Is There an Association Between Lateralization of Chronic Pain in the Body and Depression?

Karlyn A. Edwards, Theresa Lii, Troy D. Schouten, Katherine M. Kearney, Maisa S. Ziadni, Beth D. Darnall, Sean C. Mackey, Gadi Gilam

Research output: Contribution to journalArticlepeer-review


Depression commonly co-occurs with chronic pain and can worsen pain outcomes. Recent theoretical work has hypothesized that pain localized to the left hemibody is a risk factor for worse depression due to overlap in underlying neural substrates. This hypothesis has not been tested a priori. Using a large sample of treatment-seeking adults with mixed-etiology chronic pain (N = 1,185), our cross-sectional study tested whether patients with left-sided pain endorse worse depressive symptoms. We also examined differences in other pain-related functioning measures. We tested 4 comparisons based on painful body areas using the CHOIR body map: 1) only left-sided (OL) versus any right-sided pain; 2) only right-sided (OR) versus any left-sided pain; 3) OL versus OR versus bilateral pain; and 4) more left-sided versus more right-sided versus equal-sided pain. Analysis of variance models showed OL pain was not associated with worse depression (F = 5.50, P = .019). Any left-sided pain was associated with worse depression, though the effect was small (F = 8.58, P = .003, Cohens d = .29). Bilateral pain was associated with worse depression (F = 8.05, P < .001, Cohens d = .24–.33). Regardless of pain location, more body areas endorsed was associated with greater depression. Although a more rigorous assessment of pain laterality is needed, our findings do not support the hypothesis that left-lateralized pain is associated with worse depression. Perspective: Pain lateralized to the left side of the body has been hypothesized as a risk factor for worse depression in chronic pain, despite never being tested in a large, real-world sample of patients with chronic pain. Findings showed that more widespread pain, not pain laterality, was associated with worse depression.

Original languageAmerican English
JournalJournal of Pain
StateAccepted/In press - 2024


  • CHOIR body map
  • Chronic pain
  • depression
  • laterality
  • negative affect

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Neurology
  • Anesthesiology and Pain Medicine


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