Stress and Pain
Stress Feeds Pain. Pain Feeds Stress.
Break the Cycle.
Stress has the same double-edged relationship to pain that it has with the rest of the body. Healthy bodies adapt well to short-term stressors. We see this in the way short periods of intense stress can blunt pain. Soldiers who fight on after sustaining severe wounds; sports stars competing and even winning after injuring themselves.
The story is different when stress is prolonged. The analgesic pain-relief disappears. Sustained stress makes pain worse. Pain is of course itself stressful, and these two facts explain an unfortunate but undeniable medical truth. The longer pain continues, the more anxiety it generates;1 and the increased anxiety itself then makes the pain worse.2
Life in our industrialized urban world is full of stress and the pain it creates:
- Sound stress increases inflammatory pain.3
- Children who live in stressful environments display higher levels of painful complaints.4
- Women who live with high levels of stress tend to have more painful menstrual cycles.5
- Stress levels track the amount of pain and disability suffered by men with non-bacterial prostate and pelvic pain.6
- Temporal-mandibular joint (TMJ) pain in individuals also correlates well with their stress levels.7
- Visual stress (but interestingly, not postural stress!) causes an increase in trigger point sensitivity in office workers. In other words, the cause of our aching shoulders may be more the screens we stare at than the way we slump at our keyboards.8
- In gastro-intestinal disorders such as irritable bowel syndrome (IBS) increases in stress levels correlate well with increases in pain.9,10 A single stressful event will change the brain's response to gastrointestinal pain.11
The association between increased levels of stress and pain have been studied most extensively with respect to back pain.
- Heightened stress and back pain levels have been documented in Taiwanese taxi drivers,12
- supermarket workers13
- and large cross-sections of the general population.14,15,16
From a scientific point of view, simply correlating stress and pain levels may not show that stress causes or worsens pain because the pain itself causes anxiety. But this problem is addressed by a number of other studies:
- One study successfully projected how long health care workers in Washington state would be disabled by their back pain based upon their stress levels. Researchers were able to predict the severity of a worker's disability two years after an injury by assessing their initial stress levels 82% of the time.17
- Another study of uninjured workers showed that initial stress levels were highly correlated with a particular worker's odds of suffering back pain over a year.18
- Still another study shows that the risk of failure in spinal disc surgery increases in patients with high stress levels.19 This same study also showed elevated levels of pro-inflammatory cytokines (IL6) in these patients and suggested that these elevated levels could be inhibiting the healing process in such a way as to produce the unfavorable outcomes.
Another area where the relationship between chronic stress and pain has been extensively researched is fibromyalgia (FM), a chronic pain condition affecting 2% of the US population in which light touch or exertion produces intense muscle pain. There are well-established relationships between post-traumatic and childhood stress and the later development of FM.20 Poor stress response regulation characterizes FM patients.21,22
- One study showed that the more dysfunctional a married FM patient's relationship was with their spouse, the worse their pain was.23
- Another found that the less optimistic an FM sufferer was, the worse their pain would be.24
Still one more area of research shows how stress worsens chronic pain - studies documenting anxiety-relieving modalities treating pain successfully:
- Energy healing modalities such as Reiki have been shown to have significant pain-relieving effects across a wide range of medical disorders.25,26
- Breath therapy relieves low back pain.27
- Relaxation and music therapy reduces pain following intestinal surgery.28
One of the worst aspects of chronic pain has to be the sense of loss of control and hopelessness that can result. The realization that there may be things one can do oneself to improve the situation is itself stress-relieving.
1. Narita, M., et al. 2005. Chronic pain induces anxiety with concomitant changes in opioidergic function in the amygdala. Neuropsychopharmacology. Aug. 10.
2. Sareen, J., Cox, B.J., Clara, I., Asmundson, G.J. 2005 The relationship between anxiety disorders and physical disorders in the U.S. National Comorbidity Survey. Depression and Anxiety. 21(4):193-202.
3. Khasar, S.G., Green, P.G., Levine, J.D. 2005. Repeated sound stress enhances inflammatory pain in the rat. Pain. 116(1-2):79-86.
4. White, K.S., Farrell, A.D. 2005. Anxiety and psychosocial stress as predictors of headache and abdominal pain in urban early adolescents. Journal of Pediatric Psychology. July 27.
5. Wang, L., et al. 2004. Stress and dysmenorrhoea: a population based prospective study. Occupational and Environmental Medicine. 61(12):1021-1026.
6. Ullrich, P.M., et al. 2005. Stress is associated with subsequent pain and disability among men with nonbacterial prostatitis/pelvic pain. Annals of Behavioral Medicine. 30(2):112-118.
7. Glaros, A.G., et al. 2005. The role of parafunctions, emotions and stress in predicting facial pain. 136(4):451-458.
8. Treaster, D. 2005. Myofascial trigger point development from visual and postural stressors during computer work. Journal of Electromyography and Kinesiology. Sep. 5.
9. Ehlert, J. 2005. High and low unstimulated salivary cortisol levels correspond to different symptoms of functional gastrointestinal disorders. Journal of Psychosomatic Research. 59(1):7-10.
10. Borman, R. 2001. Serotonergic modulation and irritable bowel syndrome. Expert Opinion on Emerging Drugs. 6(1):57-68.
11. DeLange, R.P., et al. 2005. Altered brain stem responsivity to duodenal pain after a single stressful experience. Neuroscience Letters. 381(1-2):144-148.
12. Chen, J.C., et al. 2005. Occupational factors associated with low back pain in urban taxi drivers. Occupational Medicine (London). Sep. 1.
13. Violante, F.S., et al. 2005. Relations between occupational, psychosocial and individual factors and three different categories of back disorder among supermarket workers. International Archives of Occupational and Environmental Health. Jul. 7:1-12.
14. Linton, S.J. 2005. Do psychological factors increase the risk for back pain in the general population in both a cross-sectional and prospective analysis? European Journal of Pain. 9(4):355-361.
15. Lee, C.Y., et al. 2005. Cross-sectional view of factors associated with back pain. International Archives of Occupational and Environmental Health. 78(4):319-324.
16. Schneider, S., et al. 2005. Workplace stress, lifestyle and social factors as correlates of back pain: a representative study of the German working population. International Archives of Occupational and Environmental Health. 78(4):253-269.
17. Dionne, C.E. 2005. Psychological distress confirmed as predictor of long-term back-related functional limitations in primary care settings. Journal of Clinical Epidemiology. 58(7):714-718.
18. Linton, S.J. 2005. Ibid.
19. Geiss, A. 2005. Predicting the failure of disc surgery by a hypofunctional HPA axis: evidence from a prospective study on patients undergoing disc surgery. Pain. 114(1-2):104-117.
20. Van Houdenhove, B., Egle, U., Luyten, P. 2005. The role of life stress in fibromyalgia. Current Rheumatology Reports. 7(5):365-370.
21. Mease, P. 2005. Fibromyalgia syndrome: review of clinical presentation, pathogenesis, outcome measures, and treatment. The Journal of Rheumatology. Supplement. 75:6-21.
22. Yunus, M.B. 2004. Fibromyalgia in men: comparison of psychological features with women. Journal of Rheumatology. 31(12):2464-2467.
23. Thieme, K., et al. 2005. Predictors of pain behaviors in fibromyalgia syndrome. Arthritis and Rheumatism. 53(3):343-350.
24. Zautra, A.J., et al. 2005. Fibromyalgia: evidence for deficits in positive affect regulation. Psychosomatic Medicine. 67(1):147-155.
25. DiNucci, E.M. 2005. Energy healing: a complementary treatment for orthopaedic and other conditions. Orthopaedic Nursing. 24(4):259-269.
26. Burden, B., Herron-Marx, S., Clifford, C. 2005. The increasing use of reiki as a complementary therapy in specialist palliative care. International Journal of Palliative Nursing. 11(5):248-253.
27. Mehling, W.E., et al. 2005. Randomized, controlled trial of breath therapy for patients with chronic low-back pain. Alternative Therapies in Health and Medicine. 11(4):44-52.
28. Good, M. 2005. Relaxation and music reduce pain following intestinal surgery. Research in Nursing and Health. 28(3):240-251.