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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Thanks so much @maggiedentauthor♥️…
“Karen Young - Hey Sigmund has such a wonderful way with words especially around anxiety. This is her latest beautiful picture book that explains anxiety through the lens of the Polyvagal theory using the metaphor of a house. This shows how sometimes anxiety can be hard to notice. I think this book can help kids and teens better understand stress and anxiety. I loved it! This would be great for homes, schools and in libraries.
Congratulations Karen.💛”
Of course we love them, no matter what - but they need to feel us loving them, no matter what. Especially when they are acting in unlovable ways, or saying unlovable things. Especially then.

This is not ‘rewarding bad behaviour’. To think this assumes that they want to behave badly. They don’t. What they want is to feel calm and safe again, but in that moment they don’t have the skills to do that themselves, so they need us to help them. 

It’s leading with love. It’s showing up, even when it’s hard. The more connected they feel to us, the more capacity we will have to lead them - back to calm, into better choices, towards claiming their space in the world kindly, respectfully, and with strength. 

This is not about dropping the boundary, but about holding it lovingly, ‘I can see you’re doing it tough right now. I’m right here. No, I won’t let you [name the boundary]. I’m right here. You’re not in trouble. We’ll get through this together.’

If you’re not sure what they need, ask them (when they are calm), ‘When you get upset/ angry/ anxious, what could I do that would help you feel loved and cared for in that moment? And this doesn’t mean saying ‘yes’ to a ‘no’ situation. What can I do to make the no easier to handle? What do I do that makes it harder?’♥️
Believe them AND believe in them. 

‘Yes this is hard. I know how much you don’t want to do this. It feels big doesn’t it. And I know you can do big things, even when it feels like you can’t. How can I help?’

They won’t believe in themselves until we show them what they are capable of. For this, we’ll have to believe in their ‘can’ more than they believe in their ‘can’t’.♥️
Sometimes it feels as though how we feel directs what we do, but it also works the other way: What we do will direct how we feel. 

When we avoid, we feel more anxious, and a bigger need to avoid. But when we do brave - and it only needs to be a teeny brave step - we feel brave. The braver we do, the braver we feel, and the braver we do… This is how we build brave - with tiny, tiny uncertain steps. 

So, tell me how you feel. All feelings are okay to be there. Now tell me what you like to do if your brave felt a little bigger. What tiny step can we take towards that. Because that brave is always in you. Always. And when you take the first step, your brave will rise bigger to meet you.♥️
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#anxietyinkids #consciousparenting #parentingtips #gentleparent #parentinglife #mindfulparenting #childanxiety #heywarrior
If anxiety has had extra big teeth lately, I know how brutal this feels. I really do. Think of it as the invitation to strengthen your young ones against anxiety. It’s not the disappearance of brave, or the retreat of brave. It’s the invitation to build their brave.

This is because the strengthening against anxiety happens only with experience. When the experience is in front of you, it can feel like bloodshed. I know that. I really do. But this is when we fight for them and with them - to show them they can do this.

The need to support their avoidance can feel relentless. But as long as they are safe, we don’t need to hold them back. We’ll want to, and they’ll want us to, but we don’t need to. 

Handling the distress of anxiety IS the work. Anxiety isn’t the disruption to building brave, it’s the invitation to build brave. As their important adult who knows they are capable, strong, and brave, you are the one to help them do that.

The amygdala only learns from experience - for better or worse. So the more they avoid, the more the amygdala learns that the thing they are avoiding is ‘unsafe’, and it will continue to drive a big fight (anger, distress) or flight (avoidance) response. 

On the other hand, when they stay with the discomfort of anxiety - and they only need to stay with it for a little longer each time (tiny steps count as big steps with anxiety) - the amygdala learns that it’s okay to move forward. It’s safe enough.

This learning won’t happen quickly or easily though. In fact, it will probably get worse before it gets better. This is part of the process of strengthening them against anxiety, not a disruption to it. 

As long as they are safe, their anxiety and the discomfort of that anxiety won’t hurt them. 
What’s important making sure they don’t feel alone in their distress. We can do this with validation, which shows our emotional availability. 

They also need to feel us holding the boundary, by not supporting their avoidance. This sends the message that we trust their capacity to handle this.

‘I know this feels big, and I know you can do this. What would feel brave right now?’♥️

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