March 22, 2022 – A review in PAIN®, the official journal of the International Association for the Study of Pain (IASP) highlights significant ongoing challenges in the assessment, reporting, and treatment of pain in people with severe mental illness (SMI). The journal is published in the Lippincott portfolio by Wolters Kluwer.
People with severe mental illness have poorer physical health, shorter life spans, and experience increased likelihood of health problems that carry a high burden of pain compared to the general population. Yet “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,” according to Whitney Scott, PhD, Kings College London, in a topical review of the literature published in PAIN®. The review focuses specifically on major depression, bipolar disorder, and psychosis, and highlights potential methods to improve pain management in these populations.
Involving people with lived experience of both severe mental illness and pain is essential to improve treatment.
According to many studies, pain prevalence is higher in people with severe mental illness compared to than healthy populations. In people with depression, the mean pain prevalence is 65%; in bipolar disorder, 29%, double that of health people. In people with schizophrenia, pain prevalence is similar to healthy control groups which is surprising given the high burden of ordinarily painful health conditions in people with schizophrenia which might suggest under reporting or recognition of pain in this group. Yet current understanding of the effects of existing pain management treatments in people with severe mental illness are incomplete, as they are often excluded from clinical trials.
Although pharmacological therapies are often an important part of treatment for people with severe mental illness, medications to treat severe mental illness can adversely interact with pain medication. Both pain and severe mental illness are associated with low physical activity, and though studies do indicate the promise of exercise in improving overall physical and mental health, the data remains unclear as to its specific effects on pain in people with severe mental illness. Psychological treatments like cognitive-behavioral therapy (CBT) are also commonly used to manage the impact of pain on a person’s quality of life. However, 60% of clinical trials of such treatments for pain reviewed in one study excluded people with severe mental illness. Such exclusions also happen in clinical practice often due to the perceived “complex mental health needs” of this population.
Yet there are opportunities to more fully integrate pain and severe mental illness care, including innovations in treatment. As family and caregiver support are associated with reduced hospitalization and identification of poor health in people with severe mental illness, their involvement is integral to advancing research on pain and severe mental illness. Pain assessment in people with severe mental illness is often lacking and mental health stigma may contribute to clinicians underestimating the pain experience of people with severe mental illness.
To mitigate this stigma, Scott and her co-authors suggest service planning and funding to increase access to more integrated and inclusive treatments. They also suggest the potential benefits of clinical role-plays developed with people with lived experience “to improve clinicians’ communication with people with pain and severe mental illness so interactions are empathic and respectful.” Psychological treatments may also support people to manage the impact of mental health and pain stigma, although this needs to occur alongside wider changes in health systems and society to reduce stigma toward people with pain and severe mental illness.
Other opportunities include greater involvement of key stakeholders, such as caregivers, mental health professionals, pain specialists, and policymakers – all of which have experience supporting people with pain and severe mental illness; single-case experimental designs can enable more personalized care and understanding of how and for whom integrated treatments might work; and implementation science methodologies can help identify barriers and opportunities in managing both pain and severe mental illness in real-word practice.
Click here to read “Pain management in people with severe mental illness: an agenda for progress“
PAIN is the official publication of the International Association for the Study of Pain (IASP) and publishes original research on the nature, mechanisms, and treatment of pain. The journal continues to be a premier journal in the field of anesthesiology and provides a forum for the dissemination of basic and applied pain research.
About the International Association for the Study of Pain
The International Association for the Study of Pain (IASP) is the leading global organization supporting the study and practice of pain and pain relief. IASP brings together scientists, clinicians, health care providers, and policymakers from around the world in pursuit of their mission to bring relief to those who are in pain.
About Wolters Kluwer
Wolters Kluwer (WKL) is a global leader in professional information, software solutions, and services for the clinicians, nurses, accountants, lawyers, and tax, finance, audit, risk, compliance, and regulatory sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with advanced technology and services.
Wolters Kluwer reported 2020 annual revenues of €4.6 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 19,200 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands.
Wolters Kluwer provides trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers and students in effective decision-making and outcomes across healthcare. We support clinical effectiveness, learning and research, clinical surveillance and compliance, as well as data solutions. For more information about our solutions, visit https://www.wolterskluwer.com/en/health and follow us on LinkedIn and Twitter @WKHealth.
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