Anxiety

The coprevalence of pain and anxiety has been supported in the literature, with rates as high or perhaps greater than that for depression (Roy-Byrne et al. 2008). Research suggests a relationship between anxiety states and arthritic conditions (McWilliams et al. 2003), atypical chest pain (Katerndahl 2004), migraine (Swartz et al. 2000), back pain (McWilliams et al. 2004), and fibromyalgia (Cohen et al. 2002). In a cross-sectional study of chronic pain patients, the tendency toward worry was significantly associated with long-term suffering related to pain (Lackner and Quigley 2005). The presence of comorbid anxiety may lead to hyperarousal and increased vigilance for pain and somatic concerns. Anxiety may influence the emotional valence associated with somatic sensations and an increased proclivity to misinterpret somatic experiences (Derakshan and Eysenck 1997, van der Kolk et al. 1996).

In a survey of a nationally representative sample, panic attacks and generalized anxiety disorder were more than two times as likely to be present among patients endorsing back pain or arthritis and almost four times as likely in those endorsing migraine as compared to a control group without pain. Strikingly, rates of diagnosable clinical depression were notably lower, observed at a rate of 1.5-2 times among those with pain as compared to controls (McWilliams et al. 2004).

Commonly encountered anxiety disorders include generalized anxiety disorder, panic disorder, social anxiety disorder, and posttraumatic stress disorder (PTSD) (Gureje et al. 2008). PTSD is associated with chronic somatic pain in several studies, particularly among military veterans with chronic pain and among chronic pain patients whose pain developed after a work injury or motor vehicle accident (Asmundson et al. 2002).

Like depression, the presence of an anxiety disorder can predict poor outcomes for patients with chronic pain (Roy-Byrne et al. 2008). Fears related to precipitating pain can lead to restriction of movement and avoidance of activity thereby contributing to decondition-ing and muscle weakness and undermining rehabilitative measures such as physical therapy (Vlaeyen et al. 1995). The treatment of comorbid anxiety may serve to supplement preventive pain treatment measures, e.g., with migraine (Breslau and Davis 1993), and enhances rehabilitative measures; thus, it is a necessary component of comprehensive pain treatment.

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