Back In MotionEltham

Have you ever wondered why your back hurts less on the weekends and hurts more when you’re under the pump at work? Why is it that those injuries you sustain whilst on holidays seem insignificant compared to those same injuries that occur at home? How can the exact same stimulus result in such a different response?

Simple questions that have complex answers. Let’s try and break this down.

Stress has the ability to produce a number of outputs, which may either initiate, supress or contribute to the pain experience. Before we learn about how these two ‘do the tango’, we must first explain how stress and pain are described within the medical world.

What is pain? “An unpleasant sensory and emotional experience associated with actual or potential tissue damage.”

How do we experience pain?

1.  Danger signals (Nociceptors) are scattered all over the body.
2. When the excitement level within a neurone reaches a critical level (i.e.; our body is receiving lots of danger signals) a message is sent up the spinal cord and into the brain.
3. The pain centres in the brain take all these danger messages and then conclude what response is required. As a result, pain is an output of the brain.
4. We know the brain is influenced by a host of other chemicals, therefore it can amplify or supress our pain experience, depending on our mood.

Here is a good clinician TEDx talk on pain and a stick, quite entertaining as well with Lorimer Moseley - internationally recognised as a great pain person and Physio: https://www.youtube.com/watch?v=gwd-wLdIHjs

“Stress lives in the brain, and therefore the experience of people with chronic pain often is that their pain increases as they become more stressed,” Dr. Lorimer Moseley states in the video.

Cortisol is an important neuroendocrine hormone that is released in response to stressful situations. It has the ability to supress the perception of pain and inflammation at the site of the injury. This can be great when we roll our ankle in the last quarter of the grand final or when we have been bitten by a shark (yes, an extreme example I know).

However, when stress is present for sustained periods, the body may secrete less cortisol and/or become less sensitive to its effects leading to widespread inflammation and pain (see below)

Image source: https://www.geertlammertyn.com/blog/chronic-stress-pain-sensitivity

Chronic stress has been related to Hippocampal atrophy within the brain. Which essentially means, the longer we have stress in the body, the more likely we are to have learning and memory difficulties. Pretty crazy stuff! So, what we can do reduce our chronic levels of stress?

As stress and pain are both complex processes, they require a multimodal approach to create sustainable change:

• Meditation/Mindfulness: Purchasing the ‘Headspace’ app was the best thing I’ve done for myself; they offer a 14-day free trial. Highly recommend! (and no, unfortunately they are not sponsoring me!)
• Gratitude: Take time out of your day and reflect on the positives! Write them down and look back at it over the week.
• Drink more water! Aim for 2-3 litres per day (more if you are exercising/sweating).
• Exercise: It’s hard to find the motivation to exercise right now, but make sure you can get out for at least a 30-45min walk each day. Fresh day and the chance to clear your mind will go a long way.
• Diet can make a huge difference! Inflammatory foods will cause inflammatory outcomes. Speak to Carly, our in-clinic Dietitian for more information. 
• Sleep: Aim for seven to eight hours per night. For further detail around how sleep can help with stress and pain levels, click here.

If you have any questions or would like further information on this subject please feel free to call me on 9439 6776, or email to c.ramlu@backinmotion.com.au.

Article written by Cameron Ramlu, Physiotherapist at Back In Motion Eltham.

References:

• Chovatiya, R., & Medzhitov, R. (2014). Stress, inflammation, and defense of homeostasis. Molecular cell, 54(2), 281-288.
• Egger, G., Donovan, R. J., Giles‐Corti, B., Bull, F., & Swinburn, B. (2001). Developing national physical activity guidelines for Australians. Australian and New Zealand journal of public health, 25(6), 561-563.
• Gatchel, R. J., & Turk, D. C. (Eds.). (1999). Psychosocial factors in pain: Critical perspectives. Guilford Press.
• Hirshkowitz, M., Whiton, K., Albert, S. M., Alessi, C., Bruni, O., DonCarlos, L., ... & Neubauer, D. N. (2015). National Sleep Foundation’s sleep time duration recommendations: methodology and results summary. Sleep health, 1(1), 40-43.
• Kumar, S., Tandon, O. P., & Mathur, R. (2002). Pain measurement: a formidable task. Indian journal of physiology and pharmacology, 46(4), 396-406.
• Veena, J., Rao, B. S., & Srikumar, B. N. (2011). Regulation of adult neurogenesis in the hippocampus by stress, acetylcholine and dopamine. Journal of natural science, biology, and medicine, 2(1), 26.