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Anxiety Disorders and Chronic Pain
They often occur together

Muscle tension, body soreness, headaches. For people with anxiety disorders, pain like this may be all too familiar. Pain can be a common symptom — and sometimes a good indicator — of an anxiety disorder, particularly generalized anxiety disorder (GAD). But beyond everyday aches and pains, some people will also suffer a diagnosed chronic pain disease such as arthritis or fibromyalgia. And a co-occurring chronic pain disease can make functioning even more difficult for someone with an anxiety disorder. But people can manage anxiety disorders and chronic pain to lead full and productive lives.

What chronic pain conditions and diseases commonly occur with anxiety disorders?

Many chronic pain disorders are highly prevalent in people with anxiety disorders. These are among the most common:

Arthritis: A group of more than 100 medical conditions that affect the musculoskeletal system and specifically the joints. Arthritis-related joint problems include pain, stiffness, inflammation, and damage to joint cartilage and surrounding structures. Damage can lead to joint weakness, instability, and deformities that may interfere with even the most basic daily tasks.

The prevalence of anxiety and mood disorders (such as depression) is higher in individuals with arthritis than in the general population.

Fibromyalgia: Widespread musculoskeletal aches, pain, and stiffness, soft-tissue tenderness, general fatigue, and sleep problems. Common areas of pain include the neck, back, shoulders, pelvic girdle, and hands, but any part of the body can be affected. Symptoms may also include irritable bowel, headaches and migraines, skin problems, vision problems, and poor coordination. The causes of fibromyalgia are unknown, and there is currently no lab test that can diagnose the condition.

Those with fibromyalgia have been found to be almost seven times more likely to have suffered from an anxiety disorder than those without the disorder, and  about three times more likely to have suffered major depression. The study found the onset of an anxiety disorder or other mental illness in people with fibromyalgia preceded the onset of the fibromyalgia, suggesting that anxiety or depression may be more than just a reaction to the chronic pain. The connection remains unknown and requires further study.

Migraine: A migraine is severe pain felt on one or both sides of the head, occuring around the temples or behind one eye or ear. It may also cause nausea and vomiting and sensitivity to light and sound. The pain can last a few hours or up to two days. In a classic migraine a person experiences an aura, or visual symptoms such as losing vision or seeing flashing lights 10 to 30 minutes before an attack.

During a common migraine a person may have nausea, vomiting, or other symptoms, but does not experience an aura.
Migraines (and chronic daily headaches) are highly prevalent in people with anxiety and mood disorders. Moreover, in people with a co-occurring anxiety disorder and migraines, the likelihood of major depression increases. As with fibromyalgia, researchers have suggested that there may be a common predisposition to anxiety disorders, depression, and migraines.

Back Pain: Back pain is more common in people with anxiety and mood disorders than those without them. Illness, accidents, and infections are among the causes of back pain. Symptoms include persistent aches or stiffness anywhere along the spine; sharp, localized pain in the neck, upper back, or lower back, especially after lifting heavy objects or engaging in strenuous activity; and chronic ache in the middle or lower back, especially after sitting or standing for extended periods.

How are these co-occurring conditions treated?

Many treatments for anxiety disorders may also improve chronic pain symptoms. Usually a comprehensive plan with a number of treatment components is necessary, and may include these treatment options:

• Cognitive-Behavior Therapy (CBT) helps patients identify, challenge, and change unwanted and unproductive thoughts and feelings, as well as modify and gain control over unwanted behavior.
• Medication is often used in conjunction with therapy and other treatment techniques as a short- or long-term treatment option. Some people with an anxiety disorder and chronic pain may be able to find one medication that helps alleviate the symptoms of both conditions. Others may take one medication for anxiety and another for pain management.
• Relaxation techniques may help individuals develop the ability to cope more effectively with the stresses that contribute to anxiety and pain. Common techniques include breathing retraining, progressive muscle relaxation, and exercise.
• Complementary and alternative methods, such as yoga, acupuncture, therapeutic massage, and biofeedback (controlling how the body reacts to stress to reduce its effects), can  relieve the symptoms of both anxiety disorders and chronic pain.

What basic lifestyle changes can help?

Many lifestyle changes that improve the symptoms of an anxiety disorder also help the symptoms of chronic pain.

• Good nutrition can influence both anxiety and chronic pain symptoms. People with anxiety should limit or avoid caffeine and alcohol, which can trigger panic attacks and worsen anxiety symptoms. According to the National Fibromyalgia Association, certain foods aggravate some musculoskeletal conditions; including dairy products, gluten (found in wheat, oats, barley, and rye), corn, sugar, and members of the nightshade family (potatoes, tomatoes, eggplant, peppers, and tobacco). Individuals who experience pain should reduce their intake of tea, coffee, alcohol, red meat and other acid-forming foods. Talk to your doctor.
• Regular exercise strengthens muscles, reduces stiffness, improves flexibility, and boosts mood and self-esteem. All individuals, particularly those with chronic pain, should check with their doctors before beginning an exercise regimen.
•  Sleep management — Getting a good night’s sleep is key for anxiety disorders and chronic pain conditions. Consistent sleep and wake times, a good sleep environment (comfortable room temperature, no TV or other distractions), and avoiding caffeine late in the day can help promote restful sleep.

Excerpted with permission by the Anxiety Disorders Association of America. For references and resources, refer to the original article.

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