Stress, Pain, and the Brain

If you have been to a physical therapist, they have probably asked you what makes your pain worse. We hear all sorts of responses to this question. Some, like squatting, throwing, running, bending any which way, may not surprise you. However, some responses leave us in amazement of how individualistic pain truly is, like watching the news or checking work emails.

While we used to think that pain was strictly due to what is happening in our tissues, we now know that this simple explanation cheapens the complexity of pain. All sorts of aspects about our personal stories contribute to our individual pain experiences, including our stress levels.

Let’s say you hurt your neck. Your tissues sense that injury and send danger signals along your nerves to your spinal cord. When those signals reach your spinal cord, the nerves there deem the message important enough to pass along to the boss upstairs, the brain. Once the message arrives at your brain, the pain alarm is sounded so you can react appropriately to this potential danger. However, when that message is still in the spinal cord, it has the chance to either be dampened or amplified, in part due to stress.

When stress hormone levels are temporarily elevated in our bodies, those danger signals are dampened. We’ve all heard stories of war heroes carrying their buddy for a mile despite having a broken leg, or moms finding superhero strength to lift car debris off their kids after an accident. Sometimes we have bigger things than pain to worry about, after all!

However, when stress hormones are elevated for longer periods of time, from one day to years, they tend to amplify danger signals in the spinal cord. So, by the time these messages reach the brain, they are a lot stronger and the brain will react accordingly, anticipating a bigger threat and therefore sounding the pain alarm sonner and louder. In short, stress has the potential to make pain worse. It can even cause previously non-painful motions or sensations to be interpreted as painful, such as cold temperatures or gentle pressure. So what can we do about it?

2020 has been a rough one for most, if not all, of us. Maybe you had some tried and true coping mechanisms B.C. (before COVID) that are no longer available to you because of the restrictions we are all living under. This is a time in which we are all being forced to cope in new ways, and I have one idea that might help: mindfulness. 

Mindfulness is simply the practice of intentionally paying attention to the present moment with openness and non-judgement. I find that people often have the misconception that mindfulness is used to reach a certain goal, like relaxation or emptying the mind. In fact, it is quite the opposite. Mindfulness is accepting what is in front of you for exactly what it is in that moment, good or bad. This practice has been shown to positively affect pain, likely because it reduces stress. You can use any of your five senses to be mindful at any point in your day. For example, right now close your eyes and see what you can hear. What is the closest sound to you? What is the farthest away? Or maybe you want to use the sense of vision. When you are standing in line, make it a habit to notice what the floor is made of or the shoes of the person in front of you (again, emphasis on non-judgement here). You can also use your sense of touch. Whenever you wash your hands, something we are all doing a lot of these days, pay attention to the slickness of the soap, the temperature of the water. These are what we call informal practices, or ways to inject bits of mindfulness into your everyday life. Try starting with one tactic and sticking with it for a week. See what happens!

There are, of course, formal practices as well. These are the practices for which time is dedicated to being still and meditating. Research shows that just a few minutes a day is enough to decrease stress. There are plenty of resources to help you start dabbling in meditation, like the Calm and Headspace apps or good ol’ YouTube. Here’s  a breathing meditation one you can give a try today.

Still curious? Check out this TEDx youTube video by Lorimer Moseley for more fascinating information about the bran and pain

Be well,

Alexandra Mohamadi, PT, DPT

Adapted by Kathryn Thornburg, DPT, OCS, FAAOMPT