Stress and Chronic pain
Managing Chronic Pain: How Changing Our Stress Response can Help
Are you one of the millions who suffers from chronic pain?
Did you know that stress has an impact on how we feel pain? [link to The Effects of Stress on Chronic Pain]
How stress contributes to migraines [link to Stress and Migraine]
How stress contributes to back pain [link to Stress and Chronic Low Back Pain]
What you can do about it [Link to Solutions to Chronic Stress]
Chronic pain comes in many forms from daily headaches to migraines, to chronic low back pain and many other conditions. It can affect every aspect of day to day living and make it hard to fully participate in life.
It’s always important to have a thorough evaluation with your physician when you experience any kind of symptom including pain. While there are many therapeutic options to consider when it comes to improving pain, one aspect that is often neglected is addressing our stress response.
What if there was a way to modulate our stress response to dampen pain signaling rather than accelerating it? By understanding how stress affects our neurotransmitters and hormones, we can find ways to intervene and improve pain signaling.
Stress and Chronic Pain: What is the connection?
Chronic pain affects millions of people
Chronic stress is one modifiable factor that can change the way we experience pain
While we are all subject to stress in modern life, we can increase our resiliency to reduce pain and improve quality of life
Chronic Pain: Just How Common is it? And What Causes it?
For anyone suffering from chronic pain, you know it can significantly affect quality of life in so many ways. It is estimated that 50 million people in America alone suffer from chronic pain. While some factors affecting chronic pain may not be modifiable, such as structural changes in the body, it's important to recognize that there are some modifiable factors that have the potential to improve symptoms if addressed. We also know that structural changes alone don't always predict who will or will not have pain. For example, we know that if we did an MRI of the back on those with no back pain symptoms, up to 1/3 of them may have signs of a herniated disk or other abnormalities even though they don't have any pain. We also see the opposite where someone with back pain may not have any abnormalities at all on an MRI.
The Effects of Stress on Chronic Pain:
Psychological stress is one modifiable environmental factor that can contribute to chronic pain. The effects of psychological stress on pain can be explained by multiple potential mechanisms that alter pain signaling in the body. One of these mechanisms involves excessive muscle tension and the resulting damage this causes; many of us notice that we tense our muscles when we are under stress. Another mechanism involves changes in a part of the brain that is involved in pain processing, called the hippocampus, that alter our ability to make new signaling pathways in the brain.
With chronic stress, our neurotransmitters are also affected. You may have heard of neurotransmitters such as dopamine and serotonin that play a role in mood, energy and motivation, as well as pain. It turns out that chronic stress affects signaling involving dopamine and serotonin in a way that can lead to increased pain perception. Stress can also alter the effects of endorphins that our bodies make. Endorphins are peptides or proteins that the body makes that have an effect on how we perceive pain in our bodies. Some studies show that chronic stress can actually decrease our body's ability to use these endorphins properly, resulting in an increased perception of pain. Yet another part of the stress response involves increases in a hormone called cortisol; when cortisol goes up, this can result in more inflammation and pain.
Now that we’ve talked about some of the effects of chronic stress on our pain pathways in general, let’s look specifically at a few of the most common chronic pain conditions.
Stress and Migraine:
One common chronic pain condition that can be worsened by stress is migraine. In fact, migraine sufferers often list stress as a common trigger for attacks. There is evidence that stress can trigger migraines in those predisposed to this condition, and can also contribute to the condition becoming more chronic. While stress can be a trigger for migraine, the pain and suffering from this condition can contribute to stress. It can become cyclical, and any interruption to the cycle can be helpful.
Stress and Chronic Low Back Pain:
Chronic low back pain is another common chronic pain condition. There is evidence that stress can play a role in the development of low back pain and its persistence. One study looking at the relationship of stress and later onset of back pain found that psychological distress earlier in life doubled the risk of low back pain several years later. Another study concluded that psychological stress may play a role in the evolution of acute back pain into chronic back pain.
Solutions to Chronic Stress: Modulating the Impact of Stress on Chronic Pain:
Because of the association between stress and chronic pain, stress reduction techniques make sense as part of any approach for a chronic pain condition. These types of therapies can include breathing techniques, relaxation therapy, cognitive behavioral therapy and hypnotherapy, among others. Overall, the goal with any of these techniques is to intentionally activate the parasympathetic “rest and digest” state of our nervous system, which can modulate the impacts of stress.
Here’s a summary of some resources to consider to modulate the stress response:
Heart Rate Variability Biofeedback [link to our resources on HRV biofeedback/app when available]
Cognitive behavioral therapy (CBT): you can search for a practitioner that offers CBT through this directory
Yoga, tai chi
Conclusions: Stress and Chronic Pain:
What does all of this mean? Pain is complex and a multi-pronged approach taking into account all of the different factors that can affect someone's symptoms is important. It is especially important to identify any modifiable factors over which we have control. Recognizing the role of chronic stress and its effects on chronic pain gives us insight into a modifiable factor that can help improve quality of life.