Initially thinking about chronic pain and anxiety, one would not immediately perceive them as intertwined. Most view them as two separate conditions, potentially operating in conjunction with each other, but still separate states. The truth is so much more complicated. When faced with chronic pain AND anxiety, it turns into the chicken/egg dilemma. Which came first? Which effects which? And do the two live in a combined state? Short answer: Yes, chronic pain and anxiety are typically embedded against each other, and usually manifest in conjunction. Anxiety, a common psychiatric condition, can manifest itself as back pain, frequent headaches, or even fibromyalgia. Depending on the intensity of the anxiety one experiences, the fears can be transmuted to a physical state, both debilitating and demoralizing. Chronic pain on the other hand is exhausting, and create a demoralized mental state.
You never know when your pain may flair and prevent you from enjoying different aspects of your day to day. Your chronic pain may require a medication regimen, which could inspire harsh thoughts and judgements. A patient could be suffering from MS (multiple sclerosis) and taking edibles infused with marijuana properties to help them through their daily movements. But even this medical use of edibles can produce scorn and judgement. The patient then begins to worry about how their chronic pain is being perceived by others. As the pain increases, their anxiety over their regimen increases. The more they try to refrain from medical practices they’re afraid they’ll be judged for, their physical pain literally increases. Chronic pain and anxiety can exist separately, but are usually presented within each other and against each other.
If that example may seem too simple, there’s also a biological reason for the relationship between chronic pain and anxiety. Research in the last few years has explored this mutual relationship and has determined the same neurotransmitter that is released during stress is also released to those who suffer from chronic pain. The neurotransmitter is called pituitary adenylate cyclase activating polypeptide (PACAP). The same chemical your brain releases when in an anxious state also becomes elevated with chronic pain. PACAP travels from your spinal cord to your brain, specifically the amygdala. The amygdala is responsible for the regulation of your body’s fear and emotional state. Too much of any neurotransmitter can effect you, and PACAP effects pain and anxiety mutually.
So is there any hope? Yes! Of course regular exercise and diet matter. But addressing chemical imbalances are just as worthy as any other regimen. Research strongly suggest that finding the correct combination of medications, usually those used for other things like depression, can have a positive impact. The use of serotonin and norepinephrine re-uptake inhibitors (SNRI) or tricyclic antidepressants (TCA) can address both the physical ailments of pain and the mental state of anxiety. It is important to work with the guidance of a specialized pain management doctor, an arthritis doctor, and maybe even a therapist concurrently to make sure both of these individual conditions are addressed. In doing so, the patient can begin the process of liberation from anxious fear and the limitations of chronic pain.