Stress and Chronic Pain

Stress and Chronic Pain

By: Marcia Guy LMBT, CPT

Most people don’t find it odd that a Massage Therapist would ask them about their stress levels. After all, don’t people get massage to relax? But why is a Medical Massage Therapist asking about stress? We certainly haven’t set up a day spa in the office and with the drop table and phone lines going you can’t exactly call the office “serene”. I’ll be the first to admit I’ve not studied the latest relaxation techniques nor is it my intent to send my clients into a doze every time they come in. I’m just too chatty for that. So, why the questions about stress in a medical office that focuses on pain and chronic health conditions? It’s all about the nervous system.

If that doesn’t clear it up, keep reading to learn how it all works.

Stress = Stress = Stress

You see; our body doesn’t compartmentalize stress into work stress, relationship stress, bacterial stress, injury stress, tension stress, etc. Anything that places strain on the mind or body is stress. The stress is then interpreted by the nervous system and a response is generated. So it doesn’t matter if it’s an infection, an argument, a pulled muscle, or a mold exposure, stress is stress.

In a short-term scenario, this relationship is effective and allows us to be reactive to a world that could frequently be dangerous. In modern society however, stress is rarely (if ever) short term, especially psychological stress.

Stress is a Builder

In modern society we like to keep ourselves busy. This doesn’t leave us with the opportunity to properly process our emotions and stressors. We jump from one thing to the next without a pause for breath and it is a favorite past time for many to dwell on past arguments or social blunders. Mentally reliving these scenarios elicits the same physiological response as being in it originally.

When we fail to give ourselves a reprieve, the stress builds; physically and psychologically. This is one reason we see people losing their minds in restaurants over a mishandled order or on the road in traffic. The actual scenario is inconvenient and mild stressful. Combined with a week (or more) relationship/work stress, muscular tension, etc. and our nervous system sends us into full-blown crazy. We may even feel irrational in the moment but we can’t manage to stop ourselves.

Road rage is an example of unmanaged stress cumulating into explosive reactions at inappropriate moments.

But How Does this Relate to Pain?

Stress impacts pain through a few different ways, but it boils down to creating Hyper-Irritability in the nervous system. This in turn sensitizes the nerve receptors, creates tension, and creates chronic conditions. Let’s take a moment to look at each of these.

Nerve Sensitization

When we have chronic stress, we are constantly bombarding our nervous system with information. Over time, this causes Hyper-Irritability. In this condition, the level of input required to trigger a sensory receptor to fire is reduced. This in turn means that pain receptors are faster to respond to stimulation, we feel pain sooner and for more minor things. Even pressure receptors can start to misfire and register pressure as pain.


Tension comes on in two pathways. The direct pathway is the psychological link between stress and our body “tensing for the blow”. Tensing is a protective mechanism. When our body senses it is under threat it tenses up to prepare us for whatever danger is at hand. 

The secondary pathway ties back into the condition of Hyper-Irritability. When the nervous system is in this state, it begins to send out low-grade motor signals. This in turn causes generalized tension either throughout the body (for general psychological stress). Or if the stress is localized in an organ or muscle, it will irritate that specific nerve branch and cause tension in the muscles associated with that pathway.

Either way, when a muscle is tensed for a long time, it can start to put pressure on the blood vessels that pass through it. In this way it can reduce it’s own blood supply. With less blood comes less oxygen (which can cause pain), less nutrition (preventing proper cellular maintenance), and poor waste removal (which can cause pain).

There are also muscles in the body with nerves passing through them. Tension in these muscles can cause the nerve to become entrapped and lead to pain. Classic examples include Thoracic Outlet Syndrome and Piriformis Syndrome.

Chronic Conditions

One easily attributed condition is the development of trigger points in the muscles. These specialized knots refer pain to not only the area around themselves, but also areas completely removed from their actual location. Trigger Points in the muscles of the neck are a frequent culprit in tension headaches.

However, we also have Hyper-Irritability impacting the organs as well. This can open us up to a whole host of concerns such as IBS, acid reflux, and even heart concerns. When we remember that our GI tract is lined with muscle and our heart is a muscle, we can see why it’s so problematic that our nervous system can be sending out non-specific motor signals that tell anything down the line it should be contracting… constantly.

So What Do We Do?

Functional Medicine can be a great place to look, especially if you have developed chronic disease. Part of the process in determining the cause of your condition is evaluating any environmental factors that could be at play, such as mold, latent infections, etc.

If you know you have pain, poor posture, and/or have taken a jolt (auto accidents, falls, trail riding, etc.) chiropractic care can manage those physical stressors a misaligned skeleton can place on the muscles, ligaments, and nerves.

If you have pain, poor posture, and know you’re tense; massage can help pacify the nervous system, loosen restricted muscles, and restore proper blood flow. Adding on hot stone massage or a heat pack can increase these benefits for people dealing with a Hyper-Irritable nervous system as heat has a sedative effect on the nerves.

But What Can You Do At Home?

Things like Thai Chi, Meditation, and diaphragmatic breathing are all ways we can reduce our stress levels.

Manage environmental factors, a clean home is literally a healthy home. Additionally, exercise has been shown to be highly effective at managing stress and anxiety (even conditions such as PTSD). Regular, low intensity, aerobic exercise is generally recommended as the best option. This includes things like daily walks or Thai Chi. One direct way this helps is by strengthening the heart and reducing our resting heart rate. An elevated heart rate can be interpreted by the body as a stress signal and trigger anxiety.

We can also practice Meditation to reduce our psychological stress. Studies have shown that regular meditation can shrink the amygdala, which is the “home” of our stress response. Studies have also shown it increases the size of helpful areas of the brain. Watch a great TED Talk from Neuroscientist Sara Lazar here

A third option is Abdominal or Diaphragmatic breathing. This is best done lying down on our back (so we can’t slouch and cut off our diaphragm). We then place a hand on our belly button and breath so we raise our belly with each inhalation. Once we get the hang of this we shift our hands to be on either side at the bottom of the ribcage. Continuing to inflate the belly, we want to make sure we are expanding the sides of our ribs as well. This second part can take some time to figure out so don’t stress it if you don’t get it at first. This is the fastest way to effect your stress levels but also has the shortest impact.