To determine whether pharmacologic exposure is associated with differences in fibromyalgia neurobehavioral phenotypes and whether medication burden explains symptom variability within phenotypes.

We analyzed a multisite cohort of 695 adults meeting fibromyalgia criteria, stratified into low- and high-impact phenotypes using a disability-based classification. Medication burden was quantified as total, centrally acting, and noncentrally acting medication counts. Between-phenotype differences and within-phenotype associations between medication burden and symptom severity were evaluated using nonparametric tests, Spearman correlation analyses, and multivariable linear regression models. Phenotypes were interpreted within the framework of centrally mediated neurobehavioral dysfunction.

Participants classified within the high-impact neurobehavioral phenotype (n = 175) demonstrated substantially greater symptom burden across fibromyalgia impact, central sensitization, depressive symptoms, pain severity, and vitality compared with low-impact participants (n = 520). Centrally acting medication burden increased stepwise with phenotype severity, whereas noncentrally acting medication use did not differ between phenotypes. Within phenotypes, centrally acting medication burden showed weak and nonsignificant associations with symptom severity after adjustment for demographic covariates, explaining minimal variance in fibromyalgia impact (R2 < 0.05).

Fibromyalgia symptom phenotypes remained distinct across varying levels of pharmacologic exposure, and medication burden explained little within-phenotype symptom variability. Medication burden primarily reflects downstream clinical response to symptom severity rather than a determinant of phenotype organization. These findings support the use of stable multidimensional phenotypes for mechanistic, neurobiological, and stratified intervention studies in chronic pain and related central nervous system disorders.

Sleep disturbance, chronic pain and mental health symptoms frequently co-occur in older adults, but data from the Middle East remain limited.

This study aimed to examine sleep quality and its associations with pain and mental health symptoms among community-dwelling older adults in Jordan.

A cross-sectional study was conducted among adults aged ≥60 years recruited from geriatric clinics and rehabilitation centres. Sleep quality (primary outcome) was assessed using the Pittsburgh Sleep Quality Index (PSQI). The Insomnia Severity Index (ISI), International Restless Legs Syndrome Severity Rating Scale (IRLS), daytime sleepiness via the Epworth Sleepiness Scale (ESS), Depression Anxiety Stress Scale (DASS-21) and the Brief Pain Inventory were measured. Correlation and multiple linear regression models by domain (demographic, lifestyle/health, sleep-specific, mental health and pain), followed by a fully adjusted model, were performed.

A total of 121 participants (mean age 67.9 ± 7.5 years, 44.6% female) were included. Mean PSQI score was 13.5 ± 3.2, indicating poor sleep quality. In bivariate analysis, higher ISI, IRLS, ESS, DASS-21 and pain severity/interference were significantly associated with poorer sleep quality (all p < 0.01). Domain-specific models identified insomnia severity, depressive and anxiety symptoms and pain variables as significant predictors. In the fully adjusted model (adjusted R2 = 0.268), only insomnia severity remained as an independent predictor of poorer sleep quality, with retirement showing a borderline association.

Poor sleep quality is highly prevalent among community-dwelling older adults in Jordan and is driven primarily by insomnia severity rather than demographic or health factors. Targeting insomnia may yield the greatest improvements in sleep quality in this population.

Chronic pain represents a major global public health issue. It is associated with wide-ranging psychosocial consequences. Extensive evidence has demonstrated that pain catastrophizing (PC) contributes to the bidirectional association between chronic pain and psychological distress. The present study aims to explore the psychological and cognitive correlates of chronic pain among individuals living in Gaza.

A cross-sectional study was conducted among 272 adults with chronic musculoskeletal pain. Spearman’s correlations assessed associations between pain intensity, catastrophizing and depressive symptoms. Multiple regression and bootstrapped mediation analyses (5,000 resamples and PROCESS macro) evaluated predictors and the mediating role of catastrophizing in the pain–depression relationship.

Pain intensity was positively correlated with depression (r = 0.28, p < 0.001) and catastrophizing (r = 0.39, p < 0.001). A stronger correlation was found between catastrophizing and depression (r = 0.54, p < 0.001). Mediation analysis demonstrated that catastrophizing fully mediated the association between pain intensity and depression (indirect effect = 0.95, 95% confidence interval = [0.65–1.29]).

PC is a key psychological mechanism linking pain intensity and depression among patients with chronic pain in Gaza. Integrating cognitive-behavioral therapy, mindfulness and emotion regulation strategies into pain management may improve mental health outcomes in conflict-affected settings.

Chronic pain activates the HPA axis stress response resulting in the release of cortisol, although empirical associations are often contradictory. Quantile regression models of hair cortisol may help us measure HPA-axis dysregulation more accurately and establish more robust associations with chronic pain. We also examined whether people with chronic pain characterised by HPA-axis dysregulation are at risk of future mental ill-health.

This study examined data from the English Longitudinal Study of Ageing (ELSA, n = 4,560) and the UK Household Longitudinal Survey-Innovation Panel (UKHLS-IP, n = 473) to assess whether quantile regression methods enable us to assess more robust associations between hair cortisol and chronic pain, and whether older adults with chronic pain characterised by HPA-axis dysregulation are at risk of future mental ill-health.

In ELSA, chronic pain was associated with a 15% (CI: 6%–23%) increase in cortisol at the 10th percentile of the hair cortisol distribution among older adults and a 19% (CI: 2%–37%) increase at the 80th percentile, but no association was found at the 30th or 40th percentiles. Having a low cortisol response to chronic pain protected against the recurrence of depression. These patterns of association were replicated in the UKHLS-IP sample.

The associations demonstrated across two longitudinal population surveys from the UK indicate that quantile regression analysis of hair cortisol may be useful in identifying individuals resilient to chronic pain. Hair cortisol is a promising biomarker that can be measured in population studies to quantify the stress response and resilience to future mental ill-health.

Chronic pain (CP) and mental disorders often coexist, yet their relationship lacks comprehensive synthesis. This first hierarchical umbrella review examined systematic reviews and meta-analyses, also observational studies and randomized controlled trials (where reviews are currently lacking) to report CP prevalence, risk factors, and treatment across mental disorders.

We searched MEDLINE, PsycINFO, Embase, Web of Science, and CINAHL, identifying 20 studies on anxiety, depression, bipolar disorder, schizophrenia, ADHD, autism, or dementia, and CP. Quality was assessed using AMSTAR and Newcastle-Ottawa Scale.

Prevalence varied widely—23.7% (95% CI 13.1–36.3) in bipolar disorder to 96% in PTSD—consistently exceeding general population rates (20–25%). Risks were elevated, with bidirectional links in depression (OR = 1.26–1.88). Risk factors included female gender, symptom severity, and socioeconomic disadvantage, though data were limited beyond PTSD and depression. Treatment evidence was sparse: cognitive behavioral therapy showed small effects on pain (SMD = 0.27, 95% CI -0.08–0.61), acupuncture with medication improved pain (MD = -1.06, 95% CI -1.65–-0.47), and transcranial direct current stimulation reduced pain in dementia (d = 0.69–1.12). Methodological issues were evident, including heterogeneous designs and inconsistent pain definitions.

This review confirms CP as a significant comorbidity in mental disorders. Clinicians should prioritize routine pain screening and multimodal treatments. Researchers need longitudinal studies with standardized assessments to clarify causality and improve interventions. Taken together, this work highlights an urgent need for integrated psychiatric care approaches, emphasizing that addressing CP could enhance mental health outcomes and overall patient well-being.

Mental ill-health has a major impact on young people, with pain often co-occurring. We estimated the prevalence and impact of pain in young people with mental ill-health.

Longitudinal data (baseline and three-month follow-up) of 1,107 Australian young people (aged 12–25 years) attending one of five youth mental health services. Multi-level linear mixed models estimated associations between pain characteristics (frequency, intensity, and limitations) and outcomes with false discovery rate (FDR) adjustment. Pain characteristics were baseline-centered to estimate if the baseline score (between-participant effect) and/or change from baseline (within-participant effect) was associated with outcomes.

At baseline, 16% reported serious pain more than 3 days, 51% reported at least moderate pain, and 25% reported pain-related activity limitations in the last week. Between participants, higher serious pain frequency was associated with greater anxiety symptoms (β[95%CI]: 0.90 [0.45, 1.35], FDR-p=0.001), higher pain intensity was associated with greater symptoms of depression (1.50 [0.71, 2.28], FDR-p=0.001), anxiety (1.22 [0.56, 1.89], FDR-p=0.002), and suicidal ideation (3.47 [0.98, 5.96], FDR-p=0.020), and higher pain limitations were associated with greater depressive symptoms (1.13 [0.63, 1.63], FDR-p<0.001). Within participants, increases in pain intensity were associated with increases in tobacco use risk (1.09 [0.48, 1.70], FDR-p=0.002), and increases in pain limitations were associated with increases in depressive symptoms (0.99 [0.54, 1.43], FDR-p<0.001) and decreases in social and occupational functioning (−1.08 [−1.78, −0.38], FDR-p=0.009).

One-in-two young people seeking support for mental ill-health report pain. Youth mental health services should consider integrating pain management.

The impact of chronic pain and opioid use on cognitive decline and mild cognitive impairment (MCI) is unclear. We investigated these associations in early older adulthood, considering different definitions of chronic pain.

Men in the Vietnam Era Twin Study of Aging (VETSA; n = 1,042) underwent cognitive testing and medical history interviews at average ages 56, 62, and 68. Chronic pain was defined using pain intensity and interference ratings from the SF-36 over 2 or 3 waves (categorized as mild versus moderate-to-severe). Opioid use was determined by self-reported medication use. Amnestic and non-amnestic MCI were assessed using the Jak-Bondi approach. Mixed models and Cox proportional hazards models were used to assess associations of pain and opioid use with cognitive decline and risk for MCI.

Moderate-to-severe, but not mild, chronic pain intensity (β = −.10) and interference (β = −.23) were associated with greater declines in executive function. Moderate-to-severe chronic pain intensity (HR = 1.75) and interference (HR = 3.31) were associated with a higher risk of non-amnestic MCI. Opioid use was associated with a faster decline in verbal fluency (β = −.18) and a higher risk of amnestic MCI (HR = 1.99). There were no significant interactions between chronic pain and opioid use on cognitive decline or MCI risk (all p-values > .05).

Moderate-to-severe chronic pain intensity and interference related to executive function decline and greater risk of non-amnestic MCI; while opioid use related to verbal fluency decline and greater risk of amnestic MCI. Lowering chronic pain severity while reducing opioid exposure may help clinicians mitigate later cognitive decline and dementia risk.

Chronic pain and depression are common in older people, and creative activities may lower the perceived impact and distress related to the symptoms.

This study describes the co-development of a creative arts and crafts protocol for older people with chronic pain and depressive symptoms, and investigates its feasibility and potential effects.

This study had two phases. In phase 1, a multidisciplinary expert panel (n = 10), consisting of professionals, patients and researchers, underwent iterative rounds to co-develop the protocol. In phase 2, a pilot study was conducted among 12 older adults (mean age 71.4 years). Mixed methods were used, including questionnaires at baseline, post-intervention and 3-month follow-up, assessing pain intensity and interference, depressive symptoms and quality of life; observational notes and focus groups. Descriptive and Wilcoxon signed-rank tests were applied to analyse quantitative data, and thematic analysis was used for qualitative data.

Qualitative findings supported the programme’s feasibility. Participants reflected that the process was engaging and empowering and brought them a sense of achievement and recognition. The quantitative findings evidenced the programme’s potential effects in reducing depressive symptoms (Z = −2.60, P < 0.01) and improving mental health-related quality of life (Z = −2.67, P < 0.01) at 3-month follow-up.

Our results support the feasibility of a creative arts and crafts programme and provide preliminary evidence of its impact on reducing depressive symptoms and improving mental health-related quality of life. Given the promising results, a definitive trial is needed to reveal the effectiveness of creative activities in pain management.

Pain is a frequent symptom in cancer patients (CP), and its multidimensional assessment is essential for a comprehensive approach and to establish clinical prognoses. The Short-Form McGill Pain Questionnaire (SF-MPQ) is an internationally recognized tool for the multidimensional assessment of pain, both in clinical and research settings. However, no studies have been reported in Latin America that determine its psychometric properties in CP and chronic pain.

To determine the psychometric properties of the SF-MPQ in adult Mexican cancer patients with chronic pain.

An instrumental design was used with a non-probabilistic convenience sample of 222 cancer patients treated at the pain clinic of a tertiary care hospital. Analyses were conducted to evaluate factorial structure (exploratory and confirmatory factor analysis [CFA]), reliability (internal consistency), measurement invariance, and criterion validity (concurrent and divergent).

CFA verified a 9-item structure divided into 2 factors: (1) Affective-Nociceptive and (2) Neuropathic. A global Cronbach’s alpha coefficient of .82 and a global McDonald’s Omega index of .82 were identified. Configural, metric, and scalar invariance (ΔCFI ≤ .01; ΔRMSEA ≤ .015) were confirmed regarding the sex variable. Finally, the SF-MPQ showed a positive correlation with the Numerical Rating Scale (rho = .436, p< .01) and a negative correlation with the EORTC-QLQ C30 (rho = −.396, p< .01).

The Mexican version of the SF-MPQ presented adequate psychometric properties and fit indices, making it a valid and reliable instrument for use in clinical and research settings in Mexico. Its use is recommended for the comprehensive assessment of pain in oncology in Mexico, as it allows for the understanding of pain characteristics beyond intensity, guiding the establishment of clinical prognoses.