The stress of chronic pain

Stress and pain are both common reasons for patients to seek medical attention, both concerns are often chronic and can significantly impact the quality of life. Patients are aware that the conditions are affecting their life, but many patients are unaware of the relationship between the two. The fact is that stress can aggravate existing pain, and that the body often interprets the pain as stress.

When patients think of stress, they often think of work and their long to-do-lists. Some will consider the emotional stress of relationships, but few consider the physical aspect of stress. Physical stressors are not limited to rigorous exercise (which many use for stress management), but also the physical pain they may be experiencing, such from an injury, headache, etc. When a patient experiences any type of stress or pain, physical or psychological, it leads to adaptive or maladaptive neural and hormonal responses. Often the more chronic the stress or pain, the more likely it is for maladaptive changes to occur and contribute to cortisol dysfunction, wide-spread inflammation, and pain.

There are various models linking pain and stress, one of these models considers pain itself as a type of stress. This means, when your body is in pain, the brain processes this as a form of stress, but what can often be overlooked is the added stress of ‘pain management’. This often includes attending appointments, remembering to take medications or supplements, lifestyle changes caused by pain, etcetera. We must not forget these aspects of pain management that can also add to the overall stress burden. Whether the stimulus is pain related or non-pain related (ie work, relationships, etc.), chronic reactivation of the stress response can lead to the maladaptive changes that can ultimately impede recovery.

Stressful events are unavoidable in daily life, but as clinicians we need to help our patients cope better, especially those suffering from chronic pain. By supporting our patients’ ability to cope with stress we can encourage them to shift towards an adaptive stress response. This will allow their cortisol and epinephrine levels to return to baseline more efficiently, and lessen the likelihood of HPA axis dysfunction and associated increased risk of inflammation, pain, and depression.

We can support our patient’s stress responses in a variety of ways including adaptogenic herbs; nutrients such as magnesium, vitamin C, and B vitamins; and key lifestyle fundamentals such as sleep and nutrition. When a patient suffers from chronic pain we want to avoid needlessly provoking their inflammatory pathway, which is why an anti-inflammatory diet or eliminating food sensitivities may be warranted. By supporting our patients’ stress responses we can hope to decrease the amount of pain experienced and enhance their quality of life. Remember, most individuals know that pain can place stress on our bodies, but most importantly, stress can cause or aggravate physical pain. Addressing pain alone will not help our patients succeed, we need to take a multifaceted approach in their stress reduction.

Dr. Brittany Schamerhorn, ND, works in multiple integrative clinics along side medical doctors, chiropractors and other health care professionals to help empower and educate patients through their healing journey. She has taught at BINM, the naturopathic medical school on the west coast, and continues to be an active member of the community. For more information, visit www.drbrittanyschamerhorn.com