There is a strong connection between the experience of chronic pain and common mental health conditions, according to a new report released today by Mental Health America (MHA) entitled “Early, Equitable, and Trauma Responsive Care for Chronic Pain and Mental Health.”
MHA’s President and CEO Paul Gionfriddo noted that “the connection between chronic pain and mental health conditions is very real. And in a disturbingly high percentage of cases for a variety of populations, the mental health conditions are either untreated or undiagnosed.”
Mental health conditions are often thought to be secondary to physical health conditions when both are present. This can result in undertreatment of the mental health condition.
In analyzing data from 161,000+ people living with arthritis or other chronic pain who completed a free, online mental health screening from 2015-2019, MHA found that:
- 79 percent of people with arthritis or other chronic pain screened positive or moderate to severe for a mental health condition.
- Chronic pain was linked to worsened mental health status across a variety of mental health conditions – 54 percent of screeners with chronic pain experienced severe anxiety versus 43 percent without; 54 percent with chronic pain were positive for bipolar versus 39 percent without; 47 percent with chronic pain experienced severe depression versus 36 percent without; and 92 percent with chronic pain were positive for PTSD versus 83 percent without.
- PTSD was the primary concern for screeners with chronic pain – 48 percent of people who took a PTSD screen and reported having a chronic health condition had chronic pain.
- Arthritis or chronic pain were experienced across numerous population groups in addition to older adults. Over half (54 percent) of veterans or active duty military who reported having a chronic health condition had arthritis or other chronic pain, followed by caregivers at 47 percent and trauma survivors at 46 percent.
- Among people with arthritis or chronic pain who screened positive or moderate to severe for a mental health condition, 40 percent had never been diagnosed. And over half (52 percent) who had been treated for a mental health condition in the past were no longer receiving treatment.
Based on these findings, MHA made the following recommendations:
- Primary care physicians should proactively initiate conversations about mental health and chronic pain with patients rather than waiting for patients to report symptoms.
- Patients with arthritis or chronic pain should be screened for commonly co-occurring conditions such as PTSD, bipolar disorder, depression, and anxiety. Similarly, patients who report mental health conditions should be screened for pain.
- There should be investments in more representative research for treatment and pain measurement tools that work for diverse populations. Pain is underexamined, undermeasured, underreported and underdiagnosed among BIPOC, LGBTQ+ and gender diverse communities. To eliminate disparities in care, this new research should inform the teaching of medical professionals.
- Care for arthritis or chronic pain should include a focus on trauma, stress, anxiety, depression, PTSD, coping skills, and resilience-building, not just substance use-focused services and supports.
- Because trauma and chronic pain are strongly connected, trauma-informed care should be the standard for patients with chronic pain, even when they do not have a diagnosis of a mental illness.
- Care should be patient-centered and include the use of shared decision-making tools. The needs, goals and preferences of each individual patient must be recognized and included in the treatment plan.
- Interdisciplinary, team-based, and coordinated care, integrating peer support specialists, community health workers (CHW), and other paraprofessionals into care teams could create more effective pain management care.
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