Association between chronic pain and mental health among nurses in China: a national cross-sectional study

Due to high intensity, workloads and shift work, nurses have become a high prevalence group of pain. If not promptly intervened, pain may become chronic pain through the mechanisms of peripheral sensitization and central sensitization, which in turn induces psychological symptoms such as anxiety and depression, forming a vicious circle of "pain-mental health comorbidity". In addition, long-term pain may accelerate the transition from acute pain to chronic pain, which will cause more serious damage to nurses' health. However, few studies have deeply explored the association between chronic pain and multidimensional mental health outcomes (anxiety, depression, fatigue, burnout, loneliness, and well-being) among nurse populations. This study surveyed 147,832 nurses from 67 tertiary hospitals in China between December 2023 and January 2024, using cluster sampling and online questionnaires. Statistical analyses included descriptive analyses, correlation analysis, multivariable logistic regression, and binary logistic regression. This study followed the STROBE guidelines. Significant and robust associations were found between chronic pain and mental health among nurses' occupational group. The correlation coefficients between chronic pain and six mental health symptoms ranged from 0.106 to 0.179, with the three largest correlation coefficients for depression (r = 0.179, P < 0.001), anxiety (r = 0.168, P < 0.001) and fatigue (r = 0.159, P < 0.001). Of all pain sites, head pain had the greatest correlation with depression (r = 0.167, P < 0.001) and low back pain had the greatest correlation with fatigue (r = 0.144, P < 0.001). Moreover, subgroup analyses by sex showed that among nurses with chronic pain, males are more likely to be fatigued. For multisite pain, the strength of the association with mental health increased significantly as the number of pain sites increased. In this study, both chronic pain and number of pain sites were significantly associated with nurses' mental health and showed site variability. After progressively controlling for variables such as sociodemographic, lifestyle, and work-related factors, this association remained robust and showed consistency across sex and age groups. Not applicable. This study was not a clinical trial.