In 2013 The Journal of the American Medical Association (JAMA) published a study covering 34,000 office visits to 1,200 physicians. Surveys from the study reported that as many as 80% of these office visits included patient complaints of stress. That probably isn’t news to our readers because all of us feel some degree of stress, especially those living with chronic pain. But, what is concerning is that only 3% of those visits included any amount of stress management counseling by the physician. Why do I think that this is an important topic to write about? Because research also suggests that 80% of all physician visits include a complaint of chronic pain. High stress is associated with depression, anxiety, obesity, blood pressure, and heart disease. Chronic pain is associated with depression, anxiety, obesity, blood pressure, and heart disease. One explanation for the overlap in symptoms may be the way in which the brain sends signals throughout the body to protect itself. Consider the definitions of both stress and pain:
Stress: a state of mental or emotional strain or tension resulting from unpleasant or very demanding circumstances
Pain: an unpleasant emotional and sensory experience associated with actual or potential tissue damage or described in terms of such damage
Both definitions include the terms “emotional” and “unpleasant”, and research shows that similar areas of the brain are affected in similar ways by both pain and stress. Simply put, chronic pain and stress are both ways in which our bodies let us know that something isn’t right. The sensations alert us that change is required – either we change what we’re doing (alter) or change how we handle the stressor (adapt).
Hopefully I’ve made it clear that pain can cause stress and stress can cause pain. It’s a bidirectional relationship, or what some patients call “a vicious cycle.” It is not my intent to suggest that people living with chronic pain should just “take a deep breath,” but I do think it’s important to understand that managing stress may help manage pain. The American Psychological Association recommends the following tips for stress management:
Smile and laugh
Find social support
Those of you who have attended The Doleys Clinic Pain Cornerstone Class, have read the blog, have read Dr. Doleys’ book, or have ever had a conversation with Dr. Cianfrini will recognize several of these recommendations. Not only do the symptoms of stress and pain overlap, but so do the treatments. This is why the program at The Doleys Clinic includes psychological counseling, physical therapy, and education – these components are the “more than medicine” part of our advertising tagline.
In 2016, results from a 10 year study were published in which chronic pain patients participated in 20 sessions over the course of 10 weeks. The sessions included education, behavioral therapy, exercise, and self-management skills. 214 patients were measured across 10 outcomes including pain intensity, experience, depression, anxiety and disability and all outcomes improved regardless of the specific pain diagnosis.
New patients often ask why our clinic so strongly encourages education for self-management, mental health therapy, and home-based exercise programs. It’s because research supports that one therapy alone is not enough to properly treat chronic pain. In the wake of the “opioid epidemic,” restrictions on prescribing and insurance coverage for pain medications are tightening daily. You’re feeling the pressure, we’re feeling the pressure. We don’t want you to struggle alone. We’re excited to help you take advantage of other therapies for managing stress, managing weight, managing life, and managing pain.
Yours in Good Health,