Young people with chronic pain more likely to have clinical anxiety or depression

Young people with chronic pain are three times more likely than their peers to also have clinical anxiety or depression, a new study shows.

Led by researchers at Macquarie University, the study found that a third of children under the age of 18 with chronic pain also met the criteria for an anxiety disorder, while one in eight met the criteria for a depressive disorder.

The results have been published in the latest edition of JAMA Pediatrics and included a meta-review of 79 studies covering almost 23,000 children and young people under 18 years of age, including more than 12,000 with chronic pain.

It included conditions where pain is the primary symptom, such as juvenile idiopathic arthritis and fibromyalgia, chronic diseases where pain is a secondary symptom, such as Crohn’s disease and colitis, and cases where the pain has no known cause.

Lead author, Dr Joanne Dudeney, is a clinical psychologist and a Macquarie University Research Fellow in the School of Psychological Sciences.

“The findings indicate that we risk doing a disservice to young people if we do not take into account comorbid anxiety and depression when they present with chronic pain,” she says.

“Clinically, I saw a lot of young people with chronic pain who were also diagnosed with anxiety and depression, but those comorbid psychological conditions didn’t show up in the pain research.

“The research mainly concerned fear of pain, pain anxiety and pain catastrophization, all of which revolve around the concern that the pain will never get better.

“I thought there was a gap in our understanding, and these children showed common symptoms of anxiety and depression, but because this was not taken into account in the research into managing chronic pain, they did not enter clinical practice.”

Dr. Dudeney says one of the most important insights is that parents need to be aware of the prevalence of anxiety and depression with chronic pain so they can advocate for their children to be assessed.

It is also vital that clinicians such as GPs, rheumatologists and pain practitioners are aware of the link, with a view to establishing a more multidisciplinary approach that treats pain, anxiety and depression together, when appropriate.

A simple way to put this into practice would be for pain practitioners to consider a brief screening for symptoms of anxiety and depression in young patients.

This is a vulnerable population, and if we don’t take mental health care into account, we likely won’t achieve the clinical improvements we want to see.”

Dr. Joanne Dudeney, Clinical Psychologist and Macquarie University Research Fellow in the School of Psychological Sciences

She and her colleagues are currently developing an online program for adolescents with chronic pain, which will be offered by Macquarie University’s eCentreClinic. It is similar to the adult pain course already offered and shown to be effective in reducing pain intensity and improving quality of life.

Anxiety and depression in youth with chronic pain: a systematic review and meta-analysis, is by Joanne Dudeney, Rachel V. Aaron, Taylor Hathway, Kavya Bhattiprolu, Madelyne A. Bisby, Lakeye S. McGill, Milena Gandy, Nicole Harte, and Blake F. Dear, and is published in the September 2024 issue JAMA Pediatrics

Dr. Joanne Dudeney is a Macquarie University Research Fellow in the School of Psychological Sciences, and a member of the Macquarie University Lifespan Health and Wellbeing Research Centre.