Study identifies urgent need for more pain research in serious mental illness

The evidence review focuses on bipolar disorder, psychosis and major depression.

A study has identified an urgent need for more research into the assessment, reporting and treatment of pain in people 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 people with bipolar disorder, psychosis and major depression, and suggested potential treatment methods to improve pain. management in these people.1 The researchers noted that pain often accompanies depression, but estimates of the prevalence of pain in people with depression vary widely (15% to 100%; mean 65%). The investigators also noted that there is a high prevalence of pain in people with bipolar disorder. They cited 1 meta-analysis (k=22) indicating that 29% of participants with bipolar disorder (not= 171,352) reported experiencing pain, which was more than twice the risk of pain noted in healthy controls (not=12,342,577). They mentioned that many of the studies in the review relied on unvalidated pain assessments, which may have affected the results.2

Investigators also noted a complex relationship between pain and psychosis, with varying reports of pain in people with schizophrenia. Some meta-analyses report that these people have higher pain thresholds, although one study (not=14) found that 35% of participants with schizophrenia (not= 242,703) reported experiencing clinical pain at levels similar to sex- and age-matched controls without mental illness (not=4,259,221). The researchers also noted that associated risk factors, such as diabetes and obesity, may lead these people to underreport or underreport pain, although another study of people with psychosis (not=438) found an association between clinically relevant pain and comorbid depressive symptoms. Overall, the investigators concluded that pain reports may be diagnosis-specific, psychosis may be associated with underreported pain, and comorbid depression may be associated with more pain reports.2

As understanding of pain – particularly its biopsychosocial influences – in these patient populations and related research is limited, researchers have suggested several psychological treatments for pain in people with IMS; these treatments are increasingly supported by research. Specifically, the researchers noted that cognitive behavioral therapy (CBT), family and caregiver interventions, and exercise-based treatments—given that SMI and persistent pain are associated with low physical activity—may be effective treatments to help alleviate pain in people with IMS. . The investigators also concluded that there is an urgent need for further research in this area and that improvements need to be made in the recognition and assessment of pain in these people. stakeholder involvement (i.e. caregivers, mental health professionals); implementation science; and individualized assessment and treatment.2

“There is an urgent need to advance research and practice to improve pain management in people with MMS,” the researchers concluded. “This work should build on the synergies in existing evidence for the management of pain and IMS. Meaningful involvement of people with lived experience is essential to move this agenda forward.


1. Urgent need for more research and focus on treating pain in people with serious mental illness, according to new evidence. Press 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.

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