Chronic pain by itself is often debilitating, and the struggle to obtain a correct diagnosis, effective pain management, and ongoing treatment can be stressful and overwhelming. As we discussed in a previous post, depression often co-occurs with chronic pain, and can further complicate treatment. The same is true of anxiety disorders.
Chronic Pain Disorders Associated with the Co-Occurrence of Anxiety
Like depression, anxiety is more likely to co-occur with certain conditions, such as:
It is no secret that physicians and dentists have stressful and demanding careers. One Cardiff University study showed that of 2,000 British doctors, at various stages of their careers, 60% had experienced mental illness. Often practitioners ignore or fight through both chronic pain and anxiety and show up to work, to the point of endangering themselves or others before acknowledging their disability or seeking adequate treatment.
While anxiety alone can result in an inability to practice, either indefinitely or in the short-term, it is also quite common in those suffering from chronic pain to experience an anxiety disorder. Anxiety disorders are also the most common type of psychiatric disorders in the United States, with 19 million adults affected.
Chronic Pain and Anxiety—Worse Together
Facing a long-term or permanent disability can be anxiety provoking for a physician, who must (1) face giving up a career he or she invested so much time and financial resources to establish; (2) seek a correct diagnosis, course of treatment, and adequate pain management; and (3) often struggle with adapting to the loss of a previously enjoyed quality of life. Conversely, chronic pain is also common in people with anxiety disorders, with up to 70% of people with certain medical conditions (including hypertension, diabetes, and arthritis) had an anxiety disorder first.
Regardless of whether anxiety or chronic pain came first, individuals suffering from anxiety can experience pain that is particularly intense and hard to treat. In a 2013 study, 45% of 250 patients who had moderate to severe chronic joint or back pain screened positive for at least one of the common anxiety disorders (generalized anxiety, social anxiety, PTSD, OCD). Further, those that had an anxiety disorder reported significantly worse pain and health-related quality of life than their counterparts without anxiety.
Symptoms of Anxiety
There are several anxiety disorders and, while the below list is by no means exhaustive, sufferers of anxiety often exhibit the following symptoms:
Generalized Anxiety Disorder
- Difficulty controlling worry
- Restlessness, feeling wound-up or on edge, irritability, muscle tension
- Being easily fatigued and problems with sleep
- Difficulty concentrating or having their minds go blank
- Sudden and repeated attacks of intense fear
- Feelings of being out of control during a panic attack
- Intense worries about when the next attack will happen
- Avoidance of places where panic attacks have occurred in the past
Social Anxiety Disorder
- Feeling highly anxious about being around other people (including having a hard time talking to them, blushing, sweating, trembling, or feeling sick to your stomach)
- Feeling self-conscious in front of others and worried about feeling humiliated, embarrassed or rejected, or fearful of offending others
- Worrying before an event and/or avoiding places where there are other people
- Having a hard time making and keeping friends
Post-Traumatic Stress Disorder
- Flashbacks, bad dreams, difficulty sleeping, frightening thoughts, angry outbursts
- Avoiding places, events, objects, thoughts, or feelings that are reminders of the traumatic experience and trouble remembering key features of the traumatic event
- Being easily startled and feeling tense or “on edge”
- Negative feelings about oneself or the world, and distorted feelings like guilt or blame
- Loss of interest in enjoyable activities
Obsessive Compulsive Disorder
- Fear of germs or contamination
- Unwanted or forbidden thoughts, including aggressive thoughts towards others or self
- Having things symmetrical or in perfect order; excessive clearing and/or hand washing; ordering and arranging things in a precise way; repeatedly checking on things; compulsive counting
Treatments for Anxiety
Some of the treatments that have been successful in addressing anxiety in those with chronic pain include:
- Cognitive-behavioral therapy (CBT)
- Psychodynamic therapy (talk therapy)
- Support groups
- Relaxation or meditation training
- Alternative treatments, such as acupuncture and hypnosis
Chronic pain sufferers who recognize any of the above-referenced symptoms in themselves should talk to their doctor to address these serious issues.
 Michael Brooks, Why doctors’ mental health should be a concern for us all, NewStatesmen, April 11, 2016, http://www.newstatesman.com/politics/health/2016/04/why-doctors-mental-health-should-be-concern-us-all
 What are Anxiety Disorders?, Global Medical Education, https://www.gmeded.com/gme-info-graphics/what-are-anxiety-disorders
 Chronic Pain, Anxiety and Depression Association of America, April, 2016, https://www.adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/chronic-pain
 Global Medical Education, Supra.
 Celeste Robb-Nicholson, M.D., The pain-anxiety-depression connection, Harvard Health Publications, http://www.health.harvard.edu/healthbeat/the-pain-anxiety-depression-connection
 Health Behavior News Service, part of the Center for Advancing Health, Chronic pain sufferers likely to have anxiety, ScienceDaily, May 8, 2013, https://www.sciencedaily.com/releases/2013/05/130508213112.htm