Understanding the co-occurrence of anxiety disorders and chronic pain: state-of-the-art
Open accessAbstract
The purpose of this article is to describe the current state-of-the-art regarding the co-occurrence of the anxiety disorders and chronic pain. First, we describe the core characteristics of chronic pain and its co-occurrence with the anxiety disorders. Second, we review data on the prevalence of co-occurrence. Third, we describe the mutual maintenance and shared vulnerability models, both of which have been offered to explain the co-occurrence of posttraumatic stress disorder (PTSD) and chronic pain and may have applicability to various other anxiety disorders. Fourth, we provide an integrative review of available research addressing the postulates of these models specific to the mechanisms of anxiety sensitivity, selective attention to threat, and reduced threshold for alarm. We conclude with general recommendations for improving assessment and treatment of patients who present with an anxiety disorder accompanied by clinically significant pain. Given that most of the available evidence has come from studies of PTSD and chronic pain, we provide a detailed agenda for future investigation of the co-occurrence of chronic pain and other anxiety disorders.
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There is increasing evidence to support co-occurrence of persistent pain and anxiety disorders such as generalised anxiety disorder, panic attacks, social anxiety or PTSD.
“There is also increasing evidence to support the co-occurrence of persistent pain and anxiety disorders such as generalised anxiety disorder, panic attacks, social anxiety or post-traumatic stress disorder.6–8”
From Protocol for a feasibility and acceptability study using a brief ACT-based intervention for people from Southwest Wales who live with persistent pain (2018) · cites this paper as [7]
The COVID-19 pandemic increased psychological distress in many populations, particularly for people with chronic health conditions.
“It is well established that the COVID-19 pandemic increased psycholo gical distress in many populations, particularly for people with chronic health con ditions (CHCs).”
From ACT2COPE: A pilot randomised trial of a brief online acceptance and commitment therapy intervention for people living with chronic health conditions during the COVID-19 pandemic (2023) · cites this paper as Asmundson & Katz, 2009
The Introduction discusses associations between chronic medical conditions and psychiatric illness, including emotional distress associated with chronic pain. Our copy does not address the COVID-19 pandemic or a pandemic-related increase in psychological distress (searched: COVID-19, pandemic, psychological distress). (LLM, conf=0.76)
Experimental — accuracy not yet measuredThe biopsychosocial approach characterizes pain and disability as a multidimensional dynamic interaction among physiological, psychological, and social factors that reciprocally influence each other and produce chronic complex pain syndromes.
“Collectively, the biopsychosocial approach describes pain and disability as a multidimensional, dynamic interaction among physiological, psychological, and social factors that reciprocally influence one another, resulting in chronic and complex pain syndromes7, 12.”
From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [12]
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References 133 · Cited by 756
Research works printed but not linked: 8
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- Authors
- Asmundson, G. J. G., & Katz, J.
- Affiliations
- University of Regina (CA)
- York University (CA)
- Corresponding author
- Asmundson, Gordon J.G.
- Venue
- Depression and Anxiety
- Publisher
- Wiley
- Published
- 2009-08-18
- Volume
- 26
- Issue
- 10
- Pages
- 888-901
- ISSN
- 1091-4269 (ISSN-L)
- 1520-6394
- OpenAlex
- W1965511761
- Cited by
- 756
- References
- 133
- Citations by year
- 2026: 26 · 2025: 43 · 2024: 52 · 2023: 57 · 2022: 65 · 2021: 54 · 2020: 65 · 2019: 49 · 2018: 48 · 2017: 60 · 2016: 43 · 2015: 39 · 2014: 47 · 2013: 34 · 2012: 30
- FWCI
- 2.54
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- Locations
- Depression and Anxiety (publishedVersion)
- PubMed (publishedVersion)
- YorkSpace (York University) (submittedVersion)
- Funders
- Canadian Institutes of Health Research (CIHR); Institute of Neurosciences Mental Health and Addiction
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- anxiety disorders, chronic pain, comorbidities, post-traumatic stress disorder, anxiety sensitivity, threat attention, alarm thresholds, prevalence, assessment and treatment
- MeSH terms
- Anxiety Disorders, Attention, Chronic Disease, Depressive Disorder, Fear, Humans, Obsessive-Compulsive Disorder, Pain, Phobic Disorders, Prognosis, Risk Factors, Somatoform Disorders, Stress Disorders, Post-Traumatic, Comorbidity, Pain Management
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