Managing Stress and the Chronic Pain Relationship
Science has long believed that stress can be a causative factor for physical pain, but can stress be the sole driver of pain? If it can be, then the remedy for stress induced pain does still seem to be an enigma. It is estimated that 72 percent of adults report they have health impacts due to stress including headache, fatigue, feeling nervous, depressed or sad. Can life stressors such as poor relationships, financial hardships, difficult work environments, challenging social networks, harsh environmental conditions, or technological woes be the primary cause for someone to have chronic knee pain or even horrible back pain? That question is still up for debate. Interesting though, the mechanism for stress being a primary driver for pain might be less known scientifically, but science does know a few things.
The sympathetic nervous system and the immune system play a key role in our body’s response to stress. Chemicals released after a stressful stimulus or situation triggered by the fight of flight syndrome can last weeks or months not mere minutes or hours as we might think. Because those chemicals linger in our bodies, the effects of that stressor can linger. The fundamental anatomical stress control areas in the body are the Amygdala, the pituitary gland and Hypothalamus located in the brain and the adrenal gland located just above your kidneys. When someone encounters a stressor such as a life-threatening experience, a bad memory, or even just a tense circumstance the brain releasesa hormone into the blood called adrenocorticotropic hormone within just a few minutes which in turn triggers the adrenal gland to release another hormone called cortisol.
Cortisol is often labeled the stress chemical. It is the hormone that protects you when you are challenged mentally or physically. It slows down the body’s systems that are responsible for reproduction, digestion and healing, while stimulating the body’s systems that are needed for fighting or fleeing such as the musculoskeletal system and the brain (needed for quick thinking). The functional of cortisol is crucial in fight or flight situations, but consistent elevated levels can generate a few problems. Elevated cortisol levels have been shown to contribute to slow healing, loss of memory, depression, despair and decreased physical performance. Furthermore, cortisol levels actually change throughout the day – peaking in early morning and decreasing throughout the day with a small peak during lunch time. Perhaps a reason while some people with elevated tissue inflammation have more pain in the evenings.
Another important scientific factor in the stress and pain relationship is understanding the immune system’s role. Cortisol will also have an effect on the bone marrow and T-cells (immune system) by effecting the levels of cytokines in the blood stream. Cytokines are a type of immune system molecule floating in the bloodstream. Some cytokines promote inflammation and some try to stop it. For example, your body’s reaction to an illness like the flu. When you have the flu your body aches, you have a fever, you’re lethargic, and you have a loss of appetite. Additionally, old pains may come back to re-visit you. This is due to the pro-inflammatory cytokines stimulating that response.
Just as the immune system, when strained by a serious physiological illness, can contribute to everyday stress and pain through these pro-inflammatory cytokines. Significant mental stressors can lead to elevated levels of these pro-inflammatory cytokines as well. Thus, the immune system can be triggered not only by physiological reactions to viruses, bacteria or injury but also by the brains interpretation of those events.
The converse is true as well. A few things that might inhibit pro-inflammatory cytokines are things like quality of life, having control of your treatment options, good family and medical support, a strong belief system, having a good sense of humor, and exercising appropriately.
Additionally, our parasympathetic nervous system can trigger “feel good” hormones called endorphins. Endorphins can dampen the stress response and achieve a resting calmness. Balancing the stress response and the parasympathetic response is required to establish a healthy balance of “stress” hormones circulating in our blood stream. When this imbalance occurs and we have long periods of extended stress and thus and overreactive cortisol secretion into our bloodstream our bodies are in an elevated sense of sensitivity. Such reactions include:
- Increased Anxiety,
- Increased Pain Perception,
- Decreased Memory,
- Decreased mental focus/cognitive learning,
- Impaired Immune System,
- Impaired function of Cardiovascular System,
- Impaired Gastrointestinal Function,
- Increased Inflammation, and
- Decreased ability to sleep.
In conclusion, whether stress is the primary cause of someone’s pain or just a contributing factor, the is no question stress can contribute to a poor well-being which in turn can affect people adversely. Increased pain perception and increased inflammation are key reactions to consider when physical pain is involved. Dealing with chronic pain must be treated with a multi-faceted approach. Stress in the chronic pain patient is something that cannot be ignored. To effectively help someone with chronic pain inclusion of a stress management plan is essential. Three of many non-medication type treatments include 1) deep breathing exercises, 2) self-acupressure release, and 3) meditation and prayer. First, an example of a deep breathing exercise is the Abdominal Breath. This exercise is best done in sitting in a relaxed position with your feet firmly on the ground and your hands crossed over your belly. With your eyes open, focus on a point on the ground approximately 5 feet ahead of you, exhale fully while consciously flattening your belly by pulling it up and in towards the spine. Then breathe in, relaxing the belly as it fully rises and swells. Finish the breath by focusing on fulling exhaling in order to allow for increased oxygen to fill the lungs. Repeat in sets of three. A second example of a stress reducing technique would be using Acupressure, which is based on the traditional Chinese medicine’s acupuncture. Apply light to moderate pressure for approximately one minute to the acupressure point at a 90-degree angle to the point location. You may use a rounded end of a pencil or pen to apply pressure and always finish with a few circular motions with light pressure. One such acupressure point used for stress relief is a point called Yintang which is located between the eyebrows. Thirdly, meditation and prayer can be an additional technique for reducing stress. This is best done in a quiet room with no distractions. So, turn off all technology and sound devices. Sit in a relaxed position with a controlled breathing rate with your eyes closed creating a stillness. Then, begin your meditation by silently reciting superlatives to God for His amazing glory in as many ways as you can think of. Follow that up with silent self-talk of thankfulness for all the many positive people and material things in your life, you can be thankful for where you live and that you have a home to sleep in and transportation to get you places. Try to be thankful for as many people, circumstances and things as you can. Then, ask for petitions, mostly for other people’s needs such as health concerns or job needs as well as other things, and conclude with any person petitions for yourself. There are other types of meditation exercises as well, feel free to find one that works for you.
Pain and stress seem to go hand and hand. If you feel like your stress is a causative factor in your pain syndrome, then you might want to reach out to a physical therapist trained in stress management and chronic pain.
References:
American Psychological Association (2023). Stress in America 2022: Concerned for the future, beset by inflation. August 27, 2023. https://www.apa.org/news/press/releases/stress/2022/concerned-future-inflation
Ann Marie Amber Asselin (2023) Managing Pain and Stress for Clinicians as Well as Their Patients. Coursera. https://www.physicaltherapy.com/pt-ceus/review/4749/1386395/962d59aab1303319f5
David S. Butler and G. Lorimer Moseley (2003). Explain Pain Noigroup Publications, Adelaide Australia