What is the Fear-Pain Cycle?

The fear-pain cycle can be a distressing cycle in chronic pain where the fear amplifies the pain, and the pain increases the fear, so the level of pain escalates. However, there is hope in various techniques, including Pain Reprocessing Therapy, that can help to reduce the fear and, therefore, the pain.

What is Fear?

Fear is both a natural emotion and a survival mechanism. It alerts us to perceived danger and threat and produces both biochemical changes and an emotional response. The perceived danger can be physical or psychological.

Biochemical Changes

Fear produces universal biochemical changes, an evolutionary development that is an automatic response crucial to survival. It is known as the fight-or-flight response. This response is your body’s preparation to confront danger or run away. Each person experiences fear differently, but some of the common physical signs and symptoms that you experience with the fight-or-flight response include:

• Chest pain
• Chills
• Dry mouth
• Nausea
• Rapid heartbeat
• Shortness of breath
• Sweating
• Trembling
• Upset stomach
• High adrenaline levels that cause high alertness

Some people may also have a freeze response to particular threats or dangers. The freeze response induces a state of immobility when a threat seems too overwhelming or powerful to escape or fight. It is a form of de-escalation or emotional escape through dissociation when physical escape is impossible.

Signs of the freeze response include:

•              Sense of dread

•              Going tense, still, and silent

•              Feeling stiff, heavy, cold, and numb

•              Loud, pounding heart

•              Decreasing heart rate or pale skin

Emotional Responses

The emotional response to fear can be highly individual. Since fear involves some of the same chemical reactions in our brains that positive emotions such as happiness and excitement do, feeling fear under certain circumstances can be perceived as fun—for example, when adrenaline seekers skydive. Others have adverse reactions to the feeling of fear, avoiding fear-inducing situations at all costs.

Although the physical reaction is the same, the experience of fear can be positive or negative, depending on the person and the situation.

Causes of Fear

Some fears are innate and have been passed down through evolution. Other fears are profoundly personal and come from our experiences or trauma. Still, fears are complex in the way they are associated with different experiences (e.g., a fear of heights because it is associated with feeling dizzy) or from learning from others in your developmental years (e.g., a fear of spiders because you saw your mother scared of them).

Some common fear triggers include:

• Specific objects or situations (spiders, snakes, heights, flying, etc.)
• Rejection or abandonment
• Future events, imagined events, and uncertainty
• Real environmental dangers
• The unknown

You can learn to fear anything in the right circumstances.

Other Words for Fear

Fear can range from apprehension to terror. Here are some other words to describe feelings on the fear spectrum:

• Annoyance
• Anxiety
• Apprehension
• Despair
• Dread
• Edginess
• Excluded
• Exposed
• Fright
• Helpless
• Horror
• Hysteria
• Inadequate
• Insignificant
• Insecure
• Jumpiness
• Nervousness
• Overwhelmed
• Panic
• Persecuted
• Rejected
• Scared
• Shock
• Tenseness
• Terror
• Threatened
• Uneasiness
• Worry

Problems with the Fear Response

Unfortunately, while fear is a natural, necessary and protective response, it can be problematic when the response is out of proportion or is reacting as if something is threatening when it’s safe. Fear can also be a symptom of various mental health conditions, such as panic disorder, social anxiety disorder, phobias, and post-traumatic stress disorder (PTSD).

What is the Fear-Pain Cycle?

The fear associated with pain can create a common pattern called the fear-pain cycle. In this pattern, pain triggers fears, which amplifies the pain, which increases the fear and avoidance behaviours and reinforces the brain’s association between pain and fear. Unfortunately, this pattern can unintentionally intensify pain over time by increasing fear and avoidance behaviours.

As your pain increases, the fear-pain cycle can affect every aspect of life, from your ability to work or socialize to your connection to and safety within your own body. However, recognizing this pattern can be an empowering first step toward rebuilding a safe and trusting relationship with your body.

How Does the Fear-Pain Cycle Work?

1. Pain Appears: This is physical discomfort. It may be migraines, back pain, or another type of pain.
2. Fear Response: Fear kicks in. You worry about the impact your pain will have on your day, feel anxious about the future, or fear that it’s going to get worse.
3. Fear Increases Pain: Fear makes the brain more likely to misinterpret safe signals as dangerous, causing more pain.
4. Avoidance: To try to cope with the pain and avoid pain increases, you may avoid activities or situations that seem to cause or increase your pain. Unfortunately, this reinforces the brain’s association between pain and fear.

More fear leads to more pain, more pain leads to more fear, and the cycle continues. Over time, this cycle becomes deeply rooted, making it hard to break free.

How Does Fear Impact Pain?

Fear can cause pain, increase bias towards pain, and fuel pain.

Fear Can Cause Pain

Unfortunately, for some people, these perceived threats can trigger the body’s alarm system (pain system) and cause pain. Although there may not be any physical threat, you are experiencing pain because your nervous system is perceiving threats. Your brain interprets the signals it receives based on the communication it gets from your body and senses, previous experiences, and other information it has.

Fear Can Increase Bias Towards Pain

Fear can increase your brain’s likelihood of interpreting safe or neutral sensations as threatening or dangerous. In response, your brain may set off an alarm in the form of pain. Living in a state of fear can alter our perception of sensations toward pain. In contrast, emotions like joy and happiness may alter our brains’ perception of sensations away from pain.

Fear Can Fuel the Pain

Pain is a function of fear and learned neural pathways in the brain. Pay attention to where your mind goes when your pain is bad. Does your response make your brain feel more threatened or safer? If the answer is more threatened, it is an automatic response fueled by fear. Fear can maintain or worsen your pain.

Some patterns indicate underlying fears, such as perfectionism, preoccupation, excessive control, and self-neglect.

How Can Pain Increase Fear?

When the pain gets severe enough, your nervous system feels threatened by the pain. Severe pain makes it harder to feel safe despite the pain and can trigger anxiety, catastrophizing, and additional fears.

Often, our reactions to your pain can communicate threats to your nervous system. When we have increased anxiety, we start worrying about where the pain will lead. You may have some panic and heightened worries. These emotions and thoughts can communicate threats to our nervous system and confirm to our nervous system that pain is something to be feared.

How Can You Reduce the Fear of the Fear-Pain Cycle?

There are a few strategies, therapies, and techniques you can use to reduce the fear associated with your pain and break the fear-pain cycle.

Self-Compassion

Self-compassion can deactivate the threat system and activate the care system, lowering the intensity of fear. It is about giving yourself the compassion you would typically give someone going through something similar. Self-compassion usually involves acknowledging your suffering, acknowledging that you are trying your best, connecting to common human suffering, and some self-soothing statements.

Mindfulness

Mindfulness can help you unlearn fear responses and remain fear-free. It can also make exposure therapy more effective. Mindfulness is about fully being in the moment. It’s about accepting nonjudgmentally what is coming through your senses, just observing what you are experiencing in the moment.

Pain Reprocessing Therapy (PRT)

Pain Reprocessing Therapy (PRT) helps to retrain your brain to reinterpret the signal it’s receiving, calm the nervous system, and disrupt the fear-pain cycle. PRT enables you to reframe and reprocess how you experience sensations, reducing the automatic fear response that amplifies pain.

PRT addresses the thoughts, beliefs, and behaviours around your symptoms that may keep your pain activated. It also addresses your relationship with fear in general.

Exposure Therapy

Exposure therapy is a form of therapy that reduces the fear response by gradually making it feel familiar and enabling you to relax while being exposed to the feared object or sensation.

Cognitive Behaviour Therapy (CBT)

Cognitive Behaviour Therapy (CBT) and associated therapies like Dialectical Behavioural Therapy (DBT) offer different skills to help you reframe negative and fear-based thoughts, reduce thinking patterns that promote fear, think realistically about the probability of bad events, and find ways to use thoughts and emotions to change fear-based beliefs.

Conclusion

The fear-pain cycle can be a distressing cycle in chronic pain where the fear amplifies the pain, and the pain increases the fear, so the level of pain escalates. However, there is hope in various techniques, including Pain Reprocessing Therapy, that can help to reduce the fear and, therefore, the pain.