Introduction to pain and stress

Pain and stress are closely connected in many ways. Stress is the body’s physical response when it is put under a lot of pressure and called upon to make many changes. Symptoms of stress include; increased pain, fatigue, low mood, difficulty sleeping and changes appetite. Stress is unavoidable and experienced by everyone alike. However for people who are suffering from ongoing pain, stress often has a greater impact. Three sources of stress can be identified for people suffering from ongoing pain:

  1. The experience of pain itself is intrinsically stressful.
  2. The consequences of ongoing pain produces stressors in everyday life.
  3. Everyday stressors (which are not related with the pain itself, or consequences of pain on life).


Sources of stress

  1. The experience of pain itself is intrinsically stressful. Pain is an unpleasant sensation arising from injured or damaged body tissues. Most people do not want to experience such sensations, and automatically try to avoid or fight off pain. Reflexes (e.g. quickly pulling your hand away from a not stove) are one example of your body’s ability to try and avoid or lessen pain. However it is not always possible to avoid or fight off pain and as anyone who has had pain will tell you, pain causes stress. For example, in back pain, stress induced muscle tension or spasm can produce pressure on a nerve. This pressure can lead to more pain and further stress and tension that then may squash the nerve even more. The increased pain results in more stress and the vicious cycle involving pain and stress is begun. This vicious cycle is also affected by mental and emotional tension. This may involve feeling frustrated, irritable, angry, anxious or low. When these negative feelings are increased by pain, they in turn increase the level of stress in your body. So feeling bad can lead to more stress, which leads to more pain which makes you feel worse.
  2. The consequences of ongoing pain produces stressors in everyday life. Chronic pain can affect nearly all aspects of everyday life, including physical activity, work, social lifestyles and hobbies. Restrictions or the inability to perform certain tasks due to pain can lower your self-esteem and result in feelings of helplessness or hopelessness. If pain affects your ability to work, it can also produce financial stressors. In addition, continuous medical reviews and consultations with doctors and pain clinics can be stressful and lead to further frustration and disappointment.
  3. Stressful events which are not related with the pain itself, or consequences of pain on life. Stress is a normal part of life even for people who do not have to live with pain. In small amounts stress can help us learn and grow. However, excessive stress can cause us significant problems. In some cases, the combination of everyday stressors on top of pain-related stressors can overwhelm our coping mechanisms. This can produce chronic stress and pain.


The stress response and effect of stress on the brain

The human response to stress involve three components:

  • The brain handles the immediate short-term response. This response signals the adrenal medulla to release a hormone called norepinephrine.
  • The hypothalamus (a central area in the brain) and the pituitary gland are responsible for the slower, maintenance response. Here, the adrenal cortex is stimulated, to release cortisol and other hormones.
  • Many nerve circuits produce changes in behaviour. This involves increased arousal (alertness, sharpened awareness), redirected and focused attention and behaviour.

These components of the stress response help prepare the organism for a quick reaction through the sympathetic nervous system (SNS). When activated, the sympathetic nervous system increases the heart rate, blood pressure and redirects blood flow to vital organs such as the heart and brain, to augment the ‘fight or flight’ response, to danger. However if it is not possible to either run away or fight (as is usually the case with chronic stress and pain), this SNS activation leaves you feeling worn out and tired. However, regardless of the source of stress, the sensation of pain usually acts to intensify it. Excessive or prolonged activation of the stress response can result in muscle tension, aches and pains, headaches and high blood pressure. Ongoing stress can also cause people to become physically inactive and loose motivation to perform everyday tasks. This can lead to additional problems such as depression. All these consequences of stress result in worsening of painful states.


Stress management

There is no correct or best way to cope with stress. Each person is different, with varying reasons for being in stress and pain. Therefore it is important to look at each case individually and deal with the underlying issues for that person. Broadly, stress management should include:

  • In some situations you cannot remove or change the cause of the stress. Learning to accept that is essential for effective stress management.
  • It is also important to keep in mind that nobody is perfect. Dealing with stress is difficult and there is no correct way to cope. Saying things to yourself like “I should have coped better”, “I’m not coping with this” can often lead to additional stress. Having realistic expectations of yourself and others is essential for good stress management.


Learning techniques to reduce stress levels:

  • Identify and change maladaptive ways of coping with stress: (e.g. sometimes people will notice that they smoke more cigarettes when they are stressed. While this may make them feel better in the short term, it is not a helpful way of coping with stress in the long term).
  • Sharing problems with friends or family who are willing to listen: It can often be helpful just to tell someone what problems you are having to deal with. They may be able to suggest a solution, support you or maybe just let you know that you are not alone.
  • Organizing your time more effectively and establishing priorities: Stress often makes it difficult to get things done and to concentrate effectively. Managing your time and prioritising can reduce some of the “extra” stress and make it a little easier for you to focus on the important things.
  • Set short term goals: Having a goal can help to improve motivation, makes it easier to prioritise and can help to improve your self esteem (when you achieve it). Without goals it is very easy to drift along and not do very much of anything!
  • Get involved in regular physical exercise and other healthy physical activities: Physical activity doesn’t just help by improving your fitness; it also results in the release of chemicals in your brain (endorphins) that make you feel better and less stressed. Thirty minutes of moderate activity is all it takes to get started.


Strategies to overcome the harmful effects of stress:

  • Don’t be afraid to seek help with difficult problems: Sometimes problems are too big or too complex for you to work on by yourself. Getting help from you family, friends, GP, or other health or community worker can make it easier to deal with the problems and cope with the stress.
  • Try relaxation and meditation techniques: Relaxation and meditation can be helpful to calm yourself and feel more in control. They also have an effect on the levels of muscle tension in your body, so help to decrease your stress levels too.

 
(Kindly reviewed by Megan Varlow, BA (Psych), PG Dip (Psych), M Psych, CHP, MAPS, Director, ACTIVATE Pain Management Program, St George Hospital, Australia.)

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