The Link Between Stress and Pain

Written by Laura Howden


Stress is the body’s natural reaction to a perceived threat, known as a stressor. Stressors come in many different forms, the two most common being physical and psychological. Physical stressors cause a direct threat of strain or damage to our body. This includes physical injury, such as getting a paper cut or breaking a bone, environmental and temperature extremes, chemical exposure, illness, or anything that can have a harmful effect on the tissues of our body. Psychological stressors occur when there is a perceived lack of control over a situation. This can include work overload, troubling social situations, financial difficulties, or any situation where the demands exceed our coping abilities leading us to interpret it as negative or threatening.

When a stressor is encountered, our body initiates an acute stress response. The sympathetic nervous system is activated and adrenaline is released increasing blood pressure, heart rate, and respiration. This is part of our primitive hardwiring known as the fight or flight response which allows us to quickly react to threatening situations (our body is ready to fight the threat or flee to safety), promoting our survival in dangerous situations. These changes put our body into an inflammatory state so that it is prepared to defend and protect itself in the event of injury. Shortly after the initial stressor is encountered, our body releases a hormone called cortisol. Cortisol is an important anti-inflammatory that helps to manage the stress response and return the body to its normal state.

Stress in one form or another is inevitable. At some point in our daily lives we will all experience stress, whether it is directly related to a painful experience or as a result of the demands in our life (work, study, relationships, etc.). It is how we manage that stress that becomes important. Issues occur when stress is prolonged. If a stressor is not removed or appropriately dealt with, the stress response is repeatedly activated and cortisol continues to be released in effort to restore homeostasis (a balanced or stable state within our body). Overtime, the body’s cortisol stores begin to deplete resulting in a cortisol dysfunction. The inflammatory response becomes unregulated and widespread inflammation occurs.

Although pain and inflammation are separate, they generally go hand-in-hand. Inflammatory agents activate our body’s pain receptors (called nociceptors). With prolonged inflammation, more pain receptors become activated and we have an increased sensitivity to pain. Our pain response can become exaggerated or inappropriate, and things that we might not usually find painful suddenly begin to feel painful. Essentially our pain threshold is lowered, and our body develops a heightened response to pain.

So what can be done about this? We know that the acute stress response is normal and necessary to protect us from danger and to initiate the inflammatory healing process. We also know that a prolonged stress response can be detrimental, leading to cortisol dysfunction and a cycle of inflammation and pain. Luckily, as humans, we

have the ability to change the way we perceive and react to stressful situations. By adopting appropriate stress management strategies we play an important role in preventing and breaking the cycle of chronic stress and pain. Here are some tips on managing stress:

  • Remove or address the stressor: Persistence of a stressor increases the stress response. Don’t ignore things that bother you. Take charge, confront the situation, and make the necessary changes to alter it.
  • Increase your self-awareness: Often when stressed, we catastrophize the situation, allowing ourselves to believe that the situation is more threatening than it really is. We begin to feel that the situation is out of our control, leading to feelings of helplessness. Take time to identify the stressors in your life and to rationally assess them. Recognize any maladaptive or negative coping strategies that you may be using - you have to be aware of your behaviours before you can aim to change them.
  • Change your outlook: Welcome challenges, allow failures, and confront fears. Focus on the positives and learn to accept the things that can’t be changed… everything can’t be perfect. Setting realistic standards and adjusting your mindset can prevent a lot of unnecessary stress.
  • Find relaxation strategies: Meditation and exercise have both been shown to be effective in the management of stress and pain. Meditation helps to put the body into a state of relaxation and to shift one’s focus away from stress. Exercise increases the body’s release of endorphins, which decrease pain and produce a feeling of euphoria. Finding activities that you find fun and enjoyable helps to blow off steam, provide mental rest, and plays an important part in living a healthy, happy, balanced lifestyle.

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Hannibal KE, Mishop MD. Chronic stress, cortisol dysfunction, and pain: a psychoneuroendocrine rationale for stress management in pain rehabilitation. Phys Ther 2014;94(12):1816-25.