How is Anxiety Disorder Linked to Chronic Pain?
Anxiety Disorder and Chronic Pain is divided into two groups:
- Anxiety Disorder That Precedes Chronic Pain- Patient gives a history of prior anxiety disorder.This group is subdivided into two subgroups
- Cause of Chronic Pain is Established - Cause of pain is established by history of illness, surgery, trauma and investigations.
- Cause of Chronic Pain is Not Established- Cause of chronic pain cannot be established by history of illness, surgery, trauma and investigations.
- Anxiety Disorder That Follows Chronic Pain - Chronic pain with history of subsequent anxiety disorder. Cause of chronic pain is established by history of illness, surgery, trauma and investigations.
How To Differentiate Chronic Pain From Anxiety Induced Pain?
Chronic pain is considered to be secondary to anxiety disorder when -
- Initial history suggests - anxiety disorder was present prior to beginning of chronic pain.
- History does not suggest - any illness, trauma or personal injury resulting in chronic pain.
- Results of investigations - are normal and do not show any abnormal findings.
Is There A Different Type Of Anxiety Pain?
Yes, there are several different kinds of pain caused by anxiety disorder. Examples of chronic pain induced by anxiety are muscle pain, chest pain, headache, abdominal pain, eye pain and joint pain. Pain induced by anxiety disappears after successful treatment of anxiety disorder.
How Does Anxiety Cause Chronic Pain?
Generalized Anxiety Disorder (GAD) is an emotional disorder triggered by stress, fear and worry. Anxiety triggered by emotional sensations creates an imbalance in neurotransmitters and physiological changes in structure of pain receptors. Pain receptors are protein molecules. Physiological and pharmacological modulation of neurotransmitter and receptors causes change in behavior of neurotransmitter production and receptor sensitivity. Modified neurotransmitter and receptors in peripheral tissue, spinal cord and brain may respond to various stimulations as chronic pain. Dialogue between receptors, neurotransmitters and pain centers has to reset so that only biological pain signals are interpreted as pain. The physiological modulation of pain behavior can be reset to normal response by removing and treating anxiety disorder and modifying pharmacological influence.
Can Chronic Pain Cause An Anxiety Disorder?
Yes, chronic pain can cause anxiety disorder. Continuous pain after six months is considered chronic pain. Chronic pain may not respond to traditional treatment and may be associated with stress, worry and fear. Stress is secondary to loss of job and income, while fear is because of thought of living with pain and suffering for rest of the life. Emotional amplification of pain, fear and stress sometimes results in anxiety disorder.
How is Anxiety Induced Pain Managed?
Treatment involves initial consultation with neurologist. Neurologist will conduct complete examination and investigation to diagnose anxiety disorder. Cause of chronic pain must be ruled out by examination and investigation. Once cause of pain is established as anxiety induced pain, then you will be referred to Psychiatrist. Psychiatrist will adjust the medication to remove any pharmacological influence, which may have triggered the pain and also treat anxiety with appropriate medication. Treatment may involve physical therapy; massage treatment and diagnostic injection treatment.
Why Does Anxiety Disorder Develop In Chronic Pain Patients?
Individual with no history of anxiety disorder may develop anxiety while suffering with severe intractable chronic pain. Mental stress induced by loss of job and loss of income causes apprehension. Suffering with intense chronic pain builds apprehension about pain. Restricted daily activities, finances, loss of income and job causes worry and fear, which triggers anxiety. Physical pain and mental apprehension causes anxiety disorder. Scientific studies suggest anxiety disorder may continue even after pain is eliminated. Published scientific studies suggest positive relationship between pain, stress apprehension and anxiety. 1,2
What is Pain Hypersensitivity?
Hypersensitivity or oversensitivity is often observed in patients suffering with chronic pain and anxiety. Such a response may result in increased intensity of pain known as hyperalgesia. Hypersensitive pain and hyperalgesia causes exaggeration of emotional and physiological symptoms.
What is Hyperalgesia?
Hyperalgesia is a symptom which suggests widely distributed intense pain. Hyperalgesia is caused by irritation of pain receptors or sensory nerve. Anxiety disorder induces neurotransmitter discrepancies and change of biological behavior of pain receptors. These pain receptors now respond to anxiety related neurotransmitters and expresses severe pain as a malfunction of neuromodulation.
Is it Possible to Achieve a Pain Relief if Anxiety Disorder is Aggressively Treated?
Pain intensity associated with anxiety disorder is tolerable and less intense when patient is aggressively treated with anxiolytic medications. Research published in 1994 by Dellemijn suggest postoperative pain was less intense in anxious patient when treated with anxiolytic medications.3
How Critical is Anxiety Disorder When Induced by Chronic Pain?
Anxiety Disorder is classified into several types. Type of anxiety disorder associated with pain is known as "Generalized Anxiety Disorder". Symptoms of generalized anxiety disorder are irrational worries, agitation, restlessness and insomnia. Symptoms of anxiety disorder can be troublesome and serious if not treated earlier. Interpersonal relationship and family relationship become demanding and quarrelsome. Emotional responses exhibited out of anxiety are ill-tempered verbal gesture, tantrum, shouting, and unnecessary arguments. Anxiety induced daily symptoms like headache, nausea, numbness, muscle ache, breathing difficulties and swallowing become predominant along with pain in later stages. These symptoms become primary symptoms and leads to unnecessary diagnostic tests.
Can Anxiety Disorder Worsen Chronic Pain?
Patient with chronic pain history may later suffer with anxiety disorder. In such cases, anxiety disorder can worsen symptoms of chronic pain. Modulations of pain impulses at cortical (brain) and subcortical (secondary brain centers) centers are augmented in patients suffering with anxiety disorder resulting in exaggeration of pain or hyperalgesia. Pain causing anxiety is extensively studied in animal model but very little scientific experiments are published regarding anxiety disorder causing increased pain. 4, 5, 6
How is Anxiety Caused By Pain Treated?
Anxiety caused by chronic pain is treated with anti-anxiety medications. Anxiety induced muscle spasms are treated with muscle relaxants, massage treatment and physical therapy.
Which Are the Anti-anxiety Medications?
Anti-anxiety medications are also known as tranquilizers. Antianxiety medications slow down the brain activities. Medications are also effective in treating muscle spasm. Medications are available as pills and injections. Benzodiazepines are the most common antianxiety medications. Benzodiazepines that are most prescribed are Xanax, Valium, Klonopin and Ativan.
Is There Any Advanced Investigation to Diagnose Anxiety Induced Pain?
Event-related functional magnetic resonance imaging (FMRI) - FMRI can indicate the activation responses in certain part of the brain to noxious (painful) and thermal (temperature) stimulation.7 Activation response changes with intensity of pain stimulation. Similar changes of increased response were observed with constant pain stimulation and variable anxiety response. The FMRI is at present research tool and rarely used in clinical practice to diagnose anxiety disorder associated with chronic pain.
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Dissociating anxiety from pain: mapping the neuronal marker N-acetyl aspartate to percep- tion distinguishes closely interrelated characteristics of chronic pain.
Grachev ID, Fredickson BE, Apkarian AV (2001) Mol Psychiatry 6:256–260.
Pain: a psychophysiological analysis.
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Do benzodiazepines have a role in chronic pain management?
Dellemijn PL, Fields HL (1994), Pain 57:137–152.
Odors released by stressed rats produce opioid analgesia in unstressed rats.
Fanselow MS (1985), Behav Neurosci 99:589–592.
Stressor controllability and stress-induced analgesia.
Maier SF (1986), Ann NY Acad Sci 467:55–72.
The amygdala is essential for the expression of conditioned hypoalgesia.
Helmstetter FJ (1992), Behav Neurosci 106:518–528.
Temporal and spatial dynamics of human forebrain activity during heat pain: analysis by positron emission tomography. Casey K L, Morrow TJ, L orenz J, Minoshima S (2001) J Neurophysiol 85:951–959.