Severe chronic pain is associated with higher anxiety and depressive symptom burden and sleep disturbance in Pakistani patients

Chronic pain frequently co-occurs with elevated anxiety and depressive symptoms and sleep disturbance, significantly affecting quality of life. This study investigates the association between pain severity, clinically significant anxiety and depressive symptoms, and sleep disturbance in military patients in Pakistan. This cross-sectional observational study was conducted at a tertiary military hospital pain clinic involving 150 patients with chronic non-cancer pain. Participants were stratified into mild-to-moderate (Numerical Rating Scale [NRS] ≤ 5) and severe pain (NRS > 5) groups. Assessment tools included the Hamilton Anxiety and Depression Rating Scales and Short Form-36 Health Survey. Data were analyzed using independent t-tests, chi-square tests, and binary logistic regression to identify factors associated with clinically significant anxiety and/or depressive symptoms (defined by HAM-A ≥ 14 and/or HAM-D-17 ≥ 17). Patients with severe pain exhibited significantly higher anxiety (19.2 ± 6.8 vs. 9.8 ± 4.2, P < 0.001) and depression scores (21.3 ± 7.5 vs. 11.5 ± 5.1, P < 0.001) compared to the mild-to-moderate group. Consequently, the prevalence of clinically significant anxiety and/or depressive symptoms was markedly higher in the severe pain group (80.0% vs. 35.7%, P < 0.001). Quality of life scores were significantly lower in patients with severe pain (48.2 ± 13.6 vs. 68.4 ± 14.5, P < 0.001). In multivariable analysis adjusting for severe pain, age ≥ 50 years, pain duration ≥ 12 months, sleep disturbance, sex, and marital status, severe pain (adjusted OR 7.89, P < 0.001), age ≥ 50 years (adjusted OR 2.20, P = 0.048), pain duration ≥ 12 months (adjusted OR 2.41, P = 0.029), and sleep disturbance (adjusted OR 3.15, P = 0.005) were significantly associated with clinically significant anxiety and/or depressive symptoms. Severe chronic pain is independently associated with higher anxiety and depressive symptom burden after adjustment for age, pain duration, and sleep disturbance. Routine screening for anxiety and depressive symptoms is essential for older patients with prolonged, severe pain to facilitate integrated management. Because the study is cross-sectional and used symptom severity scales rather than structured diagnostic interviews, causal inferences cannot be drawn and formal psychiatric diagnoses cannot be confirmed.