Chronic pain in mental disorders: An umbrella review of the prevalence, risk factors, and treatments across 957,168 people with mental disorders and 16,606,910 controls.

Researchers conducted a large umbrella review examining the relationship between chronic pain and mental health conditions across nearly 1 million people with mental disorders and over 16 million without. They looked at studies covering anxiety, depression, bipolar disorder, schizophrenia, ADHD, autism, and dementia to understand how common chronic pain is in these populations, what increases the risk, and what treatments might help.

The study found that chronic pain is extremely common in people with mental health conditions. Rates ranged from about 24% in bipolar disorder to as high as 96% in PTSD—consistently higher than the general population rate of 20-25%. The relationship appears to go both ways, meaning chronic pain can increase the risk of depression, and depression can increase the risk of chronic pain. Factors that increased risk included being female, having more severe symptoms, and facing socioeconomic challenges.

For treatment options, the evidence was limited but showed some promise. Acupuncture combined with medication was found to improve pain levels significantly, with patients reporting meaningful reductions in their pain scores. Cognitive behavioral therapy showed small positive effects, and brain stimulation techniques helped with pain in dementia patients. However, the researchers noted that more high-quality studies are needed with standardized pain measurements.

For patients considering acupuncture, these findings suggest it may be a helpful addition to standard care for managing chronic pain, especially when dealing with mental health conditions. If you're interested in trying acupuncture for chronic pain, seek a licensed acupuncturist with experience treating patients with mental health conditions.

This umbrella review synthesized data from 20 studies examining chronic pain (CP) prevalence, risk factors, and treatments across mental disorders, encompassing 957,168 individuals with mental disorders and 16,606,910 controls. CP prevalence ranged from 23.7% (95% CI 13.1-36.3) in bipolar disorder to 96% in PTSD, consistently exceeding general population rates. Bidirectional associations were observed in depression (OR=1.26-1.88). Risk factors included female gender, symptom severity, and socioeconomic disadvantage. Treatment evidence was limited: acupuncture combined with medication demonstrated significant pain reduction (MD=-1.06, 95% CI -1.65 to -0.47), while cognitive behavioral therapy showed small effects (SMD=0.27, 95% CI -0.08-0.61). Transcranial direct current stimulation reduced pain in dementia (d=0.69-1.12). Quality assessment used AMSTAR and Newcastle-Ottawa Scale, though methodological heterogeneity was noted. Clinical takeaway: Implement routine pain screening in psychiatric populations and consider multimodal interventions including acupuncture as adjunctive therapy for comorbid chronic pain management.