Stress and pain have a complex and reciprocal relationship. Stress can either inhibit or exacerbate pain, depending on whether it is acute or chronic. On the other hand, chronic pain can also cause stress. Understanding this interaction is important to break the vicious cycle between chronic stress and chronic pain.
Evolution of understanding about pain
Our ancestors saw pain as an evil spirit or divine punishment. In the Renaissance, thinkers like Descartes believed that pain was a disturbance in the body that sent messages along the nerve to the brain. Today we know that the experience of pain is much more complicated, involving several brain structures.
Simply put, tissue damage leads to pain through the nerves that carry messages from the periphery to the brain. However, the brain is not a mere passive receiver. It carefully modulates the processing of pain signals depending on the situation, inhibiting or facilitating pain. This allows responding to the challenges of the physical and social world.
The effect of acute stress on pain
In dangerous situations, the body goes into a state of stress to prepare for fight or flight. The heart races, the pressure rises, the breathing pantes, attention focuses, digestion stops. In sensory terms, acute stress can mask pain by activating inhibitory pathways and endogenous opioid and cannabinoid neurotransmitters.
This gives the opportunity to escape and then the painful system rebalances itself. So, acute stress can be beneficial for surviving threats.
The effect of chronic stress on pain
Unfortunately, with chronic stress, the pain balance shifts to a less stable state. Chronic stress can facilitate pain by enhancing facilitatory pathways and making the body less sensitive to inhibitory neurotransmitters.
Consequently, chronic stress amplifies painful inputs. An innocuous stimulus can now cause chronic pain. Furthermore, chronic pain causes stress, anxiety and depression, closing the vicious cycle.
Pain Control Theory
The gate control theory of pain proposes that non-painful stimuli can inhibit pain transmission to the central nervous system. This occurs because the inhibitory neurons block the projection neurons responsible for carrying the pain signal to the brain.
Some examples of how this theory is applied:
- Physical therapy uses exercise and massage to generate non-painful impulses that close the “gate” to pain
- Psychology uses relaxation and distraction to close the gate
- Procedures such as nerve stimulation generate electrical impulses to close the gate
- Analgesic medications act biochemically to close the gate
Strategies to break the cycle
The solution is not instantaneous, since the sensitized system took a long time to develop. However, we can attack the problem on multiple fronts:
- Lifestyle modifications:
- Regular physical activity such as physical therapy, walking, swimming, yoga. This strengthens the muscles, increases energy and improves function.
- Adequate sleep, as lack of sleep increases stress hormones.
- Healthy, balanced diet to help the body heal.
- Psychological adaptations:
- Mindfulness and relaxation like meditation and deep breathing to calm the mind.
- Cognitive-behavioral therapy to identify and change negative thoughts about pain and stress. This improves coping.
- Social support:
- Interaction with family and friends prevents and relieves stress. Social support is crucial to reducing stress.
Therefore, although there is no silver bullet, with a multifaceted approach we can achieve adequate pain control and functional restoration. The key is to break the vicious cycle between chronic stress and chronic pain.