Before we continue discussing causes of chronic pain (see our posts on osteoarthritis and spinal stenosis), let’s talk about how stress affects our health.
As human beings, we are a combination of both our emotional and physical well-being. All too often, patients want to focus only on the physical aspects. By ignoring our emotional contribution we seriously limit valuable treatment options. Stress significantly impacts every aspect of our lives in a multitude of ways as we discussed in the post on stress eating. Today, I’m going to focus on how it affects chronic pain.
There is no question the more I’m stressed, the more I hurt. It’s just a fact. At the end of an unusually long and busy work day, learning a pipe burst and flooded my house, crawling into bed to find the cable TV is not working, and I have to deal with someone overseas for hours to get it running again, I feel worse pain! When I can finally take time to stretch, exercise, then soak in a hot bath, and decompress, I feel better. The pain doesn’t go away, but it is reduced and more tolerable.
When I was in college I did a research paper on stress. I was fascinated to learn of a study done on submariners who were going to be locked in a steel container under water in an environment that wouldn’t change for months. Since they weren’t able to just dock the ship and let someone off, the military had to develop a way to predict, to the person, who would be sick, and how seriously. Prior to getting onto the vessel, everybody was given a questionnaire. Based on their answers, the military knew who to watch more carefully than others. If an individual had two or more life altering events in the last 12 months they were at higher risk for having physical issues. The body doesn’t care if these are positive or negative events. It just cares if they are life altering such as a death or major illness in the family, getting fired, going through a divorce, having been seriously ill or hurt. . . All the way to the other extreme of winning the lottery, getting married, moving to a new city, having a baby, or a promotion. Regardless, the body feels it all equally as stress, good or bad. Any major change affects us chemically and therefore physiologically and emotionally. These studies showed that the sailors reactions were an autonomic response. Their subsequent physical issues were not planned or expected.
When this phenomena is explained to patients, often, patients hear this as:
“It’s all in your head.”
Or
“You’re crazy.”
This couldn’t be further from the truth.
A great deal of research is being dedicated to learning the relationship between chronic stress and pain syndromes, yet stress is rarely addressed in pain management. A physiologic stress response may be evoked by fear or a perceived threat to safety, status, or well-being and causes the secretion of sympathetic catecholamines (epinephrine and norepinephrine) and neuroendocrine hormones (cortisol) to promote survival and motivate success. Cortisol is a potent anti-inflammatory that functions to mobilize glucose reserves for energy and regulates inflammation.
I like to relate this to the “fight or flight syndrome”. When the body is stressed, it immediately responds by preparing to stand and fight, or run away. In a stressed state, chemicals needed to responded appropriately pour into our bloodstream. This forces most of our circulation to organs immediately required to survive, like the brain, heart, lungs, and our extremities and muscles. Blood flow is reduced to non-essential (in the moment) organs such as the gastrointestinal tract and bladder. This flood of epinephrines and cortisol tightens our muscles and keeps them in a perpetual state of readiness. But if prolonged, muscle fatigue and pain ensues, just as they do with strenuous exercising. The gastrointestinal tract can’t function properly with diminished blood flow and indigestion, gas, bloating, diarrhea or constipation and pain can occur. We are not meant to tolerate a stressful situation for long. The reaction is meant for short bursts to allow us to flee or fight when necessary for survival. But for many of us, this is a perpetual state. It cannot be sustained over time without tremendous physical and emotional effects.
According to an article in Psychoneuroendocrinology, “A New View On Hypercortisolism,” this has been implicated in diseases such as rheumatoid arthritis, fibromyalgia, chronic fatigue syndrome, chronic pelvic pain, temporomandibular joint dysfunction, chronic low back pain, sciatica etc. Cortisol is a potent anti-inflammatory and its failure to function in long term stress states results in an unmodulated inflammatory response. Signs and symptoms of stress-induced cortisol dysfunction include bone and muscle breakdown, fatigue, depression, pain, memory impairments, electrolyte changes, and orthostatic hypotension. It’s even thought that widespread inflammation caused by stress may be the final straw in a multi-factorial chain of events contributing to hundreds of idiopathic inflammatory auto immune diseases.
There’s no question exercise is an excellent way to release all those pent up chemicals, especially sitting in our muscle groups waiting to be used. It allows us a safe and effective way to trigger the same responses used to fight or flee that then resets our balance. Walk, get on an elliptical, swim, bike, or stretch. Anything that forces the muscles to expend their stored up energy and finally return to a relaxed state. Exercise is also effective in distracting us from the daily catastrophes, forcing us to focus on maintaining our breathing and heart rate. Take a look at our previous post on stress eating for other simple and effective ways to reduce stress.
Stress may be unavoidable in life, and challenges are inherent to success; however, as human beings, we have the unique ability to choose what we perceive as stressful and how we respond. The brain is constantly trying to keep us functioning in spite of the pain, by minimizing pain signals and maintaining a balance. Our brains act as a gateway system, allowing some signals through and denying others, such as pain. But, if you’re stressed, the brain’s ability to filter these signals is impacted and pain increases.
One thing has become clear to me: stress relief, whether by avoiding the stress or learning how to cope with it, can lead to pain reduction. I know it works for me.
-Dr. Courtney
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