Anxiety and Chronic Pain | Why They're Connected

Published March 7, 2026 · 7 min read

By Tauri Urbanik, Pain Science Researcher

You have two problems. Or do you?

Chronic pain. Anxiety. Your doctor may treat them as separate issues. One referral for the pain. Another for the anxiety. Different medications for each. Different specialists. Different appointments.

But what if they are not two separate problems? What if they are the same problem expressing itself in two ways?

The research points strongly in this direction. And understanding the connection may be the key to addressing both.

Same brain, same circuits

Here is what neuroscience has revealed. Anxiety and chronic pain activate overlapping brain regions. Not similar regions. The same regions.

The amygdala processes both fear and pain. It is the brain's threat detector. When it fires, you feel both anxious and pain-sensitive.

The anterior cingulate cortex evaluates both emotional and physical threats. It decides how much attention and distress to assign to incoming signals. Whether the signal is "this situation is scary" or "this body part hurts," it runs through the same processing center.

The insula monitors your body's internal state. It tracks both the physical sensations that become pain and the bodily feelings that become anxiety (racing heart, tight chest, churning gut).

This is not a coincidence. Pain and anxiety are both danger signals. They are both outputs of a nervous system that perceives threat. And when the nervous system is sensitized, it produces more of both. This is the core mechanism behind neuroplastic pain.

The fear-pain cycle

You have probably experienced this cycle firsthand. Pain appears. Anxiety about the pain follows. What is wrong? Is it getting worse? Will it ever stop? That anxiety increases the nervous system's threat level. The threat level amplifies pain signals. More pain. More anxiety.

Around and around.

This cycle is not a weakness. It is a predictable consequence of two systems running on the same neural hardware. When you turn up the volume on fear, you automatically turn up the volume on pain. They share the amplifier.

Central sensitization is the process underlying both (Woolf CJ, PAIN, 2011↗). The nervous system is stuck in a state of heightened reactivity. It amplifies signals across the board. Pain gets louder. Anxiety gets louder. Normal body sensations get interpreted as dangerous. Safe situations feel threatening.

The evidence that connects them

Look at where anxiety and chronic pain overlap:

Fibromyalgia and anxiety. Anxiety disorders are 2-7 times more common in fibromyalgia patients than in the general population. Not because fibromyalgia makes people anxious (though it does), but because both conditions arise from the same sensitized nervous system.

Chronic back pain and anxiety. Brain connectivity research by Apkarian and colleagues found that emotional brain circuits predict who develops chronic pain better than any structural finding (Apkarian et al., J Neurosci, 2004↗). The fear system drives the pain.

IBS and anxiety. Gut-directed anxiety reduction improves IBS symptoms more effectively than dietary restriction. Same mechanism. Different output location.

Migraines and anxiety. Anxiety disorders roughly double the risk of chronic migraine. The nervous system on high alert lowers the threshold for everything.

The pattern is universal. When the nervous system is sensitized, both anxiety and pain increase.

Why this is actually good news

If anxiety and pain were separate problems, you would need separate solutions. Two conditions to treat. Two battles to fight.

But if they share one mechanism, one sensitized nervous system, then addressing that mechanism can improve both simultaneously. You do not need to solve two problems. You need to retrain one nervous system. That is exactly what Pain Reprocessing Therapy is designed to do.

Brain-based approaches do exactly this. Pain Reprocessing Therapy, which produced 66% pain-free rates for chronic back pain (Ashar et al., JAMA Psychiatry, 2022↗), works by teaching the brain that the danger signals (both pain and fear) are false alarms. When the brain's threat system calms down, both pain and anxiety tend to improve.

This is why many people who recover from neuroplastic pain also report that their anxiety decreased. They did not treat the anxiety separately. The anxiety resolved because the nervous system that was generating both calmed down.

Breaking the cycle

Understanding the connection is itself a step toward breaking the cycle. When your pain flares alongside anxiety, you can now recognize: this is one system, not two. The anxiety is not evidence that something terrible is happening. It is the same sensitized nervous system running both programs simultaneously.

That recognition creates space. Instead of spiraling into fear about the pain (which amplifies the pain, which increases fear), you can see the whole pattern for what it is: a nervous system on high alert producing its standard outputs.

Pain neuroscience education, learning how this all works, reduces both pain and fear across chronic pain conditions (Louw et al., Physiotherapy, 2016↗). Knowledge is itself therapeutic. You are doing it now.

J

Jason, 33

back pain and anxiety for 5 years

Jason had chronic back pain and generalized anxiety for 5 years. Two separate doctors. Two separate treatment plans. SSRIs for the anxiety. Physical therapy and injections for the back. Neither fully helped. When he learned that pain and anxiety share the same brain circuits, something clicked. His worst pain days were always his most anxious days. His pain would disappear during flow states when his anxiety was absent. He started addressing them as one nervous system problem. Within 3 months, both his pain and his anxiety had dropped significantly. He didn't need separate treatments. He needed to retrain one nervous system.

Composite story based on common patient patterns. Not a specific individual.

Frequently asked questions

Can anxiety cause chronic pain?

Yes. Anxiety and chronic pain share the same brain circuits, including the amygdala, anterior cingulate cortex, and insula. A nervous system on high alert from anxiety amplifies pain signals through central sensitization. They are not two separate problems but two outputs of one sensitized nervous system.

Why do anxiety and chronic pain happen together?

They share the same brain infrastructure. The amygdala processes both fear and pain. The anterior cingulate cortex evaluates both emotional and physical threats. When the nervous system is sensitized, it produces both anxiety and pain because they run on the same circuits.

Does treating anxiety help chronic pain?

Often yes. When you reduce the nervous system's overall threat level, both anxiety and pain can improve simultaneously. Brain-based approaches that target the shared mechanism, central sensitization, often help both conditions because they address the root cause rather than each symptom separately.

Why does my pain get worse when I'm anxious?

Anxiety is your brain's danger signal. Pain is your brain's danger signal. When anxiety increases, it raises the nervous system's overall threat level, and the brain amplifies all danger signals, including pain. They feed each other in a cycle that can be broken by retraining the nervous system.

References

1. Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011;152(3 Suppl):S2-S15.DOI: 10.1016/j.pain.2010.09.030
2. Apkarian AV, et al. Chronic back pain is associated with decreased prefrontal and thalamic gray matter density. J Neurosci. 2004;24(46):10410-10415.DOI: 10.1523/JNEUROSCI.3623-04.2004
3. Ashar YK, et al. Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain. JAMA Psychiatry. 2022;79(1):13-23.DOI: 10.1001/jamapsychiatry.2021.2669
4. Louw A, et al. The efficacy of pain neuroscience education on musculoskeletal pain: a systematic review. Physiotherapy. 2016;102(1):3-12.DOI: 10.1016/j.physio.2015.10.007