Evidence review focuses on bipolar disorder, psychosis, and major depression.
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A study identified an urgent need for more research in the assessment, reporting, and treatment of pain in individuals with severe mental illness (SMI).
The study, an evidence review accepted for publication by the International Association for the Study of Pain (IASP), focused on the diagnostic challenges of pain management in individuals with bipolar disorder, psychosis, and major depression, and suggested potential treatment methods to improve pain management in these individuals.1 The investigators noted that pain commonly cooccurs with depression, but pain prevalence estimates in individuals with depression vary significantly (15% to 100%; mean 65%). The investigators also noted that there is a high prevalence of pain in individuals with bipolar disorder. They cited 1 meta-analysis (k=22) stating that 29% of participants with bipolar disorder (n=171,352) reported experiencing pain—which was more than double the pain risk noted for the healthy controls (n=12,342,577). They mentioned that many studies in the review relied on unvalidated assessments of pain, which may have affected the results.2
The investigators also noted a complex relationship between pain and psychosis, with varying reports of pain in individuals with schizophrenia. Some meta-analyses report that these individuals have higher pain thresholds, although 1 study (n=14) found that 35% of participants with schizophrenia (n=242,703) reported experiencing clinical pain at levels similar to the sex- and age-matched controls without mental illness (n=4,259,221). The investigators also noted that associated risk factors, such as diabetes and obesity, may lead to these individuals underreporting or underrecognizing pain, even though another study of individuals with psychosis (n=438) found an association between clinically relevant pain and comorbid depressive symptoms. The investigators concluded overall that reports of pain may be diagnostically specific, psychosis may be associated with underreporting pain, and comorbid depression may be associated with more reports of pain.2
As the understanding of pain—especially its biopsychosocial influences—in these patient populations and associated research is limited, the investigators suggested several psychological treatments for pain in individuals with SMI; these treatments have been increasingly supported by research. Specifically, the investigators noted cognitive-behavioral therapy (CBT), family and caregiver interventions, and exercise-based treatments—given that both SMI and persistent pain are associated with low physical activity—may be effective treatments to help mitigate pain in individuals with SMI. The investigators also concluded that there is an urgent need for more research in this area, and that improvements need to be made in the recognition and assessment of pain in these individuals; stakeholder involvement (ie, caregivers, mental health professionals); implementation science; and individualized evaluation and treatment.2
“There is an urgent need to advance research and practice to improve pain management in people with SMI,” the investigators concluded. “This work should draw on synergies in the existing evidence for managing pain and SMI. Meaningful involvement of people with lived experience is essential to advance this agenda.”
1. Urgent need for more research and focus on treating pain in people with severe mental illness, new evidence review shows. News release. Wolters Kluwer. March 22, 2022. Accessed April 13, 2022.
2. Onwumere J, Stubbs B, Stirling M, et al. Pain management in people with severe mental illness: an agenda for progress. Pain. Published online ahead of print March 16, 2022. Accessed April 13, 2022.