From the Guidelines
Pain that occurs as a result of structural muscle change due to anxiety is best described as psychosomatic, involving real physical symptoms that are worsened by psychological factors. This type of pain involves measurable physical changes, such as muscle knots, trigger points, and altered posture, which develop through psychological mechanisms 1. When someone experiences prolonged anxiety, their muscles often remain tense for extended periods, leading to these actual structural changes, and subsequently, genuine pain. Unlike conversion disorder or purely psychogenic pain, psychosomatic pain is physically based, with psychological factors initiating the cascade of physical changes. Key aspects of managing such pain include:
- Addressing physical symptoms through methods like physical therapy, massage, or muscle relaxants (such as cyclobenzaprine 5-10mg as needed)
- Simultaneously treating the underlying anxiety through cognitive behavioral therapy, stress management techniques, and sometimes anti-anxiety medications like SSRIs (such as sertraline 25-100mg daily) 1. It's crucial to understand that chronic pain, including psychosomatic pain, is real and modifiable, and its management should focus on promoting well-being and engaging patients in treatments and rehabilitation interventions supported by literature 1. Providers should master patient-friendly language about the pathogenesis of pain, leveraging advances in neuroscience and behavioral science, and avoid engaging in pain catastrophizing 1. By adopting a dual approach that recognizes the interplay between psychological and physical factors, healthcare providers can effectively manage psychosomatic pain and improve patients' quality of life.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Pain and Anxiety Relationship
- The relationship between anxiety and pain is complex, with anxiety contributing to the development and maintenance of chronic pain [(2,3,4)].
- Anxiety can lead to increased muscle tension, which can contribute to musculoskeletal pain 2.
- The association between anxiety and pain is bidirectional, with each condition acting as a risk factor for the other 4.
Mechanisms Underlying Anxiety-Pain Interactions
- Presynaptic long-term potentiation (LTP) in the anterior cingulate cortex (ACC) may mediate chronic anxiety triggered by injury or chronic pain 3.
- Postsynaptic LTP in ACC neurons may play a more important role in behavioral sensitization in chronic pain 3.
Treatment Implications
- Cognitive-behavioral therapy (CBT) appears to be efficacious and effective in the treatment of anxiety disorders, including those related to chronic pain 5.
- Combining selective serotonin reuptake inhibitors (SSRIs) and CBT may produce greater improvement in symptoms of depression and anxiety than either treatment alone 6.
- The recognition of the association between anxiety and pain is important for professionals dealing with chronic pain, and treatment approaches should take into account the complex relationship between these conditions [(2,4)].