Chronic Stress and Pain: A Rationale for Stress Management Approaches

Although it is widely accepted that chronic stress contributes to the continuation of chronic pain, it is not commonly understood the mechanisms by which stress affects pain. Stress is also a factor which is infrequently considered during pain rehabilitation. This article describes the physiological responses to stress and their impact on chronic pain.

Any fear or perceived threat to safety causes hormones to be released into the bloodstream (e.g. epinephrine, norepinephrine and cortisol) which promote survival. These hormones have several effects including modulating inflammation and consolidating fear-based memories (to aid future survival and avoid danger).

These reactions are considered adaptive in the short-term but maladaptive responses (e.g. catastrophising, anxiety, helplessness) to stressors may amplify cortisol production which can result in an increased physiological stress response. This exaggerated stress response results in dysfunctional hormone secretion, widespread inflammation and pain.

Although some stress is inevitable in life, people are capable of changing how they perceive and respond to stressful situations. Given the similar mechanisms of a maladaptive response to pain-related, and non–pain-related, stressors, therapists should consider including stress management as a means to prevent chronic disability, and improve quality of life, in people with musculoskeletal pain.