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Pain and mental health have a close relationship, according to the medical literature. A person suffering from long-term pain related to a health condition or injury is vulnerable to developing anxiety or depression; someone who has an anxiety or mood disorder is at increased risk for a worsening of symptoms because of the pain they experience. The challenge for these patients is to not only obtain treatment for the pain but to find symptom relief and treatment for their mental health condition.
The fact is, according to Harvard Health, about 65 percent of people who report depression to their doctor have at least one pain symptom. Pain may be physical, but it triggers stress that impacts the brain. Some people manifest that stress as anxiety and some depression. By managing both physical and mental health symptoms, patients may be able to improve their quality of life.
Pain Perception and Anxiety
Medical researchers believe that the perception of pain can trigger or amplify symptoms of anxiety. Unfortunately, that’s not the whole story. The stress of anxiety, while seemingly a mental health issue (and it is) can also result in physical symptoms. Anxiety can trigger increased inflammation in the body, and inflammation can lead to many different physical symptoms, including pain.
The negative feedback loop of anxiety triggering inflammation and inflammation triggering pain can exacerbate one’s overall health situation and dramatically decrease quality of life. Symptoms to look for that denote this problematic loop include:
- Nightmares–especially regarding health
- Worrying about physical health during waking hours (to a great extent)
- Insomnia caused by worry
- Experiencing panic attacks
- Avoiding any medical treatments that trigger anxiety
- Avoiding social situations and interactions
- Catastrophizing thoughts about sickness and dying
Experiencing these symptoms of anxiety heightens the distress that a person feels–and the distress can be both physical and mental.
Anxiety Sensitizing Pain
When anxiety amplifies the pain someone feels, it can make the pain more difficult to manage effectively. Because of this, anxiety and chronic pain often go hand in glove. Anxiety can cause the central nervous system to become more sensitive; and that can lead to a demonstrative increase in the pain perception. In fact, these patients aren’t merely at risk for increased pain. All of their senses can be impacted by this anxiety-inducing sensitivity. As multiple senses become involved and the perception of pain becomes amplified, the challenge to manage the pain and anxiety becomes increasingly difficult.
Shared Neurobiology
Another aspect of the anxiety-pain connection is the shared central nervous system biology that impacts both conditions. The neurotransmitters and hormones involved in central nervous system communication are involved in the communication of pain and the mechanisms of anxiety–and other conditions like depression or post-traumatic stress disorder. The shared neurobiological pathways lead to a more ‘connected’ state of the conditions–pain and anxiety.
While this may seem problematic at first, it can bode well for the effectiveness of treatment. For instance, treating anxiety with an antidepressant can reduce anxiety symptoms and, in turn, reduce the perception of pain. How? Some of the same brain circuitry involved in anxiety is also involved in pain.
Treatment Approaches
Medical providers have many different options for addressing chronic pain and anxiety together in order to enhance patients’ quality of life. Simultaneous treatment is ideal in order to prevent one condition from exacerbating the other. The use of multidisciplinary approaches, therapy, medications, and self-management techniques can all promote improvements in both conditions. Some of the most common treatments used to treat pain and anxiety include:
Cognitive Behavioral Therapy
Cognitive behavioral therapy is a form of psychotherapy that’s used to treat many mental health conditions, including anxiety. During treatment sessions, therapists work to help clients develop strategies for managing their pain-related anxiety or anxiety in general. Clients learn coping skills that can help them reduce their anxiety and manage their stress. They also learn techniques that can help them distract their thoughts from the pain they’re experiencing.
Medication
Each client is different, so clinicians will necessarily customize their treatments to ensure each client has the medication support they need. Psychiatrists often treat anxiety with anti-anxiety medications such as Xanax initially, but benzodiazepines can be habit-forming, so doctors tend to only prescribe them in the short term. In the long term, clinicians will often prescribe antidepressants to help control anxiety. Antidepressants take some time–usually a few weeks to build up in a person’s system, so doctors may prescribe anti-anxiety medications until the antidepressants have a chance to go to work.
Pain Medications
Doctors also customize pain treatments for each patient. It’s well known that opioids are an effective class of drugs for managing pain. Unfortunately, these drugs are highly addictive. Pain doctors do rely heavily on opioids to treat major pain, but that’s not all. There’s a decided push within the medical community to find and rely on alternative pain management treatments and medications in order to reduce the reliance on opioids and help prevent an increase in opiate use disorders. Doctors might recommend over-the-counter medications or therapies like exercise that can actually reduce both pain and anxiety symptoms.
Coping Strategies
Patients struggling to cope effectively with their chronic pain and anxiety can find healthful and effective ways to cope with both of their conditions. Some of these strategies include:
Relaxation Techniques: Therapists can teach patients various relaxation techniques that can reduce pain and symptoms of anxiety. Relaxation training involves teaching clients how to lower their stress response. Reducing stress leads to both reduced anxiety and pain.
Mindfulness: Anxiety involves a profound level of worry. By focusing on becoming mindful of the present, clients can reduce the worry they experience about the future. Clients can practice mindfulness by attending yoga or meditation sessions. Some people practice mindfulness by engaging in other activities such as swimming, kayaking, or even gardening. Reducing stress through mindfulness can lead to a reduction in both pain and anxiety symptoms.
Support Network
A support network also can provide effective support for patients who have anxiety and chronic pain. By attending peer group counseling or support meetings, clients can help one another and also learn that they are not alone in their experience. This can have a significant stress-reducing effect that also results in less pain and improved quality of life.
If you have a condition that involves chronic pain and are beginning to experience symptoms of anxiety, depression, or another mental health condition, it’s important to seek an evaluation of your condition and treatment right away. Need help with next steps? Contact FHE Health anytime.
