The finding:
This publication is a hierarchical umbrella review that synthesized top-tier evidence from 20 studies, including systematic reviews, meta-analyses, and large observational studies, to assess chronic pain (CP) prevalence, risk factors, and treatments across various mental disorders. The review confirmed CP as a significant comorbidity with prevalence ranging from 23.7% in bipolar disorder to 96% in PTSD. Prevalence consistently exceeded general population rates (20–25%) across all included conditions, often with elevated relative risks. Key risk factors identified included female gender, symptom severity, and socioeconomic disadvantage, with chronic pain and depression showing a significant bidirectional relationship (OR = 1.26–1.88). Treatment evidence was sparse and showed methodological issues; while interventions like Cognitive Behavioral Therapy (CBT) demonstrated only small effects on pain (SMD = 0.27), there was a noted reliance on opioid dispensing (27.2%–45.5%) in individuals with severe mental illness and chronic pain. Ultimately, the paper highlights the need for integrated psychiatric care that emphasizes routine pain screening, standardized assessments, and the development of multimodal interventions.

Strength and weaknesses:
The hierarchical umbrella review methodology gives a rigorous assessment by synthesizing findings from systematic reviews and meta-analyses, and where these were lacking, including large observational studies and randomized controlled trials (RCTs). The review consolidated evidence from over 12 million participants, enhancing the generalizability of the findings. Many studies involving chronic pain in psychiatric conditions exclude psychotic disorders, but this review included bipolar disorder (BD) and schizophrenia. And finally, this paper includes several dimensions of chronic pain and mental illness comorbidity: prevalence, risk factors, and treatment approaches. There were also some weaknesses, with one inherent in the umbrella review design being the inconsistent pain assessment methods, unclear symptom duration criteria, and inconsistent definitions of pain used, making it more difficult to produce a summary of the CP comorbidity for each diagnosis group. While psychotic disorders were included, personality disorder were not, representing a gap in our knowledge base.

Relevance:
As C-L psychiatrists, we are the mental health providers best poised to assess the interplay between chronic pain and psychiatric disease. Keeping the knowledge from this paper’s Table 1 when performing a consultation could be especially useful. For example, even if called about a different psychiatric issue, it would be important to screen for PTSD symptoms in a patient presenting with chronic pain in more than one area. The paper underemphasizes the impact of CBT and other psychotherapy approaches; given the number of participants in the studies that examined a psychotherapy approach, psychotherapy has the best evidence out of any other treatment approach in this review. Knowing that chronic pain likely affects the majority of our patients regardless of their diagnosis can help us better understand their treatment and recovery as a whole person.