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September 2023 | VISN 5 MIRECC Link

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Impact of mental health on seeking pain care among veterans with serious mental illness

Research Publication:

Tonge N, Travaglini LE, Brown CL, Muralidharan A, Goldberg R. Impact of mental health on seeking pain care among veterans with serious mental illness. General Hospital Psychiatry. 2022; 75:92-93. doi: 10.1016/j.genhosppsych.2021.07.008

Chronic pain is one of the main reasons people seek health care in the United States. It can have a serious impact on a person’s physical, social, and emotional functioning, and is often related to depression, anxiety, and other mental health concerns. Individuals with serious mental illness (SMI) – such as schizophrenia, bipolar disorder, and severe major depression – often experience chronic pain, yet it is unclear how much symptoms associated with these disorders (depression, mania, psychosis, poor sleep) affect one’s decision to seek pain care. The current study looked at the relationship between mental health symptoms (depression, psychosis, insomnia) and pain severity, and examined how they were related to help-seeking for pain (i.e., saw a provider for pain in the past six months) in a sample of 184 Veterans with SMI and joint pain.

We found that pain severity was significantly related to depression, insomnia, and psychosis. Pain severity alone did not affect whether these Veterans sought care for pain concerns. However, level of depression interacted with pain severity to determine whether a person sought care for a pain complaint. In the general population, when a person has both high pain severity and depression they are more likely to seek help for their pain. However, in this sample of Veterans with SMI, those with greater depression and pain severity were less likely to seek out pain care; those with high pain severity and low depression severity were most likely to go to a health care provider for pain concerns.

What Can Providers Do?

  • Ask all Veteran patients not only about their pain severity (0-10 rating), but also about the impact of pain on functioning, including mental and emotional well-being.
  • Teach Veteran patients about chronic pain and its relationship with mental and emotional health.
  • Monitor depression and other mental health symptoms that could impact identification and treatment of pain conditions.
  • Provide behavioral or nonpharmacological options to Veterans, such as pain psychotherapy, stretching/physical activity, or complementary/integrative health approaches.
  • Learn more about pain and pain management here:

What Can Veterans and their Families Do?

  • Learn more about pain, why chronic pain develops, and how its related to mental and emotional health.
  • Talk to providers about pain and how it’s affecting your day-to-day life. Not only can primary care and medical providers help with pain – mental health providers can also provide support and resources to better cope with pain.
  • Talk to family members – and family members can talk to Veterans – about their pain experience and ways they can support their pain management needs and goals.
  • Consider pain management strategies that can help with both pain and mental health concerns, such as stress management, physical activity, and engaging in enjoyable or meaningful activities.
  • Learn more about chronic pain and pain management strategies here:
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