ALGOPHOBIA: THE FEAR OF PAIN

al·​go·​pho·​bia | \ ˌal-gə-ˈfō-bē-ə  \

Algophobia is an intense, disruptive, and irrational fear of pain or extreme discomfort. Everyone fears pain to some degree – this is a good thing that is a very beneficial quality to have. But algophobics have irrational and hypersensitive fears that make them unable to perform normal tasks.

Examples are avoidance of movement or moving things (for fear of injury), workplace fears (such as being injured by equipment or tools), or social interactions (like sports or activity for fear of being injured). Their fears of pain or discomfort disrupt and inhibit algophobics lives and don’t allow them to live normally. Algophobia sometimes is a result of experiencing a traumatic event.

For an algophobia, when faced with a normal situation that might be painful or discomforting (a dental checkup for example) they experience anxiety symptoms such as increased heart rate, breathing issues, shaking, panic, and avoidance. Behavioral therapy has been shown to be highly effective in the treatment of algophobia.

What causes algophobia?

Sudden fear and anxiety protect us from dangerous situations. If we see a bear, it’s natural to feel scared and want to escape. But people with chronic pain may develop ongoing fear and anxiety as protective measures. They avoid activities or situations that they think could cause more pain or make their pain worse. Unfortunately, exaggerating the threat of pain can actually make the pain worse.

The same chemicals in your brain that regulate fear and anxiety also regulate how you perceive pain. So chemical imbalances can trigger both problems.

Who is at risk for algophobia?

Algophobia can affect anyone, but it’s most common in older people with chronic pain syndromes. Common types of chronic pain include:

  • Cancer-related pain.
  • Headaches.
  • Inflammatory pain (pain due to infections or autoimmune disorders).
  • Musculoskeletal pain, such as back pain or arthritis
  • Neurogenic pain (pain due to damaged nerves or nervous system disorders.
  • Nociceptive pain (pain caused by a tissue injury such as a sprain, burn or bruise).
  • Psychogenic pain (pain related to psychological factors).

What are the symptoms of algophobia?

People with algophobia may exhibit the following cycle of pain and anxiety:

  • Catastrophizing: Someone catastrophizes if they envision the worst possible outcome in any situation. If you have algophobia, you may perceive pain as a threat. For example, a simple activity like getting the mail might seem dangerous. If you fall and break your leg on the way to the mailbox, the pain might prevent you from working and earning a living.
  • Hypervigilance: You react to the threat of pain by becoming intensely focused on it. Your fear comes from anticipating pain, not experiencing pain. You may see the potential for pain in any scenario. You associate harmless activities or bodily sensations with pain.
  • Fear-avoidance: You avoid activities or movements that you believe could cause you pain. Some people develop kinesophobia (fear of pain due to movement), which prevents them from healing or rehabilitating. Avoidance can lead to further disability, increased pain or other health problems. It can also affect your ability to function at school, work or in social situations.

It’s also possible for people with algophobia to have sudden panic attacks at the thought of pain. Symptoms may include:

  • Chills.
  • Dizziness and lightheadedness.
  • Excessive sweating (hyperhidrosis).
  • Dyspepsia (upset stomach or indigestion).
  • Heart palpitations.
  • Nausea.
  • Shortness of breath (dyspnea).
  • Trembling or shaking.
  • Upset stomach or indigestion (dyspepsia).

DIAGNOSIS AND TESTS

How is algophobia diagnosed?

Algophobia is difficult to diagnose, especially in people with chronic pain syndromes. Your healthcare provider will try to distinguish your fear of pain from the actual pain you’re experiencing. It’s important to provide as much detail as you can about your pain. How much does it hurt? How long does the pain last? And, how often do you experience the pain? Your provider will also ask about your emotions surrounding pain.

Your healthcare provider may use a test called the Pain Anxiety Symptom Scale (PASS) to assess the severity of your algophobia. The test asks you to rate your responses to statements such as, “I can’t think straight when in pain” or “Pain makes me nauseous.” The rating scale goes from 0 (never) to 5 (always). Other questionnaires can evaluate your avoidance level or the presence of kinesophobia.

Your healthcare provider may diagnose you with algophobia if you:

  • Avoid activities or situations that you think could cause pain.
  • Develop excessive fear or anxiety at the thought of pain.
  • Experience a fear of pain for 6 months or longer.
  • Have a reduced quality of life due to your fear of pain.

MANAGEMENT AND TREATMENT

How is algophobia managed or treated?

Your healthcare provider may recommend the following treatments for pain-related fear:

  • Cognitive-behavioral therapy (CBT): CBT focuses on helping you change the way you think about pain. Healthcare providers may educate you about what causes pain and how your brain processes pain. This information can help minimize the threat of pain.
  • Exposure therapy: This type of therapy gradually exposes you to activities or movements that you previously avoided because you believed they would cause pain. For example, doing light leg lifts might help you conquer your fear of leg pain.
  • Physical exercise and activity: Gradually increasing your activity level and exercising may help reduce the fear of pain. Exercise can increase chemicals in your brain that improve your mood and help you manage pain more effectively.

PREVENTION

Is there a way to prevent algophobia?

There isn’t a way to prevent algophobia, but you can reduce your risk of pain anxiety and chronic pain by:

  • Avoiding things that can make anxiety worse, such as caffeine, drugs or alcohol.
  • Maintaining a healthy lifestyle by not smoking, getting plenty of sleep, exercising and eating healthy, balanced meals.
  • Sharing your fears and anxieties with a support system of family members, friends or peers.
  • Talking to your healthcare provider about your concerns.

OUTLOOK

What’s the prognosis (outlook) for people with algophobia?

Most people can manage their fear of pain with the right combination of treatments. It’s important to stay in close communication with your healthcare team, including a pain management specialist and a mental health professional.

LIVING WITH ALGOPHOBIA

When should I call the doctor?

Contact your healthcare provider if you experience:

  • Difficulty functioning in your daily life due to fear of pain.
  • Symptoms of a panic attack.

What questions should I ask my doctor?

You may want to ask your healthcare provider:

  • How long will I need treatment for pain-related fear?
  • What changes can I make in my life to help manage algophobia?
  • Will my fear ever go away?

Algophobia is a fear of pain. This fear is common in people who have chronic pain syndromes. Treatment focuses on treating your actual pain and managing how you respond to the thought of pain. Most people can manage this condition with the right combination of psychotherapy, exercise and medication.

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