Stress Pain Cycle: Part I of the Downward Cycle of Chronic Pain
February 15, 2010 by Laurance Thompson
I was speaking with a client today about the mind/body treatment of pain. His immediate concern was that I was telling him that his pain was “in his head”. This is such a common concern that I felt it was important to discuss in today’s post.
I let my client know that when I use the term mind/body, I don’t mean that pain is psychological or “in your head.” It means that pain is the result of an interaction between mind and body. We discussed this interaction and how, in many cases a downward pain cycle involving the mind and body leads to increasing pain levels, as well as emotional distress.
Stress Pain Cycle
Let’s first look at the pain cycle that involves stress.
A normal physical response to stress is to tighten the muscles in our shoulders, jaw, fists and other areas. If you already have pain in these areas, tightening the muscles can lead to increased pain. Even if you don’t have pain, staying in a prolonged state of muscle tension due to stress can lead to restricted blood flow to the muscles, eventually leading to pain. In both cases, if you don’t address the ‘mind’ part, the pain will likely continue and may even worsen.
In addition to muscle tension, stress results in hormonal and neurotransmitter changes in the body, which can contribute to pain. These changes involve biochemicals such as serotonin, cortisol, endorphins, norepinephrine and dopamine. We will revisit all of these in more detail in future posts, but for now let’s briefly look at the stress hormone, cortisol.
Cortisol is called the “stress hormone” because it is a key hormone involved in our stress response. Under short-term stress, cortisol is beneficial and is associated with reduced sensation of pain and improved healing. Under long-term stress, however, abnormal patterns of cortisol secretion can occur affecting the immune system, resulting in inflammation and autoimmune disorders. This in turn, can lead to increased pain and slowed healing.
Now for the vicious cycle. As many of you may know, having chronic pain can be intensely stressful due to not only the pain, but also the loss of activity, relationships, job, finances and hobbies. When feeling the stress from the pain, you may tighten your muscles without even knowing it and your biochemistry may be in stress mode. As a result, you may feel more pain that then leads to even more stress, resulting in a downward pain cycle from which it is hard to break out.
Treatment
My client originally felt that he only wanted to focus on reducing his pain because he believed that his stress would decrease once the pain lessened. I explained that just working on managing pain is not enough. We must address the emotional piece at the same time in order to break out of the cycle.
As part of treatment, we focused on the following strategies:
- Practice relaxation techniques that relax the muscles, improve blood flow and reduce the negative effects associated with biochemical changes
- Learn stress management strategies such as assertiveness, time management and pacing techniques that help to prevent stress from building in the first place
- Develop a more positive mental attitude using cognitive behavioral therapy and positive psychology strategies
Over time, my client reduced his emotional reaction to the pain and as a result, he noticed that his pain actually began to quiet down as well. He was able to engage in more activities and exercise, which helped his pain and improved his mood.
If you feel that this chronic pain cycle is affecting your pain, talk with your physician about treatment that includes a mind/body approach.
In the next post, we will look at other vicious cycles that can lead to increased pain.
Related posts:
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