Stress and Pain
Excerpt from the September 2000 issue of The Newsletter of The American Institute of Stress
Pain causes stress, which in turn can cause physical and physiologic responses that worsen pain. This may result in a self-perpetuating chain of events that persists until either stress or pain is abolished or one of the links in the chain is broken. Much like the chicken and the egg, it can sometimes be difficult to decide which came first.
For example, back pain can result from stress induced muscle spasm that causes pressure on a nerve. This pain can lead to more stress and muscle spasm that further impinges on the nerve. The increased pain causes more stress and the cycle of pain ¬ stress ¬ pain is repeated over and over. Or the process might have started with a pinched nerve due to arthritis or a herniated disk causing pain and subsequently stress-related muscle spasm. This could worsen the original problem leading to the same sequence of events. In either situation, analgesics to relieve pain, tranquilizers to reduce stress, or muscle relaxants to prevent spasm could interrupt this vicious cycle to provide permanent relief.
The same scenario may take place in patients with painful peptic ulcers. Emotional stress increases the secretion of acid and enzymes that produce ulcerations in the stomach and duodenum. The resultant pain causes stress and more ulcerogenic chemicals are released, resulting in increased pain and the pain ¬ stress ¬ pain ¬ stress sequence of events becomes established. Other examples involving the cardiovascular and immune systems could also be cited as illustrations of how stress can cause symptoms that in turn create more stress that intensifies these complaints.
However, we all respond to stress differently and some reactions can be exactly opposite to what one would expect. Severe stress can reduce or even completely prevent pain, especially when the problem is due to a sudden traumatic injury. This well known paradoxical phenomenon has provided important insights into the complex interrelationships between stress and pain, and the intriguing role of endorphin-like compounds.
Paul J. Rosch, M.D., F.A.C.P.
President, The American Institute of Stress
Clinical Professor of Medicine and Psychiatry
New York Medical College
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