The Stress-Pain Connection

It’s a vicious cycle people with chronic pain know well: Pain causes you stress and stress exacerbates your pain. While everyday evidence points to a connection between stress and pain (and vice versa), research is also highlighting this connection.
What Research Shows
We’ve all heard of the fight-or-flight response to stressors, and you’ve probably felt it triggered when you sense danger in your immediate surroundings. When you experience stress, your body undergoes a number of physical changes. These include an accelerated heart rate and increases in everything from the force of each heartbeat to respiration rate to gastrointestinal motility (the contractions that move food through your digestive tract).
In a way, this means that your body is preparing you to respond to an immediate threat. If you have chronic or near-constant stress, then you’re essentially preparing for an emergency at any and every moment.
Stress responses can vary widely among different people for all sorts of reasons, but whatever your background, high stress levels can hurt. Stress has been linked to conditions such as headaches, migraines, fibromyalgia and chronic pain. While some stress is a good thing (helping you to think clearly and deal with crises, for example), ongoing stress can leave us feeling anxious, and even depressed.
Have you ever had an upset stomach before giving a presentation? Because signals pass directly from the brain to the gut, stress can have a gastrointestinal impact, too. Brain signals to the gut can alter intestinal contractions; gut signals to the brain can prevent proper pain regulation. In other words, a distressed gastrointestinal system can cause pain and alter your perception of that same pain.
More research is needed, but a link between chronic stress and heart disease has also been documented, especially in men. In fact, stress can even cause a reversible heart problem called stress cardiomyopathy, in which the heart has temporary dysfunction without a clear cause.
Stress and Pain Perception
Stress increases pain, both by causing the physical changes that exacerbate physical conditions (tension, anyone?) and by changing the way we perceive pain. When we’re stressed out, pain simply seems worse. So, if you’re feeling relaxed and happy, but accidentally hit your thumb with a hammer, you may suffer less than if you were already feeling stressed before the accident.
Stress can slow healing, too. A 2011 study of wound healing suggested that stress increases the likelihood of acquiring infections and makes people more likely to discard healthy habits like getting enough sleep, exercising and limiting alcohol consumption.
Stress Relief
If you live with chronic pain, adopting stress-relief strategies such as regular exercise, meditation or guided relaxation can help limit how much stress affects your pain perception, providing a reminder that some aspects of pain are under your control. It matters little which stress-reduction activity you choose: Find something that engages and motivates you, reminding you that there’s a life outside of pain.
If a hectic healthcare schedule is increasing your stress level, create a file for medical appointment reminders, bills, insurance paperwork and medication lists that you can easily grab before each appointment. Ask a friend, partner or family member to join you if necessary, and consider an online calendar with automatic reminders that will prompt you when there’s a medical visit coming up.
Pain doesn’t need to be chronic for stress-reduction tools to work, either. Even the occasional headache or migraine can be prevented with these strategies. In addition, keeping stress reduction on your radar can help you ward off infections, acute pain and other stress-influenced illnesses.
How to Keep Pain from Adding to Stress
Mindfulness, whether you adopt it casually or spiritually, can be powerful, too. Today, mindfulness-based stress reduction has become so common that it has an easily recognized acronym (MBSR), and a 2009 study showed that quality of life for chronic pain patients increased after taking an MBSR course

Unlike medications or other therapies, MBSR doesn’t seek to resolve or mask pain. Rather, this complementary therapy teaches people with pain to stay in the moment in a non-judgmental way, and has many of the same benefits as meditation. In practice, this means observing your thoughts and letting them pass, rather than labeling them “good” and “bad” or dwelling on stressful, pain-related, or negative thoughts any longer than necessary.
Staying in the moment, though it can be difficult, helps the body avoid becoming exhausted by stress by limiting what you deal with to what is occurring in the present.
Whether your pain is the occasional twinge or a well-documented condition, the anxiety of pain is universal: What does it mean? Why is it happening? When will it stop? The good news is that whether or not these questions can be answered, there are ways to regain control over pain and stress, breaking this damaging cycle.

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Harvard Health Publications, "The Gut-Brain Connection,", accessed on May 22, 2013.
OHSU Brain Institute, "Pain Management,", accessed on May 22, 2013.
University of Maryland Medical Center, "Stress—Complications,", accessed on May 22, 2013.