When thinking about pain contributes to suffering: the example of pain catastrophizing

Depressive symptoms are highly prevalent and associated with fatigue and pain catastrophizing in the Hypermobility Spectrum Disorders and hypermobile Ehlers Danlos syndrome: a cross-sectional study

Individuals living with Hypermobility Spectrum Disorders and the hypermobile Ehlers-Danlos syndrome (HSD/hEDS) often experience recurrent joint injury, chronic pain, and fatigue. Although generalized anxiety has been recognized as a common comorbidity with HSD/hEDS, minimal research has examined depressive symptoms in this population. The purpose of this investigation was to describe the prevalence, nature, and severity of depressive symptoms in the HSD/hEDS population, and to explore associations with other potential confounding factors. All individuals with HSD/hEDS referred to a specialized connective tissue disorder Physical Medicine & Rehabilitation clinic were asked to self-report demographic data and complete the 9-item Patient Health Questionnaire (PHQ-9), 7-item Generalized Anxiety Disorder Questionnaire (GAD-7), Pain Catastrophizing Symptoms (PCS) questionnaire, and Fatigue Severity Scale (FSS) at their initial clinic visit. Data was prospectively collected between January 2019 and December 2024. Descriptive statistics were performed. A Spearman correlation matrix was used to identify relevant factors associated with depressive symptoms. Relationships emerging as significant (p < 0.001) were further analyzed using independent sample Mann-Whitney U-tests. Fifty-nine individuals (53 female, mean ± SD age: 34.4 ± 11 years) were included, with a mean ± SD PHQ-9 score of 11.2 ± 5.9, indicating moderate depressive symptom severity. 53% of participants (n = 31) met criteria for major depressive disorder (PHQ-9 ≥ 10). Higher pain catastrophizing (ρ = 0.611, p < 0.001) and higher fatigue scores (ρ = 0.593, p < 0.001) were both associated with significantly higher depressive symptoms, but there were no associations with respect to age, working status, and number of alcoholic drinks consumed per week. This research suggests that depression is highly prevalent in patients experiencing HSD/hEDS. There is also a strong association between pain catastrophizing and fatigue in those experiencing depressive symptoms. The interaction between depressive symptoms, pain catastrophizing, and fatigue should be considered in the holistic management of HSD/hEDS.

A lesson for post-COVID healthcare: assessment of physical and psychosocial risk factors on perceived pain intensity among urban individuals

Background

Perceived pain intensity is an important determinant of health-related quality of life. A lack of studies has investigated the co-influences of physical and psychosocial risk factors on perceived pain intensity and the shifts in effects after pandemic. As a post-COVID symptom, it is important to re-assess the risk factors for post-COVID heath care.

Methods

Four dimensions of physical/psychosocial risk factors were assessed: medical history, personal wellbeing and psychological distress, lifestyle, and socio-demographic characteristics. We first identified subgroups with significant increase in perceived pain intensity after pandemic by a comparison with the baseline group (all participants). Based on the variables associated with a severe increase in pain score (NRS), multivariate regression models were applied to identify risk factors on perceived pain intensity.

Results

Among 3,237 urban individuals in Hong Kong, 20.95 and 30.58% were with severe pain (NRS > = 4) before and after pandemic. Participants with respiratory disease had the most significant increase in perceived pain intensity (increase in NRS: 1.29 [0.65, 1.93]), seconded by those with known psychiatric diseases and living with special needs. After pandemic, insomnia, known psychiatric diseases, female, and low household income remained as significant risk factors, and insomnia remained as the most significant (estimate: 1.018 [CI: 0.814, 1.221]). The effect sizes of these factors were increased after pandemic. Respiratory disease, cardiovascular disease, and low education (secondary school or below) were additional risk factors.

Conclusion

It is necessary to develop up-to-date interventions targeting vulnerable populations, particularly individuals with known psychiatric diseases and insomnia, for pain reduction.