EPV1102
Inflammatory Biomarkers in Chronic Pain Predict Psychiatric Morbidity: A Multi-Network EHR Cohort
A. S. Verma 1,*, V. Sharma 2, A. Pathak 3, R. Gupta 4 5
1Psychiatry , Case Western Reserve University/ Metrohealth, Cleveland, United States, 2Psychiatry , Dayanand Medical College & Hospital, Ludhiana, India, 3Psychiatry , Cleveland Clinic Main Campus, Cleveland, 4Psychiatry , Brigham & Women's Faulkner Hospital, 5Psychiatry , Harvard Medical School, Boston, United States
Introduction: There is an increased recognition of the role of systemic inflammation, mediated through inflammatory markers like IL-6, CRP, in pathophysiology of psychiatric disorders like depression, schizophrenia and substance abuse. While bidirectional influence of chronic pain and psychiatric morbidity is also understood, large-scale, real-world estimates on this topic remain limited. We aim to bridge this gap through a cohort study using TriNetX.
Objectives: To compare 5-year risk of major depressive disorder (MDD), suicidality, and substance use disorder (SUD) in chronic pain patients with high vs. low inflammatory biomarkers.
Methods: We used the TriNetX US Collaborative Network (71 health systems). Adults (≥18y) with chronic pain (ICD-10: G89.21, G89.28, G89.29, G89.4, M79.7) were stratified by inflammatory status using most-recent lab thresholds, each with ≥2 instances: high inflammation (ESR ≥20 mm/h [LOINC 4537-7], CRP ≥3 mg/L [1988-5], hs-CRP ≥3 mg/L [30522-7], or haptoglobin ≥200 mg/dL [4542-7]) vs. low (≤ these thresholds). Index was first date meeting pain + lab criteria; outcomes were assessed from day 1 to 5 years. Propensity-score matching (1:1) balanced demographics (642,785 per group post-match). We ran risk analyses excluding prior outcomes and Kaplan–Meier with log-rank tests and hazard ratios (Table 1)
Results: After matching, MDD risk over 5 years was 19.2% in the high-inflammation cohort vs. 17.9% in low-inflammation (risk ratio [RR] = 1.074, 95% CI 1.064–1.083; HR = 1.162, 95% CI 1.151–1.174; log-rank p<0.001). Suicidality risk was 2.1% vs. 1.8% (RR = 1.170, 95% CI 1.141–1.199; HR = 1.247, 95% CI 1.216–1.279; p<0.001). SUD risk was 11.5% vs. 10.3% (RR = 1.112, 95% CI 1.100–1.125; HR = 1.188, 95% CI 1.174–1.203; p<0.001) (Table 2). Absolute risk differences were +1.3% (MDD), +0.3% (suicidality), and +1.2% (SUD).
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Conclusions: Among adults with chronic pain, elevated inflammatory biomarkers are associated with higher 5-year incidence of MDD, suicidality, and SUD. Findings support routine mental-health screening when inflammatory markers are elevated and motivate trials testing anti-inflammatory or immunomodulatory strategies alongside standard psychiatric care. Observational design and EHR limitations (measurement variability, residual confounding) apply.
Disclosure of Interest: None Declared