Stress Affects Pain. Part 3

*All content in italics taken directly from Ben Cormacks' FREE PAIN RESOURCE

Stress significantly impacts how we deal with a pain experience and often people experience stress, or stressors in many forms. The term "stressed" has connotations to it and many of us do not like openly expressing that we are so. Following is Bens' take on how stress impacts our physiology, progressing from some complicated science to more tangible take aways by the end.

Stress should be seen as the biological response to the wide range of stressors that face human beings. This could be more traditional physical overload as we may see in an overuse injury, or less apparent stressors such as work or family related. Any stressors can disrupt someones homeostasis leading to the activation of neural, hormonal and physiological processes aimed at restoring homeostasis.

This process is known as allostasis, meaning maintaining stability through change, and the longer it goes on for, in response to prolonged stressors, the greater the allostatic load can become.

Conditions that can lead to an increased allostatic load are:

Repeated frequency of stress response to multiple novel stressors.
Failure to habituate to repeated stressors.
Dysregulation of a normal adaptive response

Pain can be seen as a component of the stress system with the purpose being to motivate the organism to change its behaviour in order to protect and survive.

The hypothalamic-pituitary-adrenal axis (HPA) and the locus coeruleus-noradrenergic system (LC-NA) are both involved in releasing the two main stress hormones, epinephrine (adrenaline) and cortisol. They can suppress the immune system and also erode bone, muscle and neural structures if activated long term via a wide array of psychological and physical stressors. The HPA axis receives receives projections from, and can be activated by the amygdala, hippocampus and prefrontal cortex. This means emotions, memories and a wide array of cognitive behaviours can potentially provide an increase in stress hormones. A belief regarding the body could potentially be a stressor, as could the fear of re-injury.

Many of the systems involved in pain and stress overlap and sustained endocrine responses may be maintained by or maintain persistent pain problems.

In simple terms, what we are saying is that pain is complex and multi-dimentional. Many stressors can have an effect on someones current pain state and modern human living exposes us to many more concurrent and complex stressful situations and over longer periods of time leading to greater stress levels.

It can be good to help people recognise times pain gets better or worse and if stress could be involved and potentially reduced.

An intense period at work?
Less pain over the weekend / holiday?
Adverse life events recently?

Lots of different things can be stressors, not just what we might think traditionally as "stress" and the systems involved with stress and pain are quite similar. The hormones involved with stress can be quite destructive on the body.

Imagine stress is like a big bucket with lots of different taps dripping into it. A work tap, family tap, a money tap and maybe a physical tap too!! This is fine when the taps are only dripping and the bucket is only half full. Sometimes the stress taps turn on full blast though; a deadline at work or a family member being ill, then the buckets can overflow, making us more sensitive and this can increase the pain we experience.

The bucket analogy is a dynamic model that emphasises the nature of how we manage stress, or stressors. There are any number of daily things that can be stressors, including exercise that challenge our allostatic load (stability through change). If our bucket overfills it can stimulate our pain system and make the alarm more sensitive.

What tap in your life could have been left on and sensitised your system? Stress is intimately connected to how we feel and must be considered in any pain experience. Modern life demands that we have something pressing us from every angle. How do you manage?

Luke R. Davies :)