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Do you know what stress is? Let’s start with a definition… Stress can be defined as a situation that triggers a biological response. Anything which causes stress is known as a ‘stressor’. A ‘stressor’ can trigger a person’s ‘fight or flight’ response in which they will either fight the stressor or run away from it. As humans, we all experience stressors on a daily basis, from being stuck in traffic to delivering a public speech at work. As a Physiotherapist, I understand the effect that someone’s stress can have on their pain levels. The Biopsychosocial model views health behaviours (such as pain) as products of biological, psychological & social factors. Experiencing stress is classed as a psychological factor, which according to the Biopsychosocial model, can affect how a person experiences pain. The levels of pain felt by an individual are a result of how a person perceives the pain. One of the earliest research examples of the interaction between pain and stress was observed by Dr. Henry Beecher in the 1900’s. It was found that soldiers wounded at war needed less pain relief compared to normal civilians suffering similar injuries. This observation suggests that the amount of pain felt by a person depended on how they perceived it, e.g. a soldier in battle has the expectation to be shot or even killed, however a normal person would not, hence the increased perception of pain (Best, et al. 2010). Now we know that how we perceive pain may influence the amount of pain we feel, let’s review some research illustrating how stress can modify our perception of pain. Research involving patients with fibromyalgia has found that stress caused an increase in musculoskeletal pain (Nilsen, et al. 2006). Furthermore, Niddam, et al. (2008) found that patients with chronic pain reported enhanced pain levels during periods of stress. I don’t want to bore you with too much research, but you get the idea! Hopefully now you understand the importance of educating our patients with the role of stress in pain management as well as methods to combat stress. There are many different methods which can be used to alleviate stress such as breathing control techniques or motivational quotes. My point is… it is important to know the impact stress can have on our perception of pain as humans. As a therapist, I have observed quite a few patients improve after I had educated them on the role of stress in pain management. Please see a case study below: Case 1 I had been seeing a 25-year-old male patient with chronic thoracic and lower back pain for 6 weeks with no real improvement in pain as well as function. The day before our next appointment I was researching the roles of different factors in pain, which led me to explain the different components that can affect pain with techniques of how to alleviate stress, applying it to real life situations. A few weeks later the same patient came back to the clinic with almost a 100% improvement in pain, who reported this was due to the fact that he had paid more attention to the stressors that were present in his life, alongside compliance to exercises and good pain management. Didn’t see him again…. The bottom line is: Pain can be caused by a range of different factors and is definitely not the result of a single contributor, however research has shown that stress can affect pain which is why here at Bodylogics we thrive to look at the whole individual when treating them. That being said, please don’t assume that reducing stress levels will make your pain completely go away. Book with a physiotherapist for a thorough assessment! Remember, holistic treatment is the best treatment…

References Best M, Neuhauser D., Henry K Beecher: pain, belief and truth at the bedside. The powerful placebo, ethical research and anaesthesia safety. BMJ Quality & Safety 2010;19:466-468. Niddam DM, Chan RC, Lee SH, Yeh TC, Hsieh JC. Central representation of hyperalgesia from myofascial trigger point. Neuroimage. 2008;39(3):1299–1306 Nilsen KB, Westgaard RH, Stovner LJ, Helde G, Rø M, Sand TH. Pain induced by low-grade stress in patients with fibromyalgia and chronic shoulder/neck pain, relation to surface electromyography. Eur J Pain. 2006;10(7):615–627

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