How does stress impact chronic pain?
For many people, chronic pain is not a standalone symptom. It can come with increased physical and/or mental stress, sleep disruption, mood dysregulation, and fatigue. All of these factors can impact on how intense we might feel our chronic pain on a daily basis.
Chronic pain is generally classified as pain lasting more than 3 months, and usually with some element of central sensitization.(1) Central sensitization is where there is a heightened responsiveness of nociceptors (nerve endings that initiate the sensation of pain) which can lead to hypersensitivity to stimuli and an increased pain response in areas outside of an injured area.(2) In other words, chronic pain can be due to the fact that the body has become stuck in a “hypersensitive” state for some reason, and is unable to find its way out of that state.
If you think about this in terms of the nervous system, if we tend to live our lives in a sympathetic dominant state (always in fight or flight, unable to wind down, stressed) then we can see how this may add to the hypersensitivity of these pain receptors. Conversely, if we can find our way into the parasympathetic nervous system (rest and digest, winding down), then we can see the potential for down regulating this response, leading to (potentially) lower levels of pain.
Both pain and stress are ways the body tries to alert us to a problematic situation in order to protect it – which is required in an acute or emergency situation, such as putting your hand on the stove or acquiring an injury. However, if either of these states are prolonged and become chronic it can lead to changes in behaviour and physiology, resulting in compromised health and wellbeing. Increased stress levels can also increase inflammation in the body via the immune system – and increased inflammation can increase chronic pain levels.
There is also some evidence to indicate that “stress” in some circumstances can have the reverse effect on pain – for example the short-term physical stress of playing sports may have an analgesic effect on pain, which is why exercise can help chronic pain in some sufferers.(3)
So, if you have identified that there is a significant amount of stress in your life, what can you do?
1. Practice Mindfulness and Meditation.
We already know and understand that impact of mindfulness and meditation on stress levels, however there are also a number of studies that indicate this could be beneficial for reducing chronic pain as well.(4) Mindfulness can be helpful to create a greater sense of awareness of what is going on in the body, paying attention to breath to reduce stress levels, and creating a sense of relaxation in the body which can reduce muscle tension and pain. (5) If you’ve never practiced mindfulness or meditation before, it can be tricky for some of us with especially racing minds – so don’t try and go all out at once! Start with just finding a quiet place to sit and pay attention to your thoughts and your body for just 5 minutes every few days. Then build up from there. You will be able to find some great free resources on YouTube or Spotify to get you started.
2. Move!
This can feel really counter intuitive for people in chronic pain, however movement really is medicine. As above, you don’t have to go all out – there are many different options for movement you can try. Go for a short walk, the fresh air will do you good! If you have a local pool, try walking in the water as this reduces the impact on joints and muscles and can ease symptoms of chronic pain (and the movement will reduce your stress levels too!). Yoga can be a wonderful movement for some as it is relaxing and can be gentle – if you’re hesitant about trying a class then there are so many resources on YouTube suitable for all levels of experience.. If you train at a gym, don’t stop! Talk to a trainer about what movements are going to be suitable for you, which to avoid and which to adapt in order to support your pain problems.
3. Don’t forget about the diet
Stress can increase inflammation, and if you’re eating a diet high in inflammatory foods those issues are going to be compounded. The thought of changing a diet when you’re under stress can seem stressful in itself so again – there is no need to do a complete overhaul! Find a strategy that works for you. It may be that you replace one meal a day with something healthy or full of anti-inflammatory foods. It may be to replace one food that is not positively impacting on your health with a similar food that is a little bit healthier for you. It may be that you eat really well for 6 days and have a day off for the 7th. Do what works for you – and if you have a “bad day” then who cares! Shake it off and start again the next day. We all have bad days. I have bad days and I am a Naturopath! What I have noticed for me personally is that over time there ends up being far more “good days” than bad days, and the more you start to FEEL how your diet is impacting on your stress, pain and inflammation, the more you will be drawn to eating foods that nourish and support your mental and physical health. Click here to download an anti-inflammatory diet fact sheet to get you started.
If you feel you could benefit from some one-on-one support with any of this, then you know where to reach me! If you have started making changes yourself, I’d love to hear how you are going and what is working for you. Shoot me an email so that I can cheer your successes on with you – alexia@holistia.com.au
References:
1. Crofford LJ. Chronic Pain: Where the Body Meets the Brain. Vol. 126, Transactions of the American Clinical and Climatological Association. 2015.
2. Physiopedia. Central Sensitisation. https://www.physio-pedia.com/Central_Sensitisation.
3. United Physician Group. Does Stress Make Chronic Pain Worse? https://unitedphysiciangroup.com/2020/05/01/does-stress-make-chronic-pain-worse/.
4. Hilton L, Hempel S, Ewing BA, Apaydin E, Xenakis L, Newberry S, et al. Mindfulness Meditation for Chronic Pain: Systematic Review and Meta-analysis. Annals of Behavioral Medicine. 2017;51(2).
5. Neckar A. Use mindfulness to cope with chronic pain. https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/use-mindfulness-to-cope-with-chronic-pain#:~:text=Being%20able%20to%20focus%20on,reduce%20depression%20and%20anxiety%20symptoms. 2020.