Pain and stress impact us all. Our bodies, particularly our immune system are physically affected as well. This article looks at how our body’s self-regulating systems are influenced by stress.

Pain can be stressful, and stress can be painful!!

pain and stressThe International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.”
Stress can be viewed as a psychological phenomenon which is the degree to which one feels overwhelmed. It is a feeling we have all experienced. Stress is also a physical response which indicates the body and brain are overloaded. This physical response has the potential to affect the entire body.

Acute and Chronic stress

Acute stress is not a bad thing, it is beneficial for us to activate the fight/flight response (for us to run away from danger or threatening situations). However, when activated too long or too often, the fight/flight response causes changes to the brain and other organs of the body. This becomes chronic stress that affects brain size, structure and networking neural pathways.

When we experience constant stressful situations, the adrenal gland releases the stress hormones cortisol, adrenaline and noradrenaline. This action is triggered by the Hypothalamic Adrenal Pituitary (HPA) axis, a complex network of signals between the endocrine system of the brain and the kidney. When the brain perceives a stressful situation, the HPA axis releases cortisol which specifically prepares the body for action and to face the stressful situations. However, constant high levels of cortisol in response to chronic stress increases the neural activity with the amygdala, the fear and emotional centre of the brain.

Increased prolonged levels of cortisol also negatively affects the hippocampus, the area of the brain responsible for memory and learning and stress control. Cortisol, Noradenalin and Adrenaline travel through the bloodstream and to the heart where Adrenaline makes the heart beat faster and raises the blood pressure over a prolonged period of time, leading to hypertension and eventually chronic heart disease.

adrenal glands and the cortex combination with the kidneys

National Cancer Institute

the limbic system showing the various sections in the brain

Impact of stress on the body

Cortisol causes the lining of blood vessels to function abnormally and over time will cause cholesterol build-up of plaque and eventually atherosclerosis that causes obstruction to the blood vessels. These changes increase the chances of a heart attack or eventually a stroke.

When the brain senses stress, it sends signals to activate the autonomic nervous system (fight/flight or rest and digest response). This connects via a complex network of nerves to the “gut brain,” or intestinal nervous system. This brain-gut connection causes the sensation of “butterflies in the stomach” and can also affect the smooth muscle contractions in the gut, thus leading to poor digestion and movement of food and eventually irritable bowel syndrome (IBS). So the gut becomes more sensitive to acid and symptoms such as heartburn can also be felt with stress.

Chronic stress has also been found to affect one’s body mass or weight. Cortisol causes an increase in appetite and tells the brain and the body to increase the intake of foods rich with carbohydrates in order to increase the energy levels. This eventually causes deposits of deep visceral (organ) or belly fat. Fat cells surrounding the belly also can release immune system chemicals or inflammatory proteins called cytokines which circulate in the blood. This can increase the risk of developing chronic diseases such as heart disease and insulin resistance, which leads to diabetes.
Chronic stress also causes dysfunction of the immune cells and dampening their response to infection. One becomes more ill due to the poor susceptibility of immune system to fight off these infections and slows down the rate of healing. This is why we tend to feel sick when we are stressed and are more susceptible to getting sick.

Other more acute symptoms one can experience with chronic stress include acne, hair loss, headaches, sexual dysfunction, muscle tension, fatigue, anxiety, depression and irritability.

Managing Stress and Pain

What matters in life is how we cope with stress. Stressful situations are common and there is no way to avoid them. If we can teach our brain to view these perceived stressors as challenges, we can perform better day-to-day and in the long term, help our brain and body stay healthier and function optimally. stress management is a multi-faceted programme

There are many ways to reduce excessive cortisol levels in the stressed brain. The most powerful being regular exercise, mediation and mindfulness. Breathing exercises have been found to be most effective in lowering the fight/flight response and decreasing chronic stress levels and increasing the size of the hippocampus by assisting to improve one’s memory.

Other techniques that can help with combating chronically high levels of stress (and resultant pain) include developing good sleep hygiene practices, participating in hobbies or activities which are enjoyable, goal setting to achieve tasks or establishing a daily routine to manage unhelpful stress.

Physiotherapists are excellent at down-regulating the nervous system through specific techniques and providing helpful information in order to cope better with pain, stress and a poor immune system.

This article was prepared by Henuti Daji who practises at the Woodmead branch of Lamberti Physiotherapy. Contact her to chat through issues you may be experiencing due to stress. Book an appointment with her by completing an online form.

• Train Pain Academy Manual for Module 5: Pain and Stress, exploring the immune system and other self-regulating systems. Course attended on 29-30 January 2022 and presented by Gabi Prinsloo and Jacqui Koep.
• TED-Ed talks on Youtube: How stress affects your body narrated by Sharon Horesh Bergquist.
• TED-Ed talks on Youtube: How stress affects your brain narrated by Madhumita Murgia.
• TED-Ed talks on Youtube: Does Stress affect your memory? Narrated by Elizabeth Cox.