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A “hypochondria” dimension with its associated anxious concerns and focus on painful sensations often leads to repeated requests for additional consultations or investigations. Anxiety can also be manifested primarily in the form of physical pain states: tightness, constriction, or atypical chest pain, the latter especially during panic attacks (Huffman and Pollack 2003). In fact, the majority of patients with panic attacks report pain symptoms of one type or another (Schmidt et al. 2002). Post-traumatic stress disorder (PTSD) is often considered as an anxiety disorder.

2010) introduces distraction as a confounding factor if pain is tested during the task and cognitive fatigue if pain is tested after the task. While it could be argued that counterirritation, stress, and distraction analgesia all share a common motivational basis in the sense that they all reflect a competition between pain and other sources of motivation, most experimental paradigms used in humans do not match the purely emotional forms of fear-induced analgesia observed in animals, such as that instigated by exposure to a predator.

Similarly, the results of a recent study showed that the stress-related release of endogenous opioids secondarily induces a longlasting and latent pain hypersensitivity mediated by NMDA receptors (Le Roy et al. 2011). Thus, sustained stress may predispose individuals to develop chronic pain when exposed to injury, which could partially explain the important comorbidity between stress, chronic pain, and anxio-depressive symptoms observed in humans. Emotions thus appear to have profound influences on spinal nociceptive processing.