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Stop the Stress-Pain Connection : How Does Stress Affect My Pain?

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Stress results in high levels of Cortisol in the body, which can increase heart rate, blood pressure, LDL cholesterol and triglyceride levels. Without Cortisol, you could not possibly survive an emergency, as it literally gives you super-energy in the form of blood glucose and causes other changes in the body that help the “fight or flight” stress response. In other words, it keeps you pumped so you perform optimally at the time.

But when Cortisol levels are elevated for a while, that creates a gradual and steady cascade of harmful physiological changes to the body, including suppression of the immune system, which is associated with the development of many diseases. For instance, extensive studies show that the death of a spouse is often associated with an elevated mortality rate for the survivor, particularly in the early periods after the loss. There is also a relationship between psychological stress and the increased risk of colds. When study volunteers were given nasal drops containing one of five cold viruses, colds and cold symptoms increased, depending on the amount of psychological stress.

Stress also influences the onset of inflammatory diseases such as arthritis and specific types of pain (back, neck, muscle). Given all the scientific evidence, it makes sense to presume that decreasing stress can alter body chemicals to help modulate pain. Yet for many people, the negative stress cycle can be difficult to interrupt. These individuals live daily with back or neck pain, which is often a result of their stress response. Some of my patients suffer with chronic tension headaches—or even migraines—when life’s stressors overwhelm them. I also have patients with inflammatory arthritis, such as rheumatoid or lupus, who have much more joint pain, swelling, and stiffness when they are experiencing overwhelming stress than when their lives are calmer.

Too Much Stress Increases Waistlines

When Cortisol levels remain high, this causes abdominal fat to accumulate—evidenced by an increased waistline and the “apple” body shape. We’re now learning that people who have apple body shapes have an increased risk of diabetes, cardiovascular disease, and pro-inflammatory markers. Some findings indicate that the relationship between waistline size (called central fat) and inflammation may be more significant than the connection between total obesity and inflammation.

Regardless of your weight or waistline size, chronic or long-term stress itself also produces pro-inflammatory cytokines. So when stress continues for days to weeks, it weakens the immune system and increases inflammation. In fact, studies show that individuals who feel tremendous job stress, particularly those who harbor feelings of burnout, have high inflammatory responses in the body.

Mitch, age 48, had been slim most of his life until his brokerage firm took a financial hit a few years ago. In less than a year, Mitch’s business lost thousands of dollars and he had to lay off twenty-four employees. During this period, Mitch gained 19 pounds and 4 inches in his waist—because he could not stop eating. “Every time the stock market would fall, I’d drink another milkshake or two and snack nonstop when I got home at night. I wasn’t hungry but I literally could not stop eating. I guess the food must have filled an emotional void.”

Mitch said he started a liquid diet to lose the weight quickly, and that resulted in more feelings of overwhelming stress. “Even though I was sticking with the weight-loss plan, I felt ill at ease and anxious, and had a hard time sleeping. I had to go off the diet so I could get along with my wife and kids, and function normally at work.”

Yes, dieting, too, can add stress to a person’s life. It’s even possible that this diet plan may increase your stress, at first. There aren’t many people who can adapt to a new style of eating—not to mention a reduction in calories—without feeling a bit anxious. We know that when the body is deprived of calories or “favorite foods,” our brain’s reward system kicks in, causing us to crave some foods (probably other foods not on this diet, too!). For example, my female patients usually tell of craving sugar/fat combinations (chocolate chip cookies and rich desserts), whereas my male patients say they crave protein/fat combinations (hot dogs, double cheeseburgers, and pepperoni pizza). This brain reaction involves changes in dopamine and endorphins, two chemicals that are also involved in drug addiction, which explains why the cravings can be so strong and difficult to resist.

That’s why it’s even more important to realize your personal signs of stress and learn the relaxation therapies to reduce these signs before the chronic stress results in illness or pain. To help you reduce stress as you follow the Pain-Free Diet, I encourage you to go slowly—don’t try to lose all the weight in a few weeks or months. Make this a lifetime proposition—not a “quick fix.” I recommend that patients plot their weight loss in intervals—such as., “I’d like to lose 10 pounds by (date)_______.” Or, “I’d like to lose 5 or 10 percent of my weight by (date)_______.” I find that when my patients can lose 10 to 15 percent of their initial weight and maintain this loss for a year or longer, that this is an exceptional medical result—even if the patients do not ever reach their “ideal” weight as dictated by height/weight charts or BMI calculations. Setting short-term weight loss goals, you can easily meet will also help reduce any additional stress of following a diet.

Chronic Stress Can Lead to Depression

Alicia had lived for years with chronic back pain that resulted from an automobile accident in her early twenties. Now thirty-five, this mother of twin girls said she felt malaise most of the time. “Even when my back pain is minimal, I still feel highly anxious and have a low mood,” she told me. “It s been so long since I felt upbeat that I have honestly forgotten what it feels like to enjoy life.”

I started Alicia on a newer antidepressant, a selective serotonin reuptake inhibitor (SSRI), and within days, she noticed an improvement in her mood. She’s been on the medication for more than a year now, and reports that family and friends continually comment on her upbeat personality. Not only does she feel more relaxed and hopeful, but the medication helps her to sleep well at night and feel more alert during the daytime hours.

Serotonin is a neurotransmitter in the body linked to mood. When serotonin levels are increased in the brain, it is associated with a calming, anxiety-reducing effect, and in some cases, with drowsiness. But studies show that too much stress or pain can lead to permanently low levels of serotonin, which can result in ongoing anxiety and depression. Researchers believe that abnormal levels of serotonin and other neurotransmitters, chemical messengers in the brain, are some of the primary causes of mood disorders such as depression.

Depression is associated with many chronic illnesses. When they are in pain, patients become ever more focused on their inability to exercise and be active, and on their personal suffering. The many appointments with physicians to try to find relief, combined with the cost of these attempts, and episodes of painful flare-ups, add to this frustration.

As time goes on, those who suffer with unmanaged pain can have trouble keeping a job; the absences become too frequent. If income is reduced or lost altogether, this adds to the financial stress for the patients and their families. The stress of dealing with loss of income, along with the pain, can cause relationship problems with loved ones and friends.

Over time, the longer pain goes unmanaged, the more likely the person will experience feelings and notice signs caused by the stress, which can make the pain worsen and create even more problems, including:

image  Difficulty sleeping, leading to constant fatigue

image  Inability to exercise, resulting in poor aerobic and physical fitness

image  Difficulty concentrating from the side effects of medications, leading to poor performance

image  Increased irritability, from lack of sleep or medications’ side effects

image  Withdrawal from favorite activities, because of low energy

image  Changes in appetite, due to medications

image  Depression

There is a better way to live. Using the suggestions in this step, you can end a depressive cycle and rediscover an active and exciting life.

How Stressed Out Are You?

THINK BACK OVER the past few weeks. Check the stress symptoms you have experienced:

____I feel tired or run down.

____I get angry or frustrated easily.

____I have lost interest in my work.

____Stress bothers me more now than before.

____I get headaches or stomachaches regularly.

____I have trouble sleeping.

____I feel depressed or unhappy frequently.

____I have lost my sense of humor.

____I have become more rigid and critical.

____I feel overwhelmed or overworked.

____I frequently use mood-altering drugs or alcohol.

____I clench my jaws while sleeping.

____I have lost or gained weight recently.

If you experienced more than two or three of these symptoms, you need to work on your stress-coping skills. Continue to read this step for insight and ideas to hep you recognize your stress signs and relax—to reduce your pain.

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