Anxious? Neurotic? It May Affect How You Process Pain

Pain isn't just physical. Here's how your emotions play a role, too.

Pain is your body’s way of informing you that something’s not quite right. It can be dull or throbbing, aching or tingling. It can be short-term (acute) or long-term (chronic). But if you ask two people with the same injury to rate their pain, they’ll likely have different responses.

There are a few reasons why. Some, like where the actual tissue damage occurs, are physical. Others, like DNA and gender—women tend to feel pain more harshly than men—are genetic. But your psychology and personality traits also help determine the intensity of your pain; feelings like anxiety, depression and negativity play a role.

How anxiety affects pain

Having anxiety is normal, but if you have a clinical mood disorder or feelings of anxiety, dread, fear and worry all the time, it can make pain feel worse.

One reason is anxiety and chronic pain share a similar pathway in the brain. According to an August 2016 animal study in Biological Psychiatry, one of the peptide neurotransmitters released during a state of stress is also released when someone has chronic pain. The neurotransmitter also increases pain sensitivity.

Another reason: when your body responds to pain, it goes into a fight-or-flight mode; your heart rate and blood pressure increase, and you might experience muscle tension. This natural response is helpful, so your brain knows how to prevent further injury. But for people who have chronic pain, anxiety can contribute to this constant state of stress and alarm. “If you're overstimulated with pain, it can be exaggerated by anxiety,” says Lydia Reese, MS, a licensed acupuncturist from Lourdes Health System in Camden, New Jersey.

An anxious person may also tend to focus in on pain and think about all the “what ifs.” Googling everything about your condition could make the pain worse, especially if you convince yourself that you have an ailment when you don’t.

The relationship between depression and pain

Depression is also linked to increased pain. For example, one September 2017 study in the American Heart Journal looked at 365 patients with moderate chest pain. Although they were admitted to the emergency room, the patients were all free of coronary artery disease. After 30 days, the patients filled out three questionnaires, each gauging their stress and anxiety levels. Ultimately, 36 percent had recurring chest pain within those 30 days; they were also the patients who had higher levels of depression.

One reason depression can influence pain may be because they share a similar pathway to the brain, just like anxiety and pain. During painful moments, the brain uses similar neurotransmitters as the ones involved in mood regulation, like serotonin and norepinephrine.

Another reason is because depression can disrupt healthy habits. People who are depressed might forgo exercise, eating right and sleeping enough. These can all be associated with increased pain.

Pain can also impact depression. Not being able to do the same activities you could when you were healthy can take a toll on your happiness. This is why it helps to treat both pain and depression simultaneously.

What about negativity?

Negative thoughts can not only hinder rehabilitation, but may exacerbate pain. Highly neurotic, negative or paranoid people tend to have higher levels of physical symptoms than less-neurotic people. This might be because neurotic people tend to hyper-focus on one thing—in this case, pain.

In a small study in Neuropsychopharmacology, 50 participants took a psychological test to determine their personality traits. Afterwards, they were given two painful infusions, and then a placebo they were told would reduce their pain. Those with personality traits high in agreeableness felt pain relief from the placebo. Those who had higher levels of neuroticism felt less pain relief.

Sleep, meditation and self-care

If you are anxious or depressed, there are proven ways to elevate your mood and reduce pain simultaneously. Remember to speak with your doctor before you make any significant lifestyle change or start a new exercise program.

  • Breathe deep. “Resetting the body through mindfulness is one proven way,” says Reese. Body work like tai-chi, yoga or qigong use deep breathing, stretching and movement to assist this.
  • Get moving. Exercise can help reduce stress, anxiety and pain by releasing feel-good endorphins. Even an activity as simple as walking may help improve your mood and reduce pain.
  • Pamper yourself. Reese suggests general self-care. A gentle massage or long bath might do the trick for people with muscle aches—plus, it can help you relax and alleviate anxiety.
  • Read before bed. The National Sleep Foundation recommends seven to nine hours of sleep per night for adults aged 26 to 64—but depression and anxiety can make this difficult, and pain medications can keep you up at night. To help get enough sleep, practice good sleep hygiene. Go to sleep and wake up at a regular time each day, and try to relax or read a book if you’re having trouble falling asleep.
  • Acupuncture or massage therapy. Though more research is needed, a systematic review in Medical Acupuncture found evidence that acupuncture lowers anxiety and depression in women; it might be worth a shot to help reduce pain. If you’re not sure about acupuncture, physical or massage therapy are other options; speak with your doctor to help decide what’s right for you.
  • Open up. If your pain is made worse by anxiety, fear or depression, consider a form of talk therapy like cognitive behavioral therapy. It helps counteract negative thoughts by changing one’s behavior and attitude. Not sure which type of therapy is right for you? Head here.

Even if you have anxiety or depression, it doesn’t mean you have to live in pain. Talk to your doctor or therapist about how to address pain and underlying emotional issues, and look for healthy lifestyle changes you can make at home to help.

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