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Those with nociplastic pain conditions are more likely to experience anxiety and depression. Photo: Representational Image Those with nociplastic pain conditions are more likely to experience anxiety and depression. Photo: Representational Image

About 40 percent of adults experiencing chronic5xt, persistent pain could also have anxiety or depression, a study has found.

It observed that women, youngsters, and those suffering from nociplastic pain such as fibromyalgia are most likely to experience such pain.

Written against the backdrop of Partition, India’s Constitution adopted a unique brand of federalism that sought to respond to the twin imperatives of nation building and democratic consolidation that placed relatively weak checks and balances on the powers of the Union government. A strong Centre can, for instance, redraw state boundaries. This strong centre coexisted with the recognition that India’s diversity of language, region and religion could only be preserved through federal accommodation.  Thus the constitution allowed for other unique political arrangements that offer varying degrees of autonomy (what political scientists have termed asymmetric federalism) to accommodate specific religious, regional and ethnic identity claims. This is why federalism in India is so closely intertwined with its project of democratic consolidation. The Constitution also crafted a framework for intergovernmental power sharing that has locked the Centre and the states in a relationship of administrative and fiscal interdependence. The Union government has overwhelming revenue powers, while state governments bear the bulk of expenditure responsibilities. In this sense, states are dependent on the Union to fulfil their constitutionally-assigned responsibilities, and the Centre, in turn, is dependent on the states to pursue national goals.

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Nociplastic pain arises from changes in how one's central nervous system processes pain. Fibromyalgia is a condition marked by widespread body aches and tenderness, along with fatigue, and mood and sleep disorders.

During the study published in the Journal of the American Medical Association (JAMA) Network Open, the researchers reviewed 376 surveys, involving nearly 3.5 lakh people from across 50 countries. The participants were aged about 50 years on average, and about 70 percent were women.

The most commonly reported chronic pain conditions in the study included fibromyalgia, low back pain, and rheumatoid arthritis (inflammation of joints). Pain is said to be chronic if it persists beyond a maximum of three months.

"In this systematic review and meta-analysis of depression and anxiety among individuals with chronic pain, approximately 40 percent of adults had clinically significant depression and anxiety," the authors wrote.

Therefore, a mental health screening of patients with chronic pain is critical, they said.

While acute pain can be caused by an injury or surgery, its transition to chronic pain has psychological undertones, according to the biopsychosocial model of pain.

Developed in the 1970s, the model suggests that one's experience of pain in response to an external trigger is a complex interplay of biological, psychological, social,66br and cultural factors.

Women are considered especially vulnerable to chronic pain, owing to varied factors, including hormonal cycles and heightened emotional responses.

Further, "women, younger people, and people with nociplastic pain (arising from changes in how one perceives pain) were most likely to have depression and anxiety," the authors wrote.

According to a 2023 round-up article on pain research in The Lancet journal, the biopsychosocial risk factors of poor sleep, despondency, tiredness, stress, and a Body Mass Index of over 30 were the most important reasons for localized pain progressing into chronic pain.

While treatments commonly involve anti-inflammatory drugs and prescription medicines, such as antidepressants and opioids, experts strongly recommend psychotherapy sessions as well.

"Treatments for the most common types of chronic pain (Examples: fibromyalgia, chronic low back pain) have limited impact on pain intensity, meaning many people will live with their pain long-term," said Dr. Bronwyn Thompson, senior lecturer, department of orthopedic surgery and musculoskeletal medicine, University of Otago, New Zealand. He was not involved in the study.

Dr Debbie Bean, a health psychologist and senior lecturer, at Auckland University of Technology, New Zealand, said living with chronic pain can affect many aspects of one's life, including work and social relationships.

"People with chronic pain can also experience stigma, where others don't take their pain seriously, or they may even feel disbelieved or judged for their pain. So, it is not just the pain itself but the effects it has on a person's life that mean that chronic pain can lead to both anxiety and depression," said Dr Bean, who was not involved in the review.

Further, given that depression and anxiety can influence how the body's nervous system responds to painful experiences, the two problems — chronic pain and poor mental health — can become a vicious cycle5xt, Dr Bean said.