Anxiety is a common condition that affects millions of people. It involves feelings of worry, nervousness, and unease. Anxiety can range from mild to severe and in some cases can significantly interfere with daily life. Many people with anxiety report experiencing physical symptoms in addition to emotional distress. One common question is whether anxiety itself can directly cause physical pain. Here we’ll explore the link between anxiety and pain and discuss what the research says.
The link between anxiety and pain
There does appear to be an association between anxiety and pain. Studies show that people with anxiety disorders frequently report experiencing painful physical symptoms. For example, one study found that over half of people with generalized anxiety disorder experienced painful physical symptoms, most commonly headaches, muscle soreness, and back pain.
Research has found links between anxiety and pain in various settings:
- People with chronic pain conditions like fibromyalgia, headaches, and irritable bowel syndrome have high rates of anxiety disorders.
- In people undergoing surgery, preoperative anxiety is associated with higher postoperative pain.
- In experimental settings, people who are more anxious tend to rate pain as more intense.
So there is clearly an association where anxiety and pain often co-occur. But does anxiety directly cause pain? Or are there other factors at play?
How anxiety may contribute to pain
Studies suggest anxiety likely contributes to pain in multiple ways, including:
Increasing focus on physical sensations
Anxiety can make people more focused on and sensitive to physical sensations in their body. This hypervigilance may lead to noticing and worrying about minor aches and pains.
Increasing muscle tension
Anxiety activates the stress response, which causes physical tension including tightened muscles. This can lead to pain, headaches, and back/neck aches.
Disrupting pain signaling
The biological stress response may disrupt normal pain signaling in the nervous system, lowering pain thresholds. This may make people with anxiety perceive pain as more severe.
Increasing inflammation
Anxiety triggers inflammatory responses in the body which may heighten pain perception and make existing pain worse.
Causing avoidance and disability
Anxiety about pain can lead people to avoid exercise and activities, resulting in physical deconditioning, disability, and worsening pain.
The role of chronic stress
Experiencing frequent or chronic stress is closely linked to anxiety. And long-term stress exposure also impacts pain perception through similar mechanisms as anxiety:
- Increasing attention to bodily sensations
- Triggering muscle tension
- Disrupting nervous system pain signaling
This helps explain why people with high-stress lifestyles often experience frequent headaches, back pain, and other symptoms. Ongoing stress keeps the body in a state of hypervigilance that can worsen pain over time.
When anxiety is the primary cause of pain
In most cases anxiety is not the sole underlying cause of pain. However in some instances, anxiety is strongly suspected to be the primary driver of painful symptoms with no underlying physical cause found. Examples include:
Stress headaches
Headaches directly triggered and aggravated by stressful situations are likely linked to anxiety’s effects on muscles and pain signaling.
Chest pain from panic attacks
Panic attacks can cause chest pain, tightness, and shortness of breath due to anxiety’s physical effects on the cardiovascular system.
Abdominal pain from IBS
Irritable bowel syndrome involves digestive symptoms like abdominal cramping and pain that are associated with and worsened by anxiety.
The bi-directional relationship between anxiety and pain
The connection between anxiety and pain appears to be bi-directional:
- Anxiety can increase pain perception and make existing pain worse.
- Experiencing chronic pain can lead to developing anxiety as a result.
This two-way relationship makes anxiety and pain highly mutually reinforcing. Pain can make people anxious and worsen anxiety symptoms, while anxiety can heighten pain signals and make pain feel more severe. This vicious cycle makes both anxiety and chronic pain much more challenging to treat.
Treating co-occurring anxiety and pain
When anxiety and pain co-occur, the most effective treatment approach addresses both conditions together. This can be achieved through psychotherapy, medications, or complementary approaches like exercise, meditation, yoga, massage, etc. The key is using strategies that reduce anxiety, relax the body, and alter pain perception. Common interventions include:
- Cognitive-behavioral therapy (CBT) – CBT focuses on changing thought and behavior patterns that perpetuate anxiety and avoidance of pain.
- Antidepressant medications – Certain antidepressants like SNRIs and tricyclics also reduce pain signals.
- Relaxation techniques – Methods like deep breathing, mindfulness meditation, progressive muscle relaxation help relieve anxiety and pain.
- Exercise – Low-impact aerobic exercise and stretching helps ease anxiety and pain sensitivity.
- Stress management – Managing life stressors can relieve chronic anxiety and subsequent effects on pain.
A combined approach targeting anxiety, pain, stress, and physical deconditioning often has the greatest impact. Psychotherapy and medications help address thought and behavior patterns underlying anxiety. And complementary therapies induce the relaxation response to directly counteract anxiety’s physical effects on pain perception.
Does anxiety cause chronic pain?
The verdict is still out on whether anxiety alone directly causes chronic pain over the long-term. More research is needed to better understand the complex relationship between anxiety and pain. However, we do know anxiety can:
- Acutely worsen pain perception when anxiety levels are high
- Exacerbate chronic pain conditions like headaches and IBS
- Lead to avoidance behaviors that result in greater physical deconditioning and disability
While anxiety may not be able to single-handedly cause chronic pain, it certainly can contribute to it becoming a more severe, persistent problem. This happens through both emotional and physical mechanisms of increasing pain sensitivity.
The takeaway
Anxiety and pain have a very close, bi-directional relationship. Anxiety can worsen and increase sensitivity to pain through multiple mechanisms including increased focus on sensations, muscle tension, inflammation, and disrupted signaling. In some cases, anxiety is a major contributing cause of painful symptoms when no underlying physical pathology is found.
Treating chronic co-occurring anxiety and pain requires a multi-pronged approach. Psychotherapy, medications, relaxation techniques, exercise, and stress management together can help break the vicious cycle between anxiety and pain. While anxiety may not directly cause chronic pain, it is a significant perpetuating and exacerbating factor in many cases of persistent pain problems.
| Key Points |
|---|
| Anxiety and pain commonly co-occur and exacerbate each other through a vicious bi-directional relationship. |
| Anxiety can worsen pain perception through increasing focus on sensations, muscle tension, inflammation, and disrupting pain signals. |
| Experiencing frequent or chronic stress also serves to heighten pain sensitivity through similar mechanisms as anxiety. |
| In some instances anxiety appears to be a primary driver of painful symptoms when no underlying physical cause is found. |
| Treating co-occurring anxiety and chronic pain requires a multi-modal approach combining psychotherapy, medications, relaxation techniques, exercise, and stress management. |