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Which comes first, pain or anxiety? This is a complicated question. These two co-occurring disorders are so frequently linked that it can be difficult to untangle them because they create a vicious cycle. Anxiety is a mental illness with many physical symptoms, including muscle soreness, digestive issues, TMJ, and headaches. Our natural fight or flight instinct is to run away from physical pain but this is impossible if we suffer from chronic physical pain. Anxiety arises from not knowing where the pain is coming from, how long it will last, or if it will get worse. If we continue to suffer from the pain, anxiety could also come from other people not understanding or believing the depths of our pain. Anxiety and chronic pain are both invisible illnesses that are frequently diminished by others.

We often talk about how experiencing trauma can lead to addiction and mental illness. This is true of anxiety and chronic pain. Trauma can lead to anxiety and can manifest as physical pain. Our brains do not want to process trauma. Our natural response to a traumatic experience is to push it away and not examine it. This repression can lead to anxiety and when it lives in our bodies, can lead to long-term pain that we don’t realize the source of. At Sabino Recovery, our goal is to create a safe environment where our residents can process their trauma and begin to heal physical and emotional pain.

Pain and addiction are intrinsically linked. Pain is an aggravating stimulus that we can’t get away from without external factors like medication. So many of the medications we use to manage pain are incredibly addictive. In the 1990s, the medical community realized that morphine was effective but addictive and made a concerted effort to move away from it and to oxycodone. Pharmaceutical companies made a concerted marketing effort claiming that oxycodone isn’t addictive.

People in pain were prescribed oxycodone over and over because it was effective and allegedly not addictive. We now know that the opposite is true and millions of people have been negatively affected by the opioid crisis. People who use opioids report that it helps their pain and while it’s not specifically formulated to help anxiety, they say they’re numbed so they stop caring about their anxiety. Opioids only bring short-term relief and do not cure chronic pain.

The opioid crisis is one of the largest public health emergencies in the United States. Between 2010 and 2017, the rate of opioid-involved deaths rose from 21,088 per year to 47,600. There was a significant increase in overdose deaths in 2020 with 68,630 deaths. Millions of people are prescribed opioids and many misuse them, leading to heroin use, overdose, and the rising crisis of newborns born with opioid dependency. Since the 1990s, the opioid crisis has had three waves: overdose deaths involving prescription opioids, an increase of deaths involving heroin, and overdose deaths involving synthetic opioids like fentanyl.

So what can we do to manage pain when the most widely-used medication is highly addictive? In the United States, we have a medical model of healing. This means most people manage their health with medication or surgery prescribed by a doctor. These methods are not inherently wrong but many doctors encourage medication before a holistic approach to health. Some medical interventions such as injections can help but for long-term wellness, we should be looking at holistic treatments such as exercise, sleep, and nutrition, along with psychological treatments like therapy and mindfulness.

Our best practices for treating pain are interdisciplinary. Psychological strategies like mindfulness along with integrative therapies like acupuncture, yoga, and any kind of movement are excellent for chronic pain. Gentle movement is great for chronic pain. A movement program with walking, yoga, or swimming is incredibly helpful for chronic pain. Many people who are in chronic pain get scared to move and the less they move, the worse the pain gets.

When starting a movement program, we create small, measurable, achievable goals so that when we start any activity, we make sure we do it in small steps. We want to make sure to empower people and not introduce any other reasons for anxiety. One thing that people in pain get anxious about is their inability to control and self-manage the pain. By working through small meditation and movement goals, people are empowered to feel like they have a say in their lives and their pain which decreases anxiety and decreases pain.

In academic circles, this bio-psycho-social model of pain is gaining traction. The next step is normalizing this method with clients. Many factors make us hurt, including social and psychological factors, not just physical. When thinking about how to manage the cycle of pain and anxiety, it’s important to treat ourselves holistically and with kindness. Being mindful means being aware of our needs and taking small steps to health.