When the physical cause of pain is unknown or seems insufficient to account for the severity of pain that the patient reports, clinicians sometimes attribute the pain to the patient’s emotional state and cease treating it. However, evidence that anxiety increases pain is limited, and a cause and effect relationship is unclear (McCaffery, Herr, & Pasero, 2011). It is difficult to know if anxiety causes pain or if anxiety is the result of pain. The belief that anxiety causes pain is reflected in the common practice of combining anxiolytics and opioids, but a major problem with the administration of benzodiazepines in the perioperative period is that they increase the risk of sedation and respiratory depression and the dose of opioid that may be safely administered to the patient to relieve pain must be limited (APS, 2008).
There is no doubt that pain results in considerable distress for many patients. Until the relationship between pain and anxiety is clarified, the most practical initial approach to patients who are both in pain and anxious is to assume that pain causes this emotional response rather than to assume that the emotional response causes or intensifies pain (McCaffery, Herr, & Pasero, 2011). Anxiety appears to be a normal response to pain. When the patient is both in pain and anxious, initial interventions should be aimed at reducing the pain. Analgesic titration should precede treatment with benzodiazepines in anxious patients with pain. Pain relief may well reduce the anxiety and avoid the need for a benzodiazepine and the potential for increased sedation (McCaffery, Herr, & Pasero, 2011).