The Link Between Anxiety and Chronic Pain

  
 

CASE STUDY: Anxiety and stress

SUBMITTED BY: Phil Rasmussen

PATIENT: Female, 38 years old

INITIAL PRESENTATION:

Patient presented wanting herbal medicine support for a recent period of increased stress, and not wanting to become dependent again on lorazepam (a benzodiazepine), that her GP had prescribed her in a small quantity. She had been on this drug as well as an antidepressant for several months in her early 30s after a nervous breakdown, she didn’t like the effect they had on her, and it had been a real challenge to stop taking the lorazepam.

She had, however, fallen off a horse while riding on the beach a month ago, and had fractured her pelvis near the left femur, and had been in quite a lot of pain. While she was told it didn’t require surgery and it was less sore than initially, it was sore when sitting for prolonged periods, and she was often affected by it at night when in bed. She’d taken ibuprofen and paracetamol daily initially but was worried about the effect that these had on her stomach and liver and had taken paracetamol only 3-4 times over the past week.

Her work environment was also stressful, and after having taken a couple of weeks off following the riding accident, she was under a lot of pressure to catch up on her workload. There was also some job insecurity, as her firm wasn’t doing well. She and her partner were both very stressed, as they had taken out their first mortgage a year ago, and finances were tight. She’d wake around 4.30am or 5am worrying about everything and feeling exhausted. She’d also been unable to go to the gym since the riding accident, something she found helped her to manage stress.

Her partner had persuaded her to see her GP a week ago who had given her a prescription for 7 tablets of lorazepam, and while she had taken half or a whole tablet for a couple of nights, she felt terrible the next day, and didn’t want to become reliant on them again.

During the consultation she described having had a difficult upbringing, with a mother who suffered from depression and anxiety and a father who was very strict and not easy at times. Her mother was a very anxious person, and took antidepressant medication and sleeping tablets, throughout much of her adult life.

She had quite a nervous disposition and spoke rapidly and at some length about the many things she was feeling worried about, and how she had been struggling to keep up with things even before the accident, which had been a real setback. Her diet was relatively healthy, and she was quite aware about the importance of healthy food. Her alcohol intake was minimal, and she rarely drunk coffee or caffeinated drinks.

HERBAL TREATMENT

Main Mix (300mL)

Withania (Withania somnifera) std 3:2 120mL
Peony (Paeonia lactiflora) 1:2 75mL
Kava (Piper methysticum) 1:2  90mL
GInger (Zingiber officinale) 1:2 20mL

Total 305mL

Dosage

10mL two times daily, with water or juice. Shake well before dispensing.

Kiwiherb StressArrest (100mL)

Kava, Passionflower, Withania.

This I recommended she take as a ‘top up’ mix if she felt she needed additional support to get her through the day, or for bad bouts of anxiety.

Dosage:

10-15mLs with water or juice as needed. Shake well before dispensing.

Comfrey Cream (50gm)

Comfrey 1:10 root tincture 10mL

Comfrey 1:10 leaf tincture 10mL

These were combined then evaporated down over a hot water bath to 10mL, then this stirred into 50gm of base cream.

Dosage: Apply to the painful hip and back, once or twice daily

ADDITIONAL TREATMENT RECOMMENDATIONS

I recommended she contact a student massage clinic, as we agreed that receiving some massage therapy could be helpful both with the pain management and stress. I also encouraged her to do the gentle pelvic floor and other exercises recommended by the physiotherapist and to try and have a short walk at lunchtimes when in work, as she had fallen behind with this recovery programme recently.

However, should the back and pelvic pain continue to be debilitating, I recommended she take two paracetamol tablets, as we wanted her to achieve a better-quality sleep, and she shouldn’t let excessive pain disrupt this in the next week or two.

I also offered to treat her partner if he would like herbal support for the stress he too was experiencing.

FOLLOW-UP

2-weeks later: At the follow up appointment held over zoom, she looked cheerful and reported feeling quite a lot better, with her sleep and the pelvic pain much less bothersome. Things had started to improve within a couple of days after starting the herbal mixture, though she had taken paracetamol daily at first, but only a few times in the past week. She had taken the main mixture regularly and had just run out and was applying the Comfrey cream every night before bed.

She hadn’t managed to get a massage but was walking short distances once or twice a day and was planning to return to the gym soon. She had seen the physiotherapist again and was also doing the exercises most days.

Work had continued to be very stressful, and her sleep was still unsettled at times, but she had only resorted to taking the StressArrest twice and hadn’t needed to take any lorazepam. She and her partner had just had a long weekend away visiting some friends, which had been nice and relaxing. She was also starting a garden and trying to get more nature time.

We discussed the value of Lemon balm tea, and I offered to give her a plant at the next consult.

I repeated the Main Mix only for a further 4 weeks.

6 weeks later:

We met in person at the clinic, and she seemed very happy with how the treatment had helped her. She was feeling less tired, and their financial situation had improved somewhat, which had been a big relief.

She’d been back to the gym for the past few weeks and was virtually pain free now.

She’d used the StressArrest a few times when needed and felt it had helped.

I also gave her a Lemon balm (Melissa officinalis) plant, to put into her garden, and use as a source of fresh tea as a relaxant, in the future.

I changed her Main Mix to remove the Paeony, reduce the level of Kava and Ginger, and introduce some Lemon balm into it. The dose was reduced to 8mL twice daily. I advised her the importance of continuing with the herbal mixture for the foreseeable future as a preventative and support tonic and reassured her about the safety of StressArrest and that she should take this whenever she felt she needed.

Kiwiherb Calm Down is also a beneficial and effective option for fast relief from feelings of stress related, and anxiety disorders. This is formulated with clinically researched Withania for a therapeutic effect.

Withania (Withania somnifera) std 3:2 140mL
Lemon balm (Melissa officinalis) 1:2 140mL
Kava (Piper methysticum) 1:2 100mL
Ginger (Zingiber officinale) 1:2 20mL

Total 400mL

Dosage:

8mL two times daily, with water or juice. Shake well before dispensing.