A review of chronic pain with depression and/or anxiety comorbidities in the Indian population

Chronic pain and psychiatric conditions often coexist with shared risk factors and a reverse causal link. Depression and anxiety comorbidities are associated with increased pain intensity, less favorable response to treatments, and higher medical costs. The management of psychiatric comorbidities in chronic pain conditions is less explored in India. This paper aims to review the current literature landscape of comorbid depressive and/or anxiety disorders with chronic pain conditions in the Indian populations and identify need gaps for future research. A literature search on MEDLINE database and other sources conducted from January 2010 through March 2020 retrieved 84 shortlisted eligible articles and their findings were synthesized into a narrative review. There was a high prevalence of comorbid depression and anxiety with chronic pain observed across multiple pain etiologies and population groups in the Indian setting. Women had a higher burden of psychiatric comorbidities in chronic pain conditions compared with men. Poor socioeconomic conditions and pain severity were important risk factors that predisposed individuals to psychological distress. There was limited data on evidence-based management of chronic pain and comorbid depression or anxiety for Indian populations. Barriers toward effective pain management in India occur at the level of patients, physicians, or healthcare systems; some of these challenges relate to patient's health-seeking behavior, stigma associated with psychiatric treatment, physician awareness, and education, and access to pain medications. Future initiatives are needed toward building an evidence base for effective management of pain and comorbid psychiatric conditions in India.