The Connections Between Stress and Chronic Pain

stress and chronic pain

By Akiyao from the University of Michigan Medical School licensed under CC BY-SA 3.0 , via Wikimedia Commons

The Stress and Chronic Pain Relationship

Medical research and common sense both dictate a correlation between stress and chronic pain. Yet, neither common sense nor medical research can come up with a sure-fire way to combat that stress-chronic pain connection. Chronic pain causes stress which causes more chronic pain which causes more stress and around and around we go. It’s a vicious cycle that no one clearly understands and which no one solution can break.

Chronic Pain Leads to Stress

Chronic pain is defined as prolonged physical pain that lasts for longer than the natural healing process should allow. Often this pain is caused by injuries, inflammation, or nerve disorders. These medical conditions, and the chronic pain that accompanies them, can be very debilitating and often life altering. They can hinder somebody’s normal functioning and ability to move with ease. They may also lead to anxiety, feelings of hopelessness, and depression.

Thus, it is no wonder that people who have a sudden injury, or develop a nerve disorder such as Fibromyalgia, or begin to suffer from the inflammation caused by arthritis, also suffer from feelings of stress. They may have lost their job. They are likely to have limited freedom due to limited mobility. There may be issues with paying bills or maintaining family obligations.

That kind of stress, added to a chronic pain condition, is self-perpetuating. A prolonged period of stress can cause imbalances in the brain that then lead to anxiety and more stress. It is important to get ahead of the stress so that the underlying pain can be properly assessed and treated.

Dr. Steven Stanos of the Center for Pain Management says that the brain tries to maintain a balance when it receives pain signals by minimizing those signals in order to allow us to keep functioning despite the pain. Chronic stress however, can offset that balance.

Maggie Phillips, author of Reversing Chronic Pain, writes: “Whether or not trauma was connected to the event or condition that originated their pain, having a chronic pain condition is traumatizing in and of itself.”

Taking measures to reduce daily emotional and physical stress is essential but often easier said than done.

Meditation, deep breathing exercises, yoga, and tai chi are all ways that one may manage stress. By relaxing the mind a person can also relax their body. It is known that prolonged tension in a muscle group will create physical pain. Over time, stress can build up and will contribute to, and often obscure, the pain symptoms.

As Dr. Carmen Green said, “Patients need to manage their stress to be in the best psychological state to benefit from other therapies.” Professor of neurological sciences at the University of Vermont (UVM), Dr. Victor May confirms “Chronic pain and anxiety-related disorders frequently go hand-in-hand.

Stress Leads to Chronic Pain

Some people suffer with chronic pain not caused by any known physical reason. Rather, their chronic pain is psychological or stress-born. It is real pain nonetheless.

It is widely understood and accepted that emotional stress can lead to stomach problems, irritable bowel syndrome, and headaches. However, most do not know that it can also cause other physical complaints and even chronic pain.
Logically this makes sense. The more anxious and stressed people are, the more constricted and tense their muscles are. Over time this causes the muscles to become fatigued and inefficient.

Unresolved emotional issues or traumatic events can lead to the kind of chronic pain that does not have a physical source. People with PTSD (Post Traumatic Stress Disorder) are often at a higher risk for developing chronic pain. Experts have noticed that experiencing a traumatic event often has an impact on the development of pain.


An expert on trauma, Peter Levine, says that trauma happens “when our ability to respond to a perceived threat is in some way overwhelming.” Webster’s dictionary defines trauma three ways: a) an injury (or wound) to living tissue caused by an extrinsic agent; b) a disordered psychic or behavioral state resulting from severe mental or emotional stress or physical injury; and c) an emotional upset.

During a traumatic event, the nervous system goes into survival mode. Sometimes the trauma is so severe that the nervous system has a hard time reverting back into its normal, relaxed mode. If the nervous system stays in survival mode too long, stress hormones are constantly released. This causes an increase in blood pressure, which then reduces the immune system’s ability to heal. When the body is in constant distress like this, physical symptoms start to appear.

To paraphrase Dr. Bessel van der Kolk, a well-known trauma researcher, “Many traumatized people do not respond to stress the way other people do. Under pressure, they may feel as if they were traumatized all over again.” The nervous system may be unwittingly stuck in survival mode even after one has grieved and processed the emotional impact of a trauma.


Since trauma has been found to have a strong correlation to chronic pain, a combination of psychotherapy and physical therapy would be the most logical pain management option for stress and chronic pain relief. Beginning a daily program of walking can help to mobilize the muscles and is the best way to stimulate the lymph system to do its job and oxygenate injured muscles.

New research offers a potential target for treatment. The study’s findings, published in Biological Psychiatry, show that increased expression of PACAP (pituitary adenylate cyclase activating polypeptide)– a peptide neurotransmitter the body releases in response to stress — is also increased in response to neuropathic pain and contributes to these symptoms.

When the researchers examined the expression of PACAP along one of the nervous system’s pathways to the brain the team members were able to observe where the stress and chronic pain pathways intersected. In addition, Dr. May and his colleagues saw that the anxious behavior and pain hypersensitivity were significantly reduced when a PACAP receptor antagonist — designed to block the response — was applied.

“By targeting this regulator and pathway, we have opportunities to block both chronic pain and anxiety disorders,” says May. “This would be a completely different approach to using benzodiazepine and opioids — it’s another tool in the arsenal to battle chronic pain and stress-related behavioral disorders.”

That arsenal includes medications, Cognitive-behavioral therapy (CBT), Relaxation techniques, Yoga, acupuncture, and massage. Further, it calls for smart lifestyle choices like limiting or eliminating caffeine and alcohol, exercising more, and having healthy sleep patterns.

The link between stress and chronic pain is undeniable. As the understanding of that link grows, so do the methods to combat the chronic stress-chronic pain cycle. The only thing left to do to destroy that vicious cycle is be arming ourselves with the knowledge and weapons research has provided us.