Physical Symptoms
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Anxiety and Pain

Henry Vyner, MD, Psychiatrist
Anxiety and Pain

It seems a matter of common sense to us that anxiety causes us all kinds of bodily pains. When we are stressed and anxious, we get headaches. We feel tension and knots in our neck, and we get back pains. It seems obvious to us that stress and anxiety are the cause of these and other pains.

Nonetheless, it is difficult for science to prove that anxiety causes any of these specific pains. But again, to those of us who experience bodily pain when we are stressed or anxious, it seems obvious that those pains are caused by stress and anxiety. 

Perhaps someday science will be able to find the mechanisms  by which anxiety causes back pain, headaches and chest pain. But in the meantime, we must allow common sense, or common experience, to trump science. There are several kinds of pain that common sense tells us are associated with anxiety and stress, and in this article we are going to look at them.

Anxiety and Chest Pain

Chest pain is one of the common symptoms of Panic Disorder. Different studies have shown that somewhere between 22% and 70% of panic attacks are associated with chest pain. Either way, that’s a lot. Chest pain occurs frequently in Panic Disorder. In addition, it is estimated that 25% of the patients that come to the emergency room with chest pain have Panic Disorder.

The chest pain that occurs in Panic Disorder is often described as a sharp, stabbing sensation that starts suddenly. 

While there are similarities between anxiety chest pain and pain due to a heart problem, there are some significant differences that will help you distinguish between the two.

Anxiety chest pain most often develops when you are at rest, while heart attack pain most often develops when you are being active. This is one difference.

Another difference is that pain from a heart attack will frequently spread from your chest to other areas of your body. Typically, if it spreads, it will go to your jaw, left shoulder and arm. However, chest pain caused by anxiety will only be present in your chest.

Finally, anxiety chest pain tends to develop quickly and then fade somewhat rapidly, often within 10 minutes, but heart condition pain starts slowly and gradually increases.

If you experience chest pain in the midst of a panic attack, and you are not sure if it is caused by your panic attack, you want to go see a doctor right away to make sure that the pain is not the result of a heart problem or some other illness. Panic attacks can sometimes cause myocardial ischemia (insufficient oxygen to your heart), and it is important to make sure that there is no physical cause for the chest you experience is a panic attack. 

However, be sure to tell your doctor that you are having a panic attack or that you have a history of panic attacks. This will help your doctor understand how to best diagnose your chest pain.

Finally, people with Panic Disorder also have a higher risk of having high blood pressure and angina pectoris — which is a chest pain caused by insufficient oxygen reaching the heart. So if you have panic attacks, you will want to make sure that your doctor monitors your cardiac health.

Anxiety and Back Pain

There are many causes of back pain, and there is some indication that anxiety is one of them. Back pain occurs more frequently in people who have an anxiety disorder, and this is partial proof that anxiety can cause back pain.

The symptoms of anxiety induced back pain will include persistent aches or stiffness; especially in your neck, upper back, or lower back. 

Anxiety causes back pain because being anxious activates your stress response, and the stress response causes your muscles to tighten and become tense. This tensing of your muscles can cause pain in and of itself. It can also leave you vulnerable to having spasms and straining your back muscles — especially when you are lifting heavy weights or doing strenuous physical activities you don’t normally do.

If you are having back pain that you think is caused by anxiety and stress, spend several minutes every day doing easy exercises that gently stretch the muscles in your back. You can also apply heat to your back, get massages, take a warm bath or go to a hot springs. And of course the best thing you can do is to take measures to reduce your underlying anxiety: mindfulness training, meditation and cognitive behavioral therapy.

Finally, if your back pain persists, it is always a good idea to go see your doctor to make sure the pain isn’t being caused by a physical problem.

Anxiety and Headaches

Proving that anxiety and stress cause headaches has as of yet remained beyond the reach of science. But who among us doubts that stress and anxiety can cause headaches? Who among us has not developed a stress headache in the middle of a busy or difficult day?

Headaches are a common symptom of Generalized Anxiety Disorder. This suggests that anxiety causes headaches. Another indication that anxiety causes headaches is that people who have migraines are more likely to have anxiety disorders. And again, headaches just seem to appear when we are stressed or anxious.

Even though we don’t have the scientific proof yet, we doctors assume that there are three kinds of headaches that are caused by anxiety — tension headaches, migraines and cluster headaches — on the basis of the circumstantial association of these headaches with anxiety. 

The quickest thing to do for a tension headache is to take a mild pain reliever that you know works for you. You can also take medications to reduce your anxiety, but before resorting to medications try meditation, mindfulness training or therapy to reduce your anxiety and headaches in the long run. 

Pain Can Cause Anxiety

An important thing to understand is that the relationship between pain and anxiety can become circular. If you have a lot of chronic pain, it is only natural to think that a disease of some kind might be causing it, even if you have long believed that the pain is caused by anxiety and stress. Patients with chronic pain can develop an anxiety disorder because of their concerns about their pain. If you are worried about a pain that  you think is caused by stress and anxiety, go see your doctor and have the pain diagnosed.

If your doctor finds no physical cause for your pain, then try to accept the pain, and thoroughly accept that the pain is caused by stress and anxiety. Allow your worried thought about your pain to pass through your mind without repressing or believing the. This will help you reduce your fear of the pain, and the anxiety it is causing. The practice of mindfulness can be especially helpful in moving you to find a way to come to terms with and reduce your pain.

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