What's The Stress About Pain

If Pain = damage, does more pain = more damage? If I am in severe pain due to a back injury, I can’t bend and I can’t walk, it must mean I have a serious disc injury? Not always.

There was a famous incident of a man who shot a nail from a nail gun into his shoe. He felt searing pain through his toe and was floored by the pain. He was unable to walk and had to be carried into the emergency department. In the ED, the medical team were unable to take off the shoe (due to the gentleman’s high levels of pain) and got an x-ray done with the shoe on. They discovered the nail was lodged between his toes and had missed the toe completely. Once they had informed the man about this, his pain level settled.
It is important that we first rule out structural causes to the pain – whether it be a nail puncture injury, fracture ankle, significant disc injury, ligamentous sprain, cancer, etc. Once structural injury can be ruled out, then we need to investigate why a patient is still experiencing pain in the absence of damage (or out of proportion to the damage present).
Now remember, this man was experiencing real pain. He wasn’t imagining it, he wasn’t faking it. Real pain in the absence of damage. How does this work? We will discuss a few mechanisms below:
  1. There are nerves in the body which are called damage receptors – they sense damage to an area. They send a signal to the brain which then interprets the signal. This can be influenced by numerous factors – fear, stress, past experiences, beliefs, etc – and then produces a signal which we know as pain. In the previous example, the gentleman’s high stress and fear created a pain signal.
  2. The amount of pain we feel can be linked to the amount of damage we think we have done. The body has a natural reflex. Whenever a body part is in pain, we avoid using it and protect it. While this is a good mechanism if we have just fractured our ankle, it can backfire on us sometimes. Overprotecting an injury (excessive protection or protecting it beyond its normal healing time) can cause bracing and increase muscle tension. This can be conscious or subconscious. Muscle bracing can be a big driver for ongoing pain.
  3. There is also a chemical phenomenon related to stress that increases pain. When you are stressed (or not sleeping well, or feeling down mood-wise), your body produces more cortisol which is a “stress hormone”. This cortisol then turns up the volume on your nervous system (the same as turning up the volume dial on your stereo), meaning any small niggles will be amplified. It’s no coincidence that athletes are more prone to feeling niggles in the lead-up to a big race which they are stressed about.  In essence, stress primes your system to feel pain meaning less of a nasty stimulus results in heightened pain response.
So, what does this mean for me??
If you are in pain, it is important to first get a diagnosis and rule out structural injury.
Unfortunately, most other experiences of pain aren’t as polarised as the above examples. You may have a sprain in the back that is sending off some damage signals and the stress from having the pain amplifying that signal, increasing your pain from a 4/10 to an 8/10. Most often treating the back injury will resolve both the pain and consequently the stress.
In other cases, if stress is contributing to your pain, managing the stress allows your body to naturally heal. Some suggestions include cardiovascular exercise, modifying it if needed, (Getting your heart rate up which causes the release of serotonin, the feel good hormone which counteracts the stress hormone), getting decent sleep, meditation, spending time with people who make you feel good.
If pain is weighing you down, give us a call and we can arm you with the tools and knowledge to get you back to your peak.