Management of Stress and Chronic Pain

25th June 2007 at 02:35 BST by Dr C.A.Jenner MB BS, FRCA. Permalink.

This article discusses the management of stress in chronic pain.

Management of Stress and Chronic Pain

Introduction

Chronic pain is typically defined as a pain that does not subside after a natural healing period of three months and fails to respond to medication. Such pain often raises blood pressure and increases the chances of a heart disease to a major extent.

A vast series of factors contribute towards the development of chronic pain, including physical and behavioral reasons such as what we think, feel and do.

Stress – The Concept

Stress is typically defined as a state of affair involving a demand on the physical or mental energy of an individual. It is basically a condition or circumstance that can disturb the normal physical and mental health of an individual.

Experts also define stress as a perceived ability to cope with an unpleasant or painful situation. Stress can basically occur in three different forms, including:

• Negative - In the form of anger, anxiety or anxiety over jobs and over-committed lifestyles
• Positive – In the context of a positive experience such as a job promotion or marriage.
• Neutral – Feelings felt in seemingly neutral situations, e.g. while absorbed in a job. Stress might not be actually felt but the physical activity may lead to the same.

Stress and Chronic Pain

Stress is one of the most common behavioral factors that interact with physical factors in the perpetuation of chronic pain. When an individual is stressed out the reaction is physical as well as behavioral. In fact, the experience of pain is so stressful in itself that every chronic pain patient experiences stress to some degree.

In addition, stress interacts with chronic pain associated with different conditions in varied ways such as low back pain, temporomandibular dysfunction (TMD), headache, neck pain and irritable bowel syndrome.

Persistent stress of chronic pain can actually affect the nervous and immune system. Coping with chronic pain can also cause depression and make the brain perceive all the more pain.

The Vicious Cycle

Stress is often termed as both, the cause and effect of chronic pain.

Pain is basically made up of two different kinds of factors, physical and psychological. The physical factors include the actual cause of pain and the stimulants associated with the same.

Meanwhile, psychological factors mainly occur according to the brain's perception of pain. Research shows that human pain can be reduced or aggravated based on the manner in which it is perceived by the brain.

When an individual is affected by chronic pain, he comes under a strong bout of stress. Inability to continue work in a normal fashion, loss of friends and social activity and other such factors contribute to the overall stressful situation. This stressful environment, in turn aggravates the chronic pain. Eventually, this cycle again leads to stress, thereby signifying the onset of a vicious cycle the patient is trapped in.

Stress Management for Chronic Pain

Stress management skills are extremely crucial for dealing with chronic pain. In fact, stress management skills can even control pain in individuals who do not feel as if they are stressed.

In this section, we've discussed some of the main methods for stress management in patients with chronic pain.

a) Pharmacologic treatment

There are a series of medicines available which have a soothing effect on the patients suffering from chronic pain. These include drugs such as NSAIDs, tranquilizers and sedatives.

b) Non-pharmacologic treatment

In addition to medicines, there are a vast series of non-pharmacologic measures advised for stress management in patients of chronic pain. Non-pharmacologic forms of treatment have a major advantage over the medications, as they do not carry the risk of side effects and adverse reactions.

The main forms of non-pharmacologic treatment include:

• Yoga
• Massage
• Acupuncture
• Osteopathy
• Pilates

c) Bio-Behavioral Pain Control

The skills of bio-behavioral pain control are designed to teach patients control over their behavioral and physical reactions that play a role in the everyday life situations. Research has indicated these skills to be extremely important in management of stress-related chronic pain.

The most important amongst these are:

• Deep diaphragmatic breathing
• Progressive muscle relaxation training
• Imagery
• Cue-controlled rapid relaxation
• Cognitive therapy for stressful situations
• Guided mastery of stress/pain-management application
• Biofeedback for physiological self-regulation of pain

Appointments and more information

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