Stress and pain are collective experiences. One of my favorite quotes on pain is from Dr. Adriaan Louw, “Pain isn’t a protocol. Pain is a human lived experience.”
As a physical therapist it is common to hear a patient speak on how their pain increases during stressful moments or experiences. Increased pain can lead to more stress which may lead to fear of the body being more damaged, loss of hope, avoidance of movement, worry, and lack of confidence. This all sets up a vicious cycle of pain sensitivity and disability.
However, pain is multidimensional. There are many many more factors than we have given it credit for. As well, your body is resilient and adaptable! Too often health care practitioners have defaulted to handing out protocols for patients, and not diving into the experience behind one’s pain.
Researcher and Physiotherapist, Peter O’Sullivan explains pain well, “It is now widely acknowledged that the experience of pain is not simply an incoming message regarding tissue “damage” from the periphery (body). Instead, the pain experience reflects the person’s assessment of how dangerous a particular input is, on the basis of not just the intensity of the input but also the person’s prior experiences, beliefs, and contextual factors.”
This helps explain why a diagnostic scan, doesn’t always explain why pain persists.
Stress influences pain through the nervous system. Strategies to reduce stress and calm the nervous system are tremendously helpful. Another beneficial approach when your pain increases during stress is to first consider your experiences, beliefs, and context. Professor Lorimer Mosely tells a brilliant story about his own experiences regarding pain in this video. He refers to pain as danger detectors. He states, “Pain depends on protection index not true danger index, because it’s up to the brain to decide.”
You may be under more stress which increases your pain, but what does that tell you about your pain? How you respond to this danger detection is influenced by your past experiences, your beliefs about pain and your body, lifestyle factors, your health history, and social support. If your pain increases when stressed, I encourage you to sit down with your physical therapist and consider these 8 questions.
Identify the Stressors, can they be reduced?
Stress is part of life. No one can eliminate it completely. For you personally, can you identify one or two main stressors that can be reduced in some capacity? This gives you a starting point to build on.
What are you most worried about with your body?
Declaring this out loud can be powerful. What are you most worried about? Talk through it with your physical therapist who should empathetically listen without judgement. This worries vary widely for each person and can be deeply personal so make sure you have a trusted source to talk to.
What activities do you value? Can you make time for them?
What brings you joy? What activities do you enjoy? Is this something you have been missing or avoiding? Is there a way to bring this back in to you life?
Can you gradually expose yourself to more movement?
Do you believe movement is threatening and should be avoided ? Learning to move again with controlled exposure in the presence of a physical therapist will reinforce your resiliency and confidence in your body and in movement. Movement without fear helps you reinforce the belief that your body can be sore but safe and pain does not always equal harm.
What is your mind broadcasting about pain?
This dives in to what your beliefs are about pain. Negative beliefs about your body, moving in a protective manner, and avoid activity feeds into more distress and hypervigilence about pain. Observe where your thoughts are regarding pain. Are they helpful or hurtful thoughts? If you hold on to this thought tightly does it help you return to the life you want? If you let this thought tell you how to act will it take you toward your goals or keep you suffering? If you stop moving to avoid pain will that keep you from your goals or move you toward them?
What lifestyle factors can you change to help you along?
Lifestyle factors like nutrition and sleep can play a role in stress and pain. Sleep influences psychological and emotional well-being as well as physical health and healing. Poor sleep is a high predictor of disabling pain. Studies show Insufficient sleep quantity or quality is an independent risk factor for neck pain and low back pain.
According to The American Sleep Association, 50-70 million American adults in have a sleep disorder. If sleep is something you struggle with then consider the following tips for improving sleep quality.
How’s your support system?
What are your perceived barriers to engaging in the life/activity you want? How is your support around this desire? What are your personal goals and expectations to achieving this goal? What kind of social stress or pressure are you under? How does that play into your stress and pain levels? One’s cultural and socioeconomic status are factors to be considered respectfully by your therapist as you discuss your support system.
Do you believe in your own resilience?
Do you believe in your body’s ability to adapt and be resilient? Or do you see it as broken and needing to be fixed.
A patient recently told me she’s been to 4 other PT’s before me. Three of them took her through a list of exercises and one told her he knew exactly what was wrong and could fix her. None of it worked.
However are you as patients really problems to be fixed or people who need to be heard? My personal bias is that each patient in my clinic has more power to change themselves than I do in fixing them.
JOSPT recently reported, “the clinical message must go beyond the idea that the patients weak, deconditioned, or frail (body part) is the basis of his or her pain, and all the patient needs to do is to get strong.” In the past 20 years the language of the Physical Therapist has been about fixing the body. I apologize for any provider that has pointed out all thats wrong instead of showing you the capability inside of you. In order for you to believe in your resilience, your provider also needs to believe it.
Just like pain, there is no protocol for resilience. These questions are meant to help you dive into your pain response during stress, form an alliance with your physical therapist, and give you a framework for moving forward with confidence!