mental illness and pain often go together. so why aren't we treating both?

researchers suggest that involving people who suffer from severe mental illness and pain in clinical trials is critical to better treatment and outcomes.

by chris arnold

published mar 25, 2022

3 minute read

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3 minute read

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mental illness and pain often go together. so why aren't we treating both?

as many as 65 per cent of people with depression experience pain, as do 29 per cent of people with bipolar disorder, according to the researchers from kings college london. getty

people suffering from severe mental illness (smi) can also be subject to a number of physical ailments, including poor health, shorter life spans, and more health problems overall. researchers from kings college london have assessed why the link between mental and physical suffering exists, and are calling for more treatment options to be developed.

their findings were published in the journal pain. the study focuses specifically on people experiencing depression, bipolar disorder, and psychosis.

“pain is not routinely assessed and managed in this population and pain communication and assessment might be obscured by the nature of the severe mental illness,” whitney scott, co-author of the study, wrote.

the study itself is less focused on effective methods of treating pain and smi, but instead, how people with smi are regularly left out of clinical trials for pain mitigation, despite the fact that the two often go together.

researchers suggest that involving people who suffer from smi as well as pain is essential to improve treatment, instead of people who have one or the other. specifically, they mention previous research that highlights how people with smi can have a significantly higher pain prevalence than healthy populations.

65 per cent of people with depression also have pain

as many as 65 per cent of people with depression experience pain, as do 29 per cent of people with bipolar disorder, according to the researchers. the average number of people suffering from pain was harder to pinpoint for people with psychosis, however.

“the pain-psychosis association is complex,” the study reads. “meta-analyses of experimental studies show that adults with schizophrenia have elevated pain thresholds and tolerance, independent of antipsychotic medication.”

the current understanding of the effects of pain management on people with smi, either in forms of medication or treatments, is incomplete, say researchers, as they are regularly excluded from clinical trials.

the study looked at the inclusion of exercise for treating these conditions, since people with smi and pain generally have a lower level of physical activity compared to a healthy population. again, people with smi were found to be left out of these clinical trials when researchers looked at exercise as a form of pain management.

“psychological and exercise-based treatments are often combined to reduce pain- related distress and disability,” the study reads. “meta-analysis of randomized clinical trials shows that cognitive behavioural therapy for pain produces small to medium-sized improvements in disability and mood compared to treatment as usual.”

the research team plans to fund a campaign to increase access to more inclusive treatment for those experiencing mental illness and pain.

“there is an urgent need to advance research and practice to improve pain management in people with smi,” the study reads. “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.”

the researchers say that various methods of testing and treatment, repeat referrals between mental health and pain services, and interviews with mental health clinicians could help more people understand the issue and further drive the need for these services and studies to be expanded to those experiencing smi and pain.

each year in canada, as many as one out of every five people experiences a form of mental illness, according to the centre for addiction and mental health. by the age of 40, half of canadians have had, or have, a mental illness.

chris arnold is a toronto-based writer.

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