Week 1: Understanding chronic pain

Week 4: Healthy thinking, healthy self

Week 5: Balancing your activity patterns

Week 6: Maintaining your gains and staying well

The stress response and chronic pain

When activated, the fight or flight system leads to a series of physical changes in the body. Relevant to chronic pain, the fight or flight response causes things like muscle weakness, tension, fatigue, digestive symptoms and headaches. This is because energy is directed away from usual bodily functions and towards organs and muscle groups that are essential for survival. Importantly, some of these symptoms can persist when the threat is gone and you no longer feel anxious. 

Stress can also increase pain sensitivity, making your symptoms more intense. As discussed above, the fight or flight response is intended to be short lived. However, many of today’s stressful situations cannot be dealt with quickly. Chronic activation of the stress response often results in more severe and prolonged pain. In fact, research has suggested that the fight or flight system is overactive in people with chronic pain. In contrast, the system that reverses the stress response (called the “rest and digest” system), is likely underactive in people with chronic pain.  

When the fight or flight system is activated, the brain sends signals to the body to release stress hormones (i.e., ‘cortisol’ and ‘adrenaline’). In controlled amounts, these hormones prepare us for action. However, too much cortisol and adrenaline is bad for the body. For example, it can cause widespread inflammation, leading to pain and fatigue. These effects can lead to a range of problems, including chronic pain and other related disorders. Researchers have shown higher cortisol activity in people with chronic pain compared to people without this condition.

The relationship between stress and chronic pain appears to go both ways. Having chronic pain is debilitating and can be extremely stressful. There is often fear, avoidance and anticipation of pain on a daily basis. Not only are there the direct symptoms of pain to deal with, but there are secondary problems that come from the illness. For example, many people with chronic pain report financial worries, relationship issues, and falling behind at school or work. 

The journey towards recovery from chronic pain can also be stressful, as people worry about their capacity to start new activities or resume old ones. As such, chronic pain is a source of stress for most. If a person feels that the sensations of pain and all of the experiences associated with it are manageable, they may avoid pain-related stress. However, for most people with chronic pain, their condition is considered to be a major stressor in life.

As you can see, stress and chronic pain interact with and worsen each other. This can create a vicious cycle that’s hard to break out of. Before moving on, have a think about the stress in your life. What aspects of life make you feel stressed? Are these short-term worries or ongoing problems? Does stress seem to impact your chronic pain symptoms, or vice versa?