Pain. It’s one of the main reasons that people end up visiting the doctor. According to the CDC, an estimated 20–30% of U.S. adults (50–75 million) live with chronic pain.
While many different treatment options are available, chronic pain continues to seriously affect the life quality of patients, with almost half of pain-suffering individuals not achieving adequate pain management.
So what causes pain and what does stress have to do with it?
The Stress Pain Cycle
According to The American Institute of Stress:
33 percent of people report feeling extreme stress
77 percent of people experience stress that affects their physical health
73 percent of people have stress that impacts their mental health
48 percent of people have trouble sleeping because of stress
Unfortunately, for about half of all Americans, levels of stress are getting worse - not better.
Research has shown that pain and stress are two of the primary reasons that people seek medical care. We wanted to find out more about this. so we dug into the science behind these issues to see how, or if, the two are related.
Read on to see what we found.
Stress And Your Brain
Typically, when you go to the doctor to seek treatment for pain the doctor will ask you what hurts. They want to know where the pain is and see if they can discover the cause. Once they can determine the origin, they can treat that specific part of the body and your pain will hopefully be resolved.
But what happens when that doesn’t work?
What happens when you can’t pinpoint the specific part of your body that hurts?
What if you do a lot of expensive imaging and they still can’t find anything wrong with you?
Underlying Causes Of Pain
More and more, cases like this are occurring across the world and it has doctors starting to looking at chronic pain very differently. Instead of the old standard of care where imaging was conducted and medication was used to treat pain, doctors are now starting to explore other possible underlying causes of pain. This exploration has led them to a very unexpected organ. The brain.
Pain and stress are both important functions that affect the body’s ability to respond to its environment. They are useful and positive features that help to protect the body from things like injury or starvation. But when pain or stress become consistent, they are then considered to be “maladaptive” or bad for us and can actually compromise our health and well-being.
Chronic Stress and Cortisol
Imagine you are in the woods and you see a bear. Your body’s stress system goes into to hyper-drive. Acute stress activates the autonomic nervous system regulated by your brain, leading to increased blood pressure and the diversion of blood from the gastrointestinal tract (stomach) to your brain and your muscles. Your brain tells your legs to run and get away from the bear. This is useful. You have survived being chased by a bear.
But what happens when the source of your stress is your job, or someone in your family is ill? What happens when your body is trying to “run away” from that “bear” every day? That is when stress turns into chronic stress and it becomes maladaptive and there is no end to the stress cycle.
Fight Or Flight For Back Pain?
The brain plays a central role in stress and pain processes. As individuals interact with their environment, physical and psychological stressors can lead to adaptive or maladaptive neural and hormonal responses.
There is a sequence of events that occurs in your body in response to stress that includes physical responses from your body. These responses can include increases in pain threshold, changes in your locomotor activity (how you move) and even changes in your body temperature.
Basically your body will choose to “fight or flight” in everyday situations. This “fight or flight” response causes your adrenal glands to produce a hormone called cortisol. These days doctors can even measure how stressed your body is by testing and measuring the levels of cortisol in your saliva.
Delayed Response To Stress
When it comes to your body’s stress response, although things start to happen immediately, some effects in your brain may be delayed. After an initial stressor is detected, acute stress mediators start acting within seconds. They provide quick responses to an appropriate strategy and they can either release, or inhibit, acute responses.
Interestingly, though, even hours after being exposed to stress, some delayed effects can start to occur in your brain. Studies in rats have shown that we can actually delay our experience responses for up to 28 days after a stressful event. These delayed effects help our bodies return to normal after a stressful situation. They also help us retain and remember important information so that we can deal with similar situations if they happen again in the future.
So now that we know what happens to our bodies when we encounter stress, what does that have to do with pain?
Stress and Pain
1. Analgesia
Well, it turns out that the cascade of hormone events that happens when our bodies respond to a stressful event actually influences our pain response in two ways. In some situations, stress can cause us to not feel pain at all! In this situation stress acts like an analgesic, or numbing drug.
For example, a zebra that gets attacked by a lion will go into shock and appear to be dead. Once the lion believes that the zebra is dead and that it will not be going anywhere, it heads off to get the rest of the pack. The zebra is not feeling any pain. This analgesia enables her to wake up and run away when the lion is gone.
Have you ever injured yourself and not felt any pain until later, when you are safely in the hands of a medical professional, or a loved one, who is now taking care of you? This is an analgesic response to stress and it can be a handy tool to help our bodies survive stressful events.
2. Hyperalgesia
The second response that our bodies can have is a “hyperalgesic” response. Hyperalgesia means that instead of feeling less, or no pain, our bodies actually feel more pain when faced with stress.
Studies have shown that subjects who completed a difficult math problem actually felt pain more intensely than those who did not have to complete the problem.
Who knew math could literally be painful?!
Animal studies have shown that acute and chronic stress can actually make people more sensitive to pain, not less sensitive. Rats submitted to chronic stress displayed the hypersensitivity to pain for up to 28 days.
Another interesting finding was that chronic stress also decreased sensitivity to morphine, suggesting that opioid systems in our bodies are changed and that opioids may not work so well on chronically stressed people.
Inflammation, Stress And Low Back Pain
When it comes to pain and stress, another effect of chronic pain is that it leads to inflammation in our bodies. This inflammation is caused by “wear-and-tear” — also termed allostatic overload — in the body and brain from chronic overactivity, or chronic inactivity, of our regulatory systems.
When people are faced with unpredictable stress (or continuous stress) that can trigger pain, it can lead to our bodies responding with an inflammatory response - inflammation.
Inflammation is part of the body’s natural defense mechanism and typically plays a role in healing. If we are constantly telling our body it needs to heal (when it actually doesn’t) then our systems become chronically activated and this can increase our vulnerability to pain.
The Consequences Of Chronic Stress On The Body
Stress means different things to different people. What causes stress in one person may be of little concern to someone else. Some people are better able to handle stress than others. Some people have developed appropriate coping mechanisms over the years while others may not have learned those tools.
It is also important to remember that not all stress is bad. Our bodies are designed to handle small doses of stress, but they are not equipped to handle long-term, chronic stress without ill consequences.
Some Ways That Stress Can Affect Your Body
There are many ways that stress can affect the body. For example, stress has been shown to exacerbate pain in gastro-oesophageal reflux patients. Studies performed in fibromyalgia patients have indicated that stress causes an increase in musculoskeletal pain conditions, like lower back pain.
Stress can also affect the body in the following ways:
Low energy
Headaches
Upset stomach, including diarrhea, constipation, and nausea
Aches, pains, and tense muscles
Chest pain and rapid heartbeat
We Are In A Mental Health Crisis
Even as the world starts to return to pre-pandemic life, mental health is still a concern for people across the globe. Some facts about mental health in America include:
Anxiety disorders are the most common mental illness in the US.
Almost 20% of Americans suffer from an anxiety disorder.
More than 30% of adolescents between the ages of 13 and 18 have anxiety disorders.
Elevated levels of adverse mental health conditions, including stress, continue to be reported across the United States. New data has just been published by the CDC and it reports that "from 2019 to 2021, the percentage of adults who had received any mental health treatment increased from 19.2% to 21.6%".
Youth Risk Data recently published by the CDC reported that "nearly 60% of female students and nearly 70% of LGBQ+ students experienced persistent feelings of sadness or hopelessness".
The report also found that feelings of persistent sadness or hopelessness increased across every racial and ethnic group. The data is alarming and indicates that we are not moving in the right direction as far as mental health in America goes.
How Stress Affects Low Back Pain
Now that we know that stress can increase our sensitivity to pain, make us feel more pain, increase inflammation that makes our muscles more tense, it is easy to see how the more stressed we get, the worse our low back pain seems to get.
Our environment also plays a role in our stress and back pain levels. For instance, a study has shown that for every 1% in unemployment, we can expect to see around 770,000 new cases of low back pain.
Isolation, depression and loneliness can also increase our feelings of pain and make lower back pain worse.
Ways To Manage Stress And Back Pain
1. Exercise
Exercise is one of the most important things that you can do to combat stress. Going for a walk at the end of your day, or doing something physical, can signal to your body that the stressor is done for the day. This allows you to move into a more relaxed phase for the rest of the evening. Exercise also lowers stress hormones (cortisol) and increases endorphins that can actually act as natural pain killers.
2. Sleep
Sleep is one of the most underrated ways that we can help our bodies heal. Research has shown that our immune systems increase production of certain disease-fighting proteins during sleep. Sleeping with chronic pain can be challenging, but there are some tips and tricks to sleeping with low back pain, and chronic pain, that we discussed in one of our previous blogs, How To Sleep With Low Back Pain.
3. Meditation
While meditation may sound a bit strange to some people, some studies have shown that even paced slow breathing has been associated with reduced pain. Research shows that meditation uses neural pathways that make the brain less sensitive to pain and increases use of the brain’s own pain-reducing opioids. If you have chronic pain, meditation is worth looking at.
Conclusions
There are so many different ways that pain affects our bodies, this information is really just the tip of the iceberg. Understanding that pain and stress are connected is an important first step especially when it comes to managing musculoskeletal conditions like low back pain.
When it comes to treating low back pain it is important to remember and understand the underlying causes of pain - not just trying to treat the pain in isolation. Research has shown that incorporating stress-relieving therapies into your treatment plan as part of a biopsychosocial treatment model is so important.