How does back pain cause anxiety?

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Written By Dr. Carlos Roberto Babá

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

The rise in stress and anxiety levels during recent times has led to an increase in reported back pain, prompting many to wonder about the connection between these emotional states and their physical discomfort.

Chronic mechanical low back pain is an increasingly prevalent issue that affects a substantial percentage of people worldwide. As more individuals experience low back pain, it’s crucial to comprehend the underlying causes and devise methods to tackle the problem. Stress has emerged as one of the primary factors contributing to this widespread issue.

Sudden body pains are a common and bewildering symptom of anxiety that many individuals experience. These random, daunting sensations can be easily misinterpreted by those with health anxiety, leading to a vicious cycle of worry and obsession.

While the connection between emotional and physical health may not have been extensively covered in medical training, it has become increasingly evident through clinical experience.

In recent years, the prevalence of anxiety and depression among patients with orthopedic conditions has led to a deeper understanding of the interplay between mental and physical health.

In this blog post, we will discuss how stress and anxiety can exacerbate or even cause back pain, and provide six valuable tips to help alleviate the pain and promote overall well-being.

Understanding the Connection Between Stress, Anxiety, and Back Pain

The human body responds to stressful situations through the fight-or-flight response, a physiological change involving the release of cortisol and adrenaline into the bloodstream.

These hormones increase muscle tone, but when not used for their intended purpose, the accumulated tension can strain joints and cause discomfort in various areas, including the trapezius muscles, jaw, neck, shoulder, and lower back.

The Invisible Demon: How Stress Affects Low Back Pain

Our contemporary lifestyle has exposed us to a persistent state of stress, with numerous emotional triggers negatively impacting both our mental and physical well-being. The constant barrage of social media, emails, messages, and peer pressure, among other factors, creates a state of chronic stress that our bodies struggle to manage effectively.

When under chronic stress, our sympathetic nervous system becomes overactive, leading to increased heart rate, blood pressure, and a perpetual fight or flight response. As a result, our immune system, muscular system, and posture are adversely affected.

Posture changes, such as slouching, cause continuous micro traumas to our back muscles, leading to weakness and overstimulated nerve endings. Consequently, pain episodes become more frequent and intense, resulting in a worsening cycle of low back pain.

The Anxiety-Induced Body Pain Phenomenon

Individuals with anxiety disorders often report experiencing random body pains that can be overwhelming and distressing. These sensations may occur in moments of clarity, quickly pulling the individual’s focus inward and away from their external environment. Such experiences can lead to an obsession with the affected body part, which may exacerbate the sensation and prolong its presence.

The anxiety-driven body pains can be so perplexing that sufferers may resort to searching for answers online, ultimately falling down a rabbit hole of worry and catastrophic thinking. This cycle can be further reinforced when the body pains repeatedly occur in the same area, intensifying the fixation on that particular spot.

Understanding the Connection Between Anxiety and Body Pains


When a person is in a highly sensitized state due to anxiety, their fear response remains active, causing the body to release adrenaline and cortisol. These chemicals prepare the body to fight or flee, resulting in a wide range of bodily sensations. Individuals with anxiety may misinterpret these sensations as life-threatening, further fueling their anxiety and perpetuating the cycle.

In this heightened state of fear, the body is constantly in defensive mode, leading to the persistence of these sensations. To break free from this cycle, it is crucial to address the underlying issues driving the anxiety.

Adding poor posture, a sedentary lifestyle, and the challenges of working from home can further contribute to musculoskeletal problems. To address these issues, consider the following six tips:

  1. Early recognition and intervention: Acknowledge stress as a potential aggravator of pain and take steps to reduce its impact. Practice controlled breathing, muscle relaxation, and mental calming techniques to mitigate stress. Exercise can also be an effective stress reliever.
  2. Opt for slower-paced exercises: Choose activities like yoga, tai chi, or Pilates over high-intensity interval training or running, which may increase adrenaline and cortisol levels and worsen stress-related symptoms.
  3. Practice meditation and focused breathing: Spend at least five minutes daily focusing on your breath to enhance mood. Body scan meditation can help you connect with your body and release tension.
  4. Limit social media and news consumption: Avoid overexposure to electronic devices and news updates, as these can contribute to stress and anxiety. Establish boundaries for device usage and news intake.
  5. Prioritize sleep: Aim for eight to nine hours of sleep per night and establish a consistent sleep schedule. Avoid using electronic devices 1 hour before sleeping.
  6. Follow a balanced, nutritious diet: Opt for a wholesome, plant-based diet that is rich in proteins, vitamins, and minerals, while minimizing carbohydrates and sugars. A healthy diet can help boost your immune system, enabling your body to combat viruses and germs more effectively.

Effective Strategies for Managing and Reducing Anxiety-Induced Body Pains

  1. Implement relaxation techniques: Introducing relaxation techniques such as exercise, yoga, meditation, spending time in nature, deep breathing, and reducing workload can activate the parasympathetic nervous system, which helps to counteract anxiety. As the body becomes more relaxed, the random body pains may decrease in frequency and intensity.
  2. Reframe negative thoughts: When experiencing body pains, individuals may resort to “what-if” thinking, further fueling their anxiety. To counter these thoughts, focus on alternative explanations for the pain, such as the body’s heightened state due to anxiety. Engaging in activities that relieve tension, like meditation or going for a walk, can help alleviate the pain.
  3. Shift your perspective: Changing the way you perceive and react to these sudden body pains can make a significant difference in their occurrence. By being less reactive and more accepting of the sensations, they may gradually diminish in intensity and frequency.
  4. Address emotional memories: Emotional memories can also play a role in triggering body pains. To address these memories, engage in journaling, meditation, and reframing exercises. These techniques can help release the emotional ties and reduce the physical manifestations of anxiety.

The Impact of Stress, Anxiety, and Depression on Orthopedic Conditions

One obvious connection between stress, anxiety, and depression is the experience of chronic pain, which can significantly impact an individual’s daily life. For instance, someone with knee pain may become depressed because they can no longer participate in activities they enjoy, such as skiing. This connection between chronic pain and emotional health is evident and well-recognized.

However, another less obvious connection exists between emotional health and the perception of pain. For example, an individual with a minor knee issue may experience heightened sensations of pain due to underlying stress, anxiety, or depression. In these cases, the emotional state acts as an amplifier, making the individual hyper-aware of the physical discomfort.

This heightened awareness of pain can be compared to hearing a song played at a low volume in the background. While the song may be mildly irritating, it becomes unbearable when the volume is turned up to a higher level. Similarly, stress, anxiety, and depression can amplify the experience of physical pain.

Addressing the Emotional Component of Physical Pain

neuropathy nerve cells

To effectively address the pain experienced by patients with orthopedic conditions, it is essential to consider the potential emotional contributors. This may involve directing treatment towards the underlying cause of stress, anxiety, or depression, in addition to addressing the physical issue itself.

For example, a patient who underwent a successful hip replacement surgery but continues to experience pain may benefit from seeking treatment for their anxiety. In this case, addressing the emotional component of their pain could lead to a significant improvement in their overall well-being.

Final Thoughts

Tension, anxiety, and stress can intensify existing joint and muscle pain. Being mindful of these connections and implementing the tips above can help alleviate discomfort and promote overall well-being.

By implementing relaxation techniques, reframing negative thoughts, shifting perspectives, and addressing emotional memories, it is possible to regain control over these symptoms and break the cycle of anxiety-driven body pains. Remember, your body is trying to communicate with you—listen and work with it to overcome anxiety and reclaim your life.

Remember that serious damage is rare and the long-term prognosis for back pain is positive. Trust the advice of qualified professionals and avoid letting fear and worry hinder your recovery.

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M.D. Orthopaedic Pain Management - University of São Paulo

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