Emotional And Physical Pain: Depression Can Be A Sign Of Chronic Pain Years Before It Starts

People who develop chronic pain often feel more lonely and depressed years before the pain begins. These feelings tend to worsen over time. The study shows that treating pain should involve not only medication, but also emotional and social support, especially for those with fewer resources.

Chronic pain is a condition that lasts for months or even years and affects a large portion of the population, especially older adults. It causes not only physical discomfort, but can also profoundly affect people’s emotional and psychological well-being.

For this reason, experts have been adopting a broader view, known as the biopsychosocial model, to understand and treat pain.

This model takes into account not only the medical and biological aspects of pain, but also psychological and social factors, such as feelings of loneliness, isolation and depression. Previous studies have shown that people with chronic pain are more likely to feel lonely or depressed.

However, it was not known exactly how these feelings evolve over time, whether they appear before or after the pain, and how they vary according to age, gender or economic status.

To further investigate this relationship, researchers used data from the English Longitudinal Study of Aging (ELSA), which has been tracking the health of adults over the age of 50 since 2002.

The study analyzed responses from 7,336 participants and compared two groups: one made up of people who developed chronic pain over time, and the other made up of people who did not report pain. They looked at how feelings of loneliness, levels of social isolation, and symptoms of depression evolved over the years in both groups.

The results showed that even before chronic pain began, people who would later develop pain already had higher levels of loneliness and depressive symptoms compared to those who did not experience pain.

These feelings continued to worsen over time, even after the onset of pain. For example, eight years before the onset of pain, participants in the pain group already reported feeling slightly lonelier than those in the pain-free group, and this difference grew over the years. Similarly, depressive symptoms were significantly higher at the time the pain began and remained that way afterward.

On the other hand, no significant differences were found between the two groups in terms of social isolation, which shows that the problem is not necessarily the amount of social interactions, but rather the feeling of disconnection and the emotional state.

The study also revealed that the situation is even more difficult for people with lower educational levels and lower incomes: they felt the emotional and psychological effects of pain more intensely. This reinforces the idea that social and economic factors have a major impact on mental health and the management of chronic pain.

In short, this study shows that chronic pain is strongly linked to feelings of loneliness and depression, which can already be present long before the physical pain appears.

Therefore, pain treatment should begin as soon as possible and include not only medication, but also emotional and social support, especially for more vulnerable people. This would help prevent the worsening of symptoms and improve the quality of life of patients.

READ MORE:

Trajectories of loneliness, social isolation, and depressive symptoms before and after onset of pain in middle-aged and older adults

Mikaela Bloomberg, Feifei Bu, Daisy Fancourt, and Andrew Steptoe

eClinicalMedicine. 103209 May 19, 2025

DOI: 10.1016/j.eclinm.2025.103209

Abstract:

Chronic pain is associated with poor psychosocial wellbeing; how loneliness, social isolation, and depressive symptoms evolve leading up to and following pain onset is unclear. We examined trajectories of these outcomes before and after pain onset. We analysed data from participants aged ≥50 years from the English Longitudinal Study of Ageing (ELSA). Data collection began in 2002 (wave 1) and was repeated biennially until 2019 (wave 9); wave 10 took place in 2021/23. Participants who had data from at least 2 waves were included. Participants reporting pain between 2002 and 2023 (‘pain group’) were matched with an equivalent number without pain (‘no-pain group’; N = 7336 total). Psychosocial outcomes were also assessed at each wave: Loneliness using the three-item subscale from the revised UCLA loneliness scale; social isolation using a score ranging from 0 to 5, with a higher score indicating more severe social isolation; and depression using the 8-item Center for Epidemiologic Studies Depression Scale. Piecewise linear mixed models were used to produce trajectories of loneliness, social isolation, and depressive symptom scores before and after pain onset and during the comparable time period in the no-pain group. Subgroup analyses examined how results differed by age, sex, education, and wealth. Loneliness and depressive symptoms were more severe for the pain group than the no-pain group before pain onset (e.g., difference [pain-no pain] eight years before pain onset = 0.19 points, 95% confidence interval = 0.11–0.28 for loneliness; difference = 0.14, 0.06–0.22 for depressive symptoms). For loneliness, this difference increased consistently during the study period (e.g., difference = 0.33, 0.26–0.40 eight years after pain onset). For depressive symptoms, the difference increased sharply to 0.58 (0.52–0.65) at pain onset and remained stable thereafter. Differences in depressive symptoms were most pronounced in less educated and less wealthy participants. There were negligible differences between pain and no-pain groups for social isolation. Loneliness and depressive symptoms progressively increased in severity years before pain onset. A holistic approach to pain is needed, incorporating early psychosocial interventions and targeted strategies for vulnerable populations.