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:
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.
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,
Adapted from: “Anxiety Disorders and Chronic Pain,” by Anxiety Disorders Association of America. http://www.adaa.org/gettinghelp/MFarchives/MonthlyFeatures(july07).asp
For those of us who work in chronic pain it’s easy to see that patients who have persisting pain for more than 6 months almost always struggle with depression. And research has also shown that those who had depression before they developed pain are much more likely to have that pain become chronic. But the mechanisms linking these two disorders have not always been fully understood.
At Restore Fx we aim to provide the most research-based and current treatments for chronic pain. Our staff constantly reviews medical journals to inform our treatments and improve care for our patients. Just today I came across an interesting article that may help to explain the link between depression and chronic pain on a brain level. Researchers were able to stimulate increased release of serotonin (a neurotransmitter/brain chemical) in mice and found that it significantly reduced their sensitivity to pain. They did this through a clever use of light-sensitive neurons that produce serotonin. For more detailed information on their study please see:
Optogenetic Recruitment of Dorsal Raphe Serotonergic Neurons Acutely Decreases Mechanosensory Responsivity in Behaving MiceGuillaume P. Dugué, Magor L. Lörincz, Eran Lottem, Enrica Audero, Sara Matias, Patricia A. Correia, Clément Léna, Zachary F. MainenResearch Article | published 22 Aug 2014 | PLOS ONE
This may help to explain why taking an antidepressant helps in reducing pain. It’s also good to note that exercise, which is helpful in painful conditions such as arthritis, also reduces depression. So what’s good for your depression is probably also good for your chronic pain.
Stay tuned for more scientific advancements on understanding chronic pain and how to best treat it.
Wishing you well,
Krista Jordan, Ph.D., ABPP
Program Director, Restore Fx
Restoring Functional Life
Krista Jordan, Ph.D., ABPP