The effects of pain on behaviour and behavioural problems Part 2: Fear and anxiety

Pain, fear and anxiety are intimately linked in the brain and body, anatomically, chemically and as a function of survival. It is not surprising therefore that many behavioural problems caused by pain manifest as fear and anxiety, including separation problems; sound sensitivities; pacing and panting; and avoidance of previously accepted places to walk and/or sleep. The clues that indicate a clinical cause of a behavioural problem are often not specific to pain and further investigation or clinical assessment is often needed to identify pain as a likely cause. This article illustrates these principles by two cases of anxiety caused by pain.