Where pain, anxiety and depression intersect

In News by Justin Welton

While not so apparent at the outset, anxiety disorders and chronic pain frequently co-exist. Everyone experiences pain at some point, but in people with depression or anxiety, pain can become particularly intense and hard to treat. People suffering from depression, for example, tend to experience more severe and long-lasting pain than others and approximately twice as many people who suffer from chronic pain such as arthritis are also affected by an anxiety disorder. The increased likelihood of anxiety has also been found among those who have migraines, back pain, neck pain, and fibromyalgia.

Time of year, other coexisting conditions and familial circumstances also influence pain , anxiety and depression, But what the world is going through today with the  COVID-19 pandemic has set all records loose.

What exactly is the connection?

  • People who suffer from chronic pain and have an anxiety disorder may have a lower tolerance for pain. Those that have anxiety may also be more fearful of pain than someone who experiences pain without anxiety.
  • Chronic pain is depressing, and likewise major depression may feel physically painful. Depression commonly occurs as a result of chronic pain and needs treating to improve outcome measures and quality of life.
  • Research shows that pain actually shares some biological mechanisms with anxiety and depression. Neurotransmitters are chemicals in the brain that transport information between cells. Serotonin and norepinephrine contribute to pain signaling in the brain and nervous system. They also are implicated in both anxiety and depression. Another neurotransmitter called Pituitary Adenylate Cyclase Activating Polypeptide (PACAP) is released in response to stress and also elevated in response to chronic pain
  • Mood disorders, especially depression and anxiety, play an important role in the exacerbation of pain perception in all clinical settings.
  • Anxiety negatively affects thoughts and behaviors which hinders rehabilitation. Being in constant fight-or-flight mode, which can happen with chronic anxiety, can have negative and serious effects on your body. Tensed muscles may prepare you to get away from danger quickly, but muscles that are constantly tense can result in pain, tension headaches, and migraines

Undoubtedly, a complex situation, but I have found that following my mantra below will help you navigate this journey effectively and reach the desired goal of health and happiness we all are striving for:

You Are What You Eat and Drink, Think and Do

Eat and Drink – my top picks

  • Alkalinize – Maintaining a 1st morning pH can ensure that the body is in an “acid -alkaline balance” and will prevent metabolic acidosis. Increased acidity in the body can affect the amygdala (fear control center) and certain acid sensing ion channels increasing the propensity for anxious episodes and panic attacks. Keeping the 1st morning urine pH between 6.5-7.5 can also help keep pain in check. Choose your foods wisely – incorporate alkalinizing foods like nuts, seeds, sprouts, vegetables and do not forget to hydrate with mineral rich water preferably as opposed to canned, sweet sodas.
  • Think of an amino acid supplement – and reach for PERQUE Mood Guard™. An important compound called s- adenosyl methionine (SAMe) is made in the body from the amino acid methionine and is effective in reducing symptoms of depression, anxiety and even pain as in osteoarthritis. While many practitioners prefer using SAMe as a supplement, I recommend using free amino acids like methionine, glycine and aspartate so the body is empowered to make its own SAMe.
  • Sustain restorative sleep, memory and energy balance. Common signs of low adrenal function include: an uncontrollable need to eat, lack of restorative sleep…being tired or less than refreshed when you wake up. PERQUE Adreno Distress™ is a unique adrenal support combination micellized with healthy fats for superior bioavailability.
  • Sleep well – be well. Improve your levels of the neurotransmitter serotonin with PERQUE Sleep Guard™. The L-tryptophan formulation with vitamins B2 and B6 for better uptake and function will help you restore sleep rhythms. Restorative sleep = better brain activity, mood, and energy!
  • Eat foods your body can easily digest, assimilate and eliminate. PERQUE Plant Powered Protein™ (in Chocolate or Vanilla) is suitable for those following an alkaline, keto, paleo or similar lifestyle/meal plan. This power-packed, easily digestible organic pea protein features complex carbohydrates to help bind toxins and help with sugar and energy stability.

What about Think and Do?

It’s hard to be positive during challenging times such as these but I follow the 3 golden rules listed below that can make things easier

  • Physical Movement

Physical activity boosts mood and alleviates anxiety. At least 30 minutes a day can be helpful but frequently, people with chronic pain avoid exercise. The consequences though are not desirable – the less you do higher the risk of injury and worsened pain. I prefer using gentler therapies that are known to be effective for pain relief such as Pilates, Feldenkrais, Trager, Alexander, and Bowen technique, massage and other such bodywork aim to reeducate the brain into realizing that it is now “safe” to move freely.

  • Achieving neurochemical harmony
  • Green Light Therapy –Light therapy has been used by scores of therapists and for various benefits. I particularly like using dichromatic PAR 38 lights emitting light in the green wavelength plays a role in harmonizing and calming the pineal gland. The light travels through the retina and laying under the light for 15-20 minutes can achieve better sleep, concentration and even support healthy digestion and bio detox.
  • Active Meditation – Meditation supports the balance of neurotransmitters such as oxytocin, acetylcholine, norepinephrine and the like that are involved in the “fight or flight response”. This is an innate response that usually protects the body from harm but can go haywire in some people resulting in anxiety/depression
  • Breathing – People who are anxious tend to breathe in their upper lungs (upper chest) with shallow, rapid breaths. Breathing like a baby is what we need to do. Lower chest (diaphragmatic) or Abdominal breathing is the ideal way to fill the lungs with air slowly, provides for sufficient oxygen intake and controls the exhalation of carbon dioxide. This technique exudes calmness and can be done at any time during the day. It also has an extremely therapeutic effect on chronic pain. It has a major influence on relaxing the muscles which tense up as a result of pain and in turn further aggravate the pain itself.

Positive Thinking

While this can seem impossible at times, it is very important for the body and mind and can be achieved by

  • Trusting yourself – most importantly not focusing on negative thoughts
  • Feeling gratitude for the things we have. Gratitude can instill happiness and positive emotions, but also improve sleep quality and blood pressure
  • Staying grounded- sometimes helping others can help us realize we are in a better position

Managing pain and anxiety with or without each other is doable. You truly are and become what you eat, drink, think, and do and now is the right time to follow this mantra for a healthy life.

Woo AK. Depression and Anxiety in Pain. Rev Pain. 2010;4(1):8-12.


  • Klotsche C, Color Medicine: The secrets of color/vibrational healing, Light Tech Pub, 1993

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Justin Welton
Author: Justin Welton