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

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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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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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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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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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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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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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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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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Physical activity is the natural end to the fight or flight response (which is where the physical feelings of an anxiety attack come from). Walking will help to burn the adrenalin and neurochemicals that have surged the body to prepare it for flight or fight, and which are causing the physical symptoms (racy heart, feeling sick, sweaty, short breaths, dry mouth, trembly or tense in the limbs etc). As well as this, the rhythm of walking will help to calm their anxious amygdala. Brains love rhythm, and walking is a way to give them this. 
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Try to help your young one access their steady breaths while walking, but it is very likely that they will only be able to do this if they’ve practised outside of an anxiety attack. During anxiety, the brain is too busy to try anything unfamiliar. Practising will help to create neural pathways that will make breathing an easier, more accessible response during anxiety. If they aren't able to access strong steady breaths, you might need to do it for them. This will be just as powerful - in the same way they can catch your anxiety, they will also be able to catch your calm. When you are able to assume a strong, calm, steady presence, this will clear the way for your brave ones to do the same.
The more your young one is able to verbalise what their anxiety feels like, the more capacity they will have to identify it, acknowledge it and act more deliberately in response to it. With this level of self-awareness comes an increased ability to manage the feeling when it happens, and less likelihood that the anxiety will hijack their behaviour. 

Now - let’s give their awareness some muscle. If they are experts at what their anxiety feels like, they are also experts at what it takes to be brave. They’ve felt anxiety and they’ve moved through it, maybe not every time - none of us do it every time - maybe not even most times, but enough times to know what it takes and how it feels when they do. Maybe it was that time they walked into school when everything in them was wanting to walk away. Maybe that time they went in for goal, or down the water slide, or did the presentation in front of the class. Maybe that time they spoke their own order at the restaurant, or did the driving test, or told you there would be alcohol at the party. Those times matter, because they show them they can move through anxiety towards brave. They might also taken for granted by your young one, or written off as not counting as brave - but they do count. They count for everything. They are evidence that they can do hard things, even when those things feel bigger than them. 

So let’s expand those times with them and for them. Let’s expand the wisdom that comes with that, and bring their brave into the light as well. ‘What helped you do that?’ ‘What was it like when you did?’ ‘I know everything in you wanted to walk away, but you didn’t. Being brave isn’t about doing things easily. It’s about doing those hard things even when they feel bigger than us. I see you doing that all the time. It doesn’t matter that you don’t do them every time -none of us are brave every time- but you have so much courage in you my love, even when anxiety is making you feel otherwise.’

Let them also know that you feel like this too sometimes. It will help them see that anxiety happens to all of us, and that even though it tells a deficiency story, it is just a story and one they can change the ending of.
During adolescence, our teens are more likely to pay attention to the positives of a situation over the negatives. This can be a great thing. The courage that comes from this will help them try new things, explore their independence, and learn the things they need to learn to be happy, healthy adults. But it can also land them in bucketloads of trouble. 

Here’s the thing. Our teens don’t want to do the wrong thing and they don’t want to go behind our backs, but they also don’t want to be controlled by us, or have any sense that we might be stifling their way towards independence. The cold truth of it all is that if they want something badly enough, and if they feel as though we are intruding or that we are making arbitrary decisions just because we can, or that we don’t get how important something is to them, they have the will, the smarts and the means to do it with or without or approval. 

So what do we do? Of course we don’t want to say ‘yes’ to everything, so our job becomes one of influence over control. To keep them as safe as we can, rather than saying ‘no’ (which they might ignore anyway) we want to engage their prefrontal cortex (thinking brain) so they can be more considered in their decision making. 

Our teens are very capable of making good decisions, but because the rational, logical, thinking prefrontal cortex won’t be fully online until their 20s (closer to 30 in boys), we need to wake it up and bring it to the decision party whenever we can. 

Do this by first softening the landing:
‘I can see how important this is for you. You really want to be with your friends. I absolutely get that.’
Then, gently bring that thinking brain to the table:
‘It sounds as though there’s so much to love in this for you. I don’t want to get in your way but I need to know you’ve thought about the risks and planned for them. What are some things that could go wrong?’
Then, we really make the prefrontal cortex kick up a gear by engaging its problem solving capacities:
‘What’s the plan if that happens.’
Remember, during adolescence we switch from managers to consultants. Assume a leadership presence, but in a way that is warm, loving, and collaborative.♥️
Big feelings and big behaviour are a call for us to come closer. They won’t always feel like that, but they are. Not ‘closer’ in an intrusive ‘I need you to stop this’ way, but closer in a ‘I’ve got you, I can handle all of you’ kind of way - no judgement, no need for you to be different - I’m just going to make space for this feeling to find its way through. 

Our kids and teens are no different to us. When we have feelings that fill us to overloaded, the last thing we need is someone telling us that it’s not the way to behave, or to calm down, or that we’re unbearable when we’re like this. Nup. What we need, and what they need, is a safe place to find our out breath, to let the energy connected to that feeling move through us and out of us so we can rest. 
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But how? First, don’t take big feelings personally. They aren’t a reflection on you, your parenting, or your child. Big feelings have wisdom contained in them about what’s needed more, or less, or what feels intolerable right now. Sometimes it might be as basic as a sleep or food. Maybe more power, influence, independence, or connection with you. Maybe there’s too much stress and it’s hitting their ceiling and ricocheting off their edges. Like all wisdom, it doesn’t always find a gentle way through. That’s okay, that will come. Our kids can’t learn to manage big feelings, or respect the wisdom embodied in those big feelings if they don’t have experience with big feelings. 
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We also need to make sure we are responding to them in the moment, not a fear or an inherited ‘should’ of our own. These are the messages we swallowed whole at some point - ‘happy kids should never get sad or angry’, ‘kids should always behave,’ ‘I should be able to protect my kids from feeling bad,’ ‘big feelings are bad feelings’, ‘bad behaviour means bad kids, which means bad parents.’ All these shoulds are feisty show ponies that assume more ‘rightness’ than they deserve. They are usually historic, and when we really examine them, they’re also irrelevant.
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Finally, try not to let the symptoms of big feelings disrupt the connection. Then, when calm comes, we will have the influence we need for the conversations that matter.
"Be patient. We don’t know what we want to do or who we want to be. That feels really bad sometimes. Just keep reminding us that it’s okay that we don’t have it all figured out yet, and maybe remind yourself sometimes too."
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 #parentingteens #neurodevelopment #positiveparenting #parenting #neuronurtured #braindevelopment #adolescence  #neurodevelopment #parentingteens

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