensity (M = 4.50, SD = 2.25, and r = -0.28), pain interference (M = 4.30, SD = 2.89, and r = -0.56), physical (M = 34.95, SD = 9.52, and r = 0.34) and mental (M = 40.08, SD = 12.49, and r = 0.58) health functioning, anxiety (median = 7.00, IQR = 7, and rho = -0.57), and depression (median = 4.00, IQR = 6, and rho = -0.58). PRS-A subscale was also significantly related to all measures except pain intensity, which was correlated with cognitive/affective positivity (r = -0.33) but not behavioral perseverance (r = -0.09). Cronbach's alpha for the PRS-A was 0.87.

Conclusion

The PRS-A demonstrated validity and acceptable reliability among Arab-speaking individuals with chronic musculoskeletal pain, suggesting its potential utility for assessing pain resilience within this population.

Adolescent-onset cannabis use and parenting young children: an investigation of differential effectiveness of a digital parenting intervention

Introduction

There is scant empirical work on associations between current and past cannabis use and parenting skills in parents of young children. As recreational cannabis use is now legal in nearly half of states in the U.S., cannabis use is becoming more ubiquitous.

Methods

In the current study, parents of toddler and pre-school age children were randomly assigned to participate in an app-based parenting skills program that included telehealth coaching (Family Check-Up Online; FCU-O), with a focus on parenting in the context of substance use. We aimed to test associations between adolescent-onset and current cannabis use and parent mental health and parenting skills, as well as whether effects of the FCU-O on parent mental health outcomes varied as a function of past cannabis use. Participants were 356 parents of children ages 1.5-5 participating in a randomized controlled trial of the FCU-O. Parents screened into the study if they reported current or past substance misuse or current depressive symptoms. After completing a baseline assessment, parents were randomly assigned to the FCU-O or control group and completed a follow-up assessment 3 months later. Parents retrospectively reported on the age when they initially used substances, as well as their current use.

Results

After accounting for current cannabis use, adolescent-onset cannabis use was significantly associated with higher symptoms of anxiety and depression, but not with parenting skills. Adolescent-onset cannabis use was found to significantly moderate the effect of the FCU-O on parents' anxiety symptoms. Specifically, the FCU-O was particularly effective in reducing anxiety symptoms for parents with adolescent-onset regular cannabis use, after accounting for current cannabis use.

Discussion

Adolescent-onset regular cannabis use may be a risk factor for later mental health challenges in parents of children under 5. An app-based parenting intervention may be particularly helpful in reducing symptoms of anxiety for parents who used cannabis regularly as adolescents. The findings have significant implications for the prevention of multigenerational risk for substance use and mental health challenges.

Assessing Risk Factors and Comorbidities in the Treatment of Chronic Pain: A Narrative Review

PURPOSE OF REVIEW

Chronic pain affects a significant portion of the population globally, making it a leading cause of disability. Understanding the multifaceted nature of chronic pain, its various types, and the intricate relationship it shares with risk factors, comorbidities, and mental health issues like depression and anxiety is critical for comprehensive patient care. Factors such as socioeconomic status (SES), age, gender, and obesity collectively add layers of complexity to chronic pain experiences and pose management challenges.

RECENT FINDINGS

Low SES presents barriers to effective pain care, while gender differences and the prevalence of chronic pain in aging adults emphasize the need for tailored approaches. The association between chronic pain and physical comorbidities like cardiovascular disease, chronic obstructive pulmonary disease (COPD), and diabetes mellitus reveals shared risk factors and further highlights the importance of integrated treatment strategies. Chronic pain and mental health are intricately linked through biochemical mechanisms, profoundly affecting overall quality of life. This review explores pharmacologic treatment for chronic pain, particularly opioid analgesia, with attention to the risk of substance misuse and the ongoing opioid epidemic. We discuss the potential role of medical cannabis as an alternative treatment with a nuanced perspective on its impact on opioid use. Addressing the totality and complexity of pain states is crucial to individualizing chronic pain management. With different types of pain having different underlying mechanisms, considerations should be made when approaching their treatment. Moreover, the synergistic relationship that pain states can have with other comorbidities further complicates chronic pain conditions.

Musculoskeletal pain among Chinese women during the menopausal transition: findings from a longitudinal cohort study

ABSTRACT

The profiles of muscle and joint pain throughout the menopausal transition and the factors associated with these symptoms have not been determined. A total of 609 participants from a longitudinal cohort study conducted in an urban Chinese community were enrolled in this study. We assessed the prevalence of musculoskeletal symptoms at different menopausal stages and explored the factors associated with these symptoms. The prevalence and severity of muscle and joint pain increase as menopausal stages progress, and late menopausal transition may be a crucial timepoint that triggers the onset of musculoskeletal pain. The results of the multivariate analysis revealed that poor health status (OR = 2.245, 95% CI = 1.714-2.94, P < 0.001), body mass index (BMI) (OR = 1.046, 95% CI = 1.01-1.084, P = 0.011), the presence of anxiety (OR = 1.601, 95% CI = 1.211-2.117, P < 0.001), and depression (OR = 1.368, 95% CI = 1.143-1.639, P < 0.001) were independently associated with muscle and joint pain. In addition, the severity of musculoskeletal pain was related to poor health status (OR = 2.738, 95% CI = 1.91-3.924, P < 0.001) and depression (OR = 1.371, 95% CI = 1.095-1.718, P = 0.006). Musculoskeletal symptoms are frequent somatic symptoms experienced by Chinese middle-aged women. Women with poor health status, high BMI, anxiety, and depression were at heightened risk of experiencing musculoskeletal pain. The severity of pain increased over time.

Scoping Review: The Role of Psychedelics in the Management of Chronic Pain

Introduction

Amid a lack of effective chronic pain treatments, psychedelics have gained attention as a potential solution, although their Schedule 1 classification poses challenges. Psychedelics, such as lysergic acid diethylamide (LSD) and psilocybin, have gained popularity as alternatives and adjuncts for chronic pain treatment. Studies suggest that they may modulate pain processing through agonism primarily at the serotonin receptor, 5-HT2A. One of the first of its nature, we present an artificial intelligence (AI)-powered scoping review primarily focusing on evaluating psychedelics for chronic pain conditions such as cluster headache, phantom limb pain, and fibromyalgia.

Methods

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we used an AI-powered comprehensive search strategy utilizing the ChatGPT4.0 Bing chat to search Medline, Embase, Cochrane, and Google Scholar for articles addressing chronic pain. The query was performed on June 1, 2023, focusing on psychedelics for chronic, non-cancer pain including headache disorders. Inclusion criteria were English-only, peer-reviewed articles involving human participants >18 years, focusing on chronic pain conditions (eg, phantom limb pain and cluster headache), using LSD, 2.5-dimethoxy-4-bromophenethylamine (2C-B), N, N-dimethyltryptamine (DMT), psilocybin, or mescaline. Exclusion criteria were reviews, editorials, and opinion articles and studies focusing on tetrahydrocannabinol/cannabis and/or ketamine.

Results

A total of 186 unique database entries were retrieved, of which nine studies were included in the scoping review. These included four case reports/series, an open-label study, a cohort study, two online surveys, and a randomized, double-blind, placebo-controlled trial. They comprised three studies addressing phantom limb pain, four addressing cluster headaches, and two addressing fibromyalgia, spinal cord injury, complex regional pain syndrome, and lumbar radiculopathy.

Conclusion

Psychedelics may have potential in alleviating pain symptoms secondary to a multitude of chronic pain conditions. However, further randomized, double-blind, placebo-controlled trials are needed to further explore and evaluate the role of psychedelics in chronic, non-cancer pain.

Exploring the outcome "days with bothersome pain" and its association with pain intensity, disability, and quality of life

OBJECTIVES

The aim of this study is to investigate the criterion validity, specifically the concurrent validity of the measure of days with bothersome pain, by investigating its association with measures of pain intensity, disability, and quality of life.

METHODS

We used two separate cohorts to study the concurrent validity of "days with bothersome pain," by investigating its association with pain intensity, disability, and quality of life: (1) 321 patients with low back pain (LBP), using follow-up data at 1 year, and (2) 170 pregnant women with pelvic girdle pain (PGP), using data at 12 and 30 weeks of their pregnancy. In both studies, weekly text messages asked for the number of days with bothersome pain the previous week. Pearson's correlation, univariable, and multivariable linear regression were used to assess the association between days with bothersome pain per week and pain intensity, disability, and quality of life. Non-linear associations were explored.

RESULTS

Days with bothersome pain were moderately and inversely correlated with quality of life (r = -0.45, p < 0.001), and moderately correlated with pain intensity (r = 0.70, p < 0.001) and disability ( r = 0.51, p < 0.001), among patients with LBP, and to a lesser degree among pregnant women with PGP (corresponding values at 18 weeks of pregnancy for quality of life; r = -0.27, p = 0.005, for pain intensity r = 0.41, p < 0.001, and for disability r = 0.41, p < 0.001). Furthermore, it was best explained by pain intensity for LBP patients, and by pain intensity and disability for pregnant women with pelvic pain. For the latter cohort, non-linear analyses suggested that days with bothersome pain could not distinguish between individuals with different high pain intensities and disabilities and low quality of life.

CONCLUSIONS

We consider the concurrent validity of "days with bothersome pain" to be moderate in the correlations with pain intensity, disability, and quality of life in patients with LBP and in pregnant women with PGP. Ceiling effects may be an issue in populations with high pain severity. The differences between the cohorts suggested that also other constructs are involved in the concept of days with bothersome pain.

Transformer encoder with multiscale deep learning for pain classification using physiological signals

Pain, a pervasive global health concern, affects a large segment of population worldwide. Accurate pain assessment remains a challenge due to the limitations of conventional self-report scales, which often yield inconsistent results and are susceptible to bias. Recognizing this gap, our study introduces PainAttnNet, a novel deep-learning model designed for precise pain intensity classification using physiological signals. We investigate whether PainAttnNet would outperform existing models in capturing temporal dependencies. The model integrates multiscale convolutional networks, squeeze-and-excitation residual networks, and a transformer encoder block. This integration is pivotal for extracting robust features across multiple time windows, emphasizing feature interdependencies, and enhancing temporal dependency analysis. Evaluation of PainAttnNet on the BioVid heat pain dataset confirm the model's superior performance over the existing models. The results establish PainAttnNet as a promising tool for automating and refining pain assessments. Our research not only introduces a novel computational approach but also sets the stage for more individualized and accurate pain assessment and management in the future.