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"Looking at the list of factors that make pain worse, you can see that most of them arise as a consequence to prolonged pain. A vicious cycle may develop whereby isolation and inactivity contribute to anxiety, depression and muscle tension, which leads to increases in pain, which in turn causes more inactivity, depression, muscle tension and so on. Reactions to continuous pain can make it worse. Normally when you hurt yourself, pain causes you to stop what you are doing, leave the situation, and rest. This aids healing. With chronic pain, however, continual withdrawal from activities is boring and depressing, your fitness level decreases and you tire more easily (with one week of immobility a muscle may lose a third of its size and power). Undistracted, you focus on your pain and perceive it as more intense and your tolerance decreases. Medication you take may produce side effects, become habit forming, and not work as well (after a time they inhibit or even stop your own production of natural endorphins - morphine-like substances that help reduce your awareness of pain). Anxiety about your pain and situation may increase, muscles may become tense, and you may become depressed and less willing to become active, uncertain what to do, and, ultimately, feel helpless and defeated. "