Anxiety and Pain Fears
Anxiety and pain have a long association. We dislike or fear pain so it makes us anxious and when we are in pain, particularly chronic pain, we are more likely to suffer with anxiety. These comorbidities, as they are known, are very common in people who suffer with low back pain where there are high levels of anxiety, depression and other psychological conditions.
Anxiety and pain fear are common around the time of surgery. Most invasive surgery will result in some level of discomfort but the intensity of pain relates, in part, to the type of surgery performed. There are however certain psychological factors considered to be predictive of chronic pain following surgery and these include anxiety, depression and pain catastrophizing. Pain catastrophizing refers to the perception of pain. People who catastrophize tend to ruminate about their pain ("it hurts, it hurts"), they magnify their pain ("something worse might happen"), and they feel helpless to manage their pain ("nothing I do or take reduces my pain").
Regardless of the type of surgery, it appears that pre-operative anxiety and depression predicts the likelihood of post-surgical chronic pain. A recent French study, reported in The Journal of Pain, recommends the use of pre-operative screening for anxiety and depression in order to identify those most at risk of chronic pain.
Similar calls for screening have come from other sources. Professor of Medicine at Indiana University in Indianapolis, Kurt Kroenke, M.D., feels the message about depression and chronic pain is well established but the emphasis on anxiety lags behind. In a study of 250 patients being treated for moderate to severe chronic joint or back pain issues, it was discovered that 45 screened positive for for at least one of five common anxiety disorders. Moreover, those with an anxiety disorder reported significantly worse pain and health-related quality of life issues.
Pain medication is not always very effective and it does not help patients cope with long-term pain. An important driver of pain is its perception so techniques that help in this regard are likely to be helpful. Cognitive therapy can help, but so can other forms of distraction. Music, for example, seems to be beneficial for patients with high anxiety. Music reduces pain by activating sensory pathways that compete with pain pathways, stimulating emotional responses and moving attention away from pain. In one study reported in The Journal of Pain, those who were most anxious were found to be more receptive to the therapeutic effects of music than those with lower anxiety levels.
Bradshaw, D et al (2011) Individual Differences in the Effects of Music Engagement on Responses to Painful Stimulation. The Journal of Pain 12 (12): 1262.
Masselin-Dubois, A et al (2013) Are Psychological Predictors of Chronic Postsurgical Pain Dependent on the Surgical Model? A Comparison of Total Knee Arthroplasty and Breast Surgery for Cancer. The Journal of Pain 14 (8) 854.