A recent fibromyalgia study looked at the effects of stress on pain and cortisol levels. Interestingly, higher pain levels were not necessarily associated with greater stress but higher stress levels were associated with increased pain. That suggests, of course, that in some people increased pain is associated with increased stress but in others it is not necessarily.
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[/fright]Psychoneuroendocrinology. 2015 Sep 21;63:68-77. doi: 10.1016/j.psyneuen.2015.09.018. [Epub ahead of print]Stress exacerbates pain in the everyday lives of women with fibromyalgia syndrome-The role of cortisol and alpha-amylase. Fischer S1, Doerr JM1, Strahler J1, Mewes R2, Thieme K3, Nater UM4.
Cortisol - a key stress response hormone, however, was not associated with increased stress and pain. Reduced cortisol has been associated with childhood trauma and increased pain in FM. My guess is that they were looking at the wrong stress response axis, though; if they had looked at the autonomic nervous system they might have struck gold.
The Real Stress-Pain Axis?
Dr. Martinez-Lavin has proposed that over-activation of the sympathetic nervous system fibers leaves nerve cell bodies called the dorsal root ganglia (DRG) in a hyperexcitable state in fibromyalgia. These ganglia are the last way stations for sensory input from the body before it reaches the spinal cord. Martinez-Lavin believes these nerve bodies are overloading the spinal cord with pain signals. He has suggested that infections (herpesviruses loves these tissues) could be driving this activity. (He's also proposed that increased activity of the sodium channels that transmit pain signals in the DRG could be present.
Whatever the cause, he believes that stress in the form of epinephrine is causing these nerve fibers to sprout more fibers. The more upset or stressed you get the more nerves fibers are formed. The more nerve fibers that get formed the more sensitive they become. It's a chronic pain vicious circle.
Reducing Stress AND Pain?
The Buddhist approach used in the Mindfulness Stress Based Reduction uses meditation and yoga to reduce stress-related thoughts and alter, interestingly enough, autonomic nervous system functioning. One goal of the practice is to view pain as a sensation - not as something inherently upsetting....This, of course, takes some training
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This recent FM study finding suggests that practices like this might be a good idea. These practices are no panacea but they can be helpful. A recent review found MBSR studies may be useful in reducing pain, insomnia and irritable bowel syndrome. Small to moderate effects were found in asthma, fibromyalgia and tinnitus. More study is needed.
Conclusion
The stress-pain response is a real one in people experiencing chronic pain. (It doesn't appear to be operative in people without chronic pain.) Studies have found that even such extreme pain conditions as allodynia can be worsened by stress. Why this is so is not clear but a number of hypotheses have been suggested including inflammatory damage to pain receptors, autonomic nervous system dysfunction and increased muscle tone.
Studies suggest that calming techniques that reduce stressful thoughts may help. More work needs to be done, however, to understand the stress-pain connection and develop effective therapies to address it.
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Cortisol - a key stress response hormone, however, was not associated with increased stress and pain. Reduced cortisol has been associated with childhood trauma and increased pain in FM. My guess is that they were looking at the wrong stress response axis, though; if they had looked at the autonomic nervous system they might have struck gold.
The Real Stress-Pain Axis?
Dr. Martinez-Lavin has proposed that over-activation of the sympathetic nervous system fibers leaves nerve cell bodies called the dorsal root ganglia (DRG) in a hyperexcitable state in fibromyalgia. These ganglia are the last way stations for sensory input from the body before it reaches the spinal cord. Martinez-Lavin believes these nerve bodies are overloading the spinal cord with pain signals. He has suggested that infections (herpesviruses loves these tissues) could be driving this activity. (He's also proposed that increased activity of the sodium channels that transmit pain signals in the DRG could be present.
Whatever the cause, he believes that stress in the form of epinephrine is causing these nerve fibers to sprout more fibers. The more upset or stressed you get the more nerves fibers are formed. The more nerve fibers that get formed the more sensitive they become. It's a chronic pain vicious circle.
- Turning Stress into Pain: A Fibromyalgia Primer by Dr. Martinez-Lavin Pt I – Pain
- “How Stress Becomes Pain in Fibromyalgia” Pt. II: the Autonomic Nervous System
- The Fibromyalgia Mimics – When Your Pain is Not Due to FM: How Stress Becomes Real Pain #3
Reducing Stress AND Pain?
The Buddhist approach used in the Mindfulness Stress Based Reduction uses meditation and yoga to reduce stress-related thoughts and alter, interestingly enough, autonomic nervous system functioning. One goal of the practice is to view pain as a sensation - not as something inherently upsetting....This, of course, takes some training
....[fleft]
This recent FM study finding suggests that practices like this might be a good idea. These practices are no panacea but they can be helpful. A recent review found MBSR studies may be useful in reducing pain, insomnia and irritable bowel syndrome. Small to moderate effects were found in asthma, fibromyalgia and tinnitus. More study is needed.
Conclusion
The stress-pain response is a real one in people experiencing chronic pain. (It doesn't appear to be operative in people without chronic pain.) Studies have found that even such extreme pain conditions as allodynia can be worsened by stress. Why this is so is not clear but a number of hypotheses have been suggested including inflammatory damage to pain receptors, autonomic nervous system dysfunction and increased muscle tone.
Studies suggest that calming techniques that reduce stressful thoughts may help. More work needs to be done, however, to understand the stress-pain connection and develop effective therapies to address it.
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