Comorbidity of chronic musculoskeletal pain, depression, anxiety and sleep problems

PURPOSE OF REVIEW: Individuals with chronic pain (CP) are at elevated risk of mental health problems, but the awareness of this issue among patients as well as medical personnel is limited. Chronic musculoskeletal pain (CMP) is the most common type of CP. This narrative review summarizes the latest literature on the comorbidity of CMP with depression, anxiety and sleep problems. RECENT FINDINGS: Around 40% of CP patients suffer from depression and/or anxiety of clinical severity. Sleep problems affect up to 75% of patients with CP. CMP. Depression, anxiety and impaired sleep are characterized by common underlying physiopathological mechanisms associated with serotonin and noradrenaline neurotransmission, glutamate/γ-aminobutyric acid signaling balance, low Brain-derived neurotrophic factor (BDNF) and altered immune system response. Comorbidity of depression, anxiety and sleep impairment is associated with decline in mental health, functioning and quality of life of the affected individuals, leading to a cumulative disability burden. Evidence supports cognitive behavioral therapy and acceptance and commitment therapy psychotherapies for CMP. Duloxetine is efficacious for pain relief, improvement of mood, anxiety, sleep and quality of life in CMP. SUMMARY: Comorbidity of psychiatric issues among CMP patients is an unmet need which should be addressed to improve patient outcomes. Mental healthcare specialists ought to be integrated into the teams managing CMP patients.