Scientific Online Resource System

Scripta Scientifica Medica

Correlations between pain intensity, severity of depression, state and trait anxiety in patients with chronic pain and depression

Tatyana Telbizova, Ivan Aleksandrov


Introduction: Patients with chronic pain and depression are a specific group in which mental (depression and anxiety) and physical (pain) symptoms manifest together.

Aim: The aim of the present study is to investigate the correlations between the severity of depression, the anxiety (trait and state), and the intensity of pain in patients with chronic pain and depression.

Materials and Methods: The study included 61 patients with chronic pain and depression. It was conducted in two stages with a three-month period between them. All participants received antidepressant treatment. The severity of depression was assessed with HAM-D-17, the level of state and trait anxiety—with Spielberger’s STAI, and pain intensity—with VAS. A correlation analysis between the main indicators was carried out in both stages of the study.

Results: The mean age of the sample was 55.61 ± 10.91. Women comprised 91.8% of the sample and men—8.2%. A reduction of the mean values of the indicators in the second stage was reported, with the most pronounced being in the severity of depression from 16.15 ± 5.87 to 13.36 ± 6.96. The number of patients with high trait (80.33%) and high state anxiety (64%—first stage, 62.5%—second stage) was predominant. The correlation analysis at both stages of the study proved significant correlations between all indicators (p < 0.01).

Conclusion: The patients with chronic pain and depression are a specific group that requires a complex clinical assessment of the associated indicators depression, anxiety, and pain intensity for their effective management.


chronic pain, state anxiety, depression, trait anxiety, pain intensity, correlation analysis

Full Text


Hadi MA, McHugh GA, Closs SJ. Impact of chronic pain on patients’ quality of life: A comparative mixed-methods study. J Patient Exp. 2019;6(2):133-41. doi: 10.1177/2374373518786013.

Mills SEE, Nicolson KP, Smith BH. Chronic pain: a review of its epidemiology and associated factors in population-based studies. Br J Anaesth. 2019;123(2):e273-e283. doi: 10.1016/j.bja.2019.03.023.

Moayedi M, Davis KD. Theories of pain: from specificity to gate control. J Neurophysiol. 2013;109(1):5-12. doi: 10.1152/jn.00457.2012.

Bevers К, Watts L, Kishino ND, Gatchel RJ. The biopsychosocial model of the assessment, prevention, and treatment of chronic pain. US Neurology. 2016;12(2):98–104. doi: 10.17925/USN.2016.12.02.98.

Dueñas M, Ojeda B, Salazar A, Mico JA, Failde I. A review of chronic pain impact on patients, their social environment and the health care system. J Pain Res. 2016;9:457-67. doi: 10.2147/JPR.S105892.

Woo AK. Depression and Anxiety in Pain. Rev Pain. 2010;4(1):8-12. doi: 10.1177/204946371000400103.

van Hecke O, Torrance N, Smith BH. Chronic pain epidemiology – where do lifestyle factors fit in? Bri J Pain. 2013;7 (4):209-17. doi: 10.1177/2049463713493264.

Müller R, Landmann G, Béchir M, Hinrichs T, Arnet U, Jordan X, et al. Chronic pain, depression and quality of life in individuals with spinal cord injury: Mediating role of participation. J Rehabil Med. 2017;49(6):489-96. doi:10.2340/16501977-2241.

Kroenke K, Wu J, Bair MJ, Krebs EE, Damush TM, Tu W. Reciprocal relationship between pain and depression: a 12-month longitudinal analysis in primary care. J Pain. 2011;12(9):964-73. doi: 10.1016/j.jpain.2011.03.003.

Krishnan RRK, France RD, Pelton S, McCann UD, Davidson J, Urban BJ. Chronic pain and depression. II. Symptoms of anxiety in chronic low back pain patients and their relationship to subtypes of depression. Pain. 1985;22(3):289-94. doi: 10.1016/0304-3959(85)90029-6.

Castro MMC, Quarantini LC, Daltro C, Pires-Caldas M, Koenen KC, Kraychete DC, et al. Comorbid depression and anxiety symptoms in chronic pain patients and their impact on health-related quality of life. Rev Psiq Clín. 2011;38(4):126-9. doi: 10.1590/s0004-282x2009000600004.

Telbizova T, Aleksandrov I, Arnaoudova M. Chronic pain and depression – arbitrariness or consecution of the patient’s diagnostic and treatment route. J of IMAB. 2021;27(3):3851-7. doi: 10.5272/jimab.2021273.3851.

Mansfield KE, Sim J, Jordan JL, Jordan KP. A systematic review and meta-analysis of the prevalence of chronic widespread pain in the general population. Pain. 2016;157(1):55-64. doi: 10.1097/j.pain.0000000000000314.

Agüera-Ortiz L, Failde I, Mico JA, Cervilla J, López-Ibor JJ. Pain as a symptom of depression: Prevalence and clinical correlates in patients attending psychiatric clinics. J Affect Disord. 2011;130(1-2):106-12. doi: 10.1016/j.jad.2010.10.022.

Albert PR. Why is depression more prevalent in women? J Psychiatry Neurosci. 2015;40(4):219-21. doi: 10.1503/jpn.150205.

Munce SE, Stewart DE. Gender differences in depression and chronic pain conditions in a national epidemiologic survey. Psychosomatics. 2007;48(5):394-9. doi: 10.1176/appi.psy.48.5.394.

Lee HJ, Choi EJ, Nahm FS, Yoon IY, Lee PB. Prevalence of unrecognized depression in patients with chronic pain without a history of psychiatric diseases. Korean J Pain. 2018;31(2):116-24. doi: 10.3344/kjp.2018.31.2.116.

dos Santos EB, Quintans Junior LJ, Fraga BP, Macieira JC, Bonjardim LR. Avaliação dos sintomas de ansiedade e depressão em fibromiálgicos [An evaluation of anxiety and depression symptoms in fibromyalgia]. Rev Esc Enferm USP. 2012;46(3):590-6.

Vietri J, Otsubo T, Montgomery W, Tsuji T, Harada E. Association between pain severity, depression severity, and use of health care services in Japan: results of a nationwide survey. Neuropsychiatr Dis Treat. 2015;11:675-83. doi: 10.2147/NDT.S71768.

Hallegraeff JM, Kan R, van Trijffel E, Reneman MF. State anxiety improves prediction of pain and pain-related disability after 12 weeks in patients with acute low back pain: a cohort study. J Physiother. 2020;66(1):39-44. doi: 10.1016/j.jphys.2019.11.011.

Knowles KA, Olatunji BO. Specificity of trait anxiety in anxiety and depression: Meta-analysis of the State-Trait Anxiety Inventory. Clin Psychol Rev. 2020;82:101928. doi: 10.1016/j.cpr.2020.101928.

Tang J, Gibson SJ. A psychophysical evaluation of the relationship between trait anxiety, pain perception, and induced state anxiety. J Pain. 2005;6(9):612-9. doi: 10.1016/j.jpain.2005.03.009.

Stoyanov V. [Empirical psychological research: quantitative versus qualitative approach.] Varna: Steno Publishing House; 2020. [in Bulgarian]

Rogers HL, Brotherton HT, de Luis A, Olivera-Plaza SL, Córdoba-Patiño AF, Peña-Altamar ML. Depressive symptoms are independently associated with pain perception in Colombians with rheumatoid arthritis. Acta Reumatol Port. 2015;40(1):40-9.

Linton SJ, Götestam KG. Relations between pain, anxiety, mood and muscle tension in chronic pain patients. A correlation study. Psychother Psychosom. 1985;43(2):90-5. doi: 10.1159/000287864.

Xie J, Bi Q, Li W, Shang W, Yan M, Yang Y, et al. Positive and negative relationship between anxiety and depression of patients in pain: a bifactor model analysis. PLoS One. 2012;7(10):e47577. doi: 10.1371/journal.pone.0047577.

About The Authors

Tatyana Telbizova
Medical University of Varna

Department of Psychiatry and Medical Psychology, Faculty of Medicine

Ivan Aleksandrov
Medical University of Varna

Department of Health Care, Sliven Affiliate

Font Size