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Why Does Stress Make Chronic Pain Worse?

Chronic pain affects over 50 million adults in the United States alone. It is often a daily struggle for those who suffer from chronic conditions like arthritis, fibromyalgia, migraine headaches, and back pain. Managing the pain is challenging enough on its own, but research shows that stress can actually make chronic pain even worse. Here’s why.

The Stress Response

When we experience stress, our body goes into “fight or flight” mode, triggering a cascade of physiological changes designed to give us an energy boost to cope with potential threats. The hypothalamus signals the adrenal glands to release stress hormones like cortisol and adrenaline. Heart rate increases, blood pressure rises, breathing quickens, and muscles tense up. This stress response is crucial for dealing with immediate danger, but it causes problems when activated too often.

Living with chronic pain essentially keeps the body in a constant state of stress response. Rather than being temporary, the pain continues day after day, week after week. All of those physiological effects of the stress response go on and on, becoming physically and mentally exhausting. This persistent stress wreaks havoc and makes the body even more sensitive to pain signals.

Increased Muscle Tension

One way stress exacerbates pain is by increasing muscle tension. When the body releases stress hormones, muscles tense in preparation for physical activity. Muscles become tight and constricted. This added tension then pinches nerves, reduces blood flow, and compresses joints. For someone with chronic muscular or joint pain, increased muscle tension just amplifies existing aches and pains. It essentially creates more pain signals for the brain to process on top of the chronic pain.

Reduced Blood Flow

The stress response diverts blood flow away from the body’s periphery and toward the heart, lungs, and other vital organs. This leaves tissues in areas like the back, shoulders, and head with reduced circulation. Insufficient blood supply prevents oxygen and nutrients from reaching muscles, connective tissues, and nerves in those regions. When nerves and other tissues are deprived of needed oxygen and nutrients, they become irritated and inflamed, causing even more pain.

Sleep Disturbances

Stress and chronic pain together often lead to sleep problems. On one hand, being in constant pain makes it hard to fall and stay asleep. On the other hand, lack of quality sleep fails to restore the body and further intensifies pain. Research shows that poor sleep decreases pain tolerance. After a bad night’s sleep, the same painful stimulus feels much worse. Without restorative sleep, the body remains in a state of stress, continuing the cycle.

Increased Inflammation

Chronic stress leads to chronic inflammation in the body. Stress hormones like cortisol regulate inflammatory responses. When stress is prolonged, cortisol levels fluctuate abnormally. This contributes to excessive inflammation and swelling that can worsen joint pain and damage. Studies link chronic stress and inflammation to increased pain intensity in conditions like osteoarthritis and rheumatoid arthritis.

Heightened Pain Perception

Stress doesn’t just affect the body physically. It also amplifies the way we perceive and process pain signals mentally. MRIs reveal that chronic stress actually causes structural changes in the brain. The prefrontal cortex, which moderates pain perception, decreases in volume. This makes it harder for the brain to regulate incoming pain signals. Simultaneously, the size of the amygdala increases. Since the amygdala processes fear and emotions, this amplifies anxiety, depression, and negative feelings that worsen the pain experience.

Psychological Factors

On a psychological level, stress contributes to fears about the meaning of chronic pain. Those suffering from constant pain often develop anxiety about the future or frustration over inability to function normally. This stress and worry fuels attention toward the pain, so that it dominates thoughts and becomes more noticeable. Fear that movement will make the pain worse can also lead to avoidance of physical activity, resulting in weakened muscles, stiffness, and even more pain.

Breaking the Vicious Cycle

Since stress has such a major impact on the chronic pain experience, finding ways to reduce stress is essential. This may include psychological interventions like cognitive behavioral therapy (CBT), medications, lifestyle changes, and alternative therapies. Identifying and modifying negative thought patterns can help minimize anxiety and catastrophic thinking. Relaxation techniques such as deep breathing, meditation, yoga, massage, and hydrotherapy encourage the relaxation response, inducing calmness and better pain control. Getting adequate sleep, physical activity, and social support are also powerful stress relievers.

Managing chronic pain is difficult. But recognizing how stress contributes to the “vicious cycle” of pain provides opportunities to intervene and feel better both physically and emotionally. As stress is minimized, the body and brain become less reactive and sensitive to pain signals. By calming the stress response, patients can break out of the vicious cycle and greatly improve their pain management.