The Stress Pain Connection

Posted on Friday, December the 28th at 6:45pm

Dr. Stephen F. Grinstead, LMFT, ACRPS, CADC-II

Stress is a blessing and a curse. We need stress to motivate us and help us deal with life on life’s terms. Stress also gives us energy and fuels the fight, flight, or freeze phenomenon. For someone with chronic pain, stress intensifies their experience of pain. The stress response is a combination of biological psychological and behavioral factors.

In response to stress the body mobilizes an extensive array of physiological and behavioral changes in a process of continual adaptation. This is an important part of the body’s defenses with the goal of maintaining homeostasis and coping with stress. The body reacts to stress by secreting two types of chemical messengers – hormones in the blood and neurotransmitters in the brain. That is why stress management needs to be an integral part of an effective pain management program.

Changing thinking and behaviors is an important start in reducing the learned responses to stress, as well as developing relaxation techniques.

One of the first steps in this process is to teach your patients how to identify and challenge irrational thinking that leads to uncomfortable emotions. For example if they are under high stress the thought might be "I can’t stand this… This is impossible." This in turn could lead to, fear, anger, anxiety, or even anticipatory pain.

The next step is to teach patients to be aware of and learn how to manage those uncomfortable feelings before they lead to self-defeating urges. Developing healthy feeling management skills is very important. Learning to share with trustworthy people is one way people can deal with uncomfortable emotions. If the feelings are too intense or overwhelming, increased counseling or therapy may be necessary.

If those negative urges do surface, it is important to teach people how to make healthier decisions before indulging in self-destructive behaviors. There is a decision point between the urge and the behavior that is almost non-existent when people first get into pain management. If people keep "reacting" to their impulses instead of thinking and "responding" they very well could get themselves into serious trouble. That is why learning impulse control and delayed gratification is so important.

It is important to teach your patients about the connection between stress levels and their pain symptoms, as well as understanding that stress management can also decrease their suffering. Physically, chronic pain raises stress levels and drains physical energy, while psychologically it affects people’s ability to think clearly, logically and rationally, as well as to effectively manage their feelings or emotions. Remember that in most cases if your patients can learn to lower their stress levels, they will also experience a decrease in their perception of pain.

When they are more aware of their stress levels, they can then take action to reduce their stress, which in turn leads to a decrease in their pain symptoms. One effective stress management strategy is exercise. In addition to lowering stress levels, regular exercise can also be an important part of a pain management program. It is also important to reduce, or even eliminate, nicotine, caffeine, and sugar, and to implement a healthy eating plan. Other stress management tools could include focused breathing and relaxation exercises, meditation, Yoga, Tai Chi, soothing music, being in nature, soaking in a hot bath (or Jacuzzi), etc.

Of course before patients learn to manage their stress they need to be familiar with ways to assess their level of stress. It is important to teach them how to accurately self-assess their levels of stress and then how to develop some simple but effective stress management tools. I like to use the Gorski-CENAPS^® Stress Thermometer concept for stress identification. This concept proposes that there are ten levels of stress. When people get to the upper moderate to severe levels of stress (6-10 range) their thinking, emotions and behavior are impacted. Below are examples of stress scales and the stress thermometer for you to review.