Anxiety and Fear of Pain in Headache patients


The of psychological issues—especially anxiety and fear—in recovery from pain is a complex one, and one that is unfortunately not dealt with often enough in clinical practice. It is easier to deal with the physical mechanisms of pain than the social and emotional. A new study from Canada studied the role of Anxiety Sensitivity (AS)—or the tendency to become fearful—in patients with headache.

Since no study to date has assessed AS in headache patients, the authors investigated whether headache patients with higher AS would report more cognitive, affective, and behavioral deficiencies as compared to those with medium or low AS scores. They also were hoping to determine the behaviors that predict fear of pain and lifestyle changes in this study sample.

72 patients were involved in study; 85% were female, and � of these patients suffered from migraines. The patients took the ASI, and scores for all patients were high, approaching or exceeding the average for obsessive-compulsive disorder, generalized anxiety disorder, and social phobia. The anxiety sensitivity groups did not differ in the severity or change of lifestyle due to headache. Yet, those with high anxiety sensitivity scores had more adverse effects—such as greater depression, anxiety, fear of pain, incidence of avoidance behavior, and cognitive disruptions.

Anxiety sensitivity, pain-related cognitive disruption, and pain experience were predictors. The authors hoped determining the predictors would help formulate target treatment or intervention. The authors recommend AS intervention mixed with traditional approaches to pain management:

"The present results support the application of AS intervention within the context of chronic and recurrent pain. However, at least for patients with recurrent headaches, some lifestyle changes attributed to pain appear to be mediated primarily by the severity of the pain experiences and, to a lesser extent by the physiological anxiety, cognitive anxiety and escape/avoidance behavior...Consequently, an effective means of dealing with pain severity, whether pharmaceutically or cognitive-behaviorally based, remains a target for treatment that is of immediate importance."

Thus, a patient's expectations and anxieties regarding pain need to be examined, along with the physical aspects of the pain.

Asmundson GJG, Norton PJ, Veloso F. Anxiety sensitivity and fear of pain in patients with recurring headaches. Behaviour Research and Therapy 1999;37:703-713.

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