One in four young people have experienced chronic pain and a mental disorder. According to a new report in the Journal of Pain, the onset of pain is often preceded by mental disorders: an above-average rate of incidence of depression, anxiety disorders, and behavioral disorders occurs before the onset of headaches, back pain and neck pain. The report is based on the findings of researchers at the University of Basel and Ruhr-Universität Bochum, who analyzed data from around 6,500 teenagers from the USA.

Mental disorders and chronic pain have an adverse effect on quality of life and well-being in those affected and present a huge challenge for the health system. Studies on adults have already shown that mental disorders and chronic pain frequently occur together.

Now, a research group led by private lecturer Dr. Marion Tegethoff of the University of Basel’s Faculty of Psychology has investigated how often and in what patterns – and, above all, in what chronological order – these connections occur in children and young people. Funded by the Swiss National Science Foundation, the project analyzed a representative sample population from the USA, consisting of 6,483 young people between the ages of 13 and 18.

Living in fear

The researchers found that more than a quarter (25.9%) of the young people had suffered from chronic pain and at least one mental disorder during their lifetime. At the same time, they identified connections between all of the investigated types of mental disorders (such as affective disorders, anxiety disorders, behavioral disorders, substance-induced disorders, and eating disorders) and chronic pain disorders (such as back/neck pain and headaches). The onset of pain was frequently preceded by mental disorders. For example, affective disorders such as depression occurred particularly frequently before headaches. Furthermore, anxiety disorders often occurred before neck and back pain, as well as before headaches. Finally, behavioral disorders such as attention deficit/hyperactivity disorders also indicated a risk of headaches.

As the analyzed data stems from an interdisciplinary study, it was not possible to investigate whether and how the causes of mental disorders and chronic pain are connected to one another. «The temporal connections identified in the study can give only preliminary indications that mental disorders could be causal risk factors for chronic pain. Future studies should focus on identifying the underlying biological and psychological mechanisms with a view to developing interdisciplinary approaches to prevention and treatment,» explains Marion Tegethoff, the study’s lead author. This could lead to early avoidance of the negative long-term consequences of mental disorders and the prevention of chronic pain.