Chronic Pain and Anxiety – What’s the Connection?

Chronic Pain and Anxiety - What's the Connection?

We’ve known for a while that chronic pain and anxiety have it in them to fuel each other. It’s not uncommon for people who experience chronic pain to also experience anxiety but up until recently, little was understood about the relationship.

Research published recently in the journal Biological Psychiatry has removed some of the mystery, offering new hope for the treatment of pain, as well as anxiety. The study found that a neurotransmitter in the body called … ready? … here we go … pituitary adenylate cyclase activating polypeptide (‘PACAP’) is released in response to stress and is also elevated in response to chronic pain. Neurotransmitters are chemicals in the brain that help send information between cells.

For neurotransmitters to do their job well, their levels have to be just right – not too high and not too low. When PACAP is elevated, we see symptoms of pain, anxiety or both.  In previous research by members of the same research team, it was found that PACAP was elevated in women who had post-traumatic stress.

Here’s how it works. PACAP is found along one of the nervous system’s pathways to the brain. The pathway travels from the spinal cord to the amygdala, which is the seat of anxiety and emotions.

The researchers noticed that when there is chronic pain it’s not unusual to also see an increase in anxious behaviours – but – when the pathways for PACAP are blocked (effectively reducing the levels of PACAP), both anxious behaviour and pain are significantly decreased.

‘By targeting this [PACAP’s] regulator and pathway we have opportunities to block both chronic pain and anxiety disorders,’ – Victor May, Ph.D., senior author of study and professor neurological sciences at the University of Vermont.

The research team is now turning their attention to developing small molecule compounds that can reduce levels of PACAP.

‘This would be a completely different approach to using benzodiazepine and opiods – it’s another tool in the arsenal to battle chronic pain and stress-related behavioral disorders.’ – Victor May.

Whether chronic pain and anxiety occur together or separately, their intrusion into lives can be relentless. When they appear, they have a wide reach – for those who love someone who has to live with pain or anxiety, the struggle is also very real. Hopefully, this research brings us closer to finding an effective, safe way to manage pain and anxiety.

16 Comments

Dave Topper T

Caffeine is my disaster. One night I ended up in the ER from the anxiety. I had my triggers but the caffeine was the catalyst. But sometimes you’re in a position where an anxiety attack just has to be ridden. This last time ( I work overnight ) I had an attack ( post traumatic stress from current events? ) and had no choice but to ride it. I had the anxiety, the dizziness, the upset stomach, the whole nine. Luckily a friend was also working and we got to talking about other stuff, and had a few laughs. That made me feel remarkably better. Does laughing set off different chemicals in the body? It really tapered off after that. But the fibro took off. But HEY beats the anxiety. So is laughter the best medicine? All honesty here. I refuse medicating any of this short of Ibuprofen ( I prefer my liver and do not use acetaminophen ) for pain. I read about Cymbalta, oh the HORROR. Nope not gonna do it.

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Akanksha

At the time of annexity I feel pain in my head . right behind the eyes. What can I do to get rid of it?

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Karen - Hey Sigmund

If you are sure that your pain is from anxiety, breathe strong deep breaths. I know it might sound simplistic, but let me explain. Anxiety is a physiological response. When your brain senses that there might be threat (this doesn’t mean there is danger – sometimes the brain hits the panic button unnecessarily), it surges the body with a number of different neurochemicals, including adrenaline and cortisol (the stress hormone). These neurochemicals are designed to make you faster, more alert and stronger so that you can deal with any potential threat. When there is no need to fight or no need to flee, there is nothing to burn up these neurochemicals so they build up. You will find a more detailed description of this here https://www.heysigmund.com/dealing-with-anxiety/. This is why anxiety comes with the physical symptoms.

Strong deep breathing activates something called the relaxation response. This is a physiological response that neutralises the fight or flight neurochemicals. When this happens, the physical symptoms will start to ease. The problem is that because the brain is so busy during an anxiety attack, it can be hard to remember to breathe strong deep breaths (in for 3, hold for 1, out for 3). To deal with this, practice strong deep breathing a couple of times a day. You only need to do a few breaths at a time. This will help the response to become more automatic so it will be easier to do when you need it.

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Alysha

Hey! Thanks for this. My gp wants me to attend pain clinics but they’re held 2 1/2 hours away and i don’t enjoy long distance travel. She doesn’t get that attending will cause anxiety which will increase the pain which increases the anxiety…

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Lori

This info sounds promising. As a chronic pain patient, I’m not seeking drugs but I am seeking pain relief. If the answer was simply to stand on my head 5 minutes a day, I would do it (well, maybe not ‘simply’)! My question though is this. What about patients, like myself, that have been taking opiates for 25 years and benzodiazaines for 10 years? I have already been through hell coming off opiates due to DEA & CDC pressure. I’ve heard the coming off the benzos is even more difficult. I just hope there is some built in help for us to make these switches.

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Karen - Hey Sigmund

Coming of benzos is difficult, but with the right support it can definitely be done. It’s really important that it’s done closely with the a doctor. It sounds as though you’ve already done some tough stuff – you have what it takes to do this. I wish you all the best.

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Jasmin Beck

Lori,
I have also been on Benzos for over 30 years, mainly Valium nd Xanax.
I was withdrawn under medical supervision, in hospital and no side affects -over a period of 2 months gradual withdrawal.
I was put on Clonazapan late last year and my new psychiatrist is trying to wean me off that also, but because of sleep issues and and the positive results of combining it with melotonin, he is keeping me on it, until the Pain clinic does their procedures on my back and I see the sleep specialist.
If successful he will gradually withdraw me and HOPE for the best.
I have had no negative side-effects due to gradual withdrawal, Trust your doctor and good luck.

Reply
Karen - Hey Sigmund

Thanks so much Robert. It makes so much sense why you would feel as though you are on a knife edge when you’re in pain from your autoimmune arthritis. I hope research like this is able to move towards finding ways to bring relief for you.

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Robert Hammel

I suffer from autoimmune arthritis. When I flare and the pain level is high, it often feels like being on an emotional knife edge.

Thank you for a great article. Sharing.

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Ang Honeyb

I think like a lot of therapists I’ve felt the connection existed for a long but to have tangible clinical evidence is fantastic. As stated the link is self fuelling, chronic pain begets anxiety, enduring anxiety begets chronic pain.

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Karen - Hey Sigmund

I hear you Ang! There’s a lot we know intuitively, or through personal experience but it’s always great to have the evidence, and to know that science is working on moving things forward.

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Leanne

Any suggestions for what sufferers can do in the meantime?
Currently trying CBT, but it’s been a long gruelling road of severe anxiety and chronic pain.
Thanks

Reply
Jasmin Beck

Once again some brilliant info. Where do you get your research from -used to be able to when I worked for The Black Dog,
This info is great, just wish my doctor here at the Home would read it.
Suffering from severe back pain -new procedures being done shortly and unable to have any more ops, plus complex PTSD, boy did I identify.
Thank you so much for your dedication and help-it should be bottled

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Karen - Hey Sigmund

Thanks Jasmin! Sometimes new research can take a little while to filter through. The good doctors will be onto it though. The references for the research are hyperlinked in the article – just click on the words in dark blue print and that will take you there.

Reply

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Boundaries must come with two things - love and leadership. They shouldn’t feel hollow, and they don’t need to feel like brick walls. They can be held firmly and lovingly.

Boundaries without the ‘loving’ will feel shaming, lonely, harsh. Understandably children will want to shield from this. This ‘shielding’ looks like keeping their messes from us. We drive them into the secretive and the forbidden because we squander precious opportunities to guide them.

Harsh consequences don’t teach them to avoid bad decisions. They teach them to avoid us.

They need both: boundaries, held lovingly.

First, decide on the boundary. Boundaries aren’t about what we want them to do. We can’t control that. Boundaries are about what we’ll do when the rules are broken.

If the rule is, ‘Be respectful’ - they’re in charge of what they do, you’re in charge of the boundary.

Attend to boundaries AND relationship. ‘It’s okay to be angry at me. (Rel’ship) No, I won’t let you speak to me like that. (Boundary). I want to hear what you have to say. (R). I won’t listen while you’re speaking like that. (B). I’m  going to wait until you can speak in a way I can hear. I’m right here. (R).

If the ‘leadership’ part is hard, think about what boundaries meant for you when you were young. If they felt cruel or shaming, it’s understandable that that’s how boundaries feel for you now. You don’t have to do boundaries the way your parents did. Don’t get rid of the boundary. Add in a loving way to hold them.

If the ‘loving’ part is hard, and if their behaviour enrages you, what was it like for you when you had big feelings as a child? If nobody supported you through feelings or behaviour, it’s understandable that their big feelings and behaviour will drive anger in you.

Anger exists as a shield for other more vulnerable feelings. What might your anger be shielding - loneliness? Anxiety? Feeling unseen? See through the behaviour to the need or feeling behind it: This is a great kid who is struggling right now. Reject the behaviour, support the child.♥️
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Our nervous systems are designed to receive their distress. Fight or flight in them raises fight or flight in us - to get our bodies ready to fight for them or flee with them.

When they’re in actual danger, it’s a brilliant response, but ‘danger’ is about what the brain perceives. 

Big feelings and behaviour are a sign of a brain that has registered ‘threat’. A felt sense of relational threat and emotional threat all count as ‘threat’.

This can happen any time there is any chance at all of humiliation, judgement, missing out on something important, felt disconnection, not feeling seen, heard, validated, not having the resources for the immediate demands (stress).

Think of this in terms of interruption, transition times, sibling arguments, coming home after a big day at school.

When the threat isn’t a true physical danger, there is nothing to fight with or flee from (except maybe siblings and instructions).

This is when the fight or flight that’s been raised in us can move us to fight with them (we might get irritated, frustrated, angry, annoyed, raise our voices) or flee from them.

These are really valid feelings and signs of things working as they should, but it’s what we do in response that matters.

Think of it this way. Brains don’t care for the difference between actual danger and things that are safe, but annoying or upsetting. They all count as ‘danger’. 

Pause for a moment, and see that this is a young person with a brain that doesn’t feel ‘safe’ right now. Whether it’s emotionally safe, relationally safe, physically safe - they all matter.

First, they need to be brought back to safety. We’ll do this most powerfully through relationship - co-regulation, validation, touch. 

In practice this looks like breathe (to calm your nervous system so you can recalibrate theirs), be with (validate with or without words - let them feel you believing them and not needing anything from them in that moment), and wait.

If you need to hold a boundary, add that in (‘I won’t let you …’) but don’t take relationship away.

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Time: 9.30am – 3:30pm 
Doors open at 8.30am for a 9.30am start
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Parking: Free parking onsite
Cost: $85.00 AUD

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