Learn How Managing Stress Can Change Your Pain Experience

By Dr. Katie Casto, PT, DPT

2020 has been a stressful year for many of us. Dealing with a pandemic, losing loved ones, social isolation, unemployment and countless other stressors have caused many of us to experience unprecedentedly high levels of stress. What do you do for stress management?
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As we come into the holiday season, for many, stress levels will increase further. Due to the circumstances it is THAT much more important to take steps to keep stress levels under control. Let’s dig into the WHY & HOW you can stay on top of your stress...

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Most of us are aware of the effect of dealing with all the stress of 2020 on our mental health, but did you know it can impact our physical health as well? People with anxiety related disorders are more likely to experience poor physical health, cardiovascular diseases and premature mortality vs. the general population (Kandola et al., 2018).  Experiencing stress for a prolonged period of time or at high levels can impact how our bodies experience pain - it can cause a pain experience, intensify pain you may already be feeling, or cause pain to be longer lasting (ie.chronic pain).

How does stress actually affect pain?
Experiencing stress can be a protective mechanism for us, however it can also be harmful. Let me explain.
The good:

• When you experience pain, for example from an acute injury (a broken wrist), cortisol (“the stress hormone”) is released into the bloodstream. 
• This hormone helps give you energy to cope with stressful situations or flee from danger (fight or flight!). In addition, cortisol is anti-inflammatory and helps to prevent widespread damage that inflammation can cause.
• This is a normal response to stress, which can be beneficial and protective

The bad: 

• Issues occur when there is an exaggerated or too long lasting of cortisol response to stress, such as when someone is constantly stressed or feeling anxious over a longer period of time. 
• This can lead to cortisol dysfunction, in which our stress hormone response is not working correctly.
• As a result of the cortisol system not working correctly, negative effects on the body occur:
  • widespread inflammation
  • chronic pain
  • morning fatigue 
  • impaired healing
• Stress induced cortisol dysfunction has been associated with many disorders such fibromyalgia and chronic fatigue syndrome, in addition to many different types of chronic pain (Hannibal and Bishop, 2014).

What factors contribute to causing stress that may lead to a dysfunctioning pain system?
Anything that causes stress can eventually lead to cortisol dysfunction if the response is large enough for a long enough period of time (Hannibal and Bishop, 2014). Factors that are related to pain and not related to pain (general life events) can cause stress. These factors often play a role after an injury has occurred, and can amplify and prolong the pain response.
Pain related factors: 

• Fear (being afraid of bending forward because that’s how your back was injured; fear of movement)
• Negative coping strategies (passive/avoidant coping; having difficulty coping with your injury)
• Catastrophizing (sounds like, “There’s nothing I can do to stop the pain”, or “I’m always worrying about whether the pain will go away”)
• Maladaptive beliefs (believing that your injury makes you too fragile to do certain things, believing that moving will make it worse, etc.)

Non-pain related factors: factors that we typically think of as causing stress in daily life, that can have similar effects on pain by amplifying, prolonging and even causing a pain response.

• Financial instability
• Loss of a loved one
• Loss of a job
• Depression
• Anxiety
• Feeling overwhelmed by work

Stress is a part of life. Some things we can control and other things we cannot. We want to be able to address the things we can change (like maladaptive beliefs, for example) and manage our overall stress level so that we can avoid negative health consequences.

How can I manage my stress levels, and how can Physical Therapists help? 

• Exercise, yoga, and mindfulness based interventions all have research backing their effectiveness in reducing symptoms associated with depression, stress and stress related disorders (Saeed, Cunningha, and Bloch, 2019).
• Research also suggests that those who are physically active may be less likely to experience anxiety in the first place (Kandola, 2018).
• Physical therapists are movement experts! We can help address any barriers you may be experiencing that are holding you back from participating in more physical activity (whether it be an injury, pain, being unsure where to start, etc.)
• We can work with you to help address both pain related and non pain related psychosocial factors that may be impeding your progress or perpetuating the pain you may be experiencing. 
• We can provide you with resources to manage pain with a holistic approach,  including referrals for psychologists when necessary, pain education resources and prescribing exercise.
  

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If you need help figuring out what to do for your particular stress OR you need an accountability partner, speak with a PT to learn more about how we may be able to help with your individual needs.

Request To Speak To A PT

References:
Hannibal KE, Bishop MD. Chronic stress, cortisol dysfunction, and pain: a psychoneuroendocrine rationale for stress management in pain rehabilitation. Phys Ther. 2014 Dec;94(12):1816-25. doi: 10.2522/ptj.20130597. Epub 2014 Jul 17. PMID: 25035267; PMCID: PMC4263906.
Kandola A, Vancampfort D, Herring M, Rebar A, Hallgren M, Firth J, Stubbs B. Moving to Beat Anxiety: Epidemiology and Therapeutic Issues with Physical Activity for Anxiety. Curr Psychiatry Rep. 2018 Jul 24;20(8):63. doi: 10.1007/s11920-018-0923-x. PMID: 30043270; PMCID: PMC6061211.
​Saeed SA, Cunningham K, Bloch RM. Depression and Anxiety Disorders: Benefits of Exercise, Yoga, and Meditation. Am Fam Physician. 2019 May 15;99(10):620-627. PMID: 31083878.