High Cooccurrence of Chronic Pain With Depression, Anxiety, Warrant Better Screening and Treatment

New research out of Johns Hopkins Medicine analyzed almost 400 published studies and has found that 40% of adults with chronic pain experienced clinically significant depression and anxiety, with women, younger adults, and those with fibromyalgia at particularly high risk.1

"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 who with chronic pain who have depression or anxiety from clinical trials. We need integrated treatments that address chronic pain and mental health together,” lead investigator Rachel Aaron, PhD, assistant professor of physical medicine and rehabilitation at the Johns Hopkins University School of Medicine, said in a statement.2

Aaron and colleagues analyzed data from a total of 347,468 people with chronic pain from 376 studies across 50 countries conducted between 2013–2023. These individuals had a mean age of 51.3 years (standard deviation, 9.5) and 70.0% were female. The investigators found that clinical symptoms of depression were present in 39.3% (95% CI, 37.3-41.1; I2 = 98.9%) of these individuals and clinical symptoms of anxiety were present in 40.2% (95% CI, 38.0-42.4; I2 = 99.0%).1

The prevalence of depression and anxiety were highest among people with fibromyalgia (depression, 54.0% [95% CI, 48.5-59.4); anxiety, 55.5% [95% CI, 50.4-60.4]) and lowest among samples of people with osteoarthritis (depression, 29.1% [95% CI, 20.3-39.7]; anxiety, 17.5% [95% CI, 6.6-38.8]). Younger people (depression, β = −0.02 [95% CI, −0.03 to −0.01]; anxiety, β = −0.02 [95% CI, –0.03 to –0.01]) and women (depression, β = 0.69 [95% CI, 0.31-1.08]; anxiety, β = 0.90 [95% CI, 0.48-1.33]) also had higher rates of depression and anxiety.1

With anxiety symptoms specifically, those from South America (50.7% [95% CI, 44.6%-56.8%]) and those with a longer pain duration (β = 0.01 [95% CI, 0.002-0.004]; P < .001) had higher rates of anxiety.1

Looking into depression and anxiety diagnoses, 36.7% of individuals (95% CI, 29.0-45.1) had a major depressive disorder, and 16.7% (95% CI, 11.8-23.2) had generalized anxiety disorder. Furthermore, 6.3% (95% CI, 3.0-12.5) had persistent depressive disorder, 7.5% (95% CI, 4.5-12.3) had panic disorder, and 2.2% (95% CI, 1.0-5.8) had social anxiety disorder. In addition to women and younger people, people with nociplastic pain were most likely to have depression and anxiety.1

“People who have chronic pan are more likely than those who don’t to have depression and anxiety. This is a significant public health problem that should be addressed with routine screening of depression and anxiety in clinical settings and the development of novel treatments that target their comorbidity. At the same time, this is also a story of resilience. Most people with chronic pain 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,” Aaron said.2

REFERENCES

1. Aaron RV, Ravyts SG, Carnahan ND, et al. Prevalence of Depression and Anxiety Among Adults With Chronic Pain: A Systematic Review and Meta-Analysis. JAMA Netw Open. 2025;8(3):e250268. doi:10.1001/jamanetworkopen.2025.0268

2. Worldwide study finds high rates of depression and anxiety in people with chronic pain. News release. Johns Hopkins Medicine. March 10, 2025. https://www.eurekalert.org/news-releases/1076316