Chronic Pain Linked to Higher Anxiety, Depression in Youth

Youth with chronic pain are more likely to experience anxiety and depression than those without chronic pain, with 1 in 3 youth and 1 in 8 youth with chronic pain meeting the criteria for either condition, respectively, according to a new study published in JAMA Pediatrics.¹ Authors suggested that screening, prevention, and treatment of mental health should be important priorities for the patient population.

Anxiety and depression are reported as common comorbidities for chronic pain. However, prevalence estimates of anxiety and depression in youth with chronic pain remain unclear. Studies have yet to establish the link between chronic pain and these mental health conditions or whether factors such as gender, age, and socioeconomic status influence the relationship between chronic pain and anxiety and depression in youth.

The current meta-analysis aimed to fill this gap. Investigators’ primary focus was determining the prevalence of these mental health conditions in youth based on clinical diagnoses or symptom severity in existing research. Researchers also explored factors that might influence prevalence rates, such as study design and patient characteristics.

In total, 79 studies with 12,614 youth with chronic pain and 10,342 controls were assessed. To be included, studies had to report a sample of youth younger than 25 years with chronic pain; a measure of anxiety and/or depression, either as a clinical diagnosis of an anxiety or depressive disorder or a validated measure of anxiety or depression symptoms; and data allowing the computation of an effect size or event rate.

READ MORE: Study: A Walk a Day Keeps Low Back Pain Away

Out of these, 23 studies with 30 independent comparisons reported data on anxiety symptom scores for both pain and control samples. The prevalence estimate of anxiety diagnoses was 34.6% (95% CI: 24.0%-47.0%) and the portion that exceeded clinical cutoff scores was 23.9% (95% CI: 18.3%-30.6%). The pooled effect size was significant and medium to large (95% CI: 0.46 to 0.77), suggesting that youth with chronic pain have more severe anxiety symptoms compared with controls.

Another 33 studies with 40 independent comparisons reported data on depression symptom scores for both pain and control samples. The prevalence of depression diagnoses was 12.2% (95% CI: 7.8%-18.7%) and the portion that exceeded clinical cutoff scores was 23.5% (95% CI: 18.7%-29.2%). The pooled effect size was significant and medium to large (95% CI: 0.63 to 0.85), suggesting that youth with chronic pain have more severe depression symptoms compared with controls.

Investigators noted that sex, age, pain location and recruitment sample may moderate anxiety and depression, but considerable heterogeneity was reported for all outcomes.

Among young people with chronic pain presenting for care, 1 in 3 will also meet the criteria for an anxiety disorder and 1 in 8 will meet the criteria for a depressive disorder, according to study findings. This, coupled with the fact that 1 in 5 people younger than 18 years already report chronic pain,² highlights the substantial burden of the comorbidities. Additionally, it raises concern about associated increased pain and disability, poorer pain self-management, and impaired quality of life during adolescence that can continue into young adulthood.³

These findings also underscore the importance of prioritizing mental health and providing timely, effective screening and treatment for youth with chronic pain. Investigators suggested that health care professionals use the PROMIS Pediatric Anxiety and Depressive Symptom Scales and the Children’s Depression Inventory-Short Version screening assessments, as these tools are concise, validated in chronic pain populations, and offer continuous symptom severity score and clinically relevant cutoff points.¹

In the pharmacy, these assessments can identify patients who may be at risk and shape follow-up pathways for post-screening patient care. Additionally, pharmacists can provide education and support to patients and their families to help them understand and manage mental health challenges.

READ MORE: Pain Management Resource Center

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References

1. Dudeney J, Aaron RV, Hathway T, et al. Anxiety and depression in youth with chronic pain: A systematic review and meta-analysis. JAMA Pediatr. Published online September 9, 2024. doi:10.1001/jamapediatrics.2024.3039

2. Chambers CT, Dol J, Tutelman PR, et al. The prevalence of chronic pain in children and adolescents: a systematic review update and meta-analysis. Pain. 2024;165(10):2215-2234. doi:10.1097/j.pain.0000000000003267

3. Murray CB, Groenewald CB, de la Vega R, Palermo TM. Long-term impact of adolescent chronic pain on young adult educational, vocational, and social outcomes. Pain. 2020;161(2):439-445. doi:10.1097/j.pain.0000000000001732