Understanding stress and chronic pain

Understanding stress and chronic pain

Trevor Petrie - Chief Medical Officer
8 minute read

 

How does pain work?

The first thing to know about pain – especially chronic pain – is that there aren't any real ‘pain pathways’ in your nervous system. Nor is there really a ‘pain center’ in your brain. What you have are these interesting nerve pathways, and the nerve endings called nociceptors.

A nociceptor's job is to send signals of various strengths to your brain to let you know if there's something that maybe needed to be adjusted or uncomfortable. So, if you think about sitting in a chair, you sit there for a while, and then you subconsciously shift without even realizing it half the time. Those are your nociceptors at work. They're telling your body to move, so you don't put too much pressure on your skin for too long.

What you should also know about chronic pain, is that pain is not due to any particular thing. You cannot predict someone's pain by looking at what their injuries or what their diagnosis is.

 

What’s in your cup?

Pain is multi-faceted. There are lots of things that go into chronic pain and what you're feeling and how to help control it. Greg Lehman is a physiotherapist and chiropractor in Canada, who delved deeply into this concept. He uses the metaphor of a cup.

If you look at pain as a cup, the injury or the nerve signal is one thing that you put into your cup. The level of pain and your tolerance for that nociceptive response rises a little bit the more you put in there. But there are other things that go into that cup too, and stress is a big one. Any kind of stressors – fear, overall stress or you can be in a chronically high stress state. There's really good medical evidence that shows that, physiologically speaking, your nerves are going to be tuned up a little bit, and there is a real inflammatory increase when you have a release of adrenaline and cortisol that goes along with high stress.

Your nerves are less healthy if they're subjected to this all the time, which is part of the problem with chronic pain. The more chronic pain you have, the more stressed out you get and the higher your sympathetic nervous response gets, which makes even more stress and around and around it goes.

 

It’s not all in your head

I would say that a lot of what I do with my chronic pain patients now is before I touch them or give them exercises, is we have a talk about what's going on in their life. What are some of their outside stressors? If there's a bio-mechanical issue with your body, there are some things you can do to control that. But part of the frustration with chronic pain patients is the sense of a lack of control. The feeling that this is happening to them, and that there's nothing they can do about it, and even doctors can't help their situation.

There's a difference between saying that ‘Hey, there are other things that happen with pain’ versus ‘Pain is all in your head’. I hear that a lot from people. They get bounced around from doctor to doctor who tell them there’s nothing wrong here and it’s just in their heads. I've even had people that have been referred to psychologists or psychiatrists, which may not always be a terrible idea, but the reasoning behind sending them and the sales pitch that's given to them is basically inferred as ‘There's something wrong with me, I'm crazy, I shouldn't be having this pain, I need to be fixed mentally’, which is not the case. It shouldn't be the case.

What I try to do and what you should be doing at home, if you have any kind of chronic pain situation, is realize that there are things that you can do to help control certain pain by looking at other things that maybe you have a little bit more agency over rather than the biomechanical issue that's occurring. Sometimes it's something as simple as if it's an irritated nerve, I'll just do fabric desensitization or vibration to help calm that nerve down and get the brain used to interpreting those nociceptive responses appropriately.

 

Focus on the things you can do

One of the other things that Greg Lehman talks about in his work is that a pain response to a nociceptive signal is kind of like a fire alarm that goes off. But it keeps going off even after the fire is under control. Maybe it's still smoldering, maybe there’s still smoke but at this point the fire alarm is more of a nuisance than what the actual problem is.

Chronic pain issues are similar to that. That pain signal is no longer helpful. It's not doing anything for us. In fact, if anything, oftentimes it's counter-productive because people then get avoidant, they don't want to stress their system, and that can actually make things worse. What you need to do is you need to figure out the things you can do, and try not to focus on the things you can't do. That is not going to get you anywhere if you are only focused on everything you cannot do.

I've had patients before where I couldn't even look at whatever part of their body hurts without them jumping up and yelling at me for trying to hurt them. So sometimes I'll get them lying on a table, maybe they haven't had time to lie down in a quiet room in who knows how long.

Then I'll have them just start by breathing. There is a direct link between deep diaphragmatic breathing and calming your nervous system. Your vagus nerve goes right through the diaphragm that controls our breathing. If you stimulate that, it actually helps get you out of a sympathetic state, which is that high stress level state that releases all the cortisol adrenaline. Then I try to ask ‘What can you move?’.

Let’s say, if they've got elbow pain, can they move their thumb? Can they move their fingers? Can they reach up gently towards the ceiling? Find a stress level that's appropriate. The more you stress your system, the more you get things moving. And the more you can do that, the more you're going to calm your nervous system down.

So moving as much as you can, doing as much as you can is crucial. It keeps your system healthy, and your brain starts interpreting those nociceptive signals as what they are. They're not helpful, but keep an eye on it. You don't want to push too far, but you don't need that fire alarm going off all the time either.

 

The appropriate amount of stress

There’s a difference between emotional stress (or cognitive stress) and the physical stress I'm talking about. If you can do something to find the right amount of physical stress to your system, your brain is going to start expanding that threshold of what you can tolerate.

This is not to say that this is something you have absolute control over, but there are things you can do to start having some agency over your situation, so then you can start feeling like maybe you can get back to living the best life you can.

You need to take more than one direction to solve your chronic pain, and sometimes it's looking outside of the actual pain response. What's going on in my life right now? Why am I having a greater pain response now than I would have had to the same thing a couple of years back? Do whatever you can to stress your system appropriately.

An appropriate amount of stress to your system will help kind of reprogram your brain so that it's starting to interpret those nociceptive signals appropriately, and then hopefully, you don't have the same level of chronic pain response.

 

 

 

This content is presented for informational purposes only, and should not be seen as any kind of health, nutritional, medical or legal advice. You should consult a licensed medical practitioner if you are experiencing pain and/or discomfort or have a medical issue or suspect that you have a medical issue. If you choose to rely on the information presented in the Grace & Able LLC website, blog or social media posts, you do so at your own risk.

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