The Anxiety of the Anxiety of Pain

Patient Expert

*Note: This post could be triggering if you have difficulty managing chronic pain.

I have anxiety over writing about anxiety.   Go figure.

I also have anxiety due to pain.   As any one with severe rheumatoid arthritis will tell you, the pain never truly goes away. We may be able to address the underlying causes with the medications we take.   We may be able to manage the pain with the tricks we have learned from heat or ice, meditation, exercise endorphins, to laughing with those we love, and snuggling with our furry friends, or when all else fails - even more medication. But the pain never goes away 100 percent.   It is a constant in our lives that we learn to live with.

A few months ago while checking in for a rheumatology appointment, the nurse went through the litany of medications I was on, asked my current pain level (rarely below a 5 in the last year), clarified that I was there to discuss both my RA and Spondylitis, and asked if I was still experiencing anxiety.

Like a rabid monkey, I went wild Eyes bursting cartoonishly out of my head, my hair splaying in a frizzy mess, stiff arthritic fists waving in the air, my thought bubble stating: "Who says I have anxiety?!" At least, this is what I imagined.   In all reality, I sat quietly, feeling ashamed and asked why it was a diagnosis in my chart. The nurse told me I'd have to ask the rheumatologist that.

So I did.   He reminded me of the time several months back when I was flaring, in severe pain and "going nuts" as I reported.   He had increased my daily prednisone from 10mg to 30mgs and I proceeded to go even more "nuts."   In this crazed and painful state, I had freely used the term anxiety to describe what I was going through, and he had agreed.

Why did I feel shame then? Because mental health is never an easy topic to talk about. Because there are societal stigmas surrounding mental health. Because for so very long I have had to be tough, even prided myself on my ability to handle whatever pain my arthritis threw at me.   Because society is fearful of the use of opioids to treat chronic pain.   Because people do not understand what it's like to always be in pain.

I decided I needed to not be ashamed of my anxiety diagnosis.   This wasn't some failure on me as a person, it was another condition like my RA that is not in my control.   By recognizing it, and accepting it, I was then able to learn about it and what my triggers are: pain. Knowledge is power, and with this new found understanding, I felt like I could begin to manage it.

Chronic pain can often loop into a vicious cycle.   If I don't adequately address increasing pain within enough time, it can take over, and eventually cause even more pain.   My heart races, I become irritable - fidgety. I become grumpy and begin re-earning old college nicknames that rhyme with "witch." A nickname, that in hindsight, was due to unresolved pain.   I begin to feel anxiety.

With this knowledge I now have about how I respond to pain, I can now take a step back and say to myself, "You are experiencing this anxiety due to pain. Do something about it."   Knowing I am not in fact "going nuts" is a relief.   If there is one thing I can say about living with RA, it is that at times, having a known cause for a symptom is rather comforting.

Pain is something that I can reasonably address.   I am very fortunate that I have a team of doctors who support effective pain management.   They value my quality of life, and understand that my pain can be far more mentally and physically debilitating than any opioid they could possibly prescribe.

I have learned, with the help of other patients through social media, how to manage my pain in pill-free ways too.   I commonly use yoga to gently get my blood flowing and endorphins pumping, which has the added benefit of quieting anxiety.   I use meditation and mindfulness apps and playlists to help me focus and identify how best to help myself.   These same apps also help me find enough calm to drift to sleep, when sleep has been interrupted by pain.   I laugh and make inappropriate jokes with friends and family.   I relax with my favorite heating pad, and pet my fluffy kitty when he's not being a crank. I reach out to other patients online who understand.   Feeling like I'm not alone, and that someone understands is one of the greatest comforts.

Knowing the signs and symptoms of my anxiety has been a powerful tool, as it has allowed me to better manage my pain, and lead to a better quality of life.   In the end, isn't that what we're all after?

If any of this sounds familiar, I encourage you to take the opportunity to stop and breathe, to not let the cycle of anxiety and pain take over.   Find what works to calm your pain, and the anxiety will hopefully calm too.   Keep a list nearby of ways you can address your pain, because in those desperate moments it can be difficult to remember your tools.   Try to communicate with those in your life what you are dealing with and how they may best help you.   Talk to your doctor about what you are experiencing.   Telling my rheumatologist about my struggles allowed him to better care for me, which led to better decisions for my health that we were able to make together.

Above all, remember to breathe, and be kind to yourself.

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