How stress can change your experience of pain and what to do about it

“Unprecedented times” , “The new normal” , “Global Pandemic”

These are terms that we as a society have heard a lot of lately. I’m sure they instill a sense of stress in essentially everyone at this point. 2020 was a trying time for most and the majority of people have endured countless stressors – whether it be financial woes, social isolation, or mental and physical health issues. It’s times of immense change and stress that a person’s fight or flight system is working in high gear – our body tells us to do what we must to make it through. It’s in the moments between, the small moments of reprieve between the waves of seeming anarchy, when you have a moment to reflect that you may notice the toll this stress has taken on your well being. Perhaps you’ve noticed more aches and pains – your generally low level whining knee has turned into a full on roar. Maybe your frequency or intensity of headaches has increased and is disrupting your sleep. It’s possible an old nagging injury has decided to make a reappearance in your life. This likely isn’t a coincidence.

It’s times of immense change and stress that a person’s fight or flight system is working in high gear – our body tells us to do what we must to make it through.

Stress and pain are intricately woven together. To understand how one can affect the other (and what you can do about it) you must first understand how pain is experienced in the body. Pain is incredibly complex and every pain experience is different and valid. As a physiotherapist, having an understanding of pain is an integral part of our work. I’m here to share some knowledge and allow you a basic understanding of how pain is experienced in the body and affected by stress, and what you can do to help.

The Experience of Pain 

Sensations in the body are experienced by signals travelling through a network of nerves where those signals are delivered to your central nervous system (your brain and spinal cord). Your central nervous system then interprets the signals and decides how to experience them. There are no such thing as pain signals. That may sound odd, but hear me out. 

When we talk about pain, the signals that are getting sent through this network of nerves to your central nervous system are danger signals.

Danger Signals

• These danger signals get sent when the tissues in the body sense that something is potentially wrong. 
• The danger signals are then processed by your brain where it decides whether or not there are enough of these danger signals to be deemed as painful.
• Once those danger signals meet that threshold there will be an experience of pain.
• The brain’s threshold for what it decides is painful can change due to a number of inputs. One of the biggest modulators for pain perception is stress.

Stress can work in two ways to affect this experience of pain.

1. We’ve all heard the stories of a mother or father in a car accident with their infant child. The parent may have grave and severe injuries, but the moment their child requires aid, they report little to no pain at all and are able to carry out incredible feats of strength and perseverance despite their injuries. Stress can increase the threshold for what the brain deems dangerous enough to experience as pain. This is when stress can work in favour of the pain experience. 
2. Stress, however, can also decrease the threshold for what the brain deems dangerous enough to experience as pain. When the brain has extra inputs and stressors, the experience of pain may heighten and increase. Your brain, unbeknownst to you, may very well decrease that threshold and you may be in more pain for a seemingly “unexplainable” reason.

Pain Science

When first attempting to understand pain science, you may be asking yourself “Is she trying to tell me that my pain is all in my head?” And the simple answer is yes – but not in a bad way. Pain is in your head in the way that without your brain there is no pain. You cannot experience pain without the inputs and interpretations from your central nervous system. This does not make the increase in pain due to stress any less valid, in fact the experience of pain in times like this may be more intense and less manageable.

The good news is that we can alter this experience of pain by altering the inputs to your brain.

1. One way would be to alter the tissues and change the danger signals that are reaching your brain, but that is for another blog post for another time. 
2. Another way is to make healthy changes to control the other stressful inputs and hopefully increase the threshold for what your brain determines to experience as painful.

Every person’s experience of stress will be different, and I am by no means an expert in this even in my own life.

3 steps you can take to learn to manage the effects of stress to help manage your pain

1. Sleep is incredibly important for not only stress management, but also tissue healing and regulation. Setting a sleep schedule and prioritizing sleep can be a good first step. 
   
2. Moving your body can also be extremely helpful. A mantra in our profession is “Movement is Medicine”. Moving your body in a way that feels good for you can be incredibly impactful to help decrease stress levels as well as pain. It is shown that movement in a part of the body, even if it’s far away from where you experience your pain, can help to decrease your overall pain experience. Move in small ways or big ways, but move your body. 
   
3. Mindfulness is something I encourage most of my patients to try to manage pain and stress levels. Mindfulness is the practice of intentional focus on the present moment. It is often included in other practices like yoga and meditation but can be practiced on it’s own as well. Mindfulness is the practice of bringing awareness and focus to the present moment, accepting your current experience without judgement, and observation of sensations, thoughts and feelings. Mindfulness has been shown to improve the coping of pain in patients with chronic pain, improve mood and decrease the consequences of stress. There are some excellent resources online to assist in learning the practice of mindfulness, but I often encourage the use of simple and free apps. A few of my favorites include Headspace and Insight Timer. 

My goal of this post was to give you a basic understanding of pain science and encourage you to reflect on whether stress has changed your experience of pain. Although I have included resources on where to start, your physiotherapist will be able to give you more ideas and information about your specific pain experience. I hope you stay healthy and happy and take some time to take care of your body and mind during these crazy times. 

If you are feeling overwhelmed by the stress in your life and are finding it unmanageable, I encourage you to seek help through your family doctor, therapist or you can call Alberta’s 24-hour Mental Health Help Line at 1-877-303-2642 for confidential information and referrals.

Courteney Robinson
Physiotherapist at Pivotal Physiotherapy
Pelvic Floor Practitioner

Ask me a question! 
Book an appointment with Courteney

Sources: 

David Butler and Lorimer Moseley. Explain Pain. 

Mindfulness Fact Sheet – http://agerrtc.washington.edu/info/factsheets/mindfulness