Psychological distress can easily derive from unrelieved pain and plays a major role in the initiation and maintenance of the stress response. Pain can promote anxiety and fear. Anxiety stimulates the fight or flight response that focuses an individual's attention on avoiding further injury. Anxiety by itself can initiate the neuroendocrine stress response. Both anxiety and pain can lead to insomnia. Pain, anxiety, and sleep deprivation increase the perception of each other, resulting in a vicious cycle of mutual reinforcement.
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