Using stress to combat pain

​Over the last couple of months, we have explored the concept of pain, how it is processed and produced by our body and nervous system, and what happens when it sticks around for too long. In this final part of the series, we are discussing how we can manage this persistent pain and create a more resilient and robust body! 
 
Before tackling this, let’s recap. Pain is 100% always created by the brain. Our brain receives signals from various parts of our body. Some of these may be related to mechanical, or thermal stimuli that can indicate a threat. The brain uses information stored within itself including memories, experiences, emotions, beliefs, etc. to decide whether this stimulus is threatening enough to elicit pain. This is meant to be protective; move yourself away from this threat or get rid of the threat itself! Due to the neurological nature of pain, there is not always tissue damage or injury present. Also because of this, there does not need to be any mechanical or thermal stimuli to elicit a painful sensation. This is where it can become very frustrating because it feels impossible to get rid of pain if there is no physical source to address. However, we CAN influence the creation of pain by working through beliefs, ways of thinking, emotions, and learning more about how pain works! 
 
These efforts address the neural circuits that contribute to the creation of a painful sensation. These circuits can become TOO GOOD at creating pain when it is present for more than a few months, and are sensitive to cognitive and neural activity including thoughts, beliefs, memories, etc. In the presence of this persistent pain, it is even more likely that there is no tissue damage or injury related to the pain. One might find that they feel more pain when they’re stressed, sleep deprived, eating poorly, or not exercising vs. when they have a better handle on those factors. So how do we improve this pain that’s not related to any tissue damage or injury? 
 
Whether there is physical tissue damage or not, we may see changes in physical abilities, strength, mobility, etc. in the presence of persistent pain. Therefore, there are likely physical deficits to address to build a more resilient self! When it comes to changing these physical deficits OR addressing the non-physical components of persistent pain, I often point to an equation that is widely used in areas like strength and conditioning. 
 
This equation is stress + recovery = adaptation
 
Our bodies are geared toward adapting to stressors to better handle those in the future. It uses the information of stress to learn, evaluate, and adapt so it can be better prepared the next time. This can be applied to performing a bicep curl and becoming stronger over time or speaking in public for the first time and eventually becoming comfortable and confident with this. The thing about the stress component of this equation is that our body can’t tell the difference between types of stressors. It may be stress of work, family, finances; or it could be an intense workout, doing too much too soon, or lack of sleep. To our body, and our nervous system, these all just equal stress; it can’t decipher which is more impactful than the other. It’s the body’s goal to adapt to these and become more resilient to them; however, if the cumulative stress is too great, and recovery doesn’t match it, it will fail to adapt. Even more, it may show maladaptive signs including pain, fatigue, or potential injury. 
 
Our job is to evaluate stressors of all kinds: physical, emotional, psychological, social, etc., and to assess the cumulative impact these are having relative to your ability to recover. If we can manipulate stressors to assure an adequate dosage of not too much or too little, while focusing on recovery strategies and joyful activities, we will see adaptation take place and a resulting body that is able to handle more! 
 
I like to refer to a cup analogy I’ve learned from various mentors in the field. Imagine you, your body, and your brain are a cup. (I include all of these because we’ve learned that they all play a role in pain, right??). This cup is filled with water, and your life stressors are objects that are placed into the water – remember these stressors include anything and everything that disrupts your homeostasis (physical or non). As more of these objects are placed in the water, the water level rises. When it gets to the point of overflowing, we have met the capacity of the cup. In your life, when this happens, you may experience an exacerbation of your symptoms (more pain/stiffness, increased fatigue, decreased performance in your workouts or life, etc.). What can we do about this??
 
Our goal is to remove or modify the objects (stressors), that we can, from the water so the level lowers, while assessing and addressing recovery efforts. In doing this we see adaptation and the development of a bigger cup over time! A bigger cup means you can take on more before overflowing = greater resiliency! 
 
It may sound like a simple concept, but simple does not always mean easy, right? If it sounds like some of this applies to you (and it does to all of us to some extent!), a great place to start is to reflect on what stressors may be in your life, and how you cope (recover) with those. Do you make time for joyful activities with people you love? Do you prioritize healthy food, water, and adequate sleep? Do you move your body regularly? These foundations are key to health & wellness, but even more so to combating persistent pain and keeping yourself feeling good and moving well! 
 
Whether you want to chat more about these concepts surrounding pain or want guidance on how to start your journey of building a bigger cup, we’re here for you! 
 
Hit the Talk with a PT button at the top of the page to start your journey toward becoming more resilient! 
 
Cheers, 
 
Elle Carlson, PT, DPT