Emotions and Pain: How are they Linked?

The brain's pain response is affected by sensory and emotional factors. Emotions such as fear, anxiety, and pain memories can influence pain by either increasing or reducing pain signals to the brain.

Anxiety can cause both physical and mental symptoms, which may include pain such as:

  • Muscle aches and tension, which could possibly lead to back pain
  • Headaches
  • Chest pain
  • Stomach aches
  • Feeling tense or nervous

Stress may also be the cause of anxiety and muscle tension or pain. Stress is our response to external or internal challenges, triggering psychological and physical reactions to help us cope. Stress can directly affect our health and how we experience pain. Ongoing stress can exhaust the body's resources, making it harder to recover and struggle to handle new stress, leading to symptoms like depression, tiredness, and changes in how pain is felt, or it can cause changes in muscle and tissue that may make pain feel worse.

Anxiety Related Back pain

Studies have shown that people with ongoing low back pain (LBP) and mood or anxiety disorders, tend to have more severe pain, difficulty with daily tasks and managing their condition. Besides the medical issues, their enjoyment of life is also greatly affected. Their intensity of pain, ability to function normally, and various psychological factors are related to anxiety, which can all affect how well their back pain treatment works. Treatment of back pain should therefore be holistic by including both physical interventions, as well as psychological therapies.

How to Treat Back Pain related to Anxiety

Psychological therapies 

A study showed that stress from social and work situations is a risk factor for low back pain turning into a long-term problem. Believing in your ability to handle challenges is known as self-efficacy and it may contribute to managing stress and pain. Effective treatment and prevention of low back pain should take into account these psychological factors, including the impact of different types of stress.

Talking therapies, anxiety management courses or self-management and self-care strategies may help with treating or managing anxiety.  Applied relaxation is also an option. Speak to your healthcare professional or visit anxietyuk.org.uk or NHS Every Mind Matters [https://www.nhs.uk/every-mind-matters/mental-wellbeing-tips/self-help-cbt-techniques/] for more information about these types of treatment options.  

Cognitive Behavioural Therapy (CBT) 

CBT can be an effective treatment for anxiety. It’s a type of talking therapy to help you manage your problems by changing the way you think and behave. There are different ways to do this type of therapy. 

  • You could work through a CBT workbook or computer course in your own time or with the support of a therapist who you see every 1 or 2 weeks.  

OR 

  • You could choose to take part in a group course where you and other people with similar problems meet with a therapist every week to learn ways to tackle your anxiety 

If you’ve tried self-help or group therapy and need additional help, you may be offered more intensive CBT where you usually have weekly sessions with a therapist for 3 to 4 months, or another type of therapy called applied relaxation or medication. 

Relaxation Therapy 

To manage stress, relaxation techniques like mindfulness-based stress reduction (MBSR) can be helpful. This includes meditation, yoga, and focusing on the body, and helps people deal with pain and negative emotions. Studies have shown it works well for chronic pain, in a similar way to cognitive-behavioural therapy.  

Another option is Applied Relaxation. This therapy focuses on relaxing your muscles in a particular way during situations that usually cause anxiety. A trained therapist can teach the technique which generally involves learning how to relax your muscles: 

  • quickly and in response to a trigger, such as the word "relax" 
  • in situations that make you anxious.  

Usually with applied relaxation therapy, you’ll meet with a therapist for a 1-hour session every week for 3 to 4 months.  

Physical Activity 

Long-term back pain may cause an individual to avoid work or socialise, which may in-turn lead to depression. Negative emotions like anxiety and depression can increase a person’s fear of pain and exercise, leading them to do fewer daily activities. Reduced activity then lowers muscle strength and fitness, which makes negative feelings like irritability and frustration worse. This creates a vicious cycle where negative emotions and fear of movement keep reinforcing each other. 

If movement or daily activities don't improve over time, anxiety is more likely to develop. The likelihood of low back pain (LBP) returning is higher for people with anxiety, even after they feel better. 

Moderate exercise helps reduce stress and improve the balance of your body's stress systems, leading to less overall stress and better brain health. It can also help with depression, anxiety, and cognitive issues. Staying active and doing stretching exercises may also help with back pain. However, high-intensity exercise can disrupt this balance, causing increased stress and delaying the body's feedback mechanism to stop stress hormone release. It’s important to find the right balance to manage your stress and relieve muscle tension. 

Other ways to help with back pain: 

  • Try a heat pack or hot water bottle wrapped in a tea towel, on your sore back to help relieve joint stiffness or muscle spasms 
  • Apply an ice pack or bag of frozen peas wrapped in a tea towel, to reduce pain or swelling.  
  • You may also get pain relief by taking a medicine like ibuprofen, which has anti-inflammatory properties. Nurofen Express 200 mg Liquid Capsules contain ibuprofen and can provide up to 8 hours of relief (with a 400mg dose) from muscular pain and backache. 

When to see a doctor

Although there may be a link between physical pain and anxiety, body pain can also be caused by many reasons other than anxiety. Consult your GP or a healthcare professional if your back pain does not improve after treating it at home for a week or two, if the pain is stopping you from doing your daily activities, if the pain is severe or getting worse or if you’re worried about the pain.

It's also a good idea to speak to your doctor if you're struggling to cope with anxiety, fear or panic, things you're trying yourself are not helping or you would prefer to get a referral from a GP.