Pain and the Stress Cycle
By Dan Taylor, LPC, LMFT, CPPThere is a significant link between negative stress (distress) and pain. Although there is some debate about whether stress is caused by outside factors (stressors) or one's perception of such factors, there is clear evidence that stress produces physical, emotional, and behavioral responses.
Under stress, all the body systems are affected. When one perceives a threat to his well-being, his blood pressure increase, his heart-rate quickens, his digestive track shuts down, his eyes dilate, his hearing improves, his muscles tighten, and his entire body chemistry changes. Under constant stress, these heightened bodily responses take their toll in illness and bodily dysfunction.
Stress causes a change in behavior. Because of the energy required to cope with the stress situation, an individual usually exhibits more non-productive behavior. Stress or "reactive" behavior results in worsening the situation and causing more stress.
Emotionally, stress manifests in increased depression, anxiety or hostility. Certain emotions usually match reinforcing behaviors. A depressed person commonly withdraws from others and increases the awareness of "feeling along." Displays of anger results in reactions from other, and anxious behaviors often obsess on the fear to the point of being fearful of fear itself.
The Derogatis Stress Profile includes concerns about one's health as one of the three environmental stressors, along with job and family concerns. This explains the "double-bind" or cycle between stress and illness. Pain patients with significant or long-lasting pain become stressed over their condition. They become anxious about ever finding relief and depressed at the limitations placed on their life. There is justified anger about the "unfairness" of life. The behavior of the patient and even each family member is adjusted, especially if the pain last beyond the usual course of healing or over several months.
The most noticeable manifestation of stress is increased physical discomfort. The physical changes, especially, the increased muscle tension magnifies the pain and decreases the individual's tolerance. This cycle compounds the patience pain level and overall mental outlook.
Stress management is obviously a critical element in an affective treatment plan for chronic pain patients. An assessment of the patient's coping skills, thinking and belief patterns, and behavioral reaction to pain is important for outlining appropriate treatment. Cognitive therapy that examines defeating and often irrational thought cycles is a proven and preferred approach. Biofeedback and stress management through the use of individual or group therapy is essential in helping patients develop adequate skill for handling difficult situations skills.
An interdisciplinary approach to the treatment of chronic pain includes the use of various treatment modalities including medical treatment, physical therapy, education, assessment, and psychological services as needed. Stress management is a critical element in determining a lasting, satisfactory treatment outcome.
CME Links
Continuing Medical Education - Main Page Fibromyalgia and Myofascial Pain Epidural Blood Patch Stress Management