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Why We Worry

Have you ever laid in bed at night and just as sleep begins to creep over you... a hundred different concerns decide to wake you up like an alarm bell? People lead themselves to believe that worrying is a productive activity. Subconsciously you think that if you worry enough about a particular event, you can prevent bad things from happening and prepare a reaction if they do. Excessive worrying has now been widely recognized as anxiety and currently affects millions of people throughout their daily lives. A new topic has been circulating about whether anxiety has significant effects on chronic pain conditions. There is the age old question of what came first: the chicken or the egg. This questions is relevant to the discussion about stress and pain:

Does chronic pain lead to chronic anxiety or does chronic anxiety lead to chronic pain? 

Anxiety Disorders

Anxiety and stress go hand in hand. Our body is programmed to react to stressful situations in order to defend ourselves against danger. The stress response we experience brings on a rush of adrenaline and the release of stress hormones, which work to boost blood sugar levels and blood fats to use as fuel. These hormones then lead to symptoms like dizziness, a fast heartbeat, fatigue, headaches, muscle tension, trembling, nausea, and many other unpleasant bodily sensations. Originally these defense mechanisms were used to fight or flee from predators in times of survival. In our modern-day lives, the same responses can activate for simple daily experiences like going to a job-interview, climbing the hill of a roller coaster, going on a first date, and for people afflicted with social anxiety... even entering a crowded mall.

Can Anxiety Lead to Chronic Pain?

In short: yes. Chronic anxiety can lead to serious physical consequences because the body eventually becomes worn out from constantly being on high-alert. The immune system can become suppressed, digestive disorders appear, muscle tension manifests, and eventually mental disorders such as depression can develop. Many chronic pain disorders such as fibromyalgia or arthritis see overlap when it comes to anxiety and depression. Being in a state of constant reactivity leads many anxiety sufferers to engage in avoidance. Patients begin to avoid stressors, which results in social isolation, inactivity, de-conditioning from anxiety-inducing situations, and eventually disability. A stress response that was once acute and helpful becomes  chronic and debilitating.

Can Chronic Pain Lead to Anxiety?

Researchers conducted a study to determine the relationship between patients with chronic pain and the co-occurrence of anxiety. Out of 250 patients tested, 114 (45%) patients screened positive for at least one anxiety disorder. These patients also showed significantly worse scores across pain dimensions. The researchers concluded that detecting and treating anxiety may be an important component of pain management. It was not clear however, if the anxiety disorders manifested as a result of the chronic pain or vise versa. They did find that pain responses were higher in individuals with anxiety. In an alternate study, researchers found that patients with fibromyalgia (a widespread chronic pain disorder) were both overly sensitive to external stimulation and overly anxious about the sensation of pain. Fibromyalgia patients showed a conflict between sensory perception and nervous system processing, meaning they have a greater awareness and lower tolerance for external stimulants. This is a similar trait to patients who suffer from anxiety and feel over-stimulated, hyper-aware, and constantly observant.

Finding Solutions

The research surrounding the relationship between anxiety and chronic pain has not yet been sufficient enough to determine cause and effect. It has been proven that anxiety can increase the perception of pain and wear down the body. It is also clear that focusing on painful symptoms can cause anxiety. Finding ways to calm the anxious mind can also prove to be beneficial for the body. For helpful tips on reducing pain and anxiety, check out our article on 7 Ways to Improve Your Health Through Relaxation or download our free eBook Guide to Understanding Pain.

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Sources:

  1. 2015 Goldberg, Joseph MD. WebMD. "How worrying affects your body."
  2. 2013 Kroenke K, Outcalt S, et al. General Hospital Psychiatry. "Association between anxiety, health-related quality of life and functional impairment in primary care patients with chronic pain."
  3. 2015 McAllister, Murray PsyD. Institute for Chronic Pain. "Understanding Chronic Pain: Anxiety."
  4. 2008. The New York Times. "Fibromyalgia In-Depth Report."
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