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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Anxiety is a sign that the brain has registered threat and is mobilising the body to get to safety. One of the ways it does this is by organising the body for movement - to fight the danger or flee the danger. 

If there is no need or no opportunity for movement, that fight or flight fuel will still be looking for expression. This can come out as wriggly, fidgety, hyperactive behaviour. This is why any of us might pace or struggle to sit still when we’re anxious. 

If kids or teens are bouncing around, wriggling in their chairs, or having trouble sitting still, it could be anxiety. Remember with anxiety, it’s not about what is actually safe but about what the brain perceives. New or challenging work, doing something unfamiliar, too much going on, a tired or hungry body, anything that comes with any chance of judgement, failure, humiliation can all throw the brain into fight or flight.

When this happens, the body might feel busy, activated, restless. This in itself can drive even more anxiety in kids or teens. Any of us can struggle when we don’t feel comfortable in our own bodies. 

Anxiety is energy with nowhere to go. To move through anxiety, give the energy somewhere to go - a fast walk, a run, a whole-body shake, hula hooping, kicking a ball - any movement that spends the energy will help bring the brain and body back to calm.♥️
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#parenting #anxietyinkids #childanxiety #parenting #parent
This is not bad behaviour. It’s big behaviour a from a brain that has registered threat and is working hard to feel safe again. 

‘Threat’ isn’t about what is actually safe or not, but about what the brain perceives. The brain can perceive threat when there is any chance missing out on or messing up something important, anything that feels unfamiliar, hard, or challenging, feeling misunderstood, thinking you might be angry or disappointed with them, being separated from you, being hungry or tired, anything that pushes against their sensory needs - so many things. 

During anxiety, the amygdala in the brain is switched to high volume, so other big feelings will be too. This might look like tears, sadness, or anger. 

Big feelings have a good reason for being there. The amygdala has the very important job of keeping us safe, and it does this beautifully, but not always with grace. One of the ways the amygdala keeps us safe is by calling on big feelings to recruit social support. When big feelings happen, people notice. They might not always notice the way we want to be noticed, but we are noticed. This increases our chances of safety. 

Of course, kids and teens still need our guidance and leadership and the conversations that grow them, but not during the emotional storm. They just won’t hear you anyway because their brain is too busy trying to get back to safety. In that moment, they don’t want to be fixed or ‘grown’. They want to feel seen, safe and heard. 

During the storm, preserve your connection with them as much as you can. You might not always be able to do this, and that’s okay. None of this is about perfection. If you have a rupture, repair it as soon as you can. Then, when their brains and bodies come back to calm, this is the time for the conversations that will grow them. 

Rather than, ‘What consequences do they need to do better?’, shift to, ‘What support do they need to do better?’ The greatest support will come from you in a way they can receive: ‘What happened?’ ‘What can you do differently next time?’ ‘You’re the most wonderful kid and I know you didn’t want this to happen. How can you put things right? Do you need my help with that?’♥️
Big behaviour is a sign of a nervous system in distress. Before anything, that vulnerable nervous system needs to be brought back home to felt safety. 

This will happen most powerfully with relationship and connection. Breathe and be with. Let them know you get it. This can happen with words or nonverbals. It’s about feeling what they feel, but staying regulated.

If they want space, give them space but stay in emotional proximity, ‘Ok I’m just going to stay over here. I’m right here if you need.’

If they’re using spicy words to make sure there is no confusion about how they feel about you right now, flag the behaviour, then make your intent clear, ‘I know how upset you are and I want to understand more about what’s happening for you. I’m not going to do this while you’re speaking to me like this. You can still be mad, but you need to be respectful. I’m here for you.’

Think of how you would respond if a friend was telling you about something that upset her. You wouldn’t tell her to calm down, or try to fix her (she’s not broken), or talk to her about her behaviour. You would just be there. You would ‘drop an anchor’ and steady those rough seas around her until she feels okay enough again. Along the way you would be doing things that let her know your intent to support her. You’d do this with you facial expressions, your voice, your body, your posture. You’d feel her feels, and she’d feel you ‘getting her’. It’s about letting her know that you understand what she’s feeling, even if you don’t understand why (or agree with why). 

It’s the same for our children. As their important big people, they also need leadership. The time for this is after the storm has passed, when their brains and bodies feel safe and calm. Because of your relationship, connection and their felt sense of safety, you will have access to their ‘thinking brain’. This is the time for those meaningful conversations: 
- ‘What happened?’
- ‘What did I do that helped/ didn’t help?’
- ‘What can you do differently next time?’
- ‘You’re a great kid and I know you didn’t want this to happen, but here we are. What can you do to put things right? Do you need my help with that?’♥️
As children grow, and especially by adolescence, we have the illusion of control but whether or not we have any real influence will be up to them. The temptation to control our children will always come from a place of love. Fear will likely have a heavy hand in there too. When they fall, we’ll feel it. Sometimes it will feel like an ache in our core. Sometimes it will feel like failure or guilt, or anger. We might wish we could have stopped them, pushed a little harder, warned a little bigger, stood a little closer. We’re parents and we’re human and it’s what this parenting thing does. It makes fear and anxiety billow around us like lost smoke, too easily.

Remember, they want you to be proud of them, and they want to do the right thing. When they feel your curiosity over judgement, and the safety of you over shame, it will be easier for them to open up to you. Nobody will guide them better than you because nobody will care more about where they land. They know this, but the magic happens when they also know that you are safe and that you will hold them, their needs, their opinions and feelings with strong, gentle, loving hands, no matter what.♥️
Anger is the ‘fight’ part of the fight or flight response. It has important work to do. Anger never exists on its own. It exists to hold other more vulnerable emotions in a way that feels safer. It’s sometimes feels easier, safer, more acceptable, stronger to feel the ‘big’ that comes with anger, than the vulnerability that comes with anxiety, sadness, loneliness. This isn’t deliberate. It’s just another way our bodies and brains try to keep us safe. 

The problem isn’t the anger. The problem is the behaviour that can come with the anger. Let there be no limits on thoughts and feelings, only behaviour. When children are angry, as long as they are safe and others are safe, we don’t need to fix their anger. They aren’t broken. Instead, drop the anchor: as much as you can - and this won’t always be easy - be a calm, steadying, loving presence to help bring their nervous systems back home to calm. 

Then, when they are truly calm, and with love and leadership, have the conversations that will grow them - 
- What happened? 
- What can you do differently next time?
- You’re a really great kid. I know you didn’t want this to happen but here we are. How can you make things right. Would you like some ideas? Do you need some help with that?
- What did I do that helped? What did I do that didn’t help? Is there something that might feel more helpful next time?

When their behaviour falls short of ‘adorable’, rather than asking ‘What consequences they need to do better?’ let the question be, ‘What support do they need to do better.’ Often, the biggest support will be a conversation with you, and that will be enough.♥️
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#parenting #positiveparenting #mindfulparenting #anxietyinkids

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