Study finds mental health care gap for chronic pain patients

According to the Centers for Disease Control and Prevention, approximately 51.6 million U.S. adults experienced chronic pain in 2021. The study showed that while people with chronic pain make up 20.4% of the U.S. adult population, they also account for an estimated 55.5% of U.S. adults with clinically significant symptoms of anxiety or depression.

“The mental health movement in the United States has been extremely successful, and many people are living better lives as a result,” said lead author Jennifer S. de la Rosa, PhD, strategic director of the University of Arizona Health Sciences Comprehensive Pain and Addiction Center, which funded the study. “Yet for people whose mental health needs have not yet been effectively addressed, experiencing chronic pain is the rule rather than the exception. Too often, the needs of people with chronic pain are left out of the national mental health discussion. Our findings suggest that meaningfully engaging with the lived experiences of people with chronic pain should be a focus of the national mental health agenda going forward.”

The paper, “Unmet Mental Health Needs of US Adults with Chronic Pain,” was recently published in the journal Neurology. pain.

The study builds on previous research from the Comprehensive Center on Pain and Addiction, which found that 1 in 20 U.S. adults have co-occurring chronic pain and anxiety or depression symptoms, and adults with chronic pain are about five times more likely to have untreated symptoms of anxiety or depression than adults without chronic pain.

The new study looked at the extent to which people with chronic pain and mental health symptoms receive and benefit from mental health treatment.

The research team analyzed data from 31,997 people who participated in the National Health Interview Survey, which has been identified as the best single source of information for chronic pain monitoring. The researchers identified disparities related to chronic pain in three areas: need for mental health treatment, access to mental health treatment, and success in treating anxiety and depressive symptoms when mental health treatment is accessed.

They found that 43.2% of U.S. adults with chronic pain (about 21.5 million people) had mental health needs, compared with just 17.4% of U.S. adults without chronic pain who reported having mental health care needs.

Among all U.S. adults seeking mental health treatment, chronic pain was associated with a 40.3% decreased odds of receiving mental health treatment.

“For people with chronic pain, the conversation about what to do to address mental health is qualitatively different than it is for people who don't have chronic pain,” said de la Rosa, a research assistant professor in the Department of Family and Community Medicine at the School of Medicine in Tucson. “Improving health care for people with chronic pain requires not only connecting people to care, but also addressing the disproportionate underachievement of pain relief even in care settings.”

Researchers found that U.S. adults with chronic pain are more than twice as likely to experience ongoing anxiety or depression if they received mental health treatment than those without. The researchers found that only 44.4% of people with chronic pain (an estimated 9.5 million people) used mental health services to adequately treat their anxiety or depression, compared with 71.5% of people without chronic pain. U.S. adults with chronic pain are more than twice as likely to experience ongoing anxiety or depression if they received mental health treatment than those without.

“There are many possible reasons why people with chronic pain may experience poor outcomes from mental health care, including ease of access to care and ease of making appointments,” De La Rosa says. “Furthermore, few mental health providers are trained in chronic pain, so only a small proportion of people with chronic pain are likely receiving mental health treatment designed to address their needs. Further exploring the role chronic pain plays in the nation's mental health crisis offers the potential for scientific and policy change that will build the capacity of the U.S. health care system to address the issue of co-occurring chronic pain and mental health.”

“This study confirms that there is a significant gap in meeting the mental health needs of people living with chronic pain,” said senior author Todd Vandella, PhD, director of the Comprehensive Pain & Addiction Center, professor and chair of the Department of Pharmacology at the Tucson School of Medicine, and member of the BIO5 Institute. “Our goal at the Comprehensive Pain & Addiction Center is to use this information to rethink and transform medical care for chronic pain. By recognizing and treating the co-occurrence of anxiety and depression symptoms with chronic pain, we can empower millions of people who suffer from pain to live well.”

Other co-authors from the Comprehensive Pain and Addiction Center include Medical Director Mohab Ibrahim, MD, professor of anesthesiology and director of the Chronic Pain Management Clinic at CUMC, Director of Policy Beth Myerson, MD, professor in the Department of Family and Community Medicine at CUMC, and members Alicia Allen, MD, associate professor in the Department of Family and Community Medicine at CUMC, and Benjamin Brady, MD, PH. Additional co-authors are doctoral student Katherine Harder and Jessica S. Wallace, program evaluator in the Department of Family and Community Medicine at CUMC.