Patterns of pain perception in individuals with anxiety or depressive disorders: A systematic review and meta-analysis of experimental pain research

Abstract

Differences in pain responses between adults with or without psychiatric conditions are documented, yet the certainty of evidence on the topic has not been assessed. We examined pain responses to experimentally induced pain in individuals diagnosed with anxiety or depressive disorders compared to controls without mental health conditions. We also explored the influence of pain modality and associations between pain perception and symptoms severity. PubMed, CINAHL, PsycINFO, Cochrane, and Embase were searched from inception to March 2025. Included studies reported pain measures (pain threshold, intensity, tolerance, unpleasantness) in adults with anxiety or depression, without co-occurring chronic pain, and healthy controls. The JBI Checklist for Analytical Cross-Sectional Studies and the Quality in Prognosis Studies assessed risk of bias. Certainty of evidence was judged by the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Twenty-eight studies (1460 participants, 935 females) were included, most presenting moderate to high risk of bias. Compared to controls, individuals with depression exhibit higher pain thresholds [SMD = -.30 (95% CI -.60, -.01)] and pain intensity [SMD = .47 (95% CI .08, .86)], while those with anxiety exhibit lower pain thresholds [SMD = -.39 (95% CI -.61, -.17)] (GRADE: very low for all outcomes). Results differed depending on pain modality. Pain threshold was moderately correlated with depression severity: r = .437 (95% CI .208, .621). The data suggest distinct altered pain perception patterns, characterized by higher pain thresholds in depression and lower pain thresholds in anxiety. Adults with depression may be particularly sensitive, but not restricted to, ischemic stimuli. REGISTRATION: OSF (doi:10.17605/OSF.IO/U453J). PERSPECTIVE: This systematic review assessed how pain perception patterns may differ in individuals with anxiety or depression. Few studies included participants with anxiety, controlled for comorbidities, or were recently conducted, thus caution is needed before interpreting our findings. This underscores the need for updated and methodologically robust research on this field.

Keywords: Anxiety disorders; Depressive disorders; Meta-analysis; Pain; Perception.