By Kelly Leong, Reg. PT

Do you ever notice that your pain symptoms worsen during times of stress? Maybe you only notice your pain symptoms at work? Maybe only at home? Maybe only in the evenings? Maybe at certain times of the year?

Can stress play a role in our physical symptoms?

To answer this, we first need to understand a little more about stress:

What is stress?

Stress is the “non-specific response of the body to any demand for change”. It is your body’s way of responding and dealing with any threat or demand. Stress can arise from a physical or psychological stressor.

Stress can be helpful at times. It provides us with that boost of energy we need to get through stressful situations like a job interview or a work deadline. However, too much stress can be a bad thing. Persistent stress can negatively affect the immune, cardiovascular, endocrine and nervous systems.

What happens when we experience stress for a short period of time?

Our eyes and ears sense potential danger and a signal is sent to the amygdala, which is a part of the brain that processes emotions. The amygdala perceives danger and sends a signal to the hypothalamus (your brain’s command center). The hypothalamus communicates with the systems of the body through the autonomic nervous system, which is a part of your nervous system. The autonomic nervous system has two branches: the sympathetic (GO) and the parasympathetic (STOP) nervous systems.

The sympathetic nervous system is activated by the hypothalamus if there is perceived stress. The hypothalamus communicates with your adrenal glands to produce hormones such as epinephrine. norepinephrine and cortisol. These hormones then act to increase your heart rate and breathing rate, increase your blood pressure, dilate your pupils and tense your muscles.

This stress response evolved as a survival mechanism – humans needed to be able to respond quickly and efficiently to a potential danger. This is why the stress response is also known as the ‘fight or flight response’. This stress response has served us extremely well. As a species we’ve survived being hunted by wolves, lions and bears.

But our bodies were not meant to experience prolonged stress and we are now learning that the hormones that are produced during the stress response can negatively affect our health if they are always present in high levels in our bodies.

How does persistent stress affect the body?

In the short term, this stress response can be very useful however if the stress response continues for too long, it can start to affect other systems of the body. If the sympathetic nervous system is always overpowering the parasympathetic nervous system, then our body never gets an opportunity to rest.

The levels of cortisol in our bodies rise and never settle. These high levels of cortisol may affect our immune and GI systems – we might start to feel ill or notice diarrhea or cramping symptoms.

Persistent stress can put our nervous system and brain on high alert and make us hypersensitive to the things we may feel. We may notice that our pain symptoms are worse during times of stress because our nervous system is sensitized. Research has even shown that patients with fibromyalgia show an increase in musculoskeletal pain during times of stress.

Sometimes it’s not realistic for us to get rid of all the stressors in our lives, but we can learn how to appropriately manage stress so that it doesn’t affect our physical functioning as much.

3 ways you can evoke a relaxation response

Evoking a relaxation response is a powerful way of turning down your sympathetic nervous system and turning on your parasympathetic nervous system. This allows your body and mind to rest, reset and recharge.

1) Exercise – Get outside and go for a walk
2) Social Activity – Spend time with friends and family doing something you enjoy
3) Breathing – Spend a few moments reconnecting with your breath

For more resources about the role of persistent stress in pain:

https://www.youtube.com/watch?v=XM5hdlEOSFM
https://www.youtube.com/watch?v=ikUzvSph7Z4

References:

Ahmad, AH & Zakaria, R. (2015). “Pain in Time of Stress.” Malays J Med Sci, 22:52-61

American Psychological Association. Understanding Chronic Stress. Retrieved from https://www.apa.org/helpcenter/understanding-chronic-stress.aspx

Baum, A. & Polsusnzy, D. (1999). “Health Psychology: Mapping Biobehavioral Contributions to Health and Illness.” Annual Review of Psychology, Vol. 50, pp. 137-163.

Nilsen KB, Westgaard RH, Stovner LJ, Helde G, Rø M, Sand TH. Pain induced by low-grade stress in patients with fibromyalgia and chronic shoulder/neck pain, relation to surface electromyography. Eur J Pain. 2006;10(7):615–627.