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Algophobia, an extreme and overwhelming fear of pain, is a type of phobia that can be debilitating and have a significant impact on someone’s life.
Algophobia is most common in people who are currently experiencing or have previously experienced a chronic pain condition. In the UK, between 30% and 50% of adults experience a chronic pain condition at some point in their life.
Today, we are going to look at algophobia in more detail, including the common causes, triggers, symptoms and treatments.
What is algophobia?
Algophobia, also called agliophobia, is an extreme, irrational, overwhelming and persistent fear of physical pain. Although no one wants to experience pain, someone with algophobia will experience intense feelings of fear, anxiety or panic when in pain, at the thought of being in pain or the memory of being in pain. They are also likely to experience anticipatory anxiety in the lead-up to situations where they could be in pain or that they perceive to be risky.
Algophobia is more common in people with chronic pain conditions or those who have previously had a health condition or injury that caused them to experience significant pain. They may be afraid that their pain is going to return or that their pain will worsen.
Although it is extremely normal to dislike pain and even to be afraid of pain, the fear of pain doesn’t usually have a significant impact on a person’s day-to-day life. Instead, it may be something they think about when they are experiencing pain or in the lead-up to situations where they are likely to experience pain, for example, before a dental treatment or surgery. However, a person with algophobia will have such an intense fear of pain that it will impact their daily life, affect their behaviour and result in them being scared to engage in any behaviours that they deem to be risky or that could result in them being in pain. They may refuse to engage in any behaviours or activities that could result in an injury, even if the risk is extremely low. In some cases, the fear of pain can be so intense that the individual refuses to leave their home.
Algophobia is a type of specific phobia, meaning it is a lasting, overwhelming and unreasonable fear of a specific object, situation, activity or person; in this case, an overwhelming fear of pain. Someone with algophobia may experience difficulties functioning normally or concentrating in certain places or situations because of the fear that they could feel pain. They could become consumed with the thought of pain and find themselves constantly looking around them for any potential dangers or checking their body for any signs of injury or pain. The fear, anxiety and panic that they feel can have a significant impact on their mental and emotional well-being and their behaviour.
To be classified as algophobia, your fear of pain will include:
- Feelings of extreme fear, panic or anxiety when faced with pain or when thinking about or anticipating pain.
- Feelings of fear, panic or anxiety that are difficult to control or manage.
- Engaging in avoidance behaviours or experiencing interference with everyday activities, for example, not engaging in any activities you deem risky or dangerous or that could affect your health or well-being.
- Experiencing anticipatory anxiety or worry when thinking about pain.
- A fear of pain that lasts for a minimum of six months.
- A fear of pain that interferes with your day-to-day life, overall well-being or sense of safety.
Pain and the perception of pain are subjective. This means that not everyone experiences pain in the same way. The perception and intensity of pain can be dependent on your physiological, emotional and cognitive state. Each person has an individual pain tolerance that can be influenced by both biological and psychological factors. When something happens in your body that causes you pain, pain receptors receive stimulation from temperature, pressure or chemicals. They then transmit specialised nerve cells that send a pain message to your brain and spinal cord. Once your brain receives and interprets the pain message, it then decides how best to deal with the pain.
Your thoughts and emotions surrounding pain and your current emotional and cognitive state can significantly impact how your brain deals with pain. The fear and anxiety someone with algophobia experiences in relation to pain can make them more sensitive to pain. It can also cause them to fixate on any pain they experience, even if it is minor pain. Focusing on pain signals to the brain that the pain is worse than it is in reality, resulting in someone with algophobia feeling pain more intensely than other people.
Because pain is an anxiety inducer for people with algophobia, experiencing pain can result in a fight-or-flight response. This is an automatic physiological reaction where the perception of a threat or danger results in a sudden release of hormones that activate your sympathetic nervous system. Your body then releases catecholamines, such as adrenaline and noradrenaline, to help you fight or flee from the perceived danger. This can result in physiological symptoms such as increased heart rate and blood pressure, rapid breathing and muscle tension. When someone with algophobia experiences pain or anticipates pain, this can trick their brain into thinking they are under attack and can worsen the symptoms of their phobia.
Algophobia is a highly individualised phobia that manifests differently in different people. Because there are many different ways you can experience pain, someone with algophobia can have many different fears connected to their phobia.
- Chronic pain – Someone with algophobia may fear developing a chronic pain condition or their chronic pain condition worsening. This may be more likely if they have previously experienced chronic pain or have witnessed someone close to them having chronic pain. Chronic pain can be unpredictable and can be difficult to control and someone who fears chronic pain may become hypervigilant and even obsessive about their pain and the amount of pain they are experiencing. They may also begin to catastrophise their pain, causing their pain to feel worse than it is in reality.
- Activities that could result in injury – Someone with algophobia may fear engaging in any activities that could cause them to become injured because of the fear that they could feel pain. This could include, but is not limited to:
– Sports, such as football, basketball, tennis or swimming.
– Moving furniture or carrying heavy items.
– Repetitive movements that could result in repetitive strain injuries, e.g. from painting, texting, typing or playing an instrument.
– Going outside when it is wet or icy.
– Climbing stairs or a ladder.
– Driving or riding a bike.
- Medical treatments – Someone with algophobia may create a negative association between medical treatments and pain which can cause them to avoid visiting the doctor or seeking medical help even when they require it. Someone with algophobia may avoid:
– Visiting their GP.
– Having a dental check-up or receiving dental treatment.
– Having routine medical treatments, such as vaccines.
– Becoming pregnant and giving birth.
– Having routine check-ups, such as cervical screenings.
- Exercise – Although multiple research studies have shown that exercise can help to relieve pain and that people who exercise are more likely to be fitter and healthier overall, someone with algophobia may fear exercising because of the risk that they may sustain an injury. They may begin to avoid exercise, even low-impact and low-risk exercise.
Someone with algophobia may go to extreme lengths to avoid any possibility of them being in pain. They may avoid certain places, situations and activities to reduce the risk of them becoming injured or being in pain. For example, they may refuse to leave their house if it has rained, the ground is icy or if it is dark, and may refuse to engage in any physical activities. Although avoidance behaviours are designed to help you avoid pain and reduce the likelihood that you will feel pain or encounter any triggers that could result in negative thoughts and feelings, avoidance behaviours can have a paradoxical effect, meaning that they actually reinforce your fear and result in more severe symptoms in the future. Avoidance behaviours can also have a negative impact on your social life, your relationships and your ability to perform everyday tasks.
Someone with algophobia will likely experience negative thoughts or feelings such as anxiety, fear or panic even when the risk of being exposed to pain is negligible. Even if you are aware your fear is disproportionate to the danger, you will likely be unable to control your negative patterns of thought, your emotions and your behaviours.
Algophobia can be connected to and occur in conjunction with other phobias, including:
- Thanatophobia: An extreme fear of death or dying.
- Haemophobia: An extreme fear of blood.
- Iatrophobia: An extreme fear of doctors and medical care.
- Agoraphobia: An extreme fear of leaving safe environments (such as your home) or of being somewhere where escape may be difficult.
- Nosocomephobia: An extreme fear of hospitals.
How common is algophobia?
Pain-related fear or anxiety is significantly more common in people who currently experience or have previously experienced a chronic pain condition. It is estimated that between 30% and 50% of adults in the UK experience chronic pain, which is between 16.8 million and 28 million people. It is estimated that two-thirds of all people with chronic pain also experience a mental health condition, such as algophobia.
However, because algophobia is a type of specific phobia, any diagnoses of this phobia will fall under the specific phobia umbrella, meaning there are no individual statistics that show how many people have been assessed or diagnosed for this condition. Similarly to other phobias, algophobia is thought to be a significantly underdiagnosed condition, suggesting that many people with this phobia never seek medical help.
There are several reasons why algophobia may go undiagnosed, such as:
- Many people have never heard of this phobia and may not realise they are experiencing a diagnosable medical condition.
- Many people are not aware that effective treatments are available so may never seek medical help.
- Someone with this phobia may not discuss their thoughts and feelings with others so may not realise their fear is extreme or irrational.
- Someone with this phobia may implement avoidance behaviours or lifestyle changes that reduce how frequently they feel pain.
- Someone with this phobia may be aware that their fear is irrational and may be too embarrassed to discuss their fear with others.
Negative thoughts and feelings regarding pain also occur on a spectrum, ranging from mild fear and anxiety or anxiety only in specific situations (such as when you are in pain or are about to be in pain) to severe fear, panic and anxiety that occurs even if there is no real risk, and can impact your day-to-day life, affect your decision-making and result in avoidance behaviours of certain places and situations. Because pain is generally considered negatively, it can be difficult to determine how many people are truly experiencing algophobia.
Who is at risk of algophobia?
Although anyone can develop algophobia, there are certain risk factors that can increase the likelihood of you developing a fear of pain.
These can include:
- Currently or previously having a chronic pain condition, such as complex regional pain syndrome (CRPS).
- Having hyperalgesia (an increased sensitivity to pain and an extreme response to pain).
- Having allodynia (experiencing pain from something that does not usually cause pain).
- Previously experiencing a medical condition or injury that resulted in severe pain or pain that impacted on your life.
- Someone close to you experiencing severe or life-limiting pain.
- Working in a profession where you frequently see people in severe pain.
- Having a previous traumatic, scary, negative or painful experience involving pain or something that caused pain.
- Having another related phobia, such as thanatophobia or iatrophobia.
- Having a sensory processing disorder or sensory difficulties.
- Having a close family member, for example, a parent or sibling, with algophobia.
- Having a close family member, for example, a parent or sibling, with another phobia.
- Being exposed to algophobia or a fear of pain during childhood or adolescence.
- Being an intrinsically more anxious or nervous person.
- Currently experiencing or having a history of anxiety disorders or other mental health difficulties.
- Currently or previously experiencing panic attacks.
- Going through a significant life stressor, having higher than usual stress levels or being in a heightened mental state (particularly if you are exposed to a fear of pain or have a negative experience involving pain during this time).
- Having a substance use disorder, such as an addiction to drugs or alcohol.
It is important to note that although the above risk factors can increase the likelihood of someone developing algophobia, they do not guarantee that someone will develop this condition. Someone with none of the above risk factors may develop this phobia unexpectedly whereas someone with multiple risk factors may never develop a phobia of pain.
Unlike many other types of phobias, which are often more prevalent in children, algophobia is more common in adults. This could be because adults are more likely to have experienced severe pain or witnessed someone else in severe or chronic pain and may be more aware of the impact pain can have on their life.
How to deal with algophobia
As well as the medical interventions and treatments we will look at later, there are other effective ways you can deal with your phobia. Coping and calming strategies can be implemented to help you successfully manage and reduce the symptoms of algophobia and reduce the negative impact your fear has on your life. Coping and calming strategies should be combined with lifestyle changes to help you to alleviate your symptoms and reduce the impact your phobia has on your day-to-day life and your health and overall well-being.
Some coping and calming strategies are designed to be implemented long term and as part of your regular daily or weekly routine. Long-term strategies can help to reduce the frequency and severity of your symptoms over time and enable you to be exposed to pain in the future without experiencing negative thoughts and feelings.
Other strategies are most effective short term and should be implemented when you are faced with pain in the future. Short-term strategies are designed to minimise or prevent any physiological, psychological or behavioural symptoms in the moment and to prevent a triggering situation from worsening and your negative thoughts and feelings from taking over.
Some of the long-term and short-term strategies that can help you to manage your phobia of pain are:
- Understand your fear – Understanding your fear in more detail, including what initially caused you to develop a fear of pain and any negative thoughts, feelings and behaviours that are connected to pain can help your phobia seem more manageable. You should also try to identify any triggers and any situations, activities and movements you are avoiding because of your fear of pain. Thinking about your phobia in more detail allows you to address the root cause of your fear, understand and rationalise your phobia, reduce your automatic fear response and reduce the frequency and severity of your symptoms.
- Set goals – Setting a list of goals, both short-term and long-term, can ensure you stay motivated and hold yourself accountable. Your goals could include being active, completing your daily tasks and tracking your pain. Goals give you a long-term vision, such as no longer being afraid of pain, and short-term motivation. Setting goals can also help to eradicate problematic behaviours and trigger new positive behaviours. It can also keep you motivated to overcome your phobia.
- Physical activity and exercise – Exercise is an effective way to manage your mood, reduce your stress and anxiety and reduce your pain. Exercise can help to reduce chronic pain by building up your muscle strength and flexibility, reducing your fatigue, reducing inflammation and reducing your pain sensitivity. Research has shown that athletes feel less pain than other people and report lower pain intensity. Physical activity also causes your body to release endorphins, which interact with the pain receptors in your brain and block the nerve cells that receive the pain signals, causing you to feel less pain. Exercise has also been proven to be an effective treatment for a variety of mental health conditions, including stress, anxiety and depression.
- Physical therapy – Many people with algophobia experience weakness in their body or parts of their body or difficulties moving normally. This could be as a result of a physical condition, a chronic pain condition or because their fear of injuring themselves resulted in a lack of exercise and movement. A physical therapist can help you with exercises and therapies that are designed to safely strengthen your body. They can help you re-learn how to use parts of your body or your muscles and can help you to build confidence in functioning normally.
- Educate yourself about pain – Understanding pain, the cause of pain and how pain works can help to relieve any fear or anxiety you have surrounding pain. This can help you to understand how normal it is to feel pain and how pain can sometimes be a good thing. Understanding more about pain can also teach you coping strategies for how to deal with your pain and manage any pain symptoms. This can make the idea of being in pain in the future seem less daunting.
- Challenge negative thoughts and feelings – You may experience increased distress or anxiety when thinking or talking about pain or remembering a time when you were in pain. If you find yourself thinking about pain negatively or experiencing negative emotions, try to disrupt your thoughts and feelings to prevent your fear from escalating. Remind yourself that the activities you avoid don’t pose a risk to you and that pain is a normal part of life. If you begin to experience negative symptoms, remind yourself that the feelings will soon pass and that your fear is disproportionate to the true threat.
- Create a fear ladder – A fear ladder can help you to analyse and understand your fear of pain and can also help you to identify any situations, activities or movements that are creating fear and anxiety because of the fear that they could cause pain. A fear ladder allows you to identify the situations that are resulting in the most fear and avoidance behaviours. An example fear ladder is shown below:
– 1 = Engaging in high-impact exercise.
– 2 = Going outside when it is icy.
– 3 = Carrying heavy objects.
– 4 = Playing sports.
– 5 = Going outside or driving in the rain.
– 6 = Using a knife or scissors.
Once you have created your fear ladder, you can then confront your triggers one at a time, starting at the bottom of the ladder (the trigger that results in the least phobic response). This can help you to slowly deal with your phobia and the triggers that are worsening the symptoms of your algophobia.
- Visualise yourself overcoming your fear – Visualisation techniques can help you overcome your phobia of pain. You can utilise them by imagining yourself successfully confronting and overcoming your fear and anxiety. You can do this by visualising situations that you find triggering, such as going for a run, and imagining how you would successfully overcome your anxiety. Visualising situations that you currently avoid, in case they cause you pain, in a positive way can help to reassure your brain that everything is okay and that you are not in any danger. Your brain often cannot differentiate between thoughts and reality so visualising the situations and activities positively can reassure your brain that they do not pose a threat to you.
- Attend a support group – Attending a support group with other people who have had similar experiences to you can be extremely beneficial. You could attend an in-person or online support group with other people with phobias. Alternatively, you could attend a support group with other people with chronic pain conditions. A support group can help to validate your thoughts and feelings and allow you to receive advice, reassurance and empathy from other people who understand your experience.
- Practise mindfulness – Mindfulness teaches you how to be grounded and present in the moment, how to accept your thoughts and feelings and how to accept any pain you may be feeling. It can help you to focus your breathing and attention and reduce the likelihood of you experiencing a panic attack. Mindfulness can also help you to manage stress and anxiety and be more in control of the connection between your mind and body and help you to control the symptoms of your phobia.
- Practise meditation and yoga – Both yoga and meditation can help you to manage the symptoms of algophobia because of the meditative state of mind that people who consistently practise them can achieve. Yoga and meditation teach your brain how to achieve a highly relaxed state and how to decrease your stress levels, which can counteract the fight-or-flight response. Yoga and meditation can also teach you how to control your breathing and manage your body’s negative response to your triggers, helping you to feel more in control and calm. Practising them every day can help to improve the symptoms of your phobia over time and reduce the impact your phobia has on your life.
- Practise deep breathing techniques – Deep breathing has been proven to be an effective way of lowering stress levels, relieving tension in your body and reducing anxiety and panic. Deep breathing sends a message to your brain to relax and calm down. It can also help you to control your central nervous system, which is central to your phobic responses. Practise deep breathing regularly, as part of your daily routine and implement the strategies you have learnt when faced with your triggers in the future.
- Make lifestyle changes – Lifestyle factors such as lack of sleep, high levels of stress and a poor diet can exacerbate the symptoms of your phobia and increase your anxiety. By making lifestyle changes, you can reduce the impact your phobia of pain has on your life. Some lifestyle changes you can make include:
– Implement a successful sleep routine.
– Reduce your daily stress.
– Eat a healthy, balanced diet.
– Implement an exercise routine.
– Avoid caffeine, sugar and other stimulants.
What triggers algophobia?
A trigger is a person, place, object, situation or activity that triggers the symptoms of your phobia and causes you to experience negative thoughts and feelings, such as fear, panic, anxiety and distress.
Because algophobia is an individualised phobia, it can manifest differently in different people. This means that there are many potential triggers for this phobia, with the triggers varying from person to person. Some people find that their phobia has only one or two triggers, whereas other people’s phobia has multiple triggers.
The types of triggers and the number of triggers experienced by different people can vary depending on what initially caused their phobia of pain to develop, their perception of the potential risk, the severity of their symptoms and their current mindset and mental health.
The most common triggers of algophobia are:
- Feeling pain.
- Remembering a time when you were in pain.
- Seeing someone else in pain.
- Thinking about being in pain.
- Watching a video or seeing a picture of someone in pain.
- Becoming injured or being diagnosed with a medical condition.
- Going to a place you typically associate with pain, injury and illness, such as a hospital.
- Being in a place or situation or engaging in an activity that you judge to have a high risk of injury.
- Seeing an object that could cause you an injury, such as a knife or scissors.
- Finding something on your body that could result in pain, such as a lump.
- Experiencing symptoms of illness, even if the symptoms are mild and common and you aren’t experiencing any pain.
- Leaving your home or a place you consider to be safe.
What are the symptoms of algophobia?
The symptoms of algophobia can be wide-ranging and very varied. They can differ significantly from person to person in the way they manifest and their severity. Different people can also experience different types of symptoms. Some people only experience mild symptoms and may only experience a few symptoms, whereas others experience more severe symptoms that can have a significant impact on their everyday life.
It could also be that you experience different symptoms in different types of situations. For example, your symptoms may be significantly more severe if you are in pain or are about to undergo dental surgery compared to if you watch a TV show where someone else is in pain.
Differences in the severity of symptoms, how frequently they occur, and their manifestation can also occur for other reasons, such as how acute your phobia is, your triggers, your perception of the situation and your current mental health and mindset.
The symptoms of algophobia can occur at any time, including if you are faced with a trigger, if you feel pain or if you think about or anticipate pain. The symptoms of phobias are often automatic and uncontrollable. It may feel like you are unable to control or manage your thoughts or feelings and that your phobia is taking over your body. To be classified as algophobia, you will need to experience symptoms for a minimum of six months.
Symptoms of algophobia can be physiological, psychological and behavioural.
The most common symptoms of algophobia are:
The psychological symptoms of algophobia are the mental and emotional symptoms your experience when you are in pain or anticipate or think about being in pain.
The most common psychological symptoms of algophobia are:
- Catastrophising the possible risk to normal situations or activities and envisioning the worst possible outcome, for example, if you go outside in the rain, you’ll slip and break your leg and the pain will be agonising.
- Catastrophising any pain you feel and envisioning the worst possible outcome, for example, if you have a headache you may think you have a brain tumour.
- Intense, overwhelming persistent, excessive and unreasonable fear, anxiety, panic or distress if you are in pain or at the thought of being in pain.
- Feelings of fear, anxiety or panic that are out of proportion to the risks.
- Being unable to control your fear, anxiety or panic even if you are aware that they are out of proportion to the risk.
- Experiencing anticipatory anxiety in the lead-up to triggering or ‘risky’ situations.
- Depersonalisation or derealisation (where you feel like you no longer understand what is happening around you or you have lost touch with reality).
- Feeling immobilised or frozen by your fear.
- Feeling defenceless or vulnerable.
- Having difficulties concentrating or functioning normally in triggering situations.
- Feeling like you are losing control.
- Experiencing frequent or distressing nightmares about pain.
- Feeling like you are in danger or having a sense of impending doom.
- Feeling like you are dying or are going to die.
The behavioural symptoms you experience are any changes in your behaviour that have occurred as a result of your phobia. The behaviours will likely be negative or damaging and be unusual for you or for society as a whole.
The most common behavioural symptoms of algophobia are:
- Becoming hypervigilant to any pain in your body or any changes to your body to the point of obsession.
- Avoiding visiting the doctor or dentist or any other place you associate with pain.
- Avoiding going to new or unfamiliar places as you do not know what the potential risk will be.
- Avoiding any place, situation or activity that could put you at risk of injury.
- Not seeking medical help or treatment for an illness or condition.
- Excessively taking pain relieving medication, such as paracetamol or ibuprofen.
- Avoiding friends or family who are experiencing pain or illness.
- Being unable to eat or having a lack of appetite during or in the lead-up to triggering situations.
- Difficulties sleeping or insomnia in the lead-up to triggering situations.
- Refusing to talk about or think about pain.
- Refusing to watch a TV show or film that features someone in pain.
- Feeling like you want to run away or hide.
- Not wanting to leave your home or another place you consider safe.
- Making unreasonable or excessive modifications to your home to make it safe.
The physiological symptoms of algophobia are the physical symptoms you experience in your body. They are physical disturbances or unusual physical changes that occur as a result of the fight-or-flight response that is triggered by pain or the thought of pain. The anxiety, fear or panic that you experience in relation to pain causes your sympathetic nervous system to release stress hormones, such as adrenaline and cortisol, which can cause physical changes to your body and physiological symptoms.
The most common physiological symptoms of algophobia are:
- Difficulties breathing, rapid breathing or hyperventilation.
- Feeling like you cannot catch your breath.
- A fast heart rate, heart palpitations or feeling like your heart is pounding.
- Elevated blood pressure.
- Tightness in your chest or chest pains.
- Experiencing a choking sensation, finding it difficult to swallow or feeling like something is stuck in your throat.
- Unusual or excessive sweating or clamminess.
- Shaking, trembling or chills.
- Feeling dizzy or lightheaded.
- Feelings of confusion or disorientation.
- Stomach pain, nausea, vomiting or feeling like you need to go to the toilet.
- Feeling like you have butterflies in your stomach.
- Numbness or tingling, particularly in your hands, feet, arms or legs.
- A dry or sticky mouth.
- Unusual pain or headaches (which can then worsen the symptoms of your phobia).
- Muscle tension or feeling like your muscles are stiff.
- An unusual sensitivity to hot or cold temperatures.
- Feeling unusually tired or fatigued.
- Pale or flushed skin, particularly in the face.
- Experiencing a panic attack.
What causes algophobia?
Because algophobia is an individualised phobia, there are many possible causes, with some people developing a phobia of pain for one clear reason, and other people having multiple factors that contributed to them developing algophobia. It may be difficult for you to determine exactly when and what caused you to develop a phobia of pain, especially if your phobia developed a long time ago or if your symptoms manifested gradually over time.
However, it can be extremely beneficial to identify the root cause of your phobia, as it can allow you to identify and address the initial trigger and any negative patterns of thought or feelings that are attached to these triggers. This can make it easier to manage your symptoms and reduce the impact your phobia has on your life.
The causes of algophobia can vary from person to person. The causes can be psychological, environmental, societal or genetic.
The most common causes of algophobia are:
- Currently or previously experiencing a chronic pain condition – As mentioned earlier, people with chronic pain conditions are more likely to experience algophobia. Chronic pain is pain that continues for more than 12 weeks, despite medical treatments and interventions. In some cases, chronic pain can occur with a chronic health condition, such as arthritis. Chronic pain can be debilitating and life-long and, in many cases, can affect a person’s mental and physical health and well-being. The fear that your chronic pain will return or will worsen is a common reason why many people develop a phobia of pain. They can begin to catastrophise the ways that experiencing pain will affect their lives and may even remember the pain as being worse than it was in reality. In some cases, algophobia can occur as a result of an indirect experience, where you witnessed chronic pain in another person and how this impacted them, and this caused you to develop a fear of pain. A person may begin to experience panic or distress every time they feel pain in case it develops into chronic pain, and this can result in them developing algophobia.
- Having a previous negative or traumatic experience involving pain – Also known as traumatic conditioning or a direct learning experience, a previous negative or traumatic experience involving pain is a common cause of algophobia. The experience may not seem traumatic to others; however, as long as real pain was involved and this pain affected the individual’s mental or physical health or negatively impacted their life, then this could have developed into a phobia. Examples of traumatic experiences involving pain include:
– Obtaining an injury that limited your movement and caused a lot of pain.
– Having surgery, either medical or dental, and experiencing pain afterwards.
– Experiencing frequent and recurring pain.
– Experiencing pain that was connected to a life-threatening condition, such as cancer.
- Having a mental health condition, such as depression or anxiety, or having a chemical imbalance in your brain – The same chemicals that regulate your feelings of fear and anxiety also regulate the way that you perceive pain. Mental health conditions, such as depression and anxiety, can make you more sensitive to pain, with approximately 65% of patients with depression also reporting physical pain symptoms. The same areas of your brain that regulate your emotions and your stress response also interpret physical sensations, including pain, and the neurotransmitters (serotonin and norepinephrine) that are responsible for signalling when you are in pain are also thought to play a role in mental health conditions. This suggests that a chemical imbalance in your brain could play a role in your response to pain and your mental health. Someone who is experiencing abnormal brain responses to pain may be more likely to develop a phobia of pain, particularly if they are also experiencing another mental health condition.
- Witnessing someone you love experiencing severe pain – Also known as an indirect learning experience, this can occur when you witness someone you love experiencing severe pain and begin to fear pain yourself. The pain could be a result of a chronic pain condition or another health condition, such as cancer or diabetes. Seeing the effect the pain has on their life and well-being can cause you to experience fear or anxiety at the thought of having a similar experience yourself. You are more likely to develop algophobia if you witnessed the pain during childhood or if the person experiencing the pain died, as you may then develop an association between pain and death.
- Fear rumination – Fear rumination is a common cause of phobias and usually occurs following a negative experience involving pain. Fear rumination involves engaging in repetitive negative thought processes and persistently and repeatedly recapping the painful experience. Over time, these thoughts and memories can become increasingly upsetting and intrusive and can make you remember the event as being more painful than it was in reality. Fear rumination reinforces your natural fear responses, creates additional anxiety and can result in you developing algophobia.
- A learned phobia – Also known as an observational learning experience, a learned phobia usually means you observed a phobia of pain in another person and learnt to be scared of pain yourself. You may learn to associate pain with fear or danger or may learn that even the most minor pain can be catastrophic. You are more likely to learn a phobia if you are exposed to it during childhood or adolescence – children who grow up with a close family member, such as a parent or sibling, with algophobia are more likely to develop the condition themselves. However, a learned phobia can also develop during adulthood.
- An informational learning experience – You can develop algophobia if you are exposed to information about pain that scares you. For example, you may hear about the number of people who experience chronic pain conditions, the different types of pain someone can experience or how someone can experience severe pain or injury from a simple action, such as sneezing. Exposure to negative information can create feelings of fear or anxiety around pain which can cause someone to begin fearing pain and avoiding any situations or activities that could result in pain. This fear and aversion could then develop into a phobia.
- Being diagnosed with a serious health condition – Receiving a diagnosis of a condition that could involve pain, even if it doesn’t at the moment, can cause someone to experience anticipatory anxiety and begin to catastrophise the pain they might experience in the future. For example, receiving a diagnosis of arthritis or cancer and knowing that you are likely to experience severe pain in the future can cause you to begin to fear this expected pain, which can then develop into algophobia.
- Hypersensitivity to pain – Having a health condition that causes you to be hypersensitive to pain often results in an extreme, negative response to pain that is usually considered mild or non-existent to other people. For example, someone with hyperalgesia has pain receptors that are too sensitive, which causes their body to overreact to pain and any pain they feel to be much more intense. Their response to pain will also be more extreme. Hyperalgesia can occur because of damage to the nociceptors or peripheral nerves and may not be curable. Being hypersensitive to pain can cause someone to feel anxiety or dread at the anticipation of pain, which can result in algophobia.
- Experiencing significant or higher than usual stress levels – Significant, long-term stress can result in a disproportionate fear response or an inability to manage intense situations. This can make it more likely that you will develop a phobia, such as algophobia, particularly if you have a negative experience involving pain or are exposed to the fear of pain while experiencing higher levels of stress. A stressful or distressing event, such as a death, can also trigger a phobia, as you may be less able to manage your emotions and thought processes when experiencing grief, which can result in a disproportionate fear response.
How is algophobia diagnosed?
Algophobia can be a difficult phobia to diagnose, particularly in people with chronic pain conditions or those who have been diagnosed with a terminal illness. If you are already experiencing pain, it can be difficult to separate the pain you are experiencing (and how this could be affecting your mental health) from your fear of pain.
If you think you may be experiencing algophobia, your first step will be to make an appointment with your GP or speak to another one of your doctors. In order to ensure you are getting the correct diagnosis, you will need to provide your healthcare provider with as much information as possible.
- How often do you experience pain?
- How severe is the pain and how long does it usually last?
- How does the pain impact your life?
- Do you avoid any activities or situations to prevent the onset of pain?
- Do you feel fear, anxiety or panic at the thought of being in pain?
- How much does this fear or anxiety impact your life, your well-being and your behaviour?
- What other symptoms do you experience when you think about being in pain?
- How long have you felt fear or anxiety in relation to pain?
Your healthcare provider will also look at your medical history, including any pain disorders, anxiety or panic disorders, phobias and other physical and mental health conditions you have experienced. They may also look at any medications or supplements you are taking to ensure your symptoms cannot be attributed to another source.
Your doctor may also use a test called the Pain Anxiety Symptoms Scale (PASS-20), which is a 20-item measure of your anxiety and fear responses to the experience of pain. Each question will be scored on a scale of 0 (never) to 5 (always). This scale can help to determine how much fear and anxiety you are feeling and whether your symptoms are severe enough to classify as algophobia.
You may also be given a phobia questionnaire, which is used to determine whether you are experiencing a phobia of pain or another condition related to pain. The phobia questionnaire will look at any negative thoughts, feelings and behaviours related to pain.
Because algophobia is a type of specific phobia, your symptoms may also be compared to the seven key criteria listed in the diagnostic criteria for specific phobias.
1. The fear must be persistent, excessive and unreasonable. It can occur either when the individual feels pain or when they think about or anticipate pain.
2. Exposure to pain or another trigger leads to an immediate anxiety response in the majority of situations.
3. The fear is excessive and disproportionate to the threat, and this is recognised by the individual.
4. The individual avoids places, situations or activities that could result in pain. If they are exposed to pain, the individual will experience extreme fear, anxiety or distress.
5. The anticipation of being in pain and the avoidance behaviours associated with avoiding pain can have a significant impact on the individual’s day-to-day life.
6. The fear has lasted for a minimum of six months.
7. The phobia is not associated with another disorder or mental health condition.
If you satisfy the criteria on the PASS-20 and/or the diagnostic criteria for specific phobias, you will likely receive a diagnosis of algophobia. Because a phobia of pain can have a significant impact on your well-being, you will likely be offered treatment.
How is algophobia treated?
Once you have received a diagnosis of algophobia, your healthcare provider will create a personalised treatment plan. There are multiple treatment options that are effective in treating algophobia and it could be that you are offered one type of treatment or that you are offered multiple treatments in conjunction with each other.
Although there are effective coping and calming strategies that you can implement to help you manage your phobia of pain, the majority of people with algophobia will find medical intervention and formal treatment options to be particularly effective.
Your treatment plan will be personalised to effectively treat your phobia and the specific negative thought patterns, feelings and behaviours that are connected to your fear of pain.
When creating your treatment plan, your doctor will consider:
- Whether you are currently experiencing or have previously experienced a chronic pain condition.
- Any other health conditions which could be causing you pain.
- The severity of your phobia symptoms.
- The frequency of your phobia symptoms.
- The root cause of your phobia.
- How significantly your phobia impacts your life.
- Your overall health and well-being, including your mental health.
Cognitive Behavioural Therapy (CBT):
The most common treatment options for algophobia are:
CBT is a type of psychotherapy commonly referred to as talking therapy. It is designed to change the way that you think about pain by replacing negative thoughts and emotions, such as fear and anxiety, and negative behaviours, such as avoidance, with positive thoughts, feelings and behaviours.
Because people with algophobia usually experience automaticity of their symptoms, meaning their symptoms often occur automatically and subconsciously, many people with this phobia are not aware of where their symptoms stem from and why they think and feel the way they do. CBT can help you identify why you are scared of pain and why you think, feel and behave the way you do.
Sessions could involve learning about what causes pain, how your brain processes pain and why feeling pain can be beneficial. Learning more about pain can help you to stop seeing pain as a threat. You will try to deconstruct negative thoughts surrounding pain into smaller fragments, which can then be worked on individually. The aim is to change the way you think about and respond to pain and the anticipation of pain.
CBT sessions can be conducted individually or as part of a group, with other people with similar experiences.
Your sessions could involve:
- Discussing your experience of pain.
- Discussing the triggers and symptoms of your phobia.
- Exploring what caused your fear of pain.
- Learning how to recognise your negative thoughts and change the way you are thinking.
- Learning coping strategies and calming strategies, such as deep breathing exercises, distraction techniques and coping statements.
Acceptance and Commitment Therapy (ACT):
ACT is a type of therapy that can be effective in treating algophobia. Rather than changing your thoughts, ACT focuses on accepting your thoughts and feelings as valid. It aims to change your relationship with your thoughts and feelings, to make them more manageable and ensure they do not control you.
You will learn that the thoughts and feelings you experience in relation to pain aren’t going to hurt you and will soon pass. This allows you to face your fears head-on, rather than allowing them to control your life.
ACT teaches you mindfulness skills to enable you to deal with any negative thoughts and feelings effectively.
It has three main focuses:
1. Defusion: Letting go of any negative thoughts, beliefs, feelings and memories.
2. Acceptance: Accepting any negative thoughts and feelings and allowing them to come and go without resistance.
3. Contact with the present: Engaging completely with the present, whether positive or negative.
ACT uses a combination of acceptance strategies, mindfulness techniques and behavioural approaches.
Also known as systematic desensitisation, exposure therapy involves gradual exposure, in a safe and controlled environment, to situations, activities and movements that you previously avoided because of the fear they could result in pain. For example, it could involve gentle exercising, carrying something heavy or repetitive movements, such as painting. All activities will be conducted safely and with complete supervision.
As part of the sessions, you will also be exposed to pain with the aim of reducing your automatic fear and anxiety response. The exposure will be gradual and take place over multiple sessions. It will involve visualising your fear, talking about your fear and experiencing real-life triggers. Exposure will take place in escalating phases, with you first being exposed to a trigger with the lowest amount of anxiety, such as looking at a picture of someone else in pain. Once you are comfortable with this level of exposure, you will move on to the next trigger, such as visualising yourself in pain. With each exposure, you should experience progressively lower anxiety with the aim that you can eventually be exposed to pain without experiencing a negative response.
By creating realistic thoughts and beliefs surrounding pain, unlearning negative associations and patterns of thought, decreasing negative reactions and feelings towards pain long term, and learning relaxation techniques and coping and calming strategies, exposure therapy can help you overcome your phobia.
If you are experiencing pain or a chronic pain condition alongside your phobia, you may be offered pain relievers or other medication to help you manage your pain.
Medication is not frequently offered to treat the symptoms of a phobia. However, you may be offered medication such as anti-depressants or anti-anxiety medication if you are also experiencing another mental health condition alongside your phobia, or if your phobia is having a significant negative impact on your life. Medication is not usually prescribed as a sole treatment option for someone with algophobia and will instead likely be given alongside another treatment, such as CBT.