If your heart is racing, hands are sweaty, and muscles are tense, you may be experiencing anxiety. Anxiety is a state of worry and nervousness which triggers the “fight or flight” nervous system-the sympathetic nervous system. Once triggered, these nerves tell many organs in the body what to do in order to prepare for fleeing from danger or defending oneself. The heart will start racing. The blood vessels will dilate. Muscles will become tense and the gut will stop working. All of this is meant to protect the body from a “lion.”
Well, sometimes this protective mechanism works overtime and will not shut down; that constant state of alarm is considered a pathological anxiety disorder. Having such a permanent state of worry and nervousness can predispose someone to pain. And having pain can predispose someone to having a constant state of anxiety. This reciprocal relationship between pain and anxiety is worth understanding because treatment for one requires addressing the other. Certain signs of anxiety play key roles in chronic pain: catastrophizing, insomnia, and hyper vigilance.
Catastrophizing is a negative thought pattern that perseverates on the worst, most harmful outcome. This is not just “half-empty” thinking. People who catastrophize are really the “chicken-littles” of the world who think that the sky is falling when it is just raining. Fear is a primary driving force along with rumination, magnification, and helplessness. All of these negative thoughts greatly influence not only how someone perceives pain, but also how someone expresses painful feelings. Pain is always much worst to a catastrophizer; thus, treatment of chronic pain in such an individual is a matter of helping him/her gain perspective and proportion.
Insomnia is a perpetual inability to sleep and is usually due to a secondary illness like chronic pain. Chronic pain patients are more likely to experience insomnia. Plus, insomnia exacerbates pain. This vicious cycle is a miserable merry-go-round from hell. Getting someone off this bad ride is critical for the treatment of pain because sleep is the best weapon against pain. Improved sleep helps a great deal to reduce pain.
Hyper vigilance is a strong attentional bias towards something. In this case, pain is the subject of extreme attention. Scientists call it, “Pain Hyper Vigilance.” These same scientists have measured the degree of pain hyper vigilance in pre-operative patients and found that those who have vigilant tendencies tend to subjectively experience more pain post-operatively. This inability to disengage from the pain experience tends to amplify the pain intensity. By focusing on pain, pain levels will get worse. This sounds simple enough to avoid, but it’s not. Distracting someone’s attention away from pain is very difficult, but worth it.
The “fight or flight” nervous system that produces symptoms of anxiety is simply meant to protect the body from being eaten by a lion. When someone is unable to relieve the threat and anxiety goes unchecked, problems can occur like the onset of a chronic painful condition or the worsening of an existent painful condition. Understanding the signs of symptoms of anxiety can help people to neutralize this underlying amplifier of pain. Ultimately, anxiety is much more complex than these few signs: catastrophizing, insomnia, and hyper vigilance. But by identifying and addressing each component of anxiety, treatments can become more effective for both pain and anxiety.
Whether it is helping someone gain perspective, helping another sleep better, or distracting someone away from pain, everyone can get involved in relieving anxiety at home, at work, at the hospital or at the doctor’s office. Anyone can have anxiety at any given moment, and everyone has the capacity to help. Starting with a hug.
Christina Lasich, M.D., wrote about chronic pain and osteoarthritis for HealthCentral. She is physiatrist in Grass Valley, California. She specializes in pain management and spine rehabilitation.