Can chronic pain cause anxiety?

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Written By Dr. João Arthur Ferreira

MD, PhD. Physical Medicine & Rehabilitation Physician from São Paulo - Brazil. Pain Fellowship in University of São Paulo.

Chronic pain is a condition that affects millions of people worldwide. While the physical aspect of pain is well-known, the emotional and psychological components are often overlooked.

Chronic pain and anxiety often go hand in hand, with one exacerbating the other. In this blog post, we will dive deep into the connection between chronic pain and anxiety, exploring effective strategies to help you better manage your pain and improve your overall wellbeing[1]Lerman SF, Rudich Z, Brill S, Shalev H, Shahar G. Longitudinal associations between depression, anxiety, pain, and pain-related disability in chronic pain patients. Psychosomatic medicine. 2015 Apr … Continue reading.

Epidemiology and Prevalence of Chronic Pain and Behavioral Health Conditions

Over half of the opioids prescribed in the US go to adults with mental health disorders. One in five adults experiences a mental illness, and one in twenty-five live with a serious persistent mental illness. Chronic mental illness often begins during adolescence, but diagnosis and treatment can be delayed[2]Flor H, Birbaumer N, Turk DC. The psychobiology of chronic pain. Advances in Behaviour Research and Therapy. 1990 Jan 1;12(2):47-84..

Around 7% of adults live with depression, and 18% live with anxiety disorders. There is a significant overlap between mental health conditions and addiction. However, the majority of people with behavioral health conditions do not receive treatment for their conditions.

Similarly, chronic pain is prevalent, with approximately 126 million adults in the US experiencing pain in the last three months, and 11% suffering from chronic daily pain.

By following the guidance and recommendations provided, you can make progress on your journey towards a healthier and happier life.

Understanding the Connection Between Chronic Pain and Anxiety

anxiety chronic pain

Chronic pain can be both physically and mentally draining. Many people who suffer from chronic pain often experience anxiety as well, with the two conditions feeding off each other in a vicious cycle.

The link between chronic pain and anxiety is multifaceted, and addressing both conditions is crucial in achieving lasting relief.

The Emotional Side of Chronic Pain

One of the most challenging aspects of chronic pain is the dismissal from others, including healthcare professionals, who may claim the pain is “all in your head.” This can be incredibly demoralizing for those who suffer from chronic pain. However, it’s essential to understand that the pain is indeed in your head, but it’s rooted in the biology of your brain.

Mental health is frequently the last component addressed when treating chronic pain. However, it’s crucial to recognize that stress, anxiety, depression, and sleep quality can significantly impact the severity of chronic pain.

By addressing these issues, it’s possible to reduce pain levels and improve overall quality of life.

Focus on the Right Strategies

chronic pain relax

When dealing with chronic pain and anxiety, it is essential to focus on the right strategies that will help you cope with your symptoms and improve your overall mental and physical wellbeing. Some of these strategies include:

  1. Engaging in regular exercise: Physical activity is an excellent way to help manage pain, reduce anxiety, and improve overall health. Whether it’s walking, swimming, yoga, or another low-impact exercise, incorporating regular physical activity into your daily routine can have significant benefits.
  2. Practicing mindfulness: Mindfulness techniques, such as meditation and deep-breathing exercises, can help alleviate anxiety and improve your ability to cope with pain. By focusing on the present moment, you can gain a sense of control and reduce negative thought patterns.
  3. Building a support network: Connecting with friends, family, and others who understand your struggles can help you feel less alone and provide valuable encouragement as you navigate your journey to better health.
  4. Seeking professional help: Working with a healthcare professional, such as a therapist or physician, can help you develop a tailored treatment plan to address both your chronic pain and anxiety.
  5. Prioritizing sleep: Getting a good night’s sleep is crucial for both mental and physical wellbeing. Establishing a consistent sleep schedule and creating a relaxing bedtime routine can help improve your sleep quality and reduce anxiety.
  6. Incorporating relaxation techniques: Engaging in activities that promote relaxation, such as reading, taking a warm bath, or practicing gentle stretches, can help reduce stress and anxiety levels while also helping to manage pain.

Addressing Sleep and Emotional Factors

One of the first steps in addressing chronic pain from a mental health perspective is to focus on improving sleep quality. Many people with chronic pain struggle with sleep due to anxiety and depression, leading to a vicious cycle that exacerbates their pain.

Establishing a regular sleep schedule and addressing the stress and anxiety that may be hindering sleep are crucial components of pain management.

Living in the Present

Depression often stems from dwelling on past events, while anxiety arises from worrying about the future[3]Michaelides A, Zis P. Depression, anxiety and acute pain: links and management challenges. Postgraduate medicine. 2019 Oct 3;131(7):438-44.. People with chronic pain need to learn how to live in the present moment to reduce stress and anxiety that may be triggering their pain.

Practicing mindfulness and focusing on the present can help to calm the nervous system and minimize pain levels.

Breaking the Cycle

When addressing chronic pain, it’s essential to break the cycle of pain, stress, and anxiety that perpetuates the condition.

This can be achieved by addressing the underlying emotional issues that contribute to chronic pain, such as past traumas or relationship problems.

Working with a mental health professional can help individuals explore these issues and develop strategies to manage their pain more effectively.

Key Points

  1. Chronic pain and behavioral health conditions have a bi-directional relationship: Those with chronic pain experience more severe behavioral health conditions, while those with behavioral health conditions have a higher prevalence of chronic pain.
  2. The relationship between chronic pain and behavioral illness is driven by neurobiology, with the largest overlap occurring in depression, anxiety, and substance use disorders.
  3. Other significant drivers of chronic pain include smoking, suicide, and the experience of adverse childhood experiences, particularly sexual violence.
  4. The fear-avoidance model helps to explain how behavioral treatments, such as talk therapy, can be effective in managing chronic pain.
  5. There are highly effective non-intoxicant based strategies for the management of chronic pain, including cognitive behavioral therapy and acceptance and commitment therapy.
  6. People suffering from chronic pain deserve social compassion and the best evidence-based care. Addressing the opioid crisis should not come at the expense of providing quality care to those with chronic pain.

The Challenge of Treatment

One major challenge in addressing this overlap is the lack of sufficient psychiatrists to treat the vast number of patients with chronic pain and behavioral health conditions.

Even if other healthcare professionals, such as nurse practitioners or physician assistants, were to step in, the workforce would still fall short of the demand. Consequently, healthcare systems must employ collaborative care approaches and leverage predictive analytics to stratify patients based on their need for specialist care.

In addition, primary care providers often play a critical role in treating patients with both chronic pain and behavioral health conditions. However, these providers face several challenges, including limited resources and support from specialty services.

Treatment Strategies

  1. Cognitive Behavioral Therapy (CBT) – CBT aims to target the harmful effects of fear and catastrophizing, helping patients develop strategies to manage their pain and emotions more effectively.
  2. Acceptance and Commitment Therapy (ACT) – This therapy focuses on helping patients accept their pain non-judgmentally and commit to life goals, recognizing that they can still live a fulfilling life despite their pain.
  3. Multidisciplinary Pain Rehabilitation – This approach combines various therapies, such as physical therapy, occupational therapy, and psychological interventions, to address the multiple aspects of chronic pain.
  4. Psychopharmacology – Medications can be an essential component of treatment for patients with chronic pain and coexisting behavioral health conditions.

The Importance of Personalized Care

While implementing evidence-based strategies is crucial, healthcare providers must also recognize the importance of the art of medicine and personalized care. Each patient is unique, and treatment plans should be tailored to meet individual needs.

By striking a balance between evidence-based care and personalized medicine, healthcare providers can optimize the management of chronic pain and behavioral health conditions.


The overlap between chronic pain and behavioral health conditions presents significant challenges for both patients and healthcare providers.

By employing a combination of treatment strategies, such as CBT, ACT, multidisciplinary pain rehabilitation, and psychopharmacology, healthcare providers can improve the quality of care for patients suffering from these complex conditions.

Furthermore, embracing a personalized approach to care can ensure that each patient receives the most appropriate and effective treatment for their unique needs.

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Physiatrist, M.D. Pain Center of University of São Paulo


1Lerman SF, Rudich Z, Brill S, Shalev H, Shahar G. Longitudinal associations between depression, anxiety, pain, and pain-related disability in chronic pain patients. Psychosomatic medicine. 2015 Apr 1;77(3):333-41.
2Flor H, Birbaumer N, Turk DC. The psychobiology of chronic pain. Advances in Behaviour Research and Therapy. 1990 Jan 1;12(2):47-84.
3Michaelides A, Zis P. Depression, anxiety and acute pain: links and management challenges. Postgraduate medicine. 2019 Oct 3;131(7):438-44.

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