Urgent need for more research and focus on tr
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 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 expectancies, and an increased likelihood of health problems that lead to a high pain burden compared to the general population. Yet, “pain is not systematically assessed and managed in this population and the communication and assessment of pain can be obscured by the nature of serious mental illness,” according to Whitney Scott, PhD, Kings College London, in a thematic 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.
To improve treatment, it is essential to involve people with lived experience of both serious mental illness and pain.
According to many studies, the prevalence of pain is higher in people with severe mental illness than in healthy populations. In people with depression, the average prevalence of pain is 65%; in bipolar disorder, 29%, double that of healthy people. In people with schizophrenia, the prevalence of pain is similar to healthy control groups, which is surprising given the high burden of usually painful health conditions in people with schizophrenia, which could suggest a under-reporting or under-recognition of pain in this group. Yet current understanding of the effects of existing pain management treatments in people with severe mental illness is incomplete, as they are often excluded from clinical trials.
Although pharmacological therapies are often an important part of treatment for people with serious mental illness, medications to treat serious mental illness can interact negatively with pain medications. Pain and severe mental illness are associated with low physical activity, and while studies indicate that exercise shows promise for improving overall physical and mental health, the data remains unclear as to its specific effects on pain in adults. 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 pain treatments examined in one study excluded people with severe mental illness. Such exclusions also occur 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 serious mental illness care, including treatment innovations. Since the support of family and caregivers is associated with reduced hospitalizations and the identification of poor health in people with serious mental illness, their involvement is integral to advancing the research on pain and serious mental illness. Assessment of pain in people with serious mental illness is often lacking, and mental health stigma may contribute to clinicians underestimating the pain experience of people with serious mental illness.
To alleviate this stigma, Scott and his 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-playing games developed with people with lived experience “to improve clinicians’ communication with people with pain and severe mental illness so that interactions are empathetic and respectful.” Psychological treatments can also help people deal with the impact of stigma on mental health and pain, although this needs to happen alongside wider changes in health systems and society to reduce stigma towards people with mental illness. people with pain and severe mental illness.
Other opportunities include greater involvement of key stakeholders, such as carers, mental health professionals, pain specialists and policy makers – all of whom have experience supporting people with pain. and severe mental illness; single-case experimental designs can allow for 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 the management of pain and serious mental illness in real-word practice.
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 leading 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 world’s leading organization supporting the study and practice of pain and pain relief. IASP brings together scientists, clinicians, healthcare providers and policy makers from around the world in pursuit of their mission to bring relief to those who suffer.
About Wolters Kluwer
Wolters Kluwer (WKL) is a global leader in professional information, software solutions and services for clinicians, nurses, accountants, lawyers and the tax, finance, auditing, risk, compliance and regulation. We help our customers make critical decisions every day by delivering expert solutions that combine deep domain knowledge with advanced technology and services.
Wolters Kluwer achieved annual sales of €4.6 billion in 2020. The group serves customers in over 180 countries, maintains operations in over 40 countries and employs around 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 in healthcare. We support clinical efficiency, learning and research, clinical monitoring and compliance, and 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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