This blog is part two of a two part series on stress and the role it plays on pain at a physical level and what we can do to better manage it. Part One discusses the systems within your body that are effected by stress and how they relate to pain. Part two will look at some studies on stress in different settings while also looking at some management techniques that may be helpful to use when you are stressed and want to wind down that stress/pain response.
Pain & Stress Studies
Effect of Physical and Academic Stress on Injury and Illness in College Football Players (2016)
What was the study about? This study followed College Football players throughout an academic year and got them to measure their levels of academic stress and physical stress.
What did they find out? The results showed that students experiencing high levels of academic stress had similar rates of injuries as those experiencing high physical stress did. Injuries of smaller physical damage were also percieved to be worse than what they actually were. It also showed that athletes experiencing high levels of academic stress were three times more likely to get injured compared to periods of low academic stress.
What can we learn from this? The important take-away point from this study is the acknowledgement psychological stress can play with relation to injuries and that injuries are not solely related to physical overload. The balancing of stressful physical and academic/work periods with athletes is also something to consider.
Evaluating the Association of Workplace Psychosocial Stressors with Occupational Injury, Illness and Assault (2011)
What was the study about? This study looked at the associations between workplace psychosocial stressors (workplace harassment, sexual harassment, threat of being fired, high workload).
What did they find out? People were more likely to get sick or injured at work if they are experiencing low job satisfaction and morale. The most common morale factors included under-appreciation and poor working conditions. Interestingly, remuneration was not a factor when it came to injury and illness rates in the workplace.
What can we learn from this? The best point you can learn from this study is to simply understand that there is a link between job satisfaction/morale and our health.
Symptoms of depression and stress mediate the effect of pain on disability (2011)
What was the study about? This study investigated the relationship between pain and disability via psychological distress.
What did they find out? People with acute low back pain who reported that they feel “under stress most or all of the time” are 4.45 times more likely to still have back pain at 3 months, compared to those who reported “little or no stress". Approximately 30% of the relationship between pain and disability is dependent on psychological distress.
What can we learn from this? There is a strong relationship between psychological stress and self reported pain levels.
The stress model of chronic pain: evidence of basal cortisol and hippocampal structure and function in humans (2013)
What was the study about? This study examined the associations between basal levels of cortisol collected over seven consecutive days, the hippocampal volumes and brain activation to thermal stimulations administered in 16 patients with chronic back pain and 18 healthy control subjects. The hippocampus is involved with the formation of memories from short-term to long-term and how we respond to events based on past experiences, in particular, those dangerous or painful experiences.
What did they find out? The results found that those patients with chronic back pain had higher level of cortisol which had adverse effects on their hippocampi. These changes to hippocampus were both functional (how it worked) and structural (size/volume). These patients also showed lower thresholds to thermal pain testing compared to the healthy patients. This is apparent without any connection to increased tissue damage.
What can we learn from this? People that are already experiencing chronic pain have an increased likely of further pain or new pain events. This does not mean that those suffering chronic pain have to live the rest of their days this way. The hippocampus one of the only parts of the brain that can regenerate.
Stress Management Strategies
Acknowledgement of stress
The first step towards better management of stress is the acknowledgement that maybe stress plays a bigger role in your pain than you first thought.
Scheduling of non stressful activities
Finding time to actually do the things you enjoy, or even doing nothing at all, can be beneficially to your stress levels by giving your body and mind a chance to wind down.
Getting out your diary/schedule and setting aside an hour here or there can make all the difference.
Get a good night's sleep
There is strong research out there to suggest that sleeping impartments are a predictor of pain. It even shows that someone is more likely to take an opioid based pain reliever. It is believed that disrupted sleep effects our bodies own analgesic systems reducing its ability to reduce pain on its own while making the body more hypersensitive to stimuli.
Some tips for better night's sleep include:
Using the bed for sleep - try avoid watching television or reading in bed.
Setting regular bed times
Monitor levels of caffeine and alcohol
Reduce exposure to blue lights and screens
For a useful handout on sleep hygiene, click HERE
Minduflness is "a mental state achieved by focusing one's awareness on the present moment, while calmly acknowledging and accepting one's feelings, thoughts, and bodily sensations, used as a therapeutic technique"
Slow, controlled abdominal breathing has been found to be effective for quickly reducing stress levels.
Google "breathing exercises" for a really simple 1-minute breathing exercise
Try bookending your days with a 10-15 minute walk. Avoid taking your phone or music devices.
Thank you for reading my blog on the effect stress plays on pain. The key points to take away would be that stress can play a role in many health conditions. It is important that you realise that stress does NOT have to be a normal part of your life and that finding ways to down-regulate the stress response could be pivotal in turning around your pain.
If you think that stress may be playing a role in your pain and would like some help managing it, we can help. Book in with one of our Myotherapists at Bodywise and will can help find the causes of these stresses, but also put together an individualised plan to help you manage your stress, both physically and mentally.
Sources include -
Beyond Mechanical Pain: Stress & Pain by Alison Sim. Available at http://beyond-mechanical-pain.usefedora.com/
Brown LP, Rospenda KM, Sokas RK, Conroy L, Freels S, Swanson NG. (2011). Evaluating the association of workplace psychosocial stressors with occupational injury, illness, and assault. J Occup Environ Hyg., Jan;8(1):31-7. doi: 10.1080/15459624.2011.537985. PubMed PMID: 21154106; PubMed Central PMCID: PMC3979455.
Hall AM, Kamper SJ, Maher CG, Latimer J, Ferreira ML, Nicholas MK. (2011). Symptoms of depression and stress mediate the effect of pain on disability. Pain. 2011 May;152(5):1044-51. doi: 10.1016/j.pain.2011.01.014. PubMed PMID: 21306826.
Mann JB, Bryant KR, Johnstone B, Ivey PA, Sayers SP. (2016). Effect of Physical and Academic Stress on Injury and Illness in College Football Players, J Strength Cond Res. 2016 Jan;30(1):20-5. doi: 10.1519/JSC.0000000000001055. PubMed PMID: 26049791
Vachon-Presseau, E., Roy, M., Martel, MO., Caron, E., Marin, MF., Chen, J., Albouy, G., Plante, I., Sullivan, MJ., Lupien, SJ., Rainville, P. (2013). The stress model of chronic pain: evidence from basal cortisol and hippocampal structure and function in humans. Brain; 136 (3): 815-827. doi: 10.1093/brain/aws371