Living with chronic musculoskeletal (MSK) pain is hard enough on its own, but what often goes unrecognised is that pain rarely travels alone. It tends to bring company in the form of other health problems. Whether it's anxiety, depression, gut issues, or other chronic illnesses, the presence of pain can deeply affect many systems in the body, making daily life feel even more complicated and exhausting.

Let's unpack what we know about these common comorbidities, and more importantly, why this matters for your health and wellbeing.

Pain and the mind: The mental health connection

One of the strongest and most consistent links in chronic MSK pain is with mental health conditions, especially anxiety and depression. This isn't just a coincidence or a matter of "thinking too much about the pain". The brain regions that process pain also overlap with those involved in emotional regulation, meaning that persistent pain can directly impact mood and mental resilience.

Here's what the research shows [1]:

• Around 40% of people with chronic MSK pain also experience significant anxiety or depression.
• People with MSK pain have 1.5 to 2 times higher rates of anxiety and depression than those without pain.
• The overlap of mental health symptoms and chronic pain creates a feedback loop. Stress and low mood can amplify pain signals, while persistent pain worsens mental distress. This bidirectional relationship means each condition can intensify the other.
• Individuals with both pain and mental health issues tend to engage in more health-risk behaviours, such as smoking, inactivity, and poor sleep, which further worsen outcomes.

What this means for you: If you're struggling with mood or anxiety alongside pain, it's not your fault. It's a recognised pattern with biological underpinnings, rooted in how our nervous system processes both physical and emotional experiences.

Pain in the gut: The gastrointestinal connection

Gut problems are another common companion to chronic MSK pain. This isn't just because pain makes life stressful (although it does). The brain and the gut are deeply connected through what's called the "gut-brain axis". This communication highway runs between your central nervous system and your digestive system through neural, hormonal, and immune pathways. Chronic stress and inflammation can affect both systems simultaneously, and many people experience this as a mix of joint or back pain alongside bloating, constipation, or abdominal discomfort.

Key findings:

• In a 2025 study of 500 adults with chronic MSK pain [2]:
  • 50% reported frequent abdominal pain.
  • 40% experienced bloating.
  • 36% had constipation.
  • Almost half also reported anxiety, which may contribute to gut sensitivity.
• In people with inflammatory bowel disease, over 70% experienced both abdominal and MSK pain. This was strongly linked to fatigue, anxiety, depression, and even osteoarthritis. [3]

What this means for you: If your pain comes with gut symptoms, you're not imagining it. These symptoms are commonly linked because the same nervous system that amplifies pain signals can also heighten digestive sensitivity. The stress response triggered by chronic pain can slow digestion, increase inflammation in the gut, and alter the balance of gut bacteria. All of which contribute to gastrointestinal symptoms.

When pain travels with other illnesses

Chronic MSK pain also shows up alongside other long-term health conditions. These combinations can increase disability, worsen quality of life, and make treatment more complex. The relationship often works both way. Pain can make existing conditions harder to manage, while these conditions can intensify pain and slow recovery.

Common comorbidities include:

• Cardiometabolic conditions [4]:
  • Hypertension (up to 42.6% of people with MSK pain)
  • Type 2 diabetes (affecting 26.7% in some groups)
• Sleep disorders, which affect the majority of people with chronic pain and can worsen both pain intensity and emotional wellbeing
• Chronic fatigue, often overlapping with conditions like fibromyalgia
• Other chronic pain conditions, such as headaches and widespread pain syndromes

Why this matters:

Chronic pain, high blood pressure, and diabetes don't exist in isolation. They can influence each other in powerful ways. For example, pain can make it harder to stay active or sleep well, both of which are crucial for managing blood sugar and blood pressure. At the same time, diabetes can increase nerve pain and slow recovery. Recognising these links allows for more joined-up care that supports your overall health, not just one symptom at a time.

What to take away from all this

Understanding that pain is rarely just about muscles and joints is a crucial step toward better awareness. The more we understand the full picture of MSK pain, including its mental, digestive, and systemic comorbidities, the better we can recognise these patterns in ourselves and communicate them to healthcare providers.

If you live with chronic MSK pain, here are a few important things to remember:

• You are not alone, and your experience is valid. Many people with pain also deal with anxiety, gut issues, or other chronic illnesses.
• Your symptoms are connected, even if they seem unrelated. The same nervous system regulates pain, digestion, mood, and many other bodily functions.
• Understanding these connections matters, because it helps explain experiences that might otherwise feel confusing or isolating.

References

1. Aaron RV, Ravyts SG, Carnahan ND, et al. Prevalence of Depression and Anxiety Among Adults With Chronic Pain: A Systematic Review and Meta-Analysis. JAMA Network Open. 2025;8(3):e250268. doi:10.1001/jamanetworkopen.2025.0268
2. Huma, S., Mahar, S. A., Kalwar, S., Ahmed, J., Saeed, U., & Shah, syed shabir H. (2025). Impact of Chronic Musculoskeletal Pain on Gastrointestinal Symptoms and Mental Health Outcomes in Adult Pakistanis. MedERA - Journal of CMH LMC and IOD, 7(1). https://doi.org/10.61982/medera.v7i1.248
3. Falling C, Stebbings S, Baxter GD, Gearry RB, Mani R. Musculoskeletal Pain in Individuals With Inflammatory Bowel Disease Reflects Three Distinct Profiles. Clin J Pain. 2019 Jul;35(7):559-568. doi: 10.1097/AJP.0000000000000698. PMID: 30829736.
4. Tushingham, S., Cottle, J., Adesokan, M., Ogwumike, O. O., Ojagbemi, A., Stubbs, B., … Babatunde, O. O. (2024). The prevalence and pattern of comorbid long-term conditions with low back pain and osteoarthritis in low- and middle-income countries: a systematic review and meta-analysis. International Journal of Health Promotion and Education, 1–25. https://doi.org/10.1080/14635240.2024.2332911

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