In one of the first studies of its kind, researchers in Norway have found that 7 out of 10 adolescents with psychiatric problems suffer from chronic pain. Pain was even more common in depressed teens and girls were more likely to experience pain than boys, according to the study.
The link between pain and depression is well established in adults, but until now little was known about how common pain was in adolescents with psychiatric problems. The researchers recommend that doctors give a “short psychiatric screening” to all of their adolescent pain patients.
“These numbers are so high that the entire support system for children and adolescents needs to be made more aware of the link between physical pain and psychiatric disorders,” said Professor Marit Sæbø Indredavik at the Norwegian University of Science and Technology.
“Physical pain is most common among young people who have conditions such as anxiety and depression, where they tend to be more focused on their problems. This is not a surprise, but it is a clear signal that we need to keep this in mind when treating mental health problems.”
The researchers gave questionnaires to 566 teens between the ages of 13 and 18, who participated in a large health survey conducted by St. Olavs Hospital in Trondheim, Norway from 2009-2011. All of the teens had psychiatric conditions, ranging from attention deficit disorder (ADHD) and depression, to anxiety, eating disorders and autism.
The teens were asked whether or not they had physical pain, and if so, what kind of pain and where it was located:
- 70% reported having chronic pain
- Girls (83%) were more likely to experience pain than boys (55%)
- 37% had pain in three or more areas
- 57% had chronic musculoskeletal pain
- 22% suffered from disability caused by pain
- Teens with mood (79%) or anxiety (76%) disorders had the highest rates of pain.
“Both anxiety and depression on their own can decrease the quality of life for these adolescents. Now we see that they also suffer from chronic pain,” said lead author Wenche Langfjord Mangerud, Norwegian University of Science and Technology.
Mangerud emphasizes that physical pain and mental conditions cannot be treated separately, and that early detection is important.
“To treat anxiety in a positive way, physical pain must also be treated and vice versa. It is important that treatment in their younger years be effective, so that these problems don’t continue into adulthood, as they unfortunately often do,” she said.
“There is evidence that psychiatric disorders may increase pain intensity through a central pain modulation system, where the physiological bases of depression and pain share some of the pathways in the central nervous system. Anxious patients may also interpret pain as being more intense than do non-anxious patients. The presence of chronic pain makes it difficult to recognize and treat potential psychiatric disorders, and therefore this delay may worsen the prognosis of psychiatric disorders.”
The researchers say medical doctors should work with physiotherapists in treating adolescent pain patients.
“Unfortunately there are too few physiotherapists working in child and adolescent psychiatry, but you can find them elsewhere in the health care system. It is important that the health care providers work more closely so that both body and mind are taken care of,” says Indredavik.
“Findings from this study point to the need for treatments that dually target mental and physical distress,” said Beth Darnall, PhD, a pain psychologist and clinical associate professor in the Division of Pain Medicine at Stanford University School of Medicine.
“Pain psychology is a great example of ‘dual treatment’. As one part of pain psychology treatment, people with chronic pain learn skills to calm the nervous system (e.g., diaphragmatic breathing, progressive muscle relaxation, meditation), thereby reducing both physical and emotional distress. These types of skills are particularly important for adolescents because they may feel less control over multiple life factors, have heightened stress, and hormone fluctuations may lead to greater vulnerability to stress and pain.”
The study is published online in the journal BMC Psychiatry.