Anxiety Strongly Linked to Pain

Girl listening to music on train

By Dr. Peter Abaci


Mood changes are a common and challenging part of experiencing ongoing pain. The more chronic the pain, the more difficult it can be to undo these changes. Common mood disorders associated with chronic pain include depression and anxiety. In some cases, those struggling with prolonged pain problems report no longer feeling like their old selves, as if their personalities have changed into a different version of themselves. Family members and friends sometimes make similar observations.

Anxiety is often intricately linked to the experience of chronic pain, and it seems to play a big role in regulating the intensity and severity of perceived pain. In other words, the worse the anxiety gets, the stronger the pain becomes. As a result, treatment approaches geared toward diminishing anxiety, like relaxation training, deep breathing exercises, meditation, and psychological based therapies, can successfully be used as part of a pain management plan.

New research from the University of Toronto led by Min Zhuo sheds more light on the anxiety-pain connection. His group’s research focuses on how chronic pain and anxiety are closely connected by virtue of the activity that takes place in a key region of the brain known as anterior cingulate cortex (ACC). Over-activation of the ACC takes place during the experience of physical pain, like sciatica for example, as well as with emotional stress, such as the death of a loved one. The ACC helps create an emotional response or reaction to the pain experience, which can lead to a state of suffering. Studies on anxiety done with brain imaging technology have also shown increased activation in the ACC.

Zhuo’s research is focusing on how information is transmitted between neurons in the ACC. The connection between communicating nerve cells is known as a “synapse.” It appears that chronic nerve pain, in particular, is associated with stronger connections being made at these synapses in the ACC. In comparison, these same types of changes were not seen when examining acute pain. These experiments have been done on animals, where lesions to certain nerves lead to changes in the way the nerves communicate in the ACC. At the same time that these synaptic changes start to take place due to nerve injury, the experimental mice also show the concurrent development of anxiety, suggesting that nerve pain and anxiety develop in tandem. Next, a chemical blocking agent was used to prevent a key connection from taking place at these synapses, which not only blocked pain sensitivity from the nerve damage but also reduced signs of anxiety, as well.

Scientific studies like this further reinforce the power of the mind/body connection in its role in healing and for reducing pain. It is no longer accurate to think in terms of pain as being only a physical phenomenon. Studies like this show how readily mood changes occur in response to continued pain. Reducing symptoms of anxiety and stress can be an integral part of getting chronic pain problems like nerve pain under better control. As brain imaging technology continues to evolve, we can use this information to better target treatment.