Loneliness Early in the Pandemic Increased Pain Catastrophizing in Chronic Pain

Individuals with chronic pain who were lonely during the first months of the pandemic were found to have increased pain catastrophizing and severity of depression 1 year later, according to the results of a study published in the Journal of Pain Research.

Investigators from Harvard Medical School recruited adults with chronic pain through an online platform and invited patients who had participated in their previous chronic pain studies for this analysis. Participants (N=93) responded to 2 surveys containing questions about their pain symptoms and mental health between April and June 2020 and May and June 2021. The effect of loneliness experienced at the beginning of the COVID-19 pandemic was found to be associated with pain-related outcomes. Loneliness was defined as a UCLA Loneliness Scale Version 3 score of 6 or greater, pain catastrophizing was defined as a Pain Catastrophizing Scale score of 16 or greater, mild depression was defined as a Patient Outcome Measurement Information System (PROMIS) score ranging from 17 to 22, moderate depression was defined as a PROMIS score ranging from 23 to 32, and severe depression was defined as a PROMIS score of 33 or greater.

The mean age of the study participants was 40.6 (standard deviation [SD], 16.0) years, 80% were women, 82% were White, 59% reported back pain, 24% reported fibromyalgia, 7% reported surgical pain, and 63% described experiencing chronic pain in another location, respectively. Mean pain severity score was 5.2 (SD, 1.7) points, and mean pain interference score was 31.9 (SD, 16.5) points. Nearly three-quarters of study participants were using pain medication, among whom 58% used over-the-counter medications, 22% used marijuana, and 15% used opioids.

Early in the pandemic, 66% of patients met the criteria for loneliness.

After 1 year of living through the pandemic, 66% had high pain catastrophizing, 17% had mild depression, 24% had moderate depression, and 3% had severe depression, respectively.

Pain catastrophizing at 1 year was associated with early pandemic pain catastrophizing (r, 0.70; P <.001), depression (r, 0.63; P <.001), pain interference (r, 0.42; P <.001), loneliness (r, 0.34; P <.01), and pain intensity (r, 0.31; P <.01).

Loneliness early in the pandemic predicted pain catastrophizing at 1 year (F_[6,85], 18.19; P <.001). The relationship between loneliness and pain catastrophizing at year 1 (b, 0.66) was mediated by the relationship between loneliness early in the pandemic with depression at year 1 (b, 1.07; P <.01), and depression at year 1 was related associated with pain catastrophizing at year 1 (b, 0.53; P <.01).

This study may have been limited by the convenience sampling recruitment strategy employed.

These data indicated that patients with chronic pain who experienced loneliness early in the pandemic were found to have higher pain catastrophizing at 1 year, which was mediated by depression. The study authors conclude that “studying these associations and the mediational role of depression in this sample of patients with chronic pain is clinically important, in that it provides novel insights into how we may prioritize the employment of behavioral interventions to help individuals.”