Anxiety Disorders and Chronic Pain

There is a lot of debate in the medical literature about which came first, anxiety or chronic pain? It's one of those chicken and egg situations. To me all that matters is that I can tell you, if you have been living with pain for more than 6 months you probably have some anxiety. It is not as important to me to know which came first because you are now living with both. And anxiety increases pain and pain increases anxiety, creating what I can a "death spiral" where without help the person just gets sucked farther and farther down into misery.

So let's assess the problem:
 
Anxiety is defined as    'A negative reaction of a person to stress, often leading to over arousal'
'An emotional state, similar to fear, associated with arousal an accompanied by feelings of nervousness and apprehension'

What is an anxiety disorder?
 
Anxiety disorders are a unique group of illnesses that fill people’s lives with persistent, excessive, and unreasonable anxiety, worry, and fear. They include generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), panic disorder, posttraumatic stress disorder (PTSD), social anxiety disorder (SAD), and specific phobias. Although anxiety disorders are serious conditions, they are treatable.
 
What chronic pain conditions and diseases commonly occur with anxiety disorders?
 
Arthritis —The amount of anxiety and mood disorders (such as depression) is higher in individuals with arthritis than in the general population. Some studies have found anxiety disorders are even more strongly associated with arthritis than is depression.
 
Fibromyalgia —In a recent study of 336 adults, published in the Journal of Clinical Psychiatry, those with fibromyalgia were almost 7 times more likely to have suffered from an anxiety disorder than those without the disorder.
 
Migraine —Migraines (and chronic daily headaches) happen a lot in people with anxiety disorders, as well as in those with mood- and substance-abuse disorders. Many studies have found that generalized anxiety disorder and panic disorder are particularly associated with migraines or other types of headaches. As with fibromyalgia, researchers have suggested that there may be a common tendency to develop anxiety disorders, depression, and migraine headaches.
 
Back Pain —Anxiety disorders and back pain often co-occur; back pain is more common in people with anxiety and mood disorders than in those without them.
 
Does chronic pain complicate the condition of a person who also has anxiety disorder?
 
An anxiety disorder and a co-occurring chronic pain disease can make a person’s health more difficult to treat. But a variety of treatments and lifestyle changes can offer relief. Possible health complications are noted below:

• More disability or less functioning
• Poorer quality of life
• Poorer response to treatment
• Less likely to follow through with treatment
  
• More likely to feel the disease has gotten worse

 
Chronic pain sufferers who also have an anxiety disorder may have lower pain tolerance or a lower pain threshold. People with an anxiety disorder may be more sensitive to medication side effects or more fearful of harmful side effects of medication than chronic pain suffers who aren’t anxious, and they may also be more fearful of pain than someone who experiences pain without anxiety.
 
What treatment considerations are made when someone has co-occurring conditions?
 
Many treatments for anxiety disorders may also improve chronic pain symptoms. Usually a comprehensive plan with a number of treatment types is necessary. Below is more information about some treatment options for anxiety disorders and chronic pain.

• Cognitive-Behavior Therapy (CBT) — CBT helps patients identify, challenge, and change unwanted and unproductive thoughts and feelings, as well as modify and gain control over unwanted behavior. The patient learns recovery skills that are useful for a lifetime. CBT is used to treat anxiety disorders as well as chronic pain conditions.
  
  
• Relaxation Techniques — Relaxation methods may help individuals develop the ability to cope more effectively with the stresses that contribute to anxiety and pain. Common methods include breathing retraining, progressive muscle relaxation, and exercise.
  
  
• Complementary and Alternative Methods — Yoga, acupuncture, mindfulness meditation, and biofeedback (controlling how the body reacts to stress to lessen its effects) are among the complementary and alternative techniques that relieve the symptoms of both anxiety disorders and chronic pain.
   
  Many lifestyle changes that improve the symptoms of an anxiety disorder also help the symptoms of chronic pain.
  
  
• Good Nutrition — Nutrition and diet can influence both anxiety and chronic pain symptoms. People with anxiety should limit or avoid caffeine and alcohol, which can trigger panic attacks and worsen anxiety symptoms. A doctor can provide patients with more guidance on foods to eat regularly and those to avoid.
  
  
• Regular exercise produces many positive effects for people with anxiety disorders and chronic pain. It strengthens muscles, reduces stiffness, improves flexibility, and boosts mood and self-esteem. Some people with chronic pain find exercising difficult to do, but because it often helps reduce overall pain, its benefits may be worth any temporary discomfort. All individuals, particularly those with chronic pain, should check with their doctors before beginning an exercise program.
  

• Sleep Management — Getting a good night’s sleep is key for anxiety disorders and chronic pain conditions. Symptoms of both types of conditions often become worse without proper or enough sleep. Consistent sleep and wake times, a good sleep environment (comfortable room temperature, no TV or other distractions), and no caffeine late in the day or at night can help promote restful sleep.
  

 
 So don't be surprised if you find yourself worrying more, or even feeing symptoms of panic if you have been in pain persistently for six months or more. That is pretty common. But DO take anxiety seriously as it can have detrimental effects to your health (lower immunity, poor quality sleep, increased pain and crabby mood to name a few!). There is treatment for anxiety available so make it a priority. You will be surprised by how much lowering your anxiety level can also lower your pain.

Yours in health,

Dr. Jordan

Adapted from: “Anxiety Disorders and Chronic Pain,” by Anxiety Disorders Association of America. http://www.adaa.org/gettinghelp/MFarchives/MonthlyFeatures(july07).asp

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