Pain Management

What Role Do Anxiety and Stress Play in Long-Term Conditions and Why Is It Important to Manage This?

Written by Carron Manning, Co-Founder of Chiron and Chartered Physiotherapist MSc BSc MCSP

Anxiety and stress play significant roles in the experience and management of chronic pain. The relationship between chronic pain, anxiety, and stress is complex and bidirectional, meaning each can influence and exacerbate the other. Here are some key aspects of how anxiety and stress impact individuals with chronic pain and other long-term conditions, and why it's important to manage these psychological factors. 

How anxiety and stress impact individuals with chronic pain

Anxiety and stress can amplify the perception of pain. When individuals are anxious or stressed, their nervous systems may become more sensitised, leading to an increased awareness and intensity of pain signals. They can also often contribute to increased muscle tension and physical discomfort throughout the body. This tension can exacerbate pain, especially in conditions where muscle tension plays a role, such as tension-type headaches or musculoskeletal pain. 

Chronic pain conditions can be emotionally challenging, and the constant presence of pain can lead to heightened anxiety. Chronic stress and anxiety may impair an individual's ability to cope effectively with pain, creating a cycle of increased distress and decreased coping. And they can influence the way the brain processes pain signals. This may increase sensitivity to pain or a heightened perception of pain intensity. 

Negative moods and sleep disturbances are also two common signs, as living with chronic pain can be emotionally draining, and the ongoing stress associated with pain may lead to feelings of frustration, irritability, and sadness. Which then can contribute to sleep disturbances and poor sleep.

Anxiety about pain can lead to fear and avoidance behaviors. Individuals may avoid activities they associate with pain, leading to deconditioning and a reduced quality of life. They may also be less likely to engage in physical activities or prescribed exercises in general. And it’s not just missing out on activities, this can also lead to strain on interpersonal relationships - affecting communication, intimacy and overall relationship satisfaction. 

man holding forehead under sunset

High levels of cortisol and the immune system

Chronic stress can dysregulate the immune system, leading to an imbalance in inflammatory and anti-inflammatory responses. Prolonged activation of the stress response can suppress immune function and impair the body's ability to regulate inflammation effectively. 

Cortisol and stress also modulate the production of cytokines, promoting pro-inflammatory cytokines and activate the hypothalamic-pituitary-adrenal (HPA) axis influencing immune cell function and inflammatory processes. Glucocorticoid resistance leads to chronic inflammatory conditions and activating the sympathetic nervous system for releasing adrenaline more frequently. 

And not only can it produce too much inflammation, it can also disrupt the balance of the gut microbiota, leading to alterations in microbial composition and function. They can increase oxidative stress, contributing to tissue injury and dysfunction, and even leading to altering gene expression patterns involved in inflammation and immune regulation.

How managing anxiety and stress helps with overall wellbeing

Managing anxiety and stress is crucial for individuals with chronic pain to enhance their overall well-being and improve pain-related outcomes. Here are 6 simple reasons to make a change today.

Improved Pain Management

Effective management of anxiety and stress can contribute to better overall pain management. By addressing psychological factors, individuals may experience a reduction in pain intensity and improved coping abilities.

Enhanced Quality of Life

Managing anxiety and stress can lead to improvements in emotional well-being, sleep quality, and daily functioning. This, in turn, contributes to an enhanced quality of life.

Increased Treatment Adherence

Individuals who effectively manage stress and anxiety are more likely to adhere to prescribed pain management strategies, including medications, exercise programs, and other therapeutic interventions.

Break the Pain-Stress Cycle

By addressing stress and anxiety, individuals can break the cycle where pain exacerbates stress, and stress, in turn, worsens pain. Breaking this cycle is essential for long-term pain management, how cool.

Empowerment and Control

Learning to manage anxiety and stress provides individuals with a sense of empowerment and control over their emotional responses to pain. This empowerment can positively impact their overall perception of pain and their ability to navigate life with chronic pain.

Enhanced Functioning

Reduced anxiety and stress can lead to improved physical and emotional functioning, allowing individuals to engage more fully in activities they value and enjoy.

Effective strategies for managing anxiety and stress in the context of chronic pain may include acceptance and commitment therapy (ACT) cognitive behavioural therapy (CBT), mindfulness-based interventions, relaxation techniques, stress management strategies, and social support. 

At Chiron, we value the holistic approach to chronic pain and believe that there are many aspects to consider when looking to manage long-term pain. Reducing anxiety and stress, medication and other mindful interventions can all join forces to help provide support.