Comorbidity between pain and mental illness—evidence of a bidirectional relationship
Abstract
BACKGROUND: Pain from various locations in the body and mental illness are common and the comorbidity between the two is well-known although the temporal relationship remains to be determined. Our aim was to follow patients over time to study if pain (here dorsalgia/abdominal pain) or fibromyalgia lead to an increased risk of developing mental illness (here depression/anxiety) and/or the reverse, that is whether patients with mental illness have an increased risk to develop pain or fibromyalgia, compared to the rest of the population. METHODS: This prospective cohort study used the Skåne Healthcare Register, covering all care in the region of Skåne, southern Sweden (population ~1.3 million). The cohort included healthcare consultations in primary care, outpatient specialized care and inpatient care between 2007 and 2016 for all patients without prior registered diagnosis of mental illness or pain, aged 18 or older (n = 504,365). RESULTS: The incidence rate ratio (IRR) for developing mental illness after pain was 2.18 (95% CI = 2.14-2.22) compared to without pain. IRR for developing pain after mental illness was 2.02 (95% CI = 1.98-2.06) compared to without mental illness. Corresponding IRR for developing mental illness after fibromyalgia was 4.05 (95% CI = 3.58-4.59) and for developing fibromyalgia after mental illness 5.54 (95% CI = 4.99-6.16). CONCLUSIONS: This study shows a bidirectional influence of similar magnitude of pain and mental illness, respectively. In monitoring patients with pain or mental illness, a focus on both conditions is thus important to develop appropriate, targeted interventions and may increase the likelihood of improved outcomes. SIGNIFICANCE: We followed a population-based cohort over a period of 10 years, including incident cases of both exposure and outcome and found a bidirectional relationship between pain and mental illness. Clinicians need to pay attention on both conditions, in patients seeking care due to mental illness or pain.
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For people with comorbid CP and MI, CP is further complicated by mental health problems, which are often accompanied by long-term physical conditions associated with pain symptoms.
“For people with comorbid CP and MI, this nature of CP is further complicated by MH problems, which are often accompanied by long-term physical conditions 7 that are associated with pain symptoms. 8”
From The Effectiveness of Interventions for Improving Chronic Pain Symptoms Among People With Mental Illness: A Systematic Review (2024) · cites this paper as [8]
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- Authors
- Bondesson, E., Larrosa Pardo, F., Stigmar, K., Ringqvist, Å., Petersson, I. F., Jöud, A., & Schelin, M. E. C.
- Affiliations
- Lund University (SE)
- Division of Orthopedics Department of Clinical Sciences Lund University Sweden
- Skåne University Hospital (SE)
- Corresponding author
- Bondesson, E.
- Venue
- European Journal of Pain
- Publisher
- Wiley
- Published
- 2018-04-16
- Volume
- 22
- Issue
- 7
- Pages
- 1304-1311
- ISSN
- 1090-3801 (ISSN-L)
- 1532-2149
- OpenAlex
- W2791935110
- Cited by
- 131
- References
- 32
- Citations by year
- 2026: 23 · 2025: 22 · 2024: 19 · 2023: 26 · 2022: 19 · 2021: 9 · 2020: 7 · 2019: 4 · 2018: 2
- FWCI
- 4.30
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Pain (publishedVersion)
- PubMed (publishedVersion)
- Lund University Publications (Lund University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Keywords
- pain, mental illness, comorbidities, bidirectional relationship, fibromyalgia, depression, anxiety, back pain, abdominal pain, incidence, temporal relations
- MeSH terms
- Adult, Aged, Anxiety Disorders, Back Pain, Depressive Disorder, Female, Fibromyalgia, Hospitalization, Humans, Male, Middle Aged, Prospective Studies, Risk Factors, Sweden, Cohort Studies, Abdominal Pain, Comorbidity
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