The Surprising Link Between Anxiety & Back Pain

Did you know that there is a link between increased anxiety symptoms and back pain? They might sound unrelated, but in fact, emotions and pain are linked in more ways than one.

People with anxiety disorders sometimes have lower pain thresholds, which can increase their awareness of any symptoms of back pain – they’re more likely to notice even minor symptoms. This can often lead to muscle tension, which in turn can cause back spasms or long-term back problems.

Symptoms of anxiety can also worsen back pain, and vice versa. This creates a vicious cycle, in which tense muscles from stress cause painful symptoms, which in turn feed into anxious feelings.

In this article, we discuss how anxiety and back pain are related and provide strategies on how to alleviate your back pain by alleviating your anxious thoughts. You'll be equipped with strategies that you can consider immediately.

What causes anxiety-related back pain?

Fundamentally, the way your body responds to stress (particularly changes in muscle tension and posture) can often cause more harm than good. When experiencing anxious feelings, muscles can remain tense for far longer than normal. This can transform a minor irritating pain into intense pain.

Prolonged anxiety can keep the body in a state of semi-stress response readiness; stress hormones flood the body and muscles stay tight for extended periods.

If you have an anxiety disorder, there can be many physiological changes, such as decreased physical activity, that together can lead to chronic discomfort in your back. Your body is trying to tell you that something isn’t right.

Stress can increase your nervous system’s sensitivity, causing chronic low back pain that affects your daily routine. This stressed nervous system can act like a dull ache or sharp pains that strike without warning.

This is also referred to as central sensitization. This is where your body has a heightened pain response in an anticipatory manner. Essentially, your nervous system goes into overdrive, amplifying normal signals into painful ones, even in the absence of an actual injury or threat1.

Your body may stiffen or have muscle spasms because your muscles are reacting to the tension. Irregular breathing can worsen the situation, piling more stress on your nervous system.

Muscle tension caused by anxiety

The stress response from anxiety can elicit physical symptoms such as muscle tension, which can progress to chronic stiffness and pain in the back. Anxiety-related behaviors, such as posture changes and muscle tension, can make existing back pain worse. This is similar to the body being stuck in perpetual readiness with muscles tensed and ready for action, causing long-lasting discomfort well after the stress has gone.

Stress-related changes in breathing patterns and shoulder posture can cause tension and inflict pain, especially in the mid-to-upper regions of the back2. Such evidence shows how even the most basic actions can become entangled in the complex web of anxiety – affecting your physical health through the toll imposed on an over-aroused nervous system that manifests as muscular tension within the body itself.

Panic attacks affecting the nervous system

The clam-like hands of anxiety can often intensively herald the onset of a panic attack, during which the nervous system is over-stimulated. This hyperexcitability leads to increased muscle tension that can result in severe pain in the back and neck3. The body naturally becomes tense as part of its immediate defense mechanism. This short-term protective strategy often has harmful long-term effects. Muscle twitches and spasms are among the signs of a stressed nervous system.

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How to manage anxiety-related back pain

Achieving relief from back pain symptoms due to anxiety is possible with appropriate treatment and techniques. To reduce avoidance behaviors related to fear and increase self-management abilities through empowerment therapy, people can develop a powerful arsenal of coping skills.

One effective technique is progressive muscle relaxation, which helps people cope more effectively with the stresses that contribute to anxiety and pain. Relaxation techniques, such as deep breathing exercises and guided imagery, are also extremely helpful in reducing symptoms related to back pain.

These practices induce mental and bodily relaxation, which act as protective mechanisms against factors that exacerbate pain symptoms. A combination treatment including medications and physical exercise, along with other supporting activities, strengthen the protective mechanisms against stress-induced pain related to the spine, which can help you to return to normal routines.

Cognitive behavioral therapy (CBT)

Cognitive behavioral therapy (CBT) helps address the psychological aspects of chronic pain conditions including ongoing back pain4. It helps people cope with stress, anxiety, and depression associated with their pain by teaching coping mechanisms that can change harmful thought patterns.

Adopting this strategy involves becoming aware of when stress is compromising your quality of life or affecting interpersonal relationships, and then taking the necessary step of seeking help from trained professionals. This can be essential for building resilience against both chronic back pain and anxiety disorders.

By its systematic stages, including learning new skills and consolidating them, cognitive behavioral therapy offers a way to live without the unpleasant effects of stress on the mind and body. This therapeutic process directly addresses long-standing signs of distress which often arise from constant worry, allowing people to begin to escape the unending cycle that links states of increased anxiety with physical pain.


Gentle physical activity, including yoga or mild everyday exercise, can help strengthen muscles and alleviate discomfort in the back.

Exercise also promotes the release of endorphins, which are natural chemicals in the body that can help relieve stress and promote a sense of wellbeing. These endorphins can boost mood and give relief from the cycle of anxiety and pain5.

In addition, regular physical activity can help improve the quality of sleep, which is often disturbed due to chronic back pain and anxiety. Along with endorphins, exercise can boost the levels of other neurotransmitters, like serotonin and dopamine, which regulate mood and can help lower anxiety levels while raising the pain threshold.


Yoga offers an added advantage of relaxing tense muscles and calming an anxious mind with its various stretches and poses. It is an ancient practice that combines controlled breathing with meditation and physical postures, and provides a holistic approach to managing chronic lower back issues. The slow, deliberate movements coupled with focus on flexibility and strength training can help you to find more relaxed postures, ease stress, and develop your stability, making it useful for people with lower back pain. A 2011 randomized trial that assigned study subjects to a 12-week yoga program, yoga had improved their back function compared with standard treatments6.

Breathing exercises & mindfulness

Mindfulness and breathing exercises offer both short-term and long-term relief as useful techniques for those suffering from anxiety induced back pain.

Deep, diaphragmatic breathing activates a calming effect throughout the body, relaxing an over-aroused nervous system. And breathing exercises such as a prolonged exhale diminish the fight-or-flight reaction often associated with anxiety, which can exacerbate back pain.

Mindfulness, the simple practice of paying attention to the present moment and noticing what is happening here and now, creates a sense of inner calm and stillness. By focusing on the sensations and experiences of the present moment, people can learn to distance themselves from stressful thoughts that increase anxiety and the accompanying muscle tension in the back.

Heat therapy & cold therapy

According to a research study in 2021, heat and cold therapy have their own place in the management of pain. Cold therapy is great for inflammation and swelling, as well as providing short-term pain relief by numbing the painful area7.

Once swelling has eased, heat therapy can be very useful. Gently applying heat increases blood circulation to the injured area, delivering oxygen and nutrients that promote healing. It will also help relax any tense muscles, thereby helping the area repair.

Chiropractic care & massage therapy

Lifestyle changes, such as exercise, improving your sleep, and managing stress and any emotional or mental health challenges are likely to provide the most effective and long-lasting effects. "Passive" therapies, such as massage and acupuncture can provide short-term relief to some people, but are unlikely to give long-lasting results.

Chiropractic treatment involves diagnosis and treatment of mechanical disorders of the musculoskeletal system, especially the spine. People who visit chiropractors often report excellent relief and improved mobility after regular spinal manipulation and can be more effective than conventional medical care for patient satisfaction and pain reduction. One study showed that number of chiropractic treatment had a positive, clinically meaningful effect on pain intensity and disability at 4 weeks in individuals with chronic low back pain8.

As with any other clinician, remember that not everyone will understand or use the modern science of pain, and they might use language or explanations that can cause you additional unnecessary worry. If any healthcare provider makes you feel uncomfortable, or gives you the same treatments over and over but you only receive short-term relief, look for an alternative provider. You might also want to consider an alternative is all of your treatments are "passive" (such as manipulations, adjustments, massage or ultrasound) without any longer-term strategies such as exercise, stress reduction or lifestyle modifications.

Medication for short-term relief

Nonsteroidal anti-inflammatory drugs, or NSAIDs such as ibuprofen, are often used to relieve the pain and inflammation associated with sore back muscles. If the pain is very severe, your doctor may prescribe other advanced medications. These include muscle relaxers and even narcotic pain medications, which can offer more effective relief.

Although these medications may help manage pain, they are only a part of the overall treatment plan. They are not a permanent solution. Long-term use of any medication can cause problems for the body’s central nervous system. It can actually become tolerant to the drugs, so you may need a higher quantity of the medication to achieve the same pain-blocking effect.

If the back pain is preventing you from getting a good night’s sleep, your doctor may recommend sleep aids on a temporary basis. However, you should know that these are not intended for extended use. They do not necessarily provide restful sleep and can have side effects such as daytime grogginess and other undesirable responses.

More information

MoreGoodDays® has developed a program based on scientific research to help you cope with chronic back pain. Our methods allow you to overcome common misconceptions about back pain and instead focus on identifying the root causes, triggers, and ways to change your body’s response to pain through the principles of neuroplasticity.

We offer personalized coaching and a variety of tools to help you manage pain, support mental wellness, and improve your overall wellbeing.

Download our mobile app for free from the Apple App Store or Google Play Store for immediate access to some of our content and to see your support options.