Pain-related Anxiety
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Anxiety and Worry. Everyone experiences it sometimes. Worry happens when we are worried about the future. Worry is a normal part of life, it can even help push us to plan for the future; you probably wouldn’t bother to save money if you weren’t at least a little worried about having enough to support yourself in the future. So, worry and even anxiety (which is more complex than worry) can be helpful at times. However, when you have chronic pain or illness, anxiety is usually not a helpful experience. Additionally, people often don’t realize that health-related anxiety and anxiety about creating more pain are special types of anxiety that not everyone is aware of.
What is Anxiety?
Anxiety is a complex experience which is made up of both psychological (emotions or thoughts) and physiological (physical) components.
I like to think of worry as the emotional or though-based part of anxiety. Worry also tends to be more manageable and focused on a specific concern than anxiety. Worrisome thoughts start to become more like anxiety when those thoughts start to take up more and more of your time and brainpower, which leads to interference with your day-to-day life. Psychologists usually do not diagnose an anxiety disorder unless the worrisome thoughts are causing “impaired functioning” or interference in one or many areas of your life.
Anxiety also usually has a physical component (though worry can too). There are many symptoms associated with anxiety though some of the most common are:
Feeling nervous, restless
Muscle tension
Increased heart rate
Breathing rapidly (hyperventilation)
Sweating or feeling warm
Feeling weak or tired
Trouble concentrating or thinking about anything other than the present worry
Having trouble sleeping
Gastrointestinal (GI) upset
Difficulty controlling worry
This is not an exhaustive list of anxiety symptoms; you may experience just a few of these symptoms or all of them when you are feeling anxious.
How is Health-Related Anxiety Unique?
Health-related anxiety is not a clinical term, psychologists use a variety of other diagnoses (such as Illness Anxiety Disorder or Anxiety Disorder Due to Another Medical Condition; American Psychiatric Association, 2013) to best categorize someone’s personal experience; the diagnosis may vary based on a variety of factors.
However, regardless of what label is used, I have seen many people who experience understandable anxiety inducing thoughts about their pain condition or illness. It is makes sense that you would worry about the possibility of your condition getting worse over time, or the way that it may impact the future you had planned for yourself. Its not surprising that many people with chronic pain or illness may start limiting their activities not just due to their symptoms but also out of fear of making those symptoms even worse.
Do you recognize any of these thoughts:
“If I do _____, I won’t be able to walk for days”.
“I’d love to go to _____, but what if my pain flares up”.
“I want to exercise, but it hurts too bad and I’ll pay the price later. What’s the point?”
“I’m never going to be able to finish school/hold down a steady job, my health is too unpredictable”.
“I don’t want to draw extra attention to myself, so I’m just not going to go to _____”.
If any of these thoughts hit home to you, then you are at least a little familiar with health-related anxiety. It’s not just general worry about the future; health-related anxiety is persistent thinking about how pain or illness is going to limit your life. This type of anxiety keeps you from doing things; it keeps you from living your life. In some cases, the anxiety thoughts can be just as debilitating as the pain itself.
Fear of Movement and Injury
Fear of movement and (re)injury, or kinesiophobia (Miller et al, 1990) as psychologists call it, is a special type of pain related anxiety that refers to fear or anxiety about aggravating or causing more pain. This is especially common among people who have chronic pain. No one wants to experience more pain, so when someone is already in severe pain it makes sense that they would try to avoid creating even more pain.
For example, if you have learned from experience that every time you go for a walk it causes your back pain to flare up, which in turn leads you to have to rest and recover for several days, then you are probably not excited about walking again in the future. This may not be problematic for you, unless lack of exercise starts negatively impacting your overall health or self-esteem. Its also possible that this same pattern means you miss out on activities you value or that help you connect with others.
Fear of movement and (re)injury, while understandable, is most likely making it harder for you to live the life you want. Let me be clear, it’s not the only contributing factor, but if you have this experience, it’s probably not helping you. The anxiety thoughts that lead you away from doing things, most likely then lead to depression. Thoughts that limit your activities may also cause you more physical pain in the long run as well.
Deconditioning or “Disuse Syndrome”
When we are young, we learn that if you break a bone or get injured “rest is best”, but that’s not always the case when pain becomes chronic. The whole point behind the phrase “rest is best” is to allow the body to heal so you can get back to normal, but chronic pain by definition does not “heal”, there is no return to normal.
Our bodies our built to move. In order for our muscles to be strong enough to support both our bones and movement, we need to use them. But when you’re in pain, you likely do not want to move, or maybe you’re concerned about moving and instigating more pain. It makes sense, but here’s the problem: when we don’t use our bodies, it doesn’t take very long before the body becomes weaker. This process is referred to as deconditioning or “disuse syndrome” (Vlaeyen & Linton, 2012; Vlaeyen et al, 2016). One of the most frustrating things about deconditioning is that it actually makes it harder to do physical tasks when you are forced to do them; your body is weaker and so it takes more energy and causes even more pain. Stiffness can also occur when you are in the same position for too long. Both weakness and stiffness can increase pain.
Breaking Away from Anxiety and Doing More Again
Everything we just discussed is part of the reason that your doctor or other medical providers might be encouraging you to move more, even when you are in pain. However, even if you understand WHY you are being encouraged to move, that doesn’t always mean that it is easy to overcome the pain while you build back strength. It also doesn’t mean that it’s easy to overcome the pain-related worry that has become part of your daily thinking. That’s where professional help might be useful.
First and foremost, consult with your physician/medical provider, before starting any kind of movement plan or attempting to increase your physical activity. If the medical provider agrees that more movement would be appropriate for you, you might want to consider discussing referrals to the following types of specialists to help you break the pattern of health-related anxiety and move more again.
Physical Therapists: Physical Therapists can be especially helpful in assisting you to learn how to use your body in safe ways without causing further injury (not necessarily without creating pain). Physical Therapists are specially trained and may be able to help you gradually increase strength, flexibility, and range of motion, so that you can hopefully do more.
Pain Psychologists/Health Psychologists: These are psychologists that receive additional training in topics such as anatomy, medical terminology, medical conditions, and the relationship between pain/illness and mental health. Due to this unique training, pain psychologists/health psychologists are especially well-suited to help address pain-related anxiety. These types of psychologists use a combination of evidence-based strategies to target both the anxiety thoughts and help you find new ways of doing things that don’t lead to as much pain. Check out my therapy services page here to learn more.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Miller, T. W., & Kraus, R. F. (1990). An overview of chronic pain. Psychiatric Services, 41(4), 433-440.
Vlaeyen, J. W., Crombez, G., & Linton, S. J. (2016). The fear-avoidance model of pain. Pain, 157(8), 1588-1589.
Vlaeyen, J. W., & Linton, S. J. (2012). Fear-avoidance model of chronic musculoskeletal pain: 12 years on. Pain, 153(6), 1144-1147.
