Conversations about chronic painful problems routinely turn into conversations about anxiety. It begins with a statement like “I hold a lot of tension in my back” or “This pain is always the worst when I’m under a lot of stress.” And it often ends up at the chicken-and-egg question: did anxiety cause the pain, or is the pain causing the anxiety?
Hint: it’s both.
Excessive and chronic anxiety is a potent root cause for an awful lot of back pain, probably neck pain, as well as virtually any other kind of chronic pain, and even a bizarre array of other physical symptoms (WebMD has a good complete list). It almost certainly amplifies pain perception and suffering across the board, but it gets worse: it may also actually cause pain we wouldn’t otherwise have, by actually making us more prone to inflammation.Although the treatment of anxiety is outside my own expertise, as a “pain guy” it feels like familiar territory to me: anxiety is the other side of the chronic pain coin.
There’s also some whimsy. Because anxious people need some of that.
Anxiety is rarely just about biology or psychology. Except when it is.
We humans are chemistry, and nothing could make this clearer than the chilling story of an old family friend who suffered lifelong anxiety and panic attacks.After decades of living with this curse, he was diagnosed with a rare genetic disorder. One of the consequences of this genetic disorder are small tumours on the adrenal glands that cause spikes in adrenalin production. He had one on his adrenal gland. The gland was excised, and he was cured — or perhaps “set free” would be a better description.
That’s an exceptionally rare cause of anxiety, of course. But don’t neglect the possibility of a medical explanation or complication. Some of them are much, much more common. In fact, there are at least several insidious or underestimated medical causes of anxiety, which may explain an awful lot of allegedly “free floating” anxiety and symptoms of anxiety disorder in people who do not seem like a good psychological fit for it.
Insomnia is a simple example: it’s major risk factor for anxiety disorders,so anything that interferes with sleep — practical or pathological — is obviously an important consideration.
Chronic pain is extremely common, and can be both a cause and consequence of anxiety — sometimes equally, sometimes slanted much more one way than the other, but each always influencing the other to some degree. For many people with both anxiety and pain, solving the pain is the best possible treatment for the anxiety. Others must solve both at once. And a few will find that pain is just one of many ways that they are haunted by anxiety demons.
Spinal cord irritation is a disturbing example, with a strong tie-in to chronic pain: some people may be anxious because they have irritated spinal cords, which occurs in some arthritic necks and can cause the body to react as if it were stressed.This is called “dysautonomia.” Even minor positional cervical cord compression may cause clinically significant dysautonomia, and even just a little bit of it seems to be potent. It’s been found that many people with fibromyalgia (unexplained chronic widespread pain) also have erratic spinal cord compression,9 which has profound implications: fibromyalgia might not only associated with stress, but also with “artificial” stress brought on by a mechanical spinal cord irritation. Which is not actually all that rare, believe it or not.10 And for every case with a clear clinical presentation, there may be many that are rather vague. It’s a bit sinister, isn’t it?
Maybe you’re anxious, or maybe you just have a slightly irritated spinal cord.
And then there are a bunch of other causes of dysautonomia as well, most of them individually rare, but collectively it’s not exactly an exotic medical phenomenon.
Imagine for a moment the absurdity and futility of spending thousands on counselling to try to learn to be less anxious when your anxiety has a simple-in-principle medical cause like this. Ugh.
That’s not strictly correct, but it is funny because it’s true in a sense. Being told to calm down in the right way, or telling ourselves, can be effective. But that “right way” is maddeningly elusive. Most people feel like being “persuaded” out of anxiety is a tall order; it’s hard to outsmart it, or suppress it by force of will. We don’t feel good at calming down. Here are some of the typical ways that people reflexively try to calm down (AKA “cope with anxiety”):
These aren’t “best practices,” just the easiest and most obvious things that worried people tend to try. That doesn’t mean they are useless, and if you haven’t tried them, you should.
But most of them are just variations on telling ourselves to calm down, and they are hardly a magic bullet. Although they work some of the time for easier cases, many people with anxiety disorders have had little luck with these strategies, and we probably wouldn’t have an anxiety epidemic if they were highly effective. By nature, we can’t easily think our way out of anxiety. It’s like telling a depressed person to “think positively” — if they could do that, they wouldn’t be depressed.
But there are are other, better ways to calm down. And what if you had professional help with that?