A major new study has shown just how closely linked chronic pain is with mental health issues like depression and anxiety.
Researchers from Johns Hopkins Medicine reviewed 376 published studies from around the world and discovered that nearly 40% of adults who live with chronic pain also suffer from clinically significant depression and anxiety.
This is a serious concern for public health, according to the researchers. Chronic pain is defined as pain that lasts more than three months and affects millions of people globally.
In the United States alone, the CDC reported that over 51 million adults (about 1 in 5) had chronic pain in 2021. For many of them, this pain is not just physical—it also affects their mental and emotional health.
The new study found that certain groups are especially vulnerable, including women, younger adults, and people diagnosed with fibromyalgia, a condition that causes widespread body pain. While experts have long known that pain and mood disorders often go hand in hand, this study highlights just how common the connection is—and how it is often overlooked in treatment.
One major issue is that people who suffer from both chronic pain and mental health problems often don’t get the care they need. Specialized pain clinics usually focus on treating physical symptoms, and many clinical trials for new treatments exclude people who have depression or anxiety. This leaves a huge gap in care.
Dr. Rachel Aaron, the lead author of the study, says that although there are effective therapies for treating pain, depression, and anxiety separately, these treatments are rarely combined. “We need new approaches that address both pain and mental health at the same time,” she explains.
The research included data from 347,468 adults from 50 countries, making it one of the most comprehensive reviews of its kind. On average, the patients were 52 years old. The team looked at seven mental health conditions linked to depression and anxiety.
They found that 39% had clinical symptoms of depression, and 40% had clinical symptoms of anxiety. Rates of more specific diagnoses were also high, including 37% with major depressive disorder, 17% with general anxiety disorder, and smaller percentages with conditions like panic disorder and social anxiety.
Importantly, these mental health issues weren’t just a result of having any illness. The researchers concluded that chronic pain itself is strongly associated with emotional distress, possibly due to the way the nervous system changes in people with chronic pain.
This kind of pain—called nociplastic pain—is believed to come from changes in how the brain and spinal cord process pain signals.
Even though the study can’t say whether pain causes depression and anxiety or the other way around, the connection is clear: people with chronic pain are more likely to experience poor mental health.
But there is also a hopeful message. The study found that most people with chronic pain do not suffer from depression or anxiety. This challenges the harmful stereotype that life with chronic pain is always miserable. Many people with chronic pain continue to live full, emotionally healthy lives.
To improve care, the researchers call for regular screening of mental health symptoms in patients with chronic pain and the development of new treatments that work on both physical and emotional symptoms. With better understanding and better care, more people living with pain may also find relief from the heavy emotional toll it can bring.
The study is published in JAMA Network Open.
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