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Learning How To Combat Insomnia With A Few Strategies

Learning How To Combat Insomnia With A Few Strategies

Learning how to manage and combat insomnia. Being wide awake early in the morning, trying hard to fall back to sleep before the alarm goes off. Individuals that have trouble falling asleep find that it usually happens right before a vacation. Everyone experiences an occasional sleepless night, but if insomnia continues on a regular basis it can lead to various health issues.

The average adult requires over eight hours of sleep for the body to function properly.  But managing hectic lives means individuals end up going to bed later than sooner and not following the body’s natural biological rhythm. Remote and in-person learning, jobs, children, and other obligations require getting up with the birds with only 4-6 hours of sleep.  A disruption to the body’s circadian rhythm that regulates:

  • Hormone production
  • Body temperature
  • Sleep
  • Can lead to insomnia.

11860 Vista Del Sol, Ste. 128 Learning How To Combat Insomnia With A Few Strategies

Mind and Body Performance

The body needs adequate, restful sleep to perform its best. Insomnia that is prolonged can cause brain fog and interfere with performing daily activities. It also increases the risk for:

  • Depression
  • Headaches
  • Learning abilities
  • Accidents – auto, sports, work, personal
  • Can lead to sleep medication dependency.

Stress, anxiety, profound caffeine, and alcohol consumption can contribute to insomnia. Learning how to effectively manage stress is recommended to getting a proper night’s sleep. Making lifestyle adjustments can make a significant difference in the number of sleep hours. Here are a few strategies to try that could be effective:

Regular exercise/physical activity

  • Getting some physical activity before dinner can help put the body in a restful state before going to bed. However, do not exercise close to bedtime as this could make the body restless.
  • Getting out in the late evening sun as often as possible will help stimulate melatonin release. This will help reset the body’s circadian rhythm.


  • Stress-reduction techniques like yoga, meditation, and Tai Chi are recommended to help teach the mind and body to relax.

Caffeine, tobacco, and alcohol

  • These keep the body stimulated. Try to reduce/avoid from mid-afternoon until bedtime, and keep consumption of alcohol to a minimum.


Sleep cycle

  • Maintain the same sleep and wake schedule every day.
  • Do not alter by more than an hour on the weekends or on vacation.

Electronic devices

No television, computer, and phone use at least an hour before going to bed. This stimulates the brain, making it difficult to get to sleep.


  • Keep the bedroom dark, quiet and cool.
  • If lying awake for more than 20 minutes, get up and sit in another dimly lit room until sleepiness starts to set in, then go back to bed.

Give these strategies a try and research others. They could help. For more information contact Injury Medical Chiropractic and Functional Medicine Clinic, to see how we can help.

Body Composition

Learning How To Incorporate Prebiotics

Incorporating more prebiotics into one’s diet is best done through nutrition. Prebiotic foods supply these nutrients directly to the colon, where they are broken down, fermented, and utilized. Prebiotic foods consist mainly of fruits, vegetables, grains, and beans.

Prebiotic Food Sources

Vegetable Sources
  • Asparagus
  • Garlic
  • Onion
  • Tomato
  • Sugar Beets
  • Leeks
Fruit Sources
  • Bananas
  • Apples
Other Sources

However, cooking could alter the food’s fiber content, so look at recipes. Prebiotics also come in the form of supplements to make them easier to consume.


The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the musculoskeletal system’s injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, CTG*
phone: 915-850-0900
Licensed in Texas & New Mexico


Goto, Viviane et al. “Chiropractic intervention in the treatment of postmenopausal climacteric symptoms and insomnia: A review.” Maturitas vol. 78,1 (2014): 3-7. doi:10.1016/j.maturitas.2014.02.004

Jamison, Jennifer R. “Insomnia: does chiropractic help?.” Journal of manipulative and physiological therapeutics vol. 28,3 (2005): 179-86. doi:10.1016/j.jmpt.2005.02.013

Kingston, Jana et al. “A review of the literature on chiropractic and insomnia.” Journal of chiropractic medicine vol. 9,3 (2010): 121-6. doi:10.1016/j.jcm.2010.03.003

Injury Related Stress And Anxiety Addressed With Chiropractic Care

Injury Related Stress And Anxiety Addressed With Chiropractic Care

Going through traumatic accidents that result in injuries can cause injury-related stress and anxiety for individuals. It is understandable that stress and anxiety are high as individuals figure out how to navigate through the situation. Therefore, it is very important to find ways to manage stress and anxiety because if they go unchecked it could become chronic leading to poor health and quality of life.

Stress/Anxiety Affects Health

Injury related stress and anxiety can be exacerbated through different factors. These can include:

  • Medical bills
  • Employment
  • Relationships
  • Independence

The causes/reasons can vary however, the physical response the body goes through is the same. A stress-inducing situation can leave an individual feeling threatened and generate a physical stress response. The body responds to stress by releasing hormones that shift the body into survival mode. This requires a lot of energy placing massive strain on the body. This is an important mechanism for healthy living. However, if it begins to present on a regular basis it can lead to negative health issues that include:

  • Depression
  • Chronic anxiety
  • Heart disease
  • High blood pressure
  • Abnormal heart rhythm
  • Heart attack
  • Stroke
  • Personality disorder
11860 Vista Del Sol, Ste. 128 Injury Related Stress And Anxiety Addressed With Chiropractic Care

The body needs time every day to recover and rejuvenate. This is not possible when the body is constantly entering a heightened state of stress. Traditional treatment can lead to the over-prescription of medications that come with their own side effects. Effective injury-related stress treatment addresses issues like:

Health problems

Injury-related stress and anxiety affect mental health and can lead to physical symptoms and disease. These include:

  • Chronic pain
  • Sleep problems
  • Gastrointestinal issues
  • Obesity
  • Asthma and breathing problems
  • Alzheimer’s, dementia, and memory loss
11860 Vista Del Sol, Ste. 128 Injury Related Stress And Anxiety Addressed With Chiropractic Care

Chiropractic Treatment and Care

A healthy brain and spinal cord are vital to the body’s optimal health. When nerve energy and blood flow get blocked it can worsen injury-related stress and anxiety. Chiropractic delivers results helping to better manage mental health by addressing underlying issues with spinal misalignment. When the spine is properly aligned neural health is optimized for everyday functions. This increases vitality and an overall sense of well-being. With brain function improved adjusting to the injury and its effects no longer cause intense stress. Individuals cannot remove all the stressors and anxiety-inducing events from their lives, but proper spinal alignment can help build resilience for whatever situations life throws.

Body Composition

Recovery and Swelling

Recovery is an essential part of maintaining optimal body health. This goes for regular work, working out, athlete’s training, and just participating in physical activity. A significant sign that the body has gone through intense physical exertion and needs recovery time is swelling. Swelling presents for different reasons. It is the body’s response to tiny, microscopic tears in the muscle that happens from constant and intense use. Running or lifting heavy objects are two examples that cause swelling. Swelling can be seen in body composition analysis results. An increase in Lean Body Mass reflects an increase in water. Recovery is about giving the body a chance to:

  • Relax
  • Recuperate
  • Recover from the swelling with the end goal of resuming physical activities


The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the musculoskeletal system’s injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

phone: 915-850-0900
Licensed in Texas & New Mexico


Pickar, Joel G. “Neurophysiological effects of spinal manipulation.” The spine journal : official journal of the North American Spine Society vol. 2,5 (2002): 357-71. doi:10.1016/s1529-9430(02)00400-x

Coleman, Brian C et al. “Factors Associated With Posttraumatic Stress Disorder Among Veterans of Recent Wars Receiving Veterans Affairs Chiropractic Care.” Journal of manipulative and physiological therapeutics vol. 43,8 (2020): 753-759. doi:10.1016/j.jmpt.2019.10.016

Jamison, J R. “Stress management: an exploratory study of chiropractic patients.” Journal of manipulative and physiological therapeutics vol. 23,1 (2000): 32-6. doi:10.1016/s0161-4754(00)90111-8

Dealing With Chronic Back Pain That Is Stressing You Out El Paso, TX.

Dealing With Chronic Back Pain That Is Stressing You Out El Paso, TX.

When dealing with back pain, it’s not just the pain that has to be dealt with. It is stress, anxiety, and depression that can make coping even harder. Learn how to manage pain and mental health. Dealing with chronic back pain is difficult for anyone.

All-around mental distress can exacerbate pain and worsen the stress you are already experiencing creating a vicious cycle. There are treatments available for mental health and chronic back pain that can help get a handle on both at the same time. What you should know about the connection, along with the therapies that can help.


11860 Vista Del Sol, Ste. 128 Dealing With Chronic Back Pain That Is Stressing You Out El Paso, TX.

Dealing with Chronic Back Pain and Mental Health

Back pain is very common and it is estimated that about 90% of Americans will experience back pain. A small portion will develop chronic back pain or pain that continues more than 12 weeks. Chronic back pain can be caused by a variety of medical problems. Injuries to illness are all are pathways to chronic pain. Pain is different for everyone, depending on the cause, the area affected and the individual. For some, the pain might feel like a mild, persistent ache. While others, the pain could be a continual throbbing.

One factor of chronic back pain is the emotional response that happens when it presents. If you stress or fixate on the pain, you are perceiving it to be much worse. This can lead to more stress, and:

  • Anxiety
  • Appetite changes
  • Depression
  • Fatigue
  • Mood swings
  • Sleep issues

These problems then feedback into the pain and together significantly affect relationships, work, ability to function and your quality of life. The single step to take is to reach out to a doctor. They can check for mental health issues, begin treatment for your psychological/physical issues and refer you to specialists.




There are many approaches to treating chronic back pain and the psychological issues that come with it. Not every treatment regimen works for everybody. The best approach is usually a combination of techniques. Psychotherapy, specifically the talking therapy can help treat both physical and emotional pain. One of the most-researched forms is cognitive-behavioral therapy (CBT).

During a session, you learn how to identify negative reactions and work to change them into positive thoughts and actions. The idea is to alter the initial response to better manage how the pain affects you. This therapy is directed by a therapist and can be done individually or in a group.


For many medications are an effective way to manage mental health issues and some can help relieve the pain itself.

While these drugs can be helpful, many can come with side effects. Antidepressants can cause:

  • Blurry vision
  • Drowsiness
  • Dizziness
  • Bathroom issues

Pain Rehabilitation

Chronic pain rehabilitation programs are another option. With rehab, a team of doctors/physical therapists from different areas of medicine, work together addressing the medical, physical and mental issues that come with the pain. Every treatment program is customized to the patient, and while treatments are usually conducted at a medical clinic, they can also be done online.

Pain rehab includes:

  • Addressing any underlying conditions
  • Improving physical function
  • Reducing reliance on pain medication
  • Helping you cope with stress, anxiety, and more


patient at the physiotherapy making physical exercises

Integrative Health

Alternative health approaches can help control back pain and ease the mind. Research has shown that certain alternative practices do work to relieve pain. There is evidence that the following therapies can help reduce chronic back pain, according to the National Center for Complementary and Integrative Health:

  • Acupuncture
  • Chiropractic
  • Low-level laser therapy
  • Mindfulness-based stress breathing exercises and imagery
  • Muscle relaxation
  • Tai chi
  • Yoga


Other treatments

Electromyography biofeedback is a therapy where low-level electric signals are used to help gain control over muscle movement. Some patients find journaling, massage, prayer and other relaxation techniques to be helpful in coping. Speak with your doctor if you have questions or health issues before beginning complementary treatments.


A most effective and widely recommended method for relieving stress, anxiety, depression and chronic pain improving physical function is regular exercise and a healthy diet.

Low-impact workouts like:

  • Stretching
  • Walking
  • Swimming
  • Yoga

These all are helpful for people with chronic back issues. Talk with a doctor about physical exercises that are safe. Proper sleep can help, like poor sleep and sleep deprivation increase stress, which leads to more pain. Adults should go for 7 to 9 hours regularly, according to the National Sleep Foundation. Wake up and go to bed at the same time every night and turn off electronic devices.


Eating healthy can boost mood and help relieve back pain by promoting weight loss. Enjoy complete meals full of lean proteins, whole grains, and vegetables while limiting the intake of processed foods, added sugars, and saturated fats. Avoid excess alcohol and smoking, as both are linked to chronic back pain. Learning and dealing with chronic back pain along with re-searching successful treatment options can be a long and frustrating process. Understanding the condition and cutting yourself plenty of slack can go a long way to helping you feel better.


Depression and Chronic Pain



NCBI Resources


Yoga That Is Safe for My Spine El Paso, Texas

Yoga That Is Safe for My Spine El Paso, Texas

Yoga has gained popularity because of its ability to reduce back pain, relax tight muscles, relieve stress and exercise in a safe calm environment. Developed thousands of years ago, the practice of breathing, posing and stretching offers a variety of important health benefits. As a chiropractor, I�m often asked about the practice of yoga. Those with back pain or have undergone spine surgery want to know if yoga can help them improve their physical and psychological health.

  • Reduced stress
  • Improved blood pressure
  • Increased flexibility
  • Increased stamina
  • Greater balance
  • Improved breathing techniques

In addition to the normal exercise benefits yoga offers, the practice serves as therapy for a variety of injuries and health conditions. Yoga embodies the physical, emotional, and spiritual wellness, and touches upon other forms of traditional exercise. The concept that yoga heals the body in its entirety mirrors chiropractic care. These foundations offer enormous benefits to those dealing with a variety of injuries and conditions. By incorporating yoga, individuals are able to reap amazing rewards.

A regular exercise plan needs to include a little cardio as there are huge benefits from pumping the heart rate up. Minimal loading exercises, like biking, and swimming are great. Pain can be managed by participating in cardiovascular exercises, however, yoga�s gentleness can complement the healing process.

Here are a few reasons:


11860 Vista Del Sol, Ste. 126 Yoga That Is Safe for My Spine El Paso, Texas

Prepares the body for healing

Practicing yoga stretches and elongates the body’s muscles, releasing tension and stress. It can serve to warm up the body and clear the mind, so a chiropractor can get to the root problem. Yoga complements chiropractic treatment by preparing the body to heal itself.

Strengthens joints and ligaments

Dealing with a health condition or injury is frustrating and can seem like it takes forever to heal. Implementing yoga into a recovery plan helps strengthen joints and ligaments, which aids in promoting healing and cutting down the time it takes to get better. Yoga works on the body as a whole and promotes greater well-being from head to toe. A stronger body offers more productivity than one that is stiff, sore, and unhealthy.

Increases range of motion

Depending on the individual’s specific condition, individuals may need a few visits to prepare their bodies before the main issue can be addressed. Yoga sessions increase a body’s flexibility and help with the range of motion in the neck, back, hips, and other joints.

Prevents injury/s

Yoga provides a continual way for individuals dealing with chronic conditions to manage and reduce pain, inflammation, and other symptoms. Yoga combined with chiropractic keeps the body aligned, balanced, muscles stretched, de-stressed, and the joints working properly.

Both also serve to keep posture correct, and ligaments strong. All of this creates a body that is less susceptible to future injury, illness, and stress. Individuals enjoy increased mobility for a lot longer without changing lifestyle.


11860 Vista Del Sol, Ste. 126 Yoga That Is Safe for My Spine El Paso, Texas

The Best Way to Start

There are many different types of yoga. Most sessions usually last an hour and include breathing exercises, meditation and holding poses/postures that stretch and tone muscle groups.

To help visualize how yoga can help the spine, here’s an analogy:

Think of the spine like a cookie ice cream sandwich with the ice cream in-between and a gummy band wrapped around. The cookies represent the vertebrae, the ice cream is the disc cushion in between and the gummy band represents the ligament and muscles surrounding the area.

The tighter the gummy band is, the more it compresses the cookies and applies pressure to the ice cream. When stretching the gummy band, it loosens the pressure on the cookies and reduces the load/compression of the ice cream.

Exercise is crucial for recovery and rehabilitation. Yoga is a gentle way to get you back on your feet. It promotes circulation, relaxation, strength, and flexibility. Pure plane movements meaning moving forward then backward in basic movements are essential until the body becomes more flexible. Move carefully forward, sideways and cautiously backward.


  • At the beginning no movements combining bending and twisting.
  • The muscles need to adapt and become comfortable with these movements at first. Therefore, hold poses for at least 30 seconds without bouncing minimizing potential injury.

Certified instructor

Ask your doctor or chiropractor if they can recommend a certified yoga instructor; preferably with 500 hours of instruction. Search for small class sizes and a teacher that closely monitors movements and poses closely. It is important that the instructor be aware and make gentle adjustments or offer modifications to participants as needed.


Restorative Flow

Start off with a type known as Restorative Flow. It restores the flow from one part of the body to another with slow controlled movements/poses that emphasize stretching and correct breathing.

Listen to Your Body

When healing from injury/s, take it slow. Listen to your body and let it guide your movements so that it feels safe and comfortable. Do not push beyond. For most, a beginner or restorative Yoga class is best. Ask about modifying the poses so that the bending and twisting combinations/advanced postures are taken out so as not to overload the joints.

If you are on a budget consider purchasing an instructional DVD. DVD’s offer program variations of 20 to 60 minutes and are highly educational and easy to follow. Stretching pain/soreness is okay, but sharp pain is not.

Yoga could be an answer to many of the body’s issues, whether dealing with current conditions or just want to stay healthy in a new way check out the basics of yoga. Chiropractic coupled with yoga offers great benefits to those dealing with medical conditions or injury. Ask your chiropractor for an evaluation, and if adding yoga to your health program will help.


Chiropractic Massage Therapy


NCBI Resources


Functional Neurology: Brain Fog and Anxiety

Functional Neurology: Brain Fog and Anxiety

How high is your stress level? How often do you feel overwhelmed? Anxiety is a well-known health issue that is, unfortunately, often misunderstood, especially when it manifests other misunderstood symptoms like brain fog. � Brain fog is commonly associated with reduced thinking and processing while anxiety is frequently associated with racing thoughts that can make people overly cautious as well as worries that can keep people awake, wired, and restless. How does anxiety cause brain fog? The purpose of the following article is to understand brain fog associated with anxiety. �


How Does Brain Fog with Anxiety Happen?

Brain fog is a symptom rather than a single health issue. It�s described as the sensation that your brain isn’t functioning properly. Anxiety involves symptoms of overthinking, excessive worrying, imagining negative outcomes, and fear. � Brain fog and anxiety happens because the symptoms of one health issue can ultimately cause the symptoms of the other health issue and vice versa. This can also worsen both conditions. Brain fog and anxiety can cause an infinite loop. �


  1. Anxiety involves �what-ifs,� ruminations, and negative thinking
  2. This can then lead to mental exhaustion or fatigue
  3. Fatigue can also develop brain fog
  4. Brain fog can in turn increase anxiety because it feels frightening, worrisome
  5. Increased anxiety causes this cycle to repeat, seemingly endlessly


Brain fog associated with anxiety may vary from person to person. Several people will experience it often while others will experience it less frequently. It can also come and go quickly, or it can ultimately last for days, weeks, and even months. � Evaluating the symptoms and the causes of brain fog and anxiety will provide insights that can be used for treatment. �


Symptoms of Brain Fog with Anxiety

Brain fog and anxiety share a common symptom, frequently referred to as fatigue or tiredness. Brain fog, anxiety, and fatigue are well-known symptoms that are often connected. However, fatigue is believed to be at the heart of brain fog and anxiety. � Anxiety appears to take control of our entire brain and aggravates thoughts, emotions, and behaviors. Living in a state of constant anxiety is exhausting. Moreover, anxiety can cause sleeping problems. Fatigue can lead directly to brain fog. � Common symptoms of brain fog, anxiety, and fatigue can ultimately include: �


  • Difficulty concentrating and focusing
  • Muddled, unclear thoughts
  • Short-term memory problems
  • Difficulty reasoning logically
  • Trouble processing, storing, and retrieving information
  • Living in a fog that makes grasping comments, instructions, and conversations challenging
  • The vague sense that you just feel �off� but can�t do anything about it


Causes of Brain Fog with Anxiety

The brain fog that occurs with anxiety can have several causes, including: �


  • The�symptoms of anxiety, as previously discussed above
  • The brain�s mental, physical, and emotional response to anxiety
  • Stress as well as stress hormones and other substances or chemicals.


Understanding the cause of brain fog with anxiety can increase awareness of why these health issues can develop. � The brain�s own reaction to anxiety can also make it feel tired and foggy. The fight-or-flight response is an automatic fear response. The brain reacts in response to an extreme stressor to prepare to either stay and fight or run away to safety. �


  • Activity in the cortex, the area of rational thinking, decreases, which leads to the inability to think properly
  • Activity in the hippocampus, the area responsible for learning and memory, is suppressed, causing confusion
  • Activity in the amygdala accelerates to keep you hypervigilant and ready to leap before you look


The brain also controls the production of hormones in reaction to stress and anxiety. Cortisol, adrenaline, and norepinephrine travel through the brain and the body to keep you alert and ready for action but when these hormones are triggered for too long or in quantities that are too high, they overwhelm and exhaust the brain, causing brain fog. �


Treatment for Brain Fog and Anxiety

The best treatment for brain fog associated with anxiety is to treat it at its source. It’s essential to understand the symptoms of both brain fog and anxiety as well as take steps to reduce other symptoms like fatigue. Furthermore, know what is causing your symptoms so you can ultimately make positive changes to reduce them or even eliminate them, including: �


  • Develop stress management strategies
  • Take measures to increase the amount and quality of sleep
  • Address your anxiety, either with a therapist or other qualified healthcare professional
  • Listen to your body and brain; participate and engage in exercise, yoga, mindfulness, and meditation


� Brain fog and anxiety can be difficult. But by actively working on them, you can reduce both and promote overall well-being. �


El Paso Chiropractor Staff and Doctor

Anxiety can commonly cause a variety of symptoms, including brain fog. Although it may seem like brain fog and anxiety are two separate as well as different health issues, they are frequently connected. Both anxiety and brain fog can cause concentration, focus, and memory problems, and stress is considered to be one of the most well-known causes of brain fog associated with anxiety. Treatment for anxiety and brain fog often involves treating the underlying source of the health issues. – Dr. Alex Jimenez D.C., C.C.S.T. Insight



Neurotransmitter Assessment Form

Neurotransmitter Assessment Form AE260 (1)


The following Neurotransmitter Assessment Form can be filled out and presented to Dr. Alex Jimenez. Symptoms listed on this form are not intended to be utilized as a diagnosis of any type of disease, condition, or any other type of health issue. �



In honor of Governor Abbott’s proclamation, October is Chiropractic Health Month. Learn more about the proposal. �


How high is your stress level? How often do you feel overwhelmed? Anxiety is a well-known health issue that is, unfortunately, often misunderstood, especially when it manifests other misunderstood symptoms like brain fog. � Brain fog is commonly associated with reduced thinking and processing while anxiety is frequently associated with racing thoughts that can make people overly cautious as well as worries that can keep people awake, wired, and restless. How does anxiety cause brain fog? The purpose of the following article is to understand brain fog associated with anxiety. �


The scope of our information is limited to chiropractic, musculoskeletal and nervous health issues or functional medicine articles, topics, and discussions. We use functional health protocols to treat injuries or disorders of the musculoskeletal system. To further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900 . �


Curated by Dr. Alex Jimenez �



Additional Topic Discussion: Chronic Pain

Sudden pain is a natural response of the nervous system which helps to demonstrate possible injury. By way of instance, pain signals travel from an injured region through the nerves and spinal cord to the brain. Pain is generally less severe as the injury heals, however, chronic pain is different than the average type of pain. With chronic pain, the human body will continue sending pain signals to the brain, regardless if the injury has healed. Chronic pain can last for several weeks to even several years. Chronic pain can tremendously affect a patient’s mobility and it can reduce flexibility, strength, and endurance.




Neural Zoomer Plus for Neurological Disease

Neural Zoomer Plus | El Paso, TX Chiropractor


Dr. Alex Jimenez utilizes a series of tests to help evaluate neurological diseases. The Neural ZoomerTM Plus is an array of neurological autoantibodies which offers specific antibody-to-antigen recognition. The Vibrant Neural ZoomerTM Plus is designed to assess an individual�s reactivity to 48 neurological antigens with connections to a variety of neurologically related diseases. The Vibrant Neural ZoomerTM Plus aims to reduce neurological conditions by empowering patients and physicians with a vital resource for early risk detection and an enhanced focus on personalized primary prevention. �

Formulas for Methylation Support

Xymogen Formulas - El Paso, TX


XYMOGEN�s Exclusive Professional Formulas are available through select licensed health care professionals. The internet sale and discounting of XYMOGEN formulas are strictly prohibited.


Proudly,�Dr. Alexander Jimenez makes XYMOGEN formulas available only to patients under our care.


Please call our office in order for us to assign a doctor consultation for immediate access.


If you are a patient of Injury Medical & Chiropractic�Clinic, you may inquire about XYMOGEN by calling 915-850-0900.

xymogen el paso, tx


For your convenience and review of the XYMOGEN products please review the following link. *XYMOGEN-Catalog-Download


* All of the above XYMOGEN policies remain strictly in force.



How Chiropractic Helps Those That Suffer From Anxiety

How Chiropractic Helps Those That Suffer From Anxiety

When you struggle with anxiety, it can make living your day-to-day life more difficult. Anxiety comes in a variety of forms and varies by individual. The treatments that are most effective for one person may not be as effective for another, but there is some general guideline for dealing with anxiety that most sufferers can benefit from. Regular chiropractic care, including a focus on improving overall health, can serve as a foundation for navigating the difficulties of anxiety.


Ways Chiropractic Can Help


1. Keeping track of triggers.

Chiropractors are big fans of keeping diaries surrounding any type of health issue you are dealing with�and anxiety is no exception. Just like keeping a food diary can help you identify a food allergy, keeping an anxiety diary can help you see what things in your life are triggering your anxiety. Triggers for anxiety can include a wide range of things, not all of them related to human interactions. Some of these triggers can include:

  • Allergies to certain foods
  • Consumption of alcohol
  • Consumption of caffeine
  • Vitamin deficiencies, particularly B vitamins, calcium, and magnesium
  • Consumption of sugar

Your chiropractor can tell you how to keep a diary that will help you see what you do in your day-to-day life, and how those actions relate to your anxiety.

2. Keeping your body in Top Form.

The relationship between the body and the mind is still far from being fully understood. However, there is no denying the significant connection between our physical health and our mental health. When your body is healthier, your mood is more level and positive.

Chiropractic care is focused on treatments that improve your health. These can include chiropractic adjustments, massage therapy, spinal decompression, ultrasound and more. Which treatments are right for you will depend on the results of your physical examination with the chiropractor. What you can be sure of is that your chiropractor will do everything possible to ensure your body is healthy and functioning at an optimal level.


11860 Vista Del Sol, Ste. 128 How Chiropractic Helps Those That Suffer From Anxiety El Paso, TX.


3. Maintaining Spinal Alignment.

There are many ways that the nervous system affects the body and the brain�and the full effects are not totally clear as of yet. What we do know is that many chiropractic patients report improvements in their health seemingly unrelated to the pain in their back or neck. A few adjustments into a treatment plan and patients discover that some other health issue gets resolved.

Adjustments are designed to put your vertebrae back into proper alignment. With proper alignment, your nervous system can function optimally. The results may or may not improve your anxiety directly, but they will make you feel better and keep your body running the way it was intended to.

4. Improving Your Diet.

What you eat plays a huge role in your overall health. Improving your diet could lead to an improvement in your anxiety symptoms, which is why your chiropractor will try to help you make healthy changes to what you eat. Chiropractors are trained in the latest research in nutrition and are well-versed in the benefits of various approaches to a healthy diet. You can work with your chiropractor to shift your diet from its current state to one that includes more healthy options.

Other Healthcare Providers & Your Chiropractor

If you are seeing a mental healthcare professional for your anxiety, your chiropractor will strive to work with your provider to ensure the best possible outcomes. Sometimes the best way to improve your health is to take a multi-pronged approach�which your chiropractor can help you with!

11860 Vista Del Sol, Ste. 128 How Chiropractic Helps Those That Suffer From Anxiety El Paso, TX.

Please contact us today to schedule an appointment with our chiropractic team. We look forward to seeing you.


Depression & Chronic pain | El Paso, Tx



Chronic pain caused by accidents and/or aggravated conditions can often be one of the primary reasons for depression in patients. When painful symptoms induce patients to struggle with their everyday physical activities, their mental health can be tremendously influenced. Chiropractic care utilizes spinal adjustments and manual manipulations which could help restore the initial integrity of the backbone. Patients describe how chiropractic care has helped them recover their well-being and they highly recommend Dr. Alex Jimenez, doctor of chiropractic, as the non-surgical choice for chronic pain and depression, one of a variety of other common health issues.


Gait Related Low Back Pain

Currently, more than 2 million Americans are dependent on opioids. For many, their addiction comes from seeking pain management for an injury or chronic condition. Opioids are a convenient and fast remedy, but only provide pain relief and not actual treatment of the cause. Therefore, opioids should be a last resort when experiencing pain and discomfort. Starting at the foundation (feet) of the body with orthotics can help the rest of the body stay aligned.


VasyliMedical Gait Related Lower Back Pain


NCBI Resources

If you are suffering from depression or anxiety, you may feel hopeless and helpless. You may be less apt to seek or follow treatment, believing there is nothing you can do to make it better. When you have a chronic medical condition, it doesn�t just impact your health. Often you can�t work or miss time at work, you may have financial problems. Relationships frequently suffer when one partner is sick. While these can be true for all chronic conditions, when you add in depression or anxiety, coping is even more difficult.


The Connection Between Anxiety and Inflammation

The Connection Between Anxiety and Inflammation

Anxiety is the most common mental health disorder in the United States, impacting more than 40 million adults. Though some instances can be moderate and short-lived, others may be painfully debilitating, lasting for years, or becoming a chronic problem. While almost anyone can experience temporary anxiety before a variety of events, anxiety is regarded as problematic when it starts to interfere in one way or another with regular, everyday function, including sleep disturbances, social stress, or self-care. Anxiety is connected to a number of lifestyle, health, and nutritional aspects, but understanding the triggers and root causes can result in a more effective treatment approach.


The thought of the existence of an interaction between the immune system and the central nervous system, or CNS, has prompted extensive research attention into the subject of “psychoneuroimmunology”, carrying the area to an intriguing level where new hypotheses are being increasingly tested. So far, the presence of inflammatory reactions and the crucial effects of depression have received most attention. But considering a large socioeconomic impact due to an alarming increase in anxiety disorder patients, there is an urgent research need for better comprehension of the role of inflammation in anxiety and how this relationship can influence one another. The purpose of the article below is to demonstrate the results as well as discuss the outcome measures of a large cohort study conducted in order to determine the possible connection between anxiety disorders and brain inflammation.


Anxiety Disorders and Inflammation in a Large Adult Cohort




Although anxiety disorders, like depression, are increasingly being associated with metabolic and cardiovascular burden, in contrast with depression, the role of inflammation in anxiety has sparsely been examined. This large cohort study examines the association between anxiety disorders and anxiety characteristics with several inflammatory markers. For this purpose, persons (18�65 years) with a current (N=1273) or remitted (N=459) anxiety disorder (generalized anxiety disorder, social phobia, panic disorder, agoraphobia) according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria and healthy controls (N=556) were selected from the Netherlands Study of Depression and Anxiety. In addition, severity, duration, age of onset, anxiety subtype and co-morbid depression were assessed. Inflammatory markers included C-reactive protein (CRP), interleukin (IL)-6 and tumor-necrosis factor (TNF)-?. Results show that after adjustment for sociodemographics, lifestyle and disease, elevated levels of CRP were found in men, but not in women, with a current anxiety disorder compared with controls (1.18 (s.e.=1.05) versus 0.98 (s.e.=1.07) mg?l?1, P=0.04, Cohen’s d=0.18). No associations were found with IL-6 or TNF-?. Among persons with a current anxiety disorder, those with social phobia, in particular women, had lower levels of CRP and IL-6, whereas highest CRP levels were found in those with an older age of anxiety disorder onset. Especially in persons with an age of onset after 50 years, CRP levels were increased compared with controls (1.95 (s.e.=1.18) versus 1.27 (s.e.=1.05) mg?l?1, P=0.01, Cohen’s d=0.37). In conclusion, elevated inflammation is present in men with current anxiety disorders. Immune dysregulation is especially found in persons with a late-onset anxiety disorder, suggesting the existence of a specific late-onset anxiety subtype with a distinct etiology, which could possibly benefit from alternative treatments.


Keywords: anxiety disorder, anxiety characteristics, cohort study, inflammation




Anxiety disorders are among the most prevalent and disabling mental disorders.1, 2 Increasing evidence links anxiety to cardiovascular risk factors and diseases such as atherosclerosis,3 metabolic syndrome,4 and coronary heart disease.5, 6 As low-grade systemic inflammation is clearly involved in the etiology of these somatic conditions,7, 8, 9 it has been hypothesized that inflammation has a role in anxiety disorders and may form the link between anxiety disorders and cardiovascular burden.10 Anxiety disorders are also highly co-morbid with depression,11 which has recurrently been associated with immune dysregulation.12, 13 However, unlike depression, very few studies have investigated the relationship between anxiety disorders and inflammation. Two recent studies have correlated anxiety symptoms with increased cytokine levels, in particular C-reactive protein (CRP).14, 15 With regard to anxiety disorders, research has mainly focused on posttraumatic stress disorder, in which high levels of inflammatory markers have been found.16, 17 Sparse evidence from relatively small clinical studies (n?100) suggests increased inflammatory activation in patients with panic disorder18 and generalized anxiety disorder,19 which seems to be independent of co-morbid depression.


As there is yet limited research on immune dysregulation and anxiety, one can only speculate on the mechanisms linking these two conditions. Experimentally induced stress has been shown to produce an inflammatory reaction,20 which has led researchers to suggest that it is in particular the experience of acute stress, such as present in panic disorders, causing the high levels of inflammation in anxiety.18 On the other hand, chronic stress may initiate changes in the hypothalamic�pituitary�adrenal (HPA) axis and the immune system, which in turn can trigger depression as well as anxiety.21 These pathways are not independent as the HPA-axis and the immune system are closely linked. Although the HPA axis in normal situations should temper inflammatory reactions, prolonged hyperactivity of the HPA axis could result in blunted anti-inflammatory responses to glucocorticoids resulting in increased inflammation.22, 23 Likewise, it can be hypothesized that immune changes associated with chronic disease and aging,24 could induce similar anxiety-enhancing effects. Although several mechanisms might explain an association between inflammation and anxiety disorders, it can be expected that immune dysregulation is not a general phenomenon in anxiety disorders, but might be restricted to specific subgroups. Whether this anxiety subgroup is defined by the type of disorder, the severity or duration of the disorder, the co-morbidity with depression, or its age of onset, is yet to be examined.


The present study investigates the association between several common anxiety disorders (generalized anxiety disorder, social phobia, panic disorder, agoraphobia) and heightened inflammation (CRP, interleukin (IL)-6, tumor necrosis factor (TNF)-?) in a large sample of persons with current and remitted anxiety disorders and healthy controls. In addition, it will be examined whether specific anxiety characteristics (severity, duration, age of onset, subtype, depression co-morbidity) further discriminate those anxiety patients with elevated inflammation.


Subjects and Methods




The Netherlands Study of Depression and Anxiety (NESDA) includes 2981 persons with and without depressive and anxiety disorders, aged 18�65 years at the baseline assessment in 2004�2007. Participants were recruited from the community (19%), general practice (54%) and secondary mental health care (27%) in order to reflect the broad range and developmental trajectory of psychopathology. Persons with insufficient command of the Dutch language or a primary clinical diagnosis of bipolar disorder, obsessive compulsive disorder, severe substance use disorder, psychotic disorder or organic psychiatric disorder, as reported by themselves or their mental health practitioner, were excluded. A detailed description of the NESDA study design and sampling procedures can be found elsewhere.25 The research protocol was approved by the ethics committee of participating universities and after complete description of the study all respondents provided written informed consent.


During the baseline interview, the presence of anxiety disorder (generalized anxiety disorder, social phobia, panic disorder, agoraphobia) and depressive disorder (major depressive disorder, dysthymia) was established using the Composite Interview Diagnostic Instrument (CIDI) according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria.26 The CIDI is a highly reliable and valid instrument for assessing depressive and anxiety disorders27 and was administered by specially trained research staff. In addition, the severity of anxiety was measured in all participants using the 21-item self-report Beck Anxiety Inventory.28 For the present analyses, we selected persons with a current (that is, past 6 months) or remitted (lifetime, but not current) anxiety disorder and healthy controls. Healthy controls had no lifetime anxiety or depressive disorder and a Beck Anxiety Inventory score below 10, as a score of 10 or above indicates mild anxiety.29 Persons with anxiety disorders were allowed to have a co-morbid depression. Of these 2342 persons, 54 were excluded due to missing information on inflammatory markers, leaving a sample of 2288 persons for the present study. Persons with missing data on inflammation were less often female (55.6 versus 66.9%, P=0.08), but did not differ from included persons in terms of age, years of education and the presence of anxiety disorder.


Anxiety Characteristics


Next to subtype of CIDI anxiety disorder diagnosis (generalized anxiety disorder, social phobia, panic disorder, agoraphobia), anxiety characteristics included anxiety symptoms severity as measured by the Beck Anxiety Inventory, and anxiety symptoms duration, using the Life Chart Interview (LCI).30 The LCI uses a calendar method to determine life events during the past 4 years to refresh memory after which the presence of anxiety and avoidance symptoms during that period is assessed. From this, the per cent of time patients reported anxiety symptoms was computed. The LCI has been used by other large cohort studies31 and event history calendars such as the LCI have been suggested a natural method of choice for retrospective data collection.32 To be able to test whether inflammation was in particular associated with anxiety disorders with a later onset, as we had found for depression,33 age of anxiety onset was derived from the CIDI interview. Last, the presence of a current co-morbid depressive disorder (major depressive disorder, dysthymia) was taken from the CIDI to check whether a possible inflammation�anxiety association was independent of co-morbid depression.


Inflammatory Markers


Markers of inflammation were assessed at the baseline NESDA measurement and included CRP, IL-6 and TNF-?. Fasting blood samples of NESDA participants were obtained in the morning between 0800 and 0900 hours and kept frozen at ?80?�C. CRP and IL-6 were assayed at the Clinical Chemistry Department of the VU University Medical Center. High-sensitivity plasma levels of CRP were measured in duplicate by an in-house ELISA based on purified protein and polyclonal anti-CRP antibodies (Dako, Glostrup, Denmark). Intra- and inter-assay coefficients of variation were 5% and 10%, respectively. Plasma IL-6 levels were measured in duplicate by a high sensitivity ELISA (PeliKine CompactTM ELISA, Sanquin, Amsterdam, The Netherlands). Intra- and inter-assay coefficients of variation were 8% and 12%, respectively. Plasma TNF-? levels were assayed in duplicate at Good Biomarker Science, Leiden, The Netherlands, using a high-sensitivity solid phase ELISA (Quantikine� HS Human TNF-? Immunoassay, R&D systems, Minneapolis, MN, USA). Intra- and inter-assay coefficients of variation were 10% and 15%, respectively.




Sociodemographic characteristics included sex, age and years of education. As lifestyle characteristics can be associated with both anxiety and inflammation, smoking status (never, former, current), alcohol intake (<1, 1�14 (women)/1�21 (men), >14 (women)/>21 (men) drinks per week), physical activity (measured with the International Physical Activity Questionnaire34 in MET-minutes (ratio of energy expenditure during activity compared with rest times the number of minutes performing the activity) per week) and body mass index (weight in kilograms divided by height in meters squared) were assessed. In addition, several disease-related covariates were taken into account including the presence of cardiovascular disease (assessed by self-report supported by appropriate medication use (see Vogelzangs et al.6 for detailed description)), the presence of diabetes (fasting plasma glucose level ?7.0?mmol?l?1 or use of anti-diabetic medication (ATC code A10)) and the number of other self-reported chronic diseases for which persons received treatment (including lung disease, osteoarthritis or rheumatic disease, cancer, ulcer, intestinal problem, liver disease, epilepsy and thyroid gland disease). Medication use was assessed based on drug container inspection of all drugs used in the past month and classified according to the World Health Organization Anatomical Therapeutic Chemical classification.35 Statin use (C10AA, C10B) and use of systemic anti-inflammatory medication (M01A, M01B, A07EB, A07EC) were assessed. Antidepressant medication included regular use (>50% of the time) of selective serotonin reuptake inhibitors (SSRI; N06AB), serotonin-norepinephrine reuptake inhibitors (SNRI; N06AX16, N06AX21), tricyclic antidepressants (TCA; N06AA) and tetracyclic antidepressants (TeCA; N06AX03, N06AX05, N06AX11).


Statistical Analyses


Baseline characteristics were compared between men and women using ?2 test for dichotomous and categorical variables, independent samples t-test for continuous variables, and Mann�Whitney U-test for inflammatory markers. For subsequent analyses, CRP, IL-6 and TNF-? were ln-transformed to normalize distributions, but back-transformed values are presented to enhance interpretation. Associations between anxiety disorders and inflammatory markers were examined using analyses of (co)variance, and (adjusted) means across anxiety groups (no, remitted, current) are presented. To take the effects of potential confounding factors into account, three different models were tested: unadjusted, adjusted for sociodemographics (sex, age, education) and additionally adjusted for lifestyle and disease (smoking status, alcohol intake, physical activity, body mass index, cardiovascular disease, diabetes, number of other chronic diseases, statins, anti-inflammatory medication). As depression has been reported to differentially affect inflammation in men and women,33 a sex-interaction for anxiety disorders is plausible. Therefore, we tested sex-interactions by including a sex � anxiety disorder status interaction term. When present, analyses were repeated sex stratified.


To test whether specific anxiety characteristics were related to elevated inflammation levels, we performed linear regression analyses with inflammatory markers as the outcome for each anxiety characteristic (severity, duration, age of onset, subtype, depression co-morbidity) within the sample of persons with a current anxiety disorder.



Dr. Alex Jimenez’s Insight

Anxiety is a common term which is often used to refer to situational stress or to describe momentary tenseness, however, for individuals living with an anxiety disorder, the symptoms associated with this mental health issue can be debilitating. Anxiety can be caused by a wide variety of factors, including depression and chronic pain, however, research studies have started to hypothesize that another common factor may be the true source as to why some people develop anxiety while other don’t: inflammation. The connection between anxiety and inflammation, as well as depression and inflammation, is becoming increasingly understood. Anxiety isn’t likely caused by inflammation alone, but, measuring inflammatory levels in the body could help determine the best treatment approach for a variety of anxiety disorders and for underlying health issues most commonly associated with inflammation, such as chronic pain.




Mean age of the study sample was 41.8 (s.d.=13.1) years and 66.9% were women. Baseline characteristics of the total sample and for men and women separately are shown in Table 1. Women were younger, more often non-drinkers, had a lower body mass index, less often cardiovascular disease or diabetes and less often used statins than men. In addition, women had higher levels of CRP than men. All covariates were associated with at least one of the inflammation markers, which has been presented elsewhere.33 Pearson’s correlations between inflammatory markers were modest (CRP�IL-6: r=0.31; CRP�TNF-?: r=0.13; IL-6�TNF-?: r=0.12; all P<0.001).


Table 1 Baseline Characteristics


Table 2 shows (adjusted) mean inflammation levels across anxiety groups (controls, remitted, current) based on analyses of (co)variance. In the total sample, higher CRP levels were found in persons with a current anxiety disorder compared with controls in unadjusted analyses (1.36 (s.e.=1.04) versus 1.11 (s.e.=1.05) mg?l?1, P=0.001), but after adjustment, there were no associations between anxiety disorders and any of the inflammation markers. However, a significant sex � anxiety disorder interaction was found for CRP (remitted: P=0.57; current: P=0.002). Stratified analyses for CRP showed that even after full adjustment for lifestyle and disease, men with current anxiety disorders had higher levels of CRP compared with controls (1.18 (s.e.=1.05) versus 0.98 (s.e.=1.07) mg?l?1, P=0.04, Cohen’s d=0.18). In women, anxiety disorders were not significantly associated with CRP. No sex interactions were found for IL-6 (remitted: P=0.47; current: P=0.40) or TNF-? (remitted: P=0.92; current: P=0.87). As we have previously reported associations between inflammatory levels and antidepressant use within currently depressed persons,33 we checked the influence of antidepressant use on our current results. Higher levels of CRP were found in TCA/TeCA users within our present sample of persons with current anxiety disorders (N=1273; P=0.001). To examine whether the finding of elevated CRP in currently anxious men was independent of TCA/TeCA use, we excluded all men using TCA/TeCA (N=36). Results remained similar, although no longer significant (men with current anxiety disorders versus controls: 1.13 (s.e.=1.05) versus 0.97 (s.e.=1.07) mg?l?1, P=0.08, Cohen’s d=0.15). In addition, to reduce the possible confounding effects of acute illness on inflammatory levels at the time of blood draw, all persons who reported having had a cold or fever in the week before blood draw were excluded (N=645), but findings remained alike (men with current anxiety disorders versus controls: 1.09 (s.e.=1.06) versus 0.91 (s.e.=1.07) mg?l?1, P=0.06, Cohen’s d=0.19).


Table 2 Adjusted Mean Marker Levels


To investigate whether specific anxiety characteristics (severity, duration, age of onset, subtype, depression co-morbidity) were associated with inflammation, linear regression analyses were performed within the subgroup of persons with current anxiety disorders (N=1273; Table 3). Anxiety severity and duration did not correlate with inflammation. Later age of anxiety disorder onset was associated with elevated CRP levels (?=0.053, P=0.05), even after additional adjustment for TCA/TeCA use (?=0.053, P=0.05). Persons with social phobia had lower levels of CRP (?=?0.053, P=0.04) and IL-6 (?=?0.052, P=0.05) compared with persons with other types of anxiety disorders. The association between social phobia and IL-6 appeared to be specific for women (?=?0.089, P=0.007), but not men (?=0.025, P=0.61; P sex-interaction=0.05). Co-morbid depressive disorder did not further differentiate anxious persons with elevated inflammation.


Table 3 Association of Characteristics


To further illustrate the findings with regard to age of onset, we constructed five age of anxiety disorder onset groups (<20, 20�30, 30�40, 40�50, ?50). Figure 1 presents adjusted means of back-transformed CRP levels across controls and age of onset groups based on analysis of covariance. CRP levels were only increased in persons with an age of onset after 50 years (1.95 (s.e.=1.18) versus 1.27 (s.e.=1.05) mg?l?1 in controls, P=0.01, Cohen’s d=0.37). For comparison, adjusted mean CRP levels for persons with cardiovascular disease were 1.62 (s.e=1.11), illustrating the clinical relevance of this finding. Excluding persons reporting having had a cold or fever in the week before blood draw (N=513), yielded similar findings (age of onset after 50 years versus controls: 1.73 (s.e.=1.20) versus 1.18 (s.e.=1.05) mg?l?1, P=0.04, Cohen’s d=0.35). Results were also similar when the analysis of Figure 1 was restricted to the sample of persons aged 50 years or above (N=589; age of onset after 50 years versus controls: 2.05 (s.e.=1.16) versus 1.35 (s.e.=1.08) mg?l?1, P=0.01, Cohen’s d=0.40), underlining that higher CRP in those with an age of onset of 50 years or above was not due to the higher age itself in these persons. Last, in a post-hoc analysis, we directly compared CRP levels between persons with a late versus early onset of anxiety disorder at a cutoff of 50 years, and found significantly higher CRP levels in the late onset group (1.91 (s.e.=1.19) versus 1.35 (s.e.=1.03) mg?l?1, P=0.05, Cohen’s d=0.30).


Figure 1 Adjusted Mean CRP Levels




The current study is one of the first and the largest to date to examine the association between anxiety disorders and inflammation. The results show that men with a current anxiety disorder have somewhat increased levels of CRP, even after taking a large set of lifestyle and disease factors into account. Elevated levels of CRP were in particular found in those persons with a late onset of the anxiety disorder.


Our results are in line with the few previous studies examining the relationship between anxiety symptoms or disorders with inflammation. Available evidence until now was limited to assessing anxiety symptoms in the general population,14, 15 confined to specific anxiety disorders in small clinical samples16, 17, 18 or in a heart disease population.19 Our study adds to the literature by showing that elevated CRP levels can be found among several common anxiety disorders in a relatively large cohort of anxious persons and controls, specifically in those with a later onset of the anxiety disorder. CRP levels were in particular elevated among men with anxiety disorders, which is in line with the large-scale study by Liukkonen et al.,15 which showed an association between anxiety symptoms and CRP only in men. In contrast, Pitsavos et al.14 found associations between an anxiety symptoms score and CRP levels in both men and women. Persons included in the study by Pitsavos et al. were much older (18�89 years; mean age 45 years) than those in the study by Liukkonen et al. (all 31 years old), and slightly older than those in the present study (18�65 years; mean age 42 years). Perhaps sex differences become less clear with increasing age, as a result of hormonal changes across the lifespan of women, which affect inflammation levels.36 This could be in line with our finding that CRP levels were elevated in both men and women with a late onset of anxiety disorders.


Our findings with respect to anxiety disorders are also very comparable to our earlier findings regarding depressive disorders and inflammation.33 In that study, we found elevated inflammation, specifically CRP, in depressed men, especially among those with a later depression onset. The effect sizes for CRP in men with a current disorder are also comparable for anxiety (Cohen’s d=0.18) and depressive (Cohen’s d=0.21) disorders. A trend for association with IL-6, which was found for current depressive disorders in men, was not found for current anxiety disorders. Of note is that in persons with an anxiety disorder, a co-morbid depressive disorder was not associated with higher inflammation levels, suggesting that the effects found for anxiety disorders are independent of depression.


In line with our previous findings for current depressive disorders,33 CRP levels were in particular elevated among persons with a later onset of anxiety disorders. In contrast, characteristics that are more often associated with an early age of onset, such as higher severity and longer duration were not associated with increased inflammation. Also, in our sample, women had an earlier age of anxiety disorder onset than men, possibly contributing to the lack of an overall association between anxiety disorders and inflammation in women. Furthermore, we found that CRP levels were lowest among persons with social phobia when compared with other anxiety disorders, in particular in women. Social phobia has been reported to have a much earlier age of onset compared with generalized anxiety disorder or panic disorder,37 which was confirmed in our sample (16.6 versus 25.9 years, P<0.001). To our knowledge, no other study has yet examined the association between social phobia and inflammation. In our study, only nine persons with social phobia had an disorder onset at or after 50 years. Therefore, low inflammation levels in persons with social phobia cannot explain our findings for elevated CRP levels in persons with an age of anxiety disorder onset after 50 years. A recent study by Copeland et al.38 showed that, after taking health-related behaviors into account, generalized anxiety disorder was not associated with elevated CRP levels among children and adolescents. These findings argue against the idea that the inflammation�anxiety association is merely a result of acute stress experienced in anxiety disorders. Although we cannot make inferences about etiology based on our cross-sectional analyses, our current findings are in line with the growing evidence suggesting a distinct etiology involving vascular/metabolic/inflammatory factors in depression or anxiety disorders with an onset later in life.39, 40, 41, 42 Possibly, accumulating psychological and physical stress across the life-span might induce immunological changes24 that eventually results in depression and anxiety.


In our previous report,33 we had found differences in inflammation levels among different classes of antidepressant medication use, which was confirmed for higher CRP in TCA/TeCA users within our present sample of persons with current anxiety disorders. Excluding persons using TCA or TeCA, resulted in a slightly weaker effect size for the association between current anxiety disorder and CRP in men. This might suggest that the elevated CRP levels in men with current anxiety disorders are for some part due to use of TCA/TeCA. On the other hand, persons using TCA/TeCA might represent the more severe cases of anxiety disorders, in which case exclusion of these persons leads to an underestimation of the association. Adjustment for TCA/TeCA use had no effect on our findings for age of anxiety disorder onset, suggesting that late-onset anxiety disorders are independently associated with higher levels of CRP.


What are the clinical implications of our findings? First, our finding of increased CRP levels in particularly those with a late onset of the anxiety disorder might implicate the existence of a specific late-onset anxiety subtype with a distinct etiology. As we have found similar results for depression33 and because depression and anxiety are highly co-morbid disorders,11 this might suggest that depression and anxiety with a late onset share a similar etiology and represent one particular group of disorders, which might be more distinct from other depressive or anxiety disorders, which present earlier in life. As we can only speculate on etiology based on our cross-sectional research, longitudinal research is needed to validate the existence of an etiologically distinct late-onset subtype. Second, if confirmed, a distinct etiology for late-onset disorders implicates different treatment strategies for this subgroup. Perhaps anti-inflammatory medication or lifestyle interventions, such as exercise, for which (some) evidence exists that they normalize immune and metabolic dysregulation,43 as well as improve depressive symptoms to some degree,44, 45 could be beneficial in persons with late onset anxiety disorders as well.


Our study has some important strengths such as a large sample size, assessment of multiple inflammatory markers, clinical diagnoses of several anxiety disorders, adequate adjustment for potential confounders and the ability to examine the role of anxiety characteristics. However, some limitations need to be acknowledged. As our data are cross-sectional, we cannot make any inferences about the direction of the association. Also, although we adjusted for a large set of possible confounding factors, unmeasured poor lifestyle behaviors or health factors may be the explaining link between inflammation and anxiety disorders. For instance, subclinical cardiovascular disease could possibly precede both inflammation and anxiety. On the other hand, subclinical disease may be one pathway of how inflammation leads to anxiety in later life. Longitudinal studies are needed to investigate whether immune dysregulation is a precursor or the result of anxiety, or whether this relationship is bidirectional. Further, like most other studies, we assessed circulating levels of inflammatory markers, which show a high degree of intra-individual variation that could explain the rather modest overall associations between anxiety disorders and inflammation in our study.


In conclusion, our results show that low-grade systemic inflammation is present in men with anxiety disorders. Elevated inflammation is in particular found in both men and women with the onset of anxiety disorder later in life. Longitudinal studies are needed to confirm inflammation as an etiological factor in anxiety disorders with a late-life onset, followed by intervention trials investigating new treatment strategies (for example, anti-inflammatory medication, lifestyle interventions) for this subset of persons with late-onset anxiety.




The infrastructure for the NESDA study ( is funded through the Geestkracht program of the Netherlands Organisation for Health Research and Development (Zon-Mw, grant number 10-000-1002) and is supported by participating universities and mental health care organizations (VU University Medical Center, GGZ inGeest, Arkin, Leiden University Medical Center, GGZ Rivierduinen, University Medical Center Groningen, Lentis, GGZ Friesland, GGZ Drenthe, Institute for Quality of Health Care (IQ Healthcare), the Netherlands Institute for Health Services Research (NIVEL) and the Netherlands Institute of Mental Health and Addiction (Trimbos)). NV was supported through a fellowship from the EMGO Institute for Health and Care Research and BP through a VICI grant (NWO grant g1811602). Assaying of inflammatory markers was supported by the Neuroscience Campus Amsterdam.




The authors declare no conflict of interest.


Supporting the Endocannabinoid System | El Paso, TX Chiropractor


Beyond CBD � Supporting the Entire Endocannabinoid System


Every day, more and more health-conscious consumers are starting to take great interest in nutritional supplements that encourage the proper function of the endocannabinoid system, or ECS. Although marijuana and substances derived from or related to marijuana were believed to be the only options to achieve this effect, the focus in the consumer market has largely shifted to a single chemical: cannabidiol.


What’s CBD?


Cannabidiol, commonly known as CBD, is a chemical found in marijuana and in hemp which does interact with the ECS. CBD is just one of a wide group of chemicals known as phytocannabinoids. Cannabidiol has turned into a well-known phytocannabinoid because it is being researched to turn into a new medication and also the benefits demonstrated by CBD have created a lot of attention in this compound.


What Can CBD Do?


Although CBD does perform multiple actions within the human body, its own best-known function in the ECS, or endocannabinoid system, is in its potential to inhibit the activity of the enzyme called fatty acid amide hydrolase, or FAAH. FAAH breaks down anandamide, among the body’s endogenous cannabinoids, which is known to bind to the ECS’s CB1 receptor. The ECS’s CB1 receptor, primarily found in the brain, is the exact same receptor which THC, or tetrahydrocannabinol, binds to. In other words, anandamide, often referred to as “the bliss molecule”, is the human body’s natural THC.


Significantly, however, whereas THC could have negative effects, such as triggering feelings of anxiety, mild hallucinations, dizziness, rapid heart rate, slowed reaction times, and food cravings, the anandamide made naturally by the body appears to exert positive effects on mood, memory, brain function and pain. Because anandamide is normally rapidly broken up by FAAH and because CBD modulates FAAH, Cannabidiol’s primary importance is in the way it can maintain anandamide levels, thus enhancing anandamide’s beneficial impact in the ECS. CBD also binds directly to CB1 and CB2 receptors and has a selection of activity outside of the ECS which can result in its many health benefits.


CBD is a Drug According to the FDA


Because CBD is comparatively safe, lacks the unwanted side effects of THC, and may be easily derived from hemp instead of marijuana, the natural products industry was flooded with products labeled as CBD. However,�before this recent phenomenon, a British pharmaceutical company began studying the merits of CBD as an alternate to the drugs and/or medications being utilized to treat resistant childhood epilepsy.


This company, GW Pharmaceuticals (dba Greenwich Biosciences) began pre-clinical operations on CBD in 2007 and contains an investigational new drug called Epidiolex� in late stage clinical trials.


In multiple warning letters in 2017 sent to a number of businesses, the FDA noted ,”If an article, such as CBD, has been approved for investigation as a new drug and/or medication for which substantial clinical investigations have been instituted and for which the existence of such investigations have been made public, then products containing that chemical are outside the definition of a dietary supplement” Since the investigational work completed on CBD as a drug predates the promotion of CBD as a dietary supplement, products containing purified CBD or enriched with CBD are considered by the FDA to be medication and not dietary supplements.


Why Support the Entire ECS?


The ECS is not just a bodily system which completes a single function, as a matter of fact it’s far from it. ECS receptors are widely dispersed throughout the entire body. CBD is an isolated molecule which acts primarily on just a single component of the ECS; i.e., it inhibits the degrading enzyme FAAH, thus allowing the anandamide naturally produced by your endocannabinoid system to possess higher action. But what about the rest of the ECS?


The ECS has at least two major receptors, CB1 and CB2 receptors. And along with anandamide, humans also produce an endocannabinoid called 2-archidonoyl glycerol, or 2-AG, which can be degraded by the enzyme monoacylglycerol lipase, or MAGL. If our intention is to support and nourish the whole ECS, then focusing on a single molecule like CBD that only works on one portion of the ECS might not be the best approach.


Hemp includes heaps of active molecules, including a range of phytocannabinoids. Some such as cannabigerol, or CBG, bind weakly to the CB1 and CB2 receptors. Both CBG and cannabichromene, or CBC, may also help maintain wholesome anandamide levels. The phytocannabinoid beta-caryophyllene, or BCP, that is found in plants like black pepper and clove, binds to the CB2 receptor, which supports the actions of 2AG. Other natural plant compounds, particularly specific terpenoids, have functions which are complementary to that of phytocannabinoids.


The “Entourage” Impact


Although isolated CBD does have a part in overall health and wellness, cannabidiol is not anywhere near the entire process for encouraging the ECS. By using a whole hemp stalk infusion combined with hops, pepper, clove and rosemary that include naturally occurring complementary compounds, hemp oil nourishes the whole ECS, giving a holistic approach to a system that’s often neglected and out of equilibrium in today’s stressful world.


Hemp oil nourishes the entire ECS, giving a holistic approach to a system that’s frequently ignored and out of equilibrium in today’s stressful world. Scientists who research the ECS refer to the approach as the”entourage” effect, and several top researchers believe this approach to be extremely effective in keeping the health and tone of the valuable endocannabinoid system as well as controlling the symptoms of inflammation and anxiety in the human body.


In conclusion, anxiety is one of the most common mental health disorders in the United States. This debilitating health issue can be caused by a variety of factors, however, many research studies have started to demonstrate a connection between anxiety disorders and brain inflammation. According to the article above, stress has been shown to produce an inflammatory reaction, which has led researchers to suggest that anxiety may be causing high levels of inflammation. The outcome measures of te cohort study found that low-grade inflammation is present in individuals with anxiety disorders. Further research studies are still required to confirm the connection between anxiety and inflammation. Furthermore, supporting the function of the endocannabinoid system, or ECS, with the use of CBD or cannabidiol, has been found to have many health benefits, including helping with inflammation and anxiety.��Information referenced from the National Center for Biotechnology Information (NCBI).�The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at�915-850-0900�.


Curated by Dr. Alex Jimenez


Additional Topics: Back Pain

Back pain is one of the most prevalent causes for disability and missed days at work worldwide. As a matter of fact, back pain has been attributed as the second most common reason for doctor office visits, outnumbered only by upper-respiratory infections. Approximately 80 percent of the population will experience some type of back pain at least once throughout their life. The spine is a complex structure made up of bones, joints, ligaments and muscles, among other soft tissues. Because of this, injuries and/or aggravated conditions, such as herniated discs, can eventually lead to symptoms of back pain. Sports injuries or automobile accident injuries are often the most frequent cause of back pain, however, sometimes the simplest of movements can have painful results. Fortunately, alternative treatment options, such as chiropractic care, can help ease back pain through the use of spinal adjustments and manual manipulations, ultimately improving pain relief.




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EXTRA IMPORTANT TOPIC: Low Back Pain Management


MORE TOPICS: EXTRA EXTRA:�Chronic Pain & Treatments


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Depression and Anxiety in Chronic Pain

Depression and Anxiety in Chronic Pain

Everyone will experience some type of pain throughout their lifetime, however, for those people who have anxiety or depression, pain can become especially intense and it can be challenging to treat. Individuals experiencing depression, for instance, often experience more severe and long-term pain than other individuals. The overlap of anxiety, depression, and pain is very evident in chronic pain and sometimes debilitating syndromes, such as fibromyalgia, irritable bowel syndrome, low back pain, headaches, and nerve pain. Psychiatric disorders not only bring about pain intensity but also contribute to increased risk of disability.


Researchers once believed that the connection between pain, anxiety, and depression resulted mostly from psychological rather than biological factors. Chronic pain can lead to depression, and also, major depression may feel emotionally painful. But as researchers have learned more about how the brain works, and how the nervous system interacts with other areas of the body, they’ve found that pain shares some biological mechanisms with depression and anxiety. Therapy is challenging when pain overlaps with anxiety or depression. Focus on pain can conceal both the clinician’s and patient’s awareness that a psychiatric disorder is also present. Even when the two types of problems are properly diagnosed, they can be difficult to treat.


Depression and Anxiety in Pain




  • Mood disorders, especially depression and anxiety, play an important role in the exacerbation of pain perception in all clinical settings.
  • Depression commonly occurs as a result of chronic pain and needs treating to improve outcome measures and quality of life.
  • Anxiety negatively affects thoughts and behaviours which hinders rehabilitation.
  • Anxiety and depression in acute hospital settings also negatively affect pain experience and should be considered in both adults and children.
  • Poor pain control and significant mood disorders perioperatively contribute to the development of chronic postoperative pain.




Pain concepts have moved radically away from the early nociceptive Cartesian principle, where a specific lesion in the body is experienced as pain by the brain. This has been replaced by the widely accepted biopsychosocial model, where tissue damage, psychology and environmental factors all interact to determine pain experience. The IASP’s definition of pain as �an unpleasant sensory or emotional experience associated with tissue damage�� further emphasises the significant role of mood and emotions for pain perception. Among these, depression and anxiety have been implicated as important contributors to the experience of pain, and have been extensively studied.




Depression is characterised by a pervasive low mood, loss of interest in usual activities and diminished ability to experience pleasure. Within this definition there exists a whole spectrum of severity, symptoms and signs together with their classifications. The DSM-IV (Diagnostic and Statistical Manual) is a common diagnostic classification system for psychiatric conditions and is also used for research, insurance and administration[1]. A common prerequisite for diagnosis of depression or other psychiatric disorders is that any symptoms experienced should result in clinically significant distress or impairment of social, occupational, or other important areas of functioning.


The Scale of the Problem


The association of chronic pain with depression has been of great interest in the past few decades. Chronic musculoskeletal pain patients have higher depression than individuals without pain in a general population study[2]. A third of patients in a pain clinic population had �major depression� according to the criteria of the Diagnostic and Statistical Manual (DSM IV) following structured interviews[3]. The presence of pain can make recognition of depression more difficult, even though increased severity of pain worsens depressive symptoms[4].


Diagnostic and Assessment Issues


The association between depression and chronic pain, though widely accepted, is marred by diagnostic difficulties. In research for �depression� various definitions exist in studies, leading to a variety of assessment methods, including self report instruments, chart reviews and structured or unstructured clinical interviews. Many studies relating to depression and chronic pain include heterogenous groups of patients with different chronic pain conditions and unspecified diagnostic criteria for depression. This clearly questions the validity of studies.


In the clinical setting many tools exist for the assessment of the severity and nature of depression. In chronic pain, the Zung Self-Rating Depression Scale (SDS), Beck’s Depression Inventory (BDI) and Depression, Anxiety and Stress Scale (DASS) are commonly used. The SDS and DASS in particular, have shown high internal consistency and validity in chronic pain patients. However many criteria for depression, like fatigue, insomnia and weight change, are symptoms attributable to chronic pain itself. The DSM-IV places emphasis on weight loss, appetite change and fatigue on diagnosis, and the Beck’s Depression Inventory and Zung Self-Rating Depression Scales also include a substantial number of such somatic items. Such �criterion contamination� may lead to overestimation of depression. The DASS excludes such somatic items and is thought to provide a more accurate assessment of depression, especially in chronic pain patients[5]. Another questionnaire designed specifically for chronic pain patients is the Depression, Anxiety and Positive Outlook Scale (DAPOS). This also contains no somatic items and includes measures of optimism[6].


These points illustrate the unique difficulty present in the study of depression in chronic pain patients. It is not surprising that meta-analyses or systematic reviews in this area are relatively scarce. Just as depression is not a single entity but a spectrum, chronic pain patients are also a very heterogenous group of patients. All these have to be borne in mind when reviewing papers and studies of depression in chronic pain.


Depression and Pain: Chicken and Egg?


Physiological similarities exist between chronic pain and depression. For example, noradrenaline and serotonin involved in the pathophysiology of depression also coincide with the anatomical �descending inhibition� of pain perception. These two neurotransmitters act in the limbic system and periaqueductal areas to modulate incoming pain stimuli. Antidepressants working through these neurotransmitters are also analgesic regardless of the presence of depression.


This leads to the question of whether depression follows the establishment of chronic pain or whether chronic pain is a manifestation of a form of depression or a spectrum thereof. Some evidence exists for both views. For example, patients with preexisting depression were found to be more likely to develop chest pain and headaches in a three year period[7]. Conversely a review of forty studies supported the notion that depression is a consequence of protracted pain[8]. The �diathesis-stress� model for this conundrum is now growing in acceptance which supports that depression is a sequalae of chronic pain. Accordingly people with a psychological predisposition (diathesis), superimposed with the stresses of chronic pain go on to develop clinical depression.


Chronic pain is also associated with anxiety disorders (discussed below), somatoform disorders, substance use disorders, and personality disorders. As with depression, pre-existing, semidormant characteristics of the individual before the onset of chronic pain are activated and exacerbated by the stress of chronic pain, eventually resulting in diagnosable psychopathology[9]. Psychosocial elements which predict chronic pain and disability (yellow flags) used in clinical practice may well fit into this construct.


Yellow Flags are psychosocial factors that increase the risk of developing or perpetuating long-term disability and work loss associated with low back pain. Such include:


  • Attitudes and Beliefs about back pain. The belief that pain is harmful or disabling resulting in fear-avoidance behaviour.
  • Behaviours. Use of extended rest, disproportionate �downtime�.
  • Compensation Issues. Lack of financial incentive to return to work.
  • Diagnosis and Treatment. Health professional sanctioning disability, not providing interventions that will improve function.
  • Emotions. Fear of increased pain with activity or work.
  • Family and Work. Over-protective partner/spouse, emphasising fear of harm or encouraging catastrophising. Manual work and job dissatisfaction.


The Costs of Depression in Pain


Social functioning, work and physical activities are all decreased whilst utilisation of medical services increases if depression coexists with pain[10]. Motivation and compliance with treatment is also affected[11]. Such negative outcomes leave little doubt as to the quality of life of such patients. Clearly pain and depression should not be seen as separate dimensions but as interactive in nature. Attempting to treat pain without considering depression is likely to be a futile venture.


Anxiety in Chronic Pain


Anxiety is a physiological state characterized by cognitive, somatic, emotional, and behavioral components producing fear and worry. Anxiety is often accompanied by physical sensations such as heart palpitations and shortness of breath whilst the cognitive component entails expectation of a diffuse and certain danger. As with depression, anxiety disorders are categorised in the DSM-IV, with subtypes including generalised anxiety disorder (GAD), panic disorder and phobias. GAD is the most commonly diagnosed anxiety disorder in chronic pain populations. The coexistence of pain and anxiety is perhaps not surprising: Both signal impending danger and the necessity for action which confer survival value to the individual.


Anxiety disorders are second only to depression in psychological comorbidity in chronic pain populations. Whilst anxiety is a normal response in everyone, clinical anxiety results in increased intensity and prolongation of the feelings of dread that interfere with normal functioning. Measurements of anxiety with chronic pain also show a strong association: as with depression. One such study showed a doubling in the prevalence of anxiety disorders compared to the general population[12]. Anxiety is thought to be an important mediator in the cognitive constructs of catastrophising, hypervigilance and fear avoidance in the exacerbation of pain experiences.


  • Catastfophising is �dwelling on the worst possible outcomes�. It is associated with higher disability and pain severity and is an important cognitive measure and prognostic indicator in chronic pain patients.
  • Hypervigilance in pain is the increased attendance to pain and decreased ability to distract oneself from pain-related stimuli.
  • Fear avoidance is the avoidance of movement or activities based on fear of pain or re-injury. This is especially counterproductive for physical rehabilitation and is termed �kinesophobia�.


Measurement of Anxiety in Pain


As with depression many measures of anxiety states exist. The State-Trait Anxiety Inventory questionnaire is a well-validated tool used in general psychology but has also been used in pain clinics. For chronic pain, more specific measures of anxiety-related to cognitive and behavioural variables have been designed. Such an instrument is the Pain Anxiety Symptoms Scale (PASS) which measures behavioural responses to pain[13]. The Fear of Pain Inventory measures degree of fear in hypothetical pain inducing situations[14]. These are more useful than general anxiety measurements and give more specific information in relation to the pain experienced. The DASS and DAPOS used for depression also measure anxiety.


Anxiety and Depression Coexist


Despite their differences in symptoms and classification, depression and anxiety seem to exist concurrently to a surprisingly frequent extent. In psychiatry, terms like �agitated depression� have been coined for a state of depression that presents as anxiety which includes restlessness, insomnia and nonspecific panic.


Even mild anxiety symptoms can have a major impact on the course of a depressive illness. Depressed or bipolar patients with lifetime panic symptoms have significant delays in remission for depression[15]. To this end, the presence of both depression and anxiety make treatment of pain more challenging but the presence of one should alert rather than deter the diagnosis of the other.


Treatment of Depression and Anxiety


Mainstays of treatment of depression and anxiety are psychological and pharmacological. Whilst the scope of these is well beyond this article, it is worth noting that cognitive behavioural therapy, which addresses depression and anxiety, has very good evidence for efficacy in chronic pain patients[16]. Important concepts of CBT are also incorporated into Pain Management Programs for delivery to patients with different types of pain.


Depression and Anxiety in Acute Pain


Hitherto depression and anxiety have only been discussed in a chronic setting. Current multidimensional concepts of pain are equally important in the acute setting. Apart from the degree of surgical insult to tissue, psychological and environmental factors influence acute pain experience to a high degree[17].


Preoperative anxiety is correlated with higher pain intensity postoperatively for a variety of operations. In the hospital setting, anxiety is worsened by sleep deprivation in the postoperative period due to interruptions in the wards for observations, other patients and medications. This vicious circle is exacerbated by fear of complications, loss of control and helplessness. Admission to hospital and having an operation is a highly stressful event for most and that is often forgotten by professionals who are frequently involved in perioperative care. Preoperative depression also increases pain intensity, opioid requirements by any route and number of demands from the PCAS (Patient controlled analgesia system) in the postoperative period. Higher levels of dissatisfaction with analgesia also occur if depression coexists[18].



Dr. Alex Jimenez’s Insight

From headaches to muscle tension and body soreness, pain may be all too familiar for individuals who suffer from anxiety and depression. However, many research studies have demonstrated that chronic pain, such as that resulting from conditions like arthritis or fibromyalgia, may in turn lead to a variety of mental health issues. Both anxiety and depression have been implicated to be fundamental contributors in the exacerbation of as well as in the perception of pain. As a result, many healthcare professionals have developed a treatment approach based on therapeutic strategies to help manage symptoms of anxiety and depression. By first controlling these symptoms, many doctors can safely and effectively help in the management of chronic pain. Recent research studies have found a connection between the endocannabinoid system and the management of chronic pain, as well as anxiety and depression.


Treatment Strategies


Strategies used include procedural and sensory information, relaxation and attentional strategies, hypnosis and cognitive behavioural treatments. The use of anxiolytic drugs on the morning of procedure or hypnotics the night before are also widespread.


Combination of procedural information of the surgery together with expected sensations felt by the patient postoperatively have yielded Level I evidence (evidence obtained from at least one properly designed randomised controlled trial) for benefits on pain perception[19]. Another meta-analysis on giving information regarding the conduct of surgical treatment showed decreased hospital stay[20].


Relaxation techniques involve teaching patients calming methods, including breathing techniques, self hypnosis and muscle relaxation.


This has been verified in a metanalysis providing Level I evidence for reducing pain as well as blood pressure and pulse[21]. Hypnosis and attention diversion from pain has also garnered evidence for effectiveness. A �moderate to large� effect size on reduction of pain has been shown in yet another meta-analysis of hypnosis, in both laboratory and clinical participants[22].


Psychological interventions for children are also increasingly recognized and being used. Cognitive behavioural strategies are shown to be effective in procedural related pain in children and adolescents[23].


Techniques used involve breathing exercises, distraction and incentives. These techniques involve psychologists, parents and medical staff.


Even in the intensive care, mood disorders need attention. Mechanically ventilated patients without surgery or trauma are known to experience pain, which leads to increased anxiety and adverse physiological effects[24]. Analgesia and sedation thus need to be adjusted with evaluation of pain in mind.


There is very good evidence to implicate mood disorders, especially anxiety, in worsening pain experience in acute surgical or procedural situations. Evidence extends to oncology and paediatric patients also. As a basic strategy, careful explanation and allaying of fears should be practiced by any healthcare professional involved in interventions. This can be combined with some of the psychological techniques described above. There is a greater wealth of high level evidence for mood disorders in acute compared to chronic pain. Shorter time frames of studies and greater numbers of suitable patients for recruitment are contributory factors to this.


Bridging the Gap


What causes acute pain to become chronic? Many patients who do develop chronic pain can pin down an episode of acute pain as a precipitant[25]. Some risk factors are known. Surgical procedures like amputation, thoracotomy and radical mastectomy are notorious for causing chronic pain postoperatively. Psychosocial contributors like �psychological vulnerability� preoperatively, and depression and anxiety postoperatively have been implicated[26]. Treatment or attenuation of anxiety and depression could thus be a vital component of perioperative pain control when considering longer term outcomes. Increased pain intensity is also a risk factor for chronic pain development. Treating acute pain is therefore vital for preventing chronicity.




Pain is one of the commonest symptoms for which patients seek medical attention. Depression and anxiety symptoms are important to consider not only in primary healthcare settings and pain clinics but also in hospital and palliative care settings. They must be borne in mind not only in adults but in children too. The education of patients of the role of depression and anxiety in pain is paramount, but awareness of these issues by healthcare professionals in all disciplines is the preceding and necessary step for good quality patient management.


The Endocannabinoid System


What is the ECS?


The significance of the ECS, or the endocannabinoid system, has just recently been realized and is currently being referred to as the most essential body system which you may have never heard of. Although the ECS is one of the principal systems in the body, it is not an isolated structural system like the nervous system or the vascular system. Instead, the endocannabinoid system is broadly dispersed throughout the human body and is composed of its own receptor sites, similar to little docking stations, which can in turn be found on nearly every organ in the human body.


What does the ECS do?


The ECS is the human body’s main regulatory system. It’s like an inner balancing mechanism, constantly keeping a wide range of bodily functions in equilibrium. The body produces its own endocannabinoids which modulate different biological processes throughout the body, providing these endocannabinoids with a variety of ranging consequences on everything from fertility to pain. Cannabinoid receptors can be found in the brain, nervous system, GI, or gastrointestinal, tract, bones, immune system, skin, and nearly every other organ in the body. Furthermore, the ECS helps regulate:


  • Appetite
  • Bone health
  • Caloric metabolism
  • Fertility
  • Immune function
  • Inflammation
  • Mood
  • Memory
  • Pain sensation
  • Skin health
  • Sleep
  • Stress response


Are There Any Plant Sources of Cannabinoids?


To put it simply, yes. We now know that many animals, from fish to birds to mammals, have their own ECS. Additionally, it’s well understood that while humans make their own cannabinoids which interact with the ECS, known as endocannabinoids, there are also compounds which interact with the ECS that are found in an assortment of plants and foods, known as phytocannabinoids. These plant-based cannabinoids either directly attach to, and also have an effect on, cannabinoid receptors, or they may even have an influence on the metabolism of endocannabinoids produced within the body. These can ultimately slow down their destruction, keeping them within the body longer.


Cannabis cultivated as hemp contains numerous phytocannabinoids, including tetrahydrocannabinolic acid, or THCA, cannabidiol, or CBD, tetrahydrocannabivarin, or THCV, cannabigerol, or CBG, cannabinol, or CBN, among many others. Common non-cannabis plants which contain phytocannabinoids include black pepper, clove, Echinacea, green tea, Panax ginseng, and black truffles. Within nature, chemical substances rarely act in isolation, and this is particularly true of both phytocannabinoids, which actually work together in a carefully coordinated manner.


What is the Distinction Between Hemp and Marijuana?


Hemp and marijuana are basically different cultivars of the same plant, Cannabis sativa L. A cultivar is a plant type that has been made or cultivated through a process of selective breeding. Marijuana is a sort of cannabis that has been bred to concentrate high levels of the psychoactive chemical, THC, or tetrahydrocannabinoid, for recreational and medicinal use, often containing about 18 percent� of THC. Conversely, hemp is a version of cannabis that is primarily utilized in clothing, paper, biofuels, bio-plastics, dietary supplements, cosmetics, and foods. Hemp contains less than 0.3 percent of THC as measured in the dried flowering tops.


In conclusion, recent research studies have found a strong connection between the psychology of chronic pain, especially the relationship between anxiety, depression and pain. For individuals with mental health issues, chronic pain can be a common symptoms which may or may not be directly associated with their specific condition. Fortunately, patients can successfully manage their anxiety, depression and chronic pain through a variety of treatments. The purpose of the article above is to demonstrate the connection between anxiety, depression and chronic pain as well as to discuss the significance of the endocannabinoid system, or ECS, and the use of cannabinoids as chronic pain treatment. Information referenced from the National Center for Biotechnology Information (NCBI).�The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at�915-850-0900�.


Curated by Dr. Alex Jimenez




Additional Topics: Back Pain


Back pain is one of the most prevalent causes for disability and missed days at work worldwide. As a matter of fact, back pain has been attributed as the second most common reason for doctor office visits, outnumbered only by upper-respiratory infections. Approximately 80 percent of the population will experience some type of back pain at least once throughout their life. The spine is a complex structure made up of bones, joints, ligaments and muscles, among other soft tissues. Because of this, injuries and/or aggravated conditions, such as herniated discs, can eventually lead to symptoms of back pain. Sports injuries or automobile accident injuries are often the most frequent cause of back pain, however, sometimes the simplest of movements can have painful results. Fortunately, alternative treatment options, such as chiropractic care, can help ease back pain through the use of spinal adjustments and manual manipulations, ultimately improving pain relief.




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EXTRA IMPORTANT TOPIC: Low Back Pain Management


MORE TOPICS: EXTRA EXTRA:�Chronic Pain & Treatments


1.�American Psychiatric Association.�DSM �IV-TR.�Sourcebook�2000.
2.�Magni G, Marchetti M, Moreschi C, Merskey H, Luchini SR.�Chronic musculoskeletal pain and depression symptoms in the national health and nutrition examination I. Epidemiologic follow-up study.�Pain�1993;�53(2): 163�8.�[PubMed]
3.�Wilson KG, Eriksson MY, Joyce L, Mikail SF, Emery PC.�Major depression and insomnia in chronic pain.�Clin J Pain�2002;�18: 77�83.�[PubMed]
4.�Bair MJ, Robinson RL, Katon W, Kroenke K.�Depression and pain comorbidity: a literature review.�Arch Intern Med�2003;�163(20): 2433�45.�[PubMed]
5.�Taylor R, Lovibond PF, Nicholas MK, Cayley C, Wilson PH.�The utility of somatic items in the assessment of depression in patients with chronic pain: a comparison of the zung self-rating depression scale and the depression anxiety stress scales in chronic pain and clinical and community samples.�Clin J Pain�2005;�21(1): 91�100.�[PubMed]
6.�Pincus T, Williams AC, Vogel S, Field A.�The development and testing of the depression, anxiety, and positive outlook scale (DAPOS).�Pain�2004; May�109�(1�2): 181�8.�[PubMed]
7.�von Korff M, Le Resche L, Dworkin SF.�First onset of common pain symptoms: a prospective study of depression as a risk factor.�Pain�1993;�55(2): 251�8.�[PubMed]
8.�Fishbain DA, Cutler R, Rosomoff HL, Rosomoff RS.�Chronic pain-associated depression: antecedent or consequence of chronic pain? A review.�Clin J Pain�1997;�13(2): 116�37.�[PubMed]
9.�Dersh J, Polatin PB, Gatchel RJ.�Chronic pain and psychopathology: research findings and theoretical considerations.�Psychosom Med�2002;�64(5): 773�86.�[PubMed]
10.�Worz R.�Pain in depression, depression in pain.�Pain Clinical Updates�2003; IASP�Vol XI,�No. 5.
11.�Kerns RD, Haythornthwaite JA.�Depression among chronic pain patients: cognitive-behavioural analysis and effect on rehabilitation outcome.�J Consult Clin Psychol�1988;�56(6): 870�6.�[PubMed]
12.�McWilliams LA, Cox BJ, Enns MW.�Mood and anxiety disorders associated with chronic pain: an examination in a nationally representative sample.�Pain�2003;�106(1�2): 127�33.�[PubMed]
13.�McCracken LM, Zayfert C, Gross RT.�The pain anxiety symptoms scale: development and validation of a scale to measure fear of pain.�Pain�1992;�50(1): 67�73.�[PubMed]
14.�McNeil D, Rainwater A.�Development of the fear of pain questionnaire – III.�J Behav Med�1998;�21(4): 389�410.�[PubMed]
15.�Frank E, Prien RF, Jarrett RB, Keller MB, Kupfer DJ, Lavori PL, et al.�Conceptualization and rationale for consensus definitions of terms in major depressive disorder. Remission, recovery, relapse and recurrence.�Arch Gen Psychiatry�1991;�48(9): 851�5.�[PubMed]
16.�Morley S, Eccleston C, Williams A.�Systematic review and meta-analysis of randomized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache.�Pain�1999;�80(1�2): 1�13.�[PubMed]
17.�Siddall PJ, Cousins MJ.�Persistent pain as a disease entity: implications for clinical management.�Anesth Analg�2004;�99(2): 510�20.�[PubMed]
18.�ANZCA Acute Pain Management:�Scientific Evidence: Australian & New Zealand College of Anaesthetists; (2nd Ed.) 2005.
19.�Suls J, Wan CK.�Effect of sensory and procedural information on coping with stressful medical procedures and pain. A meta-analysis.�J Consult Clin Psychol�1989;�57: 372�9.�[PubMed]
20.�Johnston M, Vogele C.�Benefits of psychological preparation for surgery: a meta-analysis.�Ann Behav Med�1993;�15(4): 245�56.
21.�Luebert K, Hahme B, Hasenbring M.�The effectiveness of relaxation training in reducing treatment-related symptoms and improving emotional adjustment in acute non-surgical cancer treatment. A meta-analytical review.�Psychooncology�2001;�10(6): 490�502.�[PubMed]
22.�Montgomery GH, DuHamel KN, Redd WH.�A meta analysis of hypnotically induced analgesia: how effective is hypnosis?Int J Clin Exp Hypn�2000;�48(2): 138�53.�[PubMed]
23.�Powers SW.�Empirically supported treatment in pediatric psychology: procedure-related pain.�J Pediatr Psychol�1999;�24: 131�45.�[PubMed]
24.�Schweickert WD, Kress JP.�Strategies to optimize analgesia and sedation.�Crit Care�2008;�12(Suppl. 3): S6.�[PMC free article][PubMed]
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26.�Perkins FM, Kehlet H.�Chronic pain as an outcome of surgery: a review of predictive factors.�Anesthesiology�2000;�93(4): 1123�33.�[PubMed]
Close Accordion

The Psychology of Chronic Pain

The Psychology of Chronic Pain

The perception of pain involves a lot more complex processes than mere feeling. As a matter of fact, the affective and evaluative elements of pain tend to be as significant as the creation and transmission of the pain signal itself. These emotional as well as psychological aspects are most prominent in chronic pain sufferers, but knowledge of the psychology of this type of persistent pain can help greatly enhance the treatment of chronic pain.


Perception of Pain


The limbic system, where emotions and/or feelings are processed, is in charge of regulating the amount of pain experienced for a given noxious stimulus. It has been proven in cancer patients [1] that their affective part of pain can be completely blocked by frontal lobectomy. Lobectomized patients still register intense pain, however, it doesn’t “bother” them. Pain can thus be seen as only a “signal” demonstrating that something has gone wrong somewhere in the body, until it reaches the mental performance element of the brain, where this signal becomes what we believe to be perceived as pain.


The emotional response to pain in the brain requires the function of the anterior cingulate gyrus and the perfect ventral prefrontal cortex. These centers are also activated by social rejection. Serotonin and norepinephrine circuits are also included in the modulation of sensory stimulation, which probably influence how depression and antidepressant drugs and/or medications affect the perception of pain.[2]


Even the perception of acute pain is highly determined by the context in which it occurs [3]. It’s been revealed that the pain involving battle wounds bears very little connection to the degree of the wounds [4]. There are reports of soldiers in conflict who endure a compound fracture, and report just twinges of pain [5]. In research studies of experimental pain in which context, fear, and anxiety are controlled, the placebo effect and opioids are much less effective. This occurs because the decrease of both the fear and anxiety is a large region of the placebo effect and also the purpose of opioids [6].




Focusing one’s attention on pain is often believed to make the symptoms worse [1]. Patients that have somatic preoccupation or hypochondriasis are overaware about physiological senses. It’s been found that by attending these sensations, they amplify them towards the purpose of feeling painful [7].


Conversely, distracting patients is highly effective in reducing their pain. Burn patients undergoing therapies or physical treatment experience excruciating pain, even after they have been given opioids. It has been proven that these patients report only a portion of the pain if they are distracted using a virtual-reality kind of videogame during the process [8].




Anxiety, stress, fear, and a feeling of loss of control leads to individual suffering. Treating anxiety and supplying emotional support was shown to improve pain and decrease analgesic use in patients. Improving patients’ sense of control and allowing them to participate in their care can also be useful [9]. Healthcare professionals should try to make an environment that’s nonthreatening. For procedures, prepare needles and other gear out of sight from the patient. Besides assuring that procedures are performed in the least painful way possible, use nonthreatening words such as “mild discomfort” rather than “pain”. It’s also helpful to divert patients with dialog about subjects that interest them, such as their hobbies or household [10].




Patients with low levels of pain remember it as being worse than they originally reported, which will worsen with time. Almost all patients report relief with treatment, even when true measured changes in pain scale are not significant, and occasionally when quantified pain is much worse, and it’s all often due to the memory of their pain [11].


Learned Pain


Pain can be a learned response, rather than a purely physical health issue. As cancer sufferers may develop nausea as a learned reaction to treatment and report feeling it even before chemotherapy is administered, patients can learn to get pain even in the absence of a physical stimulation [12]. Sometimes, pain can be completely “in the head,” as in the case of a butcher who slipped and caught his arm on a meat hook, and had been reported to be in tremendous distress. When he learned that the hook had simply captured on to his sleeve and his arm was uninjured, his pain solved [13].


Patients may learn how to feel different levels of pain by simply watching different men and women. When research study subjects were shown models demonstrating high pain tolerance, they took 3.48 times higher stimulus before they ranked it as painful, in comparison with those that observed models who showed poor tolerance. Nonaversive shock, usually called “tingling,” was rated as painful by just 3 percent of those who had viewed a tolerant model, in comparison with 77 percent of those subjects who viewed models who revealed lower levels of tolerance [14].




Patients’ expectations of how much pain they ought to have also affected how much pain they feel, their response to treatment [15], and whether or not the illness becomes chronic and disabling. The outcomes of minor whiplash injuries are demonstrated to be very variable in various regions. It was attributed to the local cultures and expectations. Any messages that speak with individuals on whether they have a serious or debilitating injury can lead to deconditioning and maladaptive postures that worsens their pain. Prescribing drugs and/or medications can contribute to the issue. Patients who are not given sick leave and are advised to “act as normal” have much better outcomes [7].


The placebo effect can be influenced by patients’ and doctors’ expectations [15]. It can be assumed that the “nocebo” effect, or the understanding of harm caused by an individual’s beliefs, may also bring about messages that inadvertently increase the patient’s stress, anxiety and expectations of pain.


Beliefs and Coping


Other psychosocial problems, such as what patients believe about their pain [16,17], their abilities to manage [18-21], their tendency to “catastrophize” [17,18,20], self-efficacy [17], locus or restrain [22], and their involvement in the “sick role” [13], have an effect on just how much pain patients feel, and the way it ultimately affects them.


In successfully getting low back pain sufferers back to work, the most crucial factor identified is a decrease in subjective feelings of disability [23]. Patients diagnosed with fibromyalgia have to quit catastrophizing to enhance their well-being, and they need to be convinced that they have the capacity to be functional [24]. Consequently, healthcare professionals should focus on improved function and long-term management. Patients should be led to know that they themselves have an essential role in distracting themselves, and they can decrease the disturbance that pain has in their own quality of life.


Chronic Pain


Chronic pain patients frequently have issues with the psychological and emotional facets of pain [25]. Preexisting psychological variables have been demonstrated to be very significant in the evolution of chronic pain after surgical interventions [26,27] and in complex regional pain syndrome, or CRPS [28,29], tension-type headaches [30], and fibromyalgia [24]. The National Institutes of Health Technology Assessment Conference Statement [31] identified six factors that related to treatment failures of low back pain, and they were all psychosocial. Even chronic, episodic, low back pain may have a vital component of socioeconomic and psychological influences [32].


There is a vicious cycle in which pain causes stress and handicap, which in turn worsens the perception of pain [21]. An unhealthy lifestyle, lack of social support, depression, and substance abuse are predisposing factors to chronic pain [33]. Chronic pain has been known to become “complicated” if there are interactions of psychological, legal, drugs and/or medication, and family issues [34].




Immobility may be a factor in adult “reflex sympathetic dystrophy,” that some healthcare professionals feel is overdiagnosed [35]. A research study of reflex neurovascular dystrophy in children revealed that prominent swelling, skin changes, and decreased skin temperature had been due to maintaining the extremity within an immobile, determined position. The prolonged immobility also caused chronic fibrosis of adrenal tissues and contractures of ligaments and tendons. This was effectively relieved with physical treatments, which included active sensory stimulation and usage of the affected extremity [36].


Inactivity is a serious impediment to progress in chronic pain, and also may produce concurrent myofascial pain [37]. Many fibromyalgia patients are found to have a vicious cycle of maladaptive pain behavior, resulting in further deconditioning, social dysfunction, and subsequent worsening pain [24].


Obesity can also be an issue in chronic pain. An overview of patients at a rehab clinic found that among those who could not be returned to gainful employment or function of purpose, 78 percent were morbidly obese [38]. Many lower back pain sufferers have been found to be in the lowest quartile for aerobic capacity [39].


Pain behavior, like guarding, bracing, rubbing, grimacing, and sighing, was shown to be strongly affected by emotional factors [40]. Some chronic pain sufferers demonstrate pain behavior only around staff [41], or decrease this behaviour when they think nobody is watching [42]. Reinforcing this behavior can cause some patients to perceive that they have more pain. Eliminating the behavior leads to improved pain [40]. It’s been noted that when neuropathic pain sufferers are allowed to develop behavioral and guarding disorder, then drugs and/or medications aren’t successful, and the patients need multidisciplinary pain therapy [37].


Pain may be a conditioned response similar to learned nausea related to chemotherapy. The behavior begins purely in response to the existence of harm. It is then reinforced and becomes a conditioned response, an iatrogenic complication of therapy [12], particularly when wages are made contingent on the term of pain behavior [21]. The effect of reinforcement is exemplified by the case of a 10-year-old girl who had chronic daily abdominal pain for which no medical condition could be discovered. During episodes, her mother allowed her to rest in bed together with her toys and view television, and brought her food and drinks. After an hour or so, she would go back to play. After the mother ceased strengthening the patient’s pain behavior, the episodes rapidly diminished, in addition to her use of belladonna and phenobarbital elixir [43].


Pain can result from conditioned fear reactions which persist even after the settlement of pain [42], phobic reactions to pain and also to nonpainful activities [44], and posttraumatic stress disorder, or PTSD [45]. Some individuals have experienced good improvement of the pain or work with desensitization therapy [46].


Psychiatric Disease


Overall, some psychiatric morbidity is present in around 67 percent of chronic pain patients [47]. Personality disorders have been observed in 31 percent to 59 percent of chronic pain sufferers [48]. Among lower back pain patients admitted to a multidisciplinary pain center, 70 percent were found to have a hysterical conversion disorder, and 8 percent had a sociopathic personality disorder [49].


Somatoform Pain Disorders


Somatoform disorders are conditions where the existence of physical symptoms indicates a general medical condition, but cannot be explained by such a condition. One of the somatoform disorders, “pain disorder associated with psychological factors” is specified in the Diagnostic and Statistical Manual of Mental disorders, fourth edition, or DSMIV, [50] as a clinical condition in which pain is the concentration and in which emotional factors have the major role in the onset, severity, maintenance, or exacerbation The epidemiology of the condition isn’t understood, but unexplained chronic pain which causes disability is common in general practice and is often seen in emergency rooms. Pain disorder associated with psychological variables was found in 88 percent of referrals into a pain clinic serving an indigent population [51]. Many somatoform patients had pain which spread to new regions from the site of injury, whereas this did not occur in the patients that had objective signs of injury. Compared with individuals who had severe injuries involving long-term pain, mildly injured somatoform pain patients are over five times as likely to utilize daily opioids [52]. Moreover, one program found a 30 percent prevalence of abuse of opioids among those patients that had somatoform pain disorder, many times greater than that of the other patients [53].


Hypochondriasis, another sort of somatoform disorder that involves anxiety about having a disease if there is none, has also been diagnosed with chronic pain patients [54]. It’s been found to be worsened by the chronic medical use of morphine [55], and by its own abuse [56].


Mood Disorders


In a report on chronic pain patients on opioids, 61 percent have been found to have major depression [57]. It looks like the pain causes depression at least as frequently as depression causes pain [58,59]. However, depression is proven to make the individual’s pain feel worse [48]. In postsurgical pain after cholecystectomy, patients who had subclinical depressive symptoms reported greater pain [60]. Treating depression can improve, and sometimes eliminate, chronic pain [6]. Whether depression is regarded as a cause or an effect of chronic pain, then it needs to be considered at a comorbid condition which needs concurrent therapy [61].


An anxiety disorder was found in 10.6 percent of chronic work-related musculoskeletal pain patients [62]. The lifetime risk of a major anxiety disorder in men who have chronic low back pain is 30.9 percent, compared with 14.3 percent in men who do not have low back pain [59]. It’s likely that some “chronic pain” sufferers are actually using antipsychotic drugs to self-treat anxiety or depression, rather than relying on more effective anxiolytic or antidepressant agents [57]. These patients aren’t merely using the incorrect medication for their condition, but what small subjective advantage they originally feel is rapidly lost with endurance, and substituted with dependence.




Due to the influence of psychological variables on chronic pain, at least brief screening needs to be performed on first evaluation. It’s very beneficial to test for Waddell signs or nonphysiological findings, which may be accomplished quickly during the physical evaluation and test [63]. A particularly good evaluation is that the application of pressure at the top of the head once the patient is standing, to place strain on the backbone or spine. The low back pain patient who has a somatoform pain disorder will frequently complain of increased pain. If the pain were only of spinal root origin, this maneuver wouldn’t increase it.


Whenever psychiatric comorbidity is present or suspected, more comprehensive screening should include tests like the Multidimensional Pain Inventory, or MPI, and the Minnesota Multiphasic Personality Inventory 2, or MMPI-2 [21]. This comprehensive testing is generally impractical in the emergency setting, and ideally should be done by a psychiatric consultant acquainted with chronic pain [48]. Although acute care physicians are not very likely to test themselves, they should insure that it has been finished, or it will be carried out as soon as possible. Failing to address emotional health issues in chronic pain patients might lead to prolonged disability in a substantial number of individuals [25].



Dr. Alex Jimenez’s Insight

Whether it’s headaches, back pain, arthritis or fibromyalgia, chronic pain is a common and persistent health issue which often lasts for an extended period of time, greatly affecting an individual’s quality of life. Approximately 30 million people in the United States alone suffer from some for of chronic pain, which is influenced by a variety of factors, including a person’s emotions and memory. Many chronic pain patients report a dull ache or even a throbbing pain and it can last months or years for some people. Other common symptoms associated with chronic pain include mood swings, sleep problems and fatigue. As mentioned in the following article, chronic pain can also lead to stress, anxiety, depression and low self-esteem, among other health issues.


The Psychology of Opioid Dependence


The topic of opioid dependence in patients complaining of chronic pain is controversial. It should be mentioned that persistent opioid usage, especially in large doses, can make a condition of enhanced pain sensitivity [64]. Patients dependent on daily doses feel worse as soon as the drug and/or medication wears off, and closer to baseline amounts of pain temporarily when they take that, even though the general pain condition fails to improve [65]. These patients may observe opioids as necessary for survival. It may become hard to control using opioids, and they see the emergency room when they run out. They complain of increased pain from ailments that wouldn’t typically call for opioids. The individual who escalates demands for opioids when these are not coming is typically opioid-dependent, and may have issues of problematic use.


The psychology of this doctor also influences the use of opioids for chronic pain, and the interpretation of the efficacy. Some patients are insistent that specific medicines must be prescribed. They’ll exaggerate the advantages and deny adverse effects. Some physicians have difficulty setting limits. It is quicker and easier to give into the patient’s requirements than to institute another course. The doctor may understand that the prescription is in excess of regular practice, but rationalizes that for this specific patient, nothing else works. The emergency physician can anticipate these problems, and strategy, with consultation if desired, the way to deal with them.


CBD for Chronic Pain Relief


Cannabidiol (CBD) oil is used by some individuals with chronic pain. CBD oil may decrease pain, inflammation, and overall discomfort related to many different health conditions. CBD oil is a product. It’s a kind of cannabinoid, a compound found naturally in marijuana and hemp plants. It doesn’t cause the “high” feeling often related to cannabis, which is brought on by another type of cannabinoid called THC. Studies on CBD oil and chronic pain management have shown a fantastic deal of promise. CBD can supply an alternative for those who have chronic pain and also rely on more dangerous, habit-forming drugs and/or medications like opioids. However there should be more research in order to verify the pain-relieving benefits of CBD oil.


CBD products are not approved by the U.S. Food and Drug Administration (FDA) for any medical condition. They are not controlled like other drugs and/or medications for dose and purity. Researchers believe that the CBD interacts with pain receptors on the brain and immune system. Receptors are miniature proteins attached to your cells which receive chemical signals from different stimulation and assist your cells to react accordingly to a specific stimulus. This produces anti-inflammatory and painkilling effects which help with pain control. This means that CBD oil may benefit people with chronic pain, including chronic low back pain.


One 2008 research study evaluated how good CBD works to relieve chronic pain. The review looked at studies conducted between the late 1980s and 2007. Based on these reviews, researchers concluded that CBD was successful in total pain management without adverse side effects. They also noted that CBD was valuable in treating insomnia linked to chronic pain. The authors of this study also noted that CBD was helpful in people with multiple sclerosis, or MS.


Overall, researchers agree that while there is no conclusive data to support CBD oil as the preferred method of pain control, these kinds of goods have a lot of potential. CBD products may be able to offer relief for many individuals that have chronic pain, all without causing intoxication and dependence. Oil versions of CBD might not be as powerful as other forms, and more human studies are required. CBD oil is available in some clinics in areas where its use is lawful.




Emotional and evaluative problems are fundamental in the evaluation and treatment of pain. Treating the physical pain can leave these issues unresolved, and potentially exacerbate them during reinforcement. Understanding the effect of anxiety, fear, expectations, and attention can help doctors deal more efficiently with acute pain. Psychological issues are especially notable in chronic pain. Though acute care doctors may not be treating those emotional conditions, they could help by referring patients into the proper psychological or multidisciplinary setting. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at�915-850-0900�.


Curated by Dr. Alex Jimenez




Additional Topics: Back Pain


Back pain is one of the most prevalent causes for disability and missed days at work worldwide. As a matter of fact, back pain has been attributed as the second most common reason for doctor office visits, outnumbered only by upper-respiratory infections. Approximately 80 percent of the population will experience some type of back pain at least once throughout their life. The spine is a complex structure made up of bones, joints, ligaments and muscles, among other soft tissues. Because of this, injuries and/or aggravated conditions, such as herniated discs, can eventually lead to symptoms of back pain. Sports injuries or automobile accident injuries are often the most frequent cause of back pain, however, sometimes the simplest of movements can have painful results. Fortunately, alternative treatment options, such as chiropractic care, can help ease back pain through the use of spinal adjustments and manual manipulations, ultimately improving pain relief.




blog picture of cartoon paperboy big news


EXTRA IMPORTANT TOPIC: Low Back Pain Management


MORE TOPICS: EXTRA EXTRA:�Chronic Pain & Treatments


Pain Anxiety Depression In El Paso, TX.

Pain Anxiety Depression In El Paso, TX.

Pain Anxiety Depression�Everyone has experienced pain, however, there are those with depression, anxiety, or both. Combine this with pain and it can become pretty intense and difficult to treat. People that are suffering from depression, anxiety or both tend to experience severe and long term pain more so than other people.

The way anxiety, depression, and pain overlap each other is seen in chronic and in some disabling pain syndromes, i.e. low back pain, headaches, nerve pain and fibromyalgia. Psychiatric disorders contribute to the pain intensity and also increase the risk of disability.

Depression:�A (major depressive disorder or clinical depression) is a common but serious mood disorder. It causes severe symptoms that affect how an individual feels, thinks, and how the handle daily activities, i.e. sleeping, eating and working. To be diagnosed with depression, the symptoms must be present for at least two weeks.

  • Persistent sad, anxious, or �empty� mood.
  • Feelings of hopelessness, pessimistic.
  • Irritability.
  • Feelings of guilt, worthlessness, or helplessness.
  • Loss of interest or pleasure in activities.
  • Decreased energy or fatigue.
  • Moving or talking slowly.
  • Feeling restless & having trouble sitting still.
  • Difficulty concentrating, remembering, or making decisions.
  • Difficulty sleeping, early-morning awakening & oversleeping.
  • Appetite & weight changes.
  • Thoughts of death or suicide & or suicide attempts.
  • Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease with treatment.

Not everyone who is depressed experiences every symptom. Some experience only a few symptoms while others may experience several. Several persistent symptoms in addition to low mood are�required�for a diagnosis of major depression. The severity and frequency of symptoms along with the duration will vary depending on the individual and their particular illness. Symptoms can also vary depending on the stage of the illness.



  • What is the relationship?
  • What is the neurophysiology behind it?
  • What are the central consequences?

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pain anxiety depression el paso tx.

pain anxiety depression el paso tx.

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Brain Changes In Pain

pain anxiety depression el paso tx.

pain anxiety depression el paso tx.

pain anxiety depression el paso tx.

pain anxiety depression el paso tx.

pain anxiety depression el paso tx.

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pain anxiety depression el paso tx.

pain anxiety depression el paso tx.

pain anxiety depression el paso tx.

Figure 1 Brain pathways, regions and networks involved in acute and chronic pain

pain anxiety depression el paso tx.

Davis, K. D. et al. (2017) Brain imaging tests for chronic pain: medical, legal and ethical issues and recommendations Nat. Rev. Neurol. doi:10.1038/nrneurol.2017.122

pain anxiety depression el paso tx.

pain anxiety depression el paso tx.



  • Pain, especially chronic is associated with depression and anxiety
  • The physiological mechanisms leading to anxiety and depression can be multifactorial in nature
  • Pain causes changes in brain structure and function
  • This change in structure and function can alter the ability for the brain to modulate pain as well as control mood.

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The Link Between Anxiety and Fibromyalgia

The Link Between Anxiety and Fibromyalgia

A number of studies have shown a link between anxiety and fibromyalgia, however, the nature of the link is not yet understood. Some experts, according to a report, “Fibromyalgia,” in The New York Times, “believe that fibromyalgia is not a disease, but is rather a chronic pain condition brought on by several abnormal body responses to stress.” Others believe that physical injuries, emotional trauma or viral infections, such as Epstein-Barr trigger the disorder.

Fibromyalgia causes widespread and chronic pain the joints and symptoms are similar to arthritis, however, unlike arthritis, there is no inflammation in the joints. Karen Lee Richards, a patient expert at, states the additional symptoms of fibromyalgia include:

  • Fatigue
  • Sleep Problems
  • Cognitive Dysfunction
  • Sensitivity to Cold and/or Heat
  • Depression
  • Anxiety
  • Digestive Problems
  • Headaches
  • Hypersensitivity

The Anxiety Disorders Association of America indicates that approximately 20 percent of those with fibromyalgia also have an anxiety disorder or depression. Studies put this number anywhere between 14 percent and 42 percent. While dealing with a chronic disease is certainly stressful, there may be physical causes of the increased levels of anxiety.

Cortisol is a hormone produced by our bodies when we are under stress. However, when under chronic stress, our cortisol levels can become skewed. Patients with fibromyalgia may have lower levels of this stress hormone resulting in muscle aches, fatigue, high blood pressure and anxiety. Reducing stress can often normalize cortisol levels.

Serotonin, a chemical “messenger” found in the brain is linked to feelings of well-being, adjusting pain levels and promoting sleep. Some patients with fibromyalgia have lower than normal serotonin levels.

Sleep problems are also common in those with fibromyalgia. Lack of sleep can increase feelings of anxiety and depression.

The Role of Anxiety in Your Life and Illness

Because dealing with any chronic illness causes stress, you may believe that anxiety is simply something you must deal with, however, in fibromyalgia there is evidence that stress and anxiety actually increase symptoms and make it more difficult to cope with those symptoms.

If you are suffering from depression or anxiety, you may feel hopeless and helpless. You may be less apt to seek or follow treatment, believing there is nothing you can do to make it better. You may not be willing to make lifestyle changes that can help improve symptoms.

When you have a chronic medical condition, it doesn’t just impact your health. Often you can’t work or miss time at work, you may have financial problems. Relationships frequently suffer when one partner is sick. While these can be true for all chronic conditions, when you add in depression or anxiety, common in patients with fibromyalgia, coping is even more difficult.

It is important to talk with your doctor about how you are feeling emotionally as well as physically. Your doctor may recommend treatments including medication, physical and occupational therapy to treat the symptoms of fibromyalgia. He may also suggest antidepressants to help treat your anxiety symptoms.

Lifestyle changes including getting the proper amount of sleep and exercising. According to the Anxiety Disorders Association of America, a Harvard Medical School study indicated that strength training, aerobic activity and flexibility training were effective at helping women with fibromyalgia feel better both physically and emotionally.

Sourced through from:

As a widely misunderstood chronic condition causing pain and fatigue among a number of people, fibromyalgia still remains a highly misunderstood condition. According to researchers, the painful condition not only causes the above mentioned symptoms, it can also cause symptoms of anxiety to develop.

For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900�.

Coping with Neuropathy Pain, Anxiety, & Depression

Coping with Neuropathy Pain, Anxiety, & Depression

Coping with Neuropathy Pain, Anxiety, &�Depression

Dr Scott Berman MD & Neuropathy Patient discusses the strong overlap between Neuropathy pain, anxiety and depression Pain & depression often occur together

There is a great correlation between neuropathy pain, anxiety, and depression. Each of the three can increase the risk of developing the other two. About 30-60% of people with chronic pain develop feelings of depression and anxiety as well as�

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TMJ and Anxiety

TMJ and Anxiety

Temporomandibular joint disorder, or TMJ, is a disorder that most commonly affects the joint found in between the back of the jaw and the skull. TMJ can be a difficult condition and, in some cases, the disorder could lead to the development of anxiety.

Anxiety is usually a condition that occurs gradually over time as a result of life experiences or genetics but temporomandibular joint disorder�

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