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.

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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

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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.

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For our children, we start building the foundations for adolescence in their earliest years - the relationship we’ll have with them, who they are going to be, how they are going to be. One of the things we’ll want to build is their capacity to know their own minds and be brave enough to use it. This isn’t easy, even for adults, so the more practice we give them, the more they’ll be able to access their strong, brave, beautiful minds when they need to - when we aren’t there.

This means letting them have a say when we can, asking their opinions, and letting them disagree.

When kids and teens argue, they’re communicating. We need to listen, but the need won’t always be obvious. When littles argue because it’s spaghetti for dinner and ‘I hate spaghetti so much’ (even though last week and the 5 years before last week, spaghetti was their favourite), they might be expressing a need for sleep, power and influence, or independence. All are valid. When your teen argues because they want to do something you’ve said no to, the need might be to preserve their felt sense of inclusion with their tribe, or independence from you. Again, all valid. 

Of course, a valid need doesn’t mean it will always be met. Sometimes our needs might need to take priority to theirs, such as our need to keep them safe, or for them to learn that they can still be okay if everything doesn’t go their way, or that sometimes people will have conflicting needs that need to take priority. What’s important is letting them know we hear them and we get it.

It’s going to take time for kids to learn how to argue and express themselves respectfully. In the meantime, the words might be clumsy, loud, angry. This is when we need to hold on to ourselves, meet them where they are, let them know we hear them, and step into our leadership presence. We might give them what they need because it makes sense and because there isn’t enough reason not to. Sometimes, after giving them space to be heard we’ll need to stand our ground. Other times we might solve the problem collaboratively: This is what you want. This is what I want. Let’s talk about how we can we both get what we need.♥️
Anxiety will always tilt our focus to the risks, often at the expense of the very real rewards. It does this to keep us safe. We’re more likely to run into trouble if we miss the potential risks than if we miss the potential gains. 

This means that anxiety will swell just as much in reaction to a real life-threat, as it will to the things that might cause heartache (feels awful, but not life-threatening), but which will more likely come with great rewards. Wholehearted living means actively shifting our awareness to what we have to gain by taking a safe risk. 

Sometimes staying safe will be the exactly right thing to do, but sometimes we need to fight for that important or meaningful thing by hushing the noise of anxiety and moving bravely forward. 

When children or teens are on the edge of brave, but anxiety is pushing them back, ask, ‘But what would it be like if you could?’ ♥️

#parenting #parent #mindfulparenting #childanxiety #positiveparenting #heywarrior #heyawesome
Except I don’t do hungry me or tired me or intolerant me, as, you know … intolerably. Most of the time. Sometimes.
Growth doesn’t always announce itself in ways that feel safe or invited. Often, it can leave us exhausted and confused and with dirt in our pores from the fury of the battle. It is this way for all of us, our children too. 

The truth of it all is that we are all born with a profound and immense capacity to rise through challenges, changes and heartache. There is something else we are born with too, and it is the capacity to add softness, strength, and safety for each other when the movement towards growth feels too big. Not always by finding the answer, but by being it - just by being - safe, warm, vulnerable, real. As it turns out, sometimes, this is the richest source of growth for all of us.
When the world feel sunsettled, the ripple can reach the hearts, minds and spirits of kids and teens whether or not they are directly affected. As the important adult in the life of any child or teen, you have a profound capacity to give them what they need to steady their world again.

When their fears are really big, such as the death of a parent, being alone in the world, being separated from people they love, children might put this into something else. 

This can also happen because they can’t always articulate the fear. Emotional ‘experiences’ don’t lay in the brain as words, they lay down as images and sensory experiences. This is why smells and sounds can trigger anxiety, even if they aren’t connected to a scary experience. The ‘experiences’ also don’t need to be theirs. Hearing ‘about’ is enough.

The content of the fear might seem irrational but the feeling will be valid. Think of it as the feeling being the part that needs you. Their anxiety, sadness, anger (which happens to hold down other more vulnerable emotions) needs to be seen, held, contained and soothed, so they can feel safe again - and you have so much power to make that happen. 

‘I can see how worried you are. There are some big things happening in the world at the moment, but my darling, you are safe. I promise. You are so safe.’ 

If they have been through something big, the truth is that they have been through something frightening AND they are safe, ‘We’re going through some big things and it can be confusing and scary. We’ll get through this. It’s okay to feel scared or sad or angry. Whatever you feel is okay, and I’m here and I love you and we are safe. We can get through anything together.’

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