How does stress affect my pain?

Stress has been increasingly recognized as a major factor in all kinds of chronic pain. Why is that? The answer is Cortisol. Cortisol is the hormone your body creates in response to stress. 

But let’s back up a little and learn something about our nervous system. We have two major functions of our autonomic nervous system: parasympathetic, or rest and relax, and sympathetic, or fight or flight. How it should work is that most of the time, our bodies are in a fairly restful state, until a stress comes along. To deal with that stress (historically, think like a wolf invading your camp or something), we move into a fight or flight state to deal with it, and then when it’s dealt with, we return to our rest and relax state. 

In our modern world, though, stresses are coming at us from all angles. And while these stresses may not be as immediately life threatening as a wolf, our body doesn’t know the difference. And we rarely get a break from many of the stresses of life. Sometimes, if we’ve been stressed our whole lives, we may not even recognize that we are living in a constant fight or flight state. 

When we’re in that fight or flight state, Cortisol levels are much higher. They fluctuate throughout the day, but if they’re elevated most of the time, we’re feeling the effects of a constant threat at our doorstep. 

Some of the immediate effects of Cortisol include:

  • Increasing substances in the body that repair tissues (AKA inflammation)

  • Increased heart rate and blood pressure to provide energy to prepare for a fight

  • Increased blood sugar to feed the brain to deal with the current stress

  • Slowing of non-essential functions like digestion, reproduction, and growth

  • Changing mood and creating a feeling of fear 

When the stress doesn’t go away, chronic elevation of Cortisol turns these functions into:

  • Mood changes including anxiety, depression, low energy and motivation

  • Digestive problems including constipation or bowel urgency/diarrhea

  • Difficulty sleeping (which also leads to low energy and fatigue)

  • Muscle tension and aches

  • Headaches

  • Difficulty focusing and poor memory

  • Weight gain

  • Chronic inflammation, which also increases tissue sensitivity

  • Increased risk of heart attack and stroke

In regards to pain, the main things to note above are that stress causes tense/tight muscles and chronic inflammation. Tense muscles can be the primary cause of pain or can constrict nerve pathways, causing pain along the path of the nerve. Add in the inflammation, so that the nerve is already constricted in its sheath due to excess fluid, and we have a recipe for chronic pain. And no matter how many stretches you do, how many massages you get, how many times you use your theragun, it doesn’t go away. Because it’s fed by stress that’s not going away either.

So… what do I do about it? In physical therapy, we use manual (hands-on) techniques to calm the nervous system, reduce inflammation, increase nerve mobility, and reduce muscle tension, but that MUST also be paired with some combination of the following to reduce the constant stress response in your body:

  • Mindfulness and/or meditation

  • Physical activity / exercise (especially outside in nature)

  • Yoga or other mindful movement

  • Mindful Breathing

  • Anti-inflammatory nutrition and/or eliminating/reducing processed foods, dairy, sugar, gluten, soy, and alcohol

  • Journaling, particularly gratitude journaling

  • Mental health therapy

  • Participating in hobbies or activities that bring you joy / make you happy - often this is music (listening/playing/singing), being in nature, art (drawing/painting/etc), reading, writing, participating in sports, etc.

Do you have to do all of those things? No. But each individual will find their unique combination of things that work for them. You may say, “ugh, I’ve tried meditation and it didn’t help my pain.” But it’s really an overall lifestyle change with a combination of the above that’s helpful, not just any one item individually. I would argue the most important one is that last one - making time for the things you love. And I think it’s one of the ones we’re worst at.

Sarah Shimanek