Stress, Pain, and a Pinch of Sad

How are stress and pain connected?

Almost all of us experience stress in some form or another. According to the NIH (National Institutes of Health), long term stress could affect your immune, cardiovascular, sleep, and reproductive systems (among others). Worse still, studies have also shown anxiety and depression can independently worsen chronic pain.

Pain matters a lot to me, and not just because I am a pain doctor. I care about informing folks about the different ways in which pain manifests. I believe this not only enriches the doctor-patient experience, but also empowers my patients, to choose how to better care for themselves and also a better way of life.. 

Today we’ll discuss the following points: 

1) the link between stress, sadness and pain 

2) how medications can directly treat BOTH anxiety/depression and pain

3) how some lifestyle modifications can protect us from going down the stress-pain-depression cycle.

The Basics: Brain Chemistry, Pain and Medicine

Our nervous system, including the brain, communicates through molecules called neurotransmitters. Although there are A LOT of these molecules, today we will focus on two: serotonin and norepinephrine.

Research has tied serotonin and norepinephrine, as key players in transmitting pain. The specific role they play in controlling pain is still uncertain, but it is thought that a possible “imbalance” of serotonin and norepinephrine may contribute to a persistent pain state.

With this knowledge in hand, medical experts came up with ways to treat persistent pain with medications that alter serotonin and norepinephrine levels. Today, medical professionals use meds called SNRIs (serotonin-norepinephrine reuptake inhibitors) and TCAs (tricyclic antidepressants) to control pain.

Stress, Pain, Sadness—and Treatment,

So how does our preliminary discussion bring us to the links among stress, pain, and sadness? Simple. You may have heard of SNRIs in the past. A common description for some of these meds is “antidepressants.” 

And there you have it. What’s interesting is that these meds are also used for pain management. This is no coincidence: it may be that depression and anxiety involves decreased levels of these neurotransmitters.

This link also helps explain the well documented association found between these seemingly very different medical problems. Thankfully, the interactions among anxiety, depression, and pain give medical providers an opportunity to make the best use of common treatment options. Think of it as a sort of miracle: we are trying to find a way to treat anxiety, depression, and pain with a single medication.

Healthy Living, Bright Lights, and Exercise

So why am I talking about neurotransmitters like serotonin and norepinephrine? Why am I even discussing SNRIs? 

Researchers have associated higher serotonin levels with other behaviors. One being mood: individuals with happy outlooks tend to have higher levels of serotonin. 

Improving our mood, however, is not just about—and should not only be about—medication management. A healthy mind requires a healthy lifestyle. This is where Orchid professionals can help: mental health professionals trained in evidence-based therapy appear to vastly improve our health.

In addition to chatting with an Orchid professional, consider light therapy. Early research has shown exposure to bright lights (>1000 lumen) is correlated with elevated serotonin levels. This explains why bright lights are commonly used to treat seasonal depression.

Lastly, exercise! Working your body has been shown, time and time again, to be beneficial in treating anxiety and depression. It’s with this train of thought that I regularly send my pain patients for physical therapy and encourage regular exercise, which gives additional emotional benefits and has pain-relieving effects.

At the end of day, it’s difficult for us to diagnose ourselves, so I always recommend consulting a medical professional. Having said that, my experience in pain management has taught me that the value in combining mental health therapy alongside medication management and exercise leads to very encouraging results.