Stress and Pain

  • Catherine M. Stoney


Chronic pain can affect every aspect of life, from functional disability to social isolation, financial problems, and stress and psychiatric disorders such as depression and anxiety. However, there are enormous individual differences in how those with pain function; while many chronic pain patients experience relatively low levels of daily functioning, others are able to adapt and function well. For these reasons, an understanding of individual differences in coping strategies, background or consequent psychological stress, and environmental and social resources may help to understand how stress and pain are related. Because pain incorporates both a sensory and emotional component, it is important to understand both when considering assessment and treatment of pain. This chapter will focus specifically on the relationship between pain (both chronic and acute) and psychological stress, but the fundamental message of what follows is that the comorbidity between stress and pain requires careful assessment of psychological, social, and environmental factors when assessing patients in pain, and when planning a treatment strategy. Whether the pain specifically increases stress or whether similar amounts of stress are induced by illness in general, stress can increase the experience and perception of pain, the mode and degree of success in coping with the pain, the degree to which patients and healthcare providers can effectively work together, and adherence to and success with treatment.


Chronic Pain Major Depressive Disorder Pain Condition Psychosocial Stress Interstitial Cystitis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Cognitive behavioral therapy




Functional magnetic resonance imaging




Magnetic resonance imaging




Perceived Stress Scale


Posttraumatic stress disorder


Socioeconomic status


  1. Abbott, F. V., & Fraser, M. I. (1998). Use and abuse of over-the-counter analgesic agents. Journal of Psychiatry & Neuroscience, 23, 13–34.Google Scholar
  2. Adler, N. E., & Ostrove, J. M. (1999). Socioeconomic status and health: What we know and what we don’t. Annals of the New York Academy of Science, 896, 3–15.CrossRefGoogle Scholar
  3. Amit, Z., & Galina, Z. H. (1986). Stress-induced analgesia: Adaptive pain suppression. Physiological Reviews, 66, 1091–1120.PubMedGoogle Scholar
  4. Arena, J. G., Blanchard, E. B., & Andrasik, F. (1984). The role of affect in the etiology of chronic headache. Journal of Psychosomatic Research, 28, 79–86.PubMedCrossRefGoogle Scholar
  5. Arena, J. G., Sherman, R. A., Bruno, G. M., & Smith, J. D. (1990). The relationship between situational stress and phantom limb pain: Cross-lagged correlational data from six month pain logs. Journal of Psychosomatic Research, 34, 71–77.PubMedCrossRefGoogle Scholar
  6. Arguelles, L. M., Afrai, N., Buchwald, D. S., Clauw, D. J., Ferner, S., & Soldbert, J. (2006). A twin study of posttraumatic stress disorder symptoms and chronic widespread pain. Pain, 124, 150–157.PubMedCrossRefGoogle Scholar
  7. Bai, M., Tomenson, B., Creed, F., Mantis, D., Tsifetaki, N., Voulgari, P. V., Drosos, A. A., & Hyphantis, T. N. (2009). The role of psychological distress and personality variables in the disablement process in rheumatoid arthritis. Scandanavian Journal of Rheumatology, 38, 419–430.CrossRefGoogle Scholar
  8. Bair, M. J., Robinson, R. L., Katon, W., & Kroenke, K. (2003). Depression and pain comorbidity: A literature review. Archives of Internal Medicine, 163, 2433–2445.PubMedCrossRefGoogle Scholar
  9. Bazzichi, L., Maser, J., Piccinni, A., Rucci, P., Del Debbio, A., Vivarelli, L., et al. (2005). Quality of life in rheumatoid arthritis: Impact of disability and lifetime depressive spectrum symptomatology. Clinical and Experimental Rheumatology, 23, 783–788.PubMedGoogle Scholar
  10. Bondy, B., Baghal, T. C., Minov, C., Schule, C., Schwarz, M. J., Zwanzger, P., Rupprecht, R., & Moller, J. J. (2003). Substance P serum levels are increase in major depression: Preliminary results. Biological Psychology, 53, 538–542.CrossRefGoogle Scholar
  11. Cairns, M. C., Foster, N. E., Wright, C. C., & Pennington, D. (2003). Level of distress in a recurrent low back pain population referred for physical therapy. Spine, 28, 952–959.Google Scholar
  12. Campbell, C. M., Witmer, K., Simango, M., Carteret, A., Loggia, M. L., Campbell, J. N., Haythornthwaite, J. A., & Edwards, R. R. (2010). Catastrophizing delays the analgesic effect of distraction. Pain, 149, 202–207.PubMedCrossRefGoogle Scholar
  13. Chambers, C. T., Taddio, A., Uman, L. S., McMurtry, C. M.; for the HELPinKIDS Team. (2009). Psychological interventions for reducing pain and distress during routine childhood immunizations: A systematic review. Clinical Therapeutics. 31(Suppl B), S77–S103.Google Scholar
  14. Clauw, D. J. (2009). Fibromyalgia: An overview. The American Journal of Medicine, 122, S3–S13.PubMedCrossRefGoogle Scholar
  15. Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, 385–396.PubMedCrossRefGoogle Scholar
  16. Cohen, S., & Williamson, G. (1988). Perceived stress in a probability sample of the United States. In S. Spacapam & S. Oskamp (Eds.), The social psychology of health: Claremont Symposium on applied social psychology. Newbury Park: Sage.Google Scholar
  17. Croft, P. R., Papageorgiou, A. C., Ferry, S., Thomas, E., Jayson, M. I., & Silman, A. J. (1995). Psychological distress and low back pain: Evidence from a prospective study in the general population. Spine, 20, 2731–2737.PubMedCrossRefGoogle Scholar
  18. Crosbie, T. W., Packman, W., & Packman, S. (2009). Psychological aspects of patients with Fabry disease. Journal of Inherited Metabolic Diseases, 32, 745–753.CrossRefGoogle Scholar
  19. Demitrack, M. A., & Crofford, L. J. (1998). Evidence for and pathophysiologic implications of hypothalamic-pituitary-adrenal axis dysregulation in fibromyalgia and chronic fatigue syndrome. Annals of the New York Academy of Science, 840, 684–697.CrossRefGoogle Scholar
  20. Flor, H. (2008). Maladaptive plasticity, memory for pain and phantom limb pain: Review and suggestions for new therapies. Expert Review of Neurotherapeutics, 8, 809–818.PubMedCrossRefGoogle Scholar
  21. Flor, H., Fydrich, T., & Turk, D. C. (1992). Efficacy of multidisciplinary pain treatment centers: A meta-analytic review. Pain, 49, 221–230.PubMedCrossRefGoogle Scholar
  22. Gallo, L. C., & Matthews, K. A. (2003). Understanding the association between socioeconomic status and physical health: Do negative emotions play a role? Psychological Bulletin, 129, 10–51.PubMedCrossRefGoogle Scholar
  23. Gill, K. M., Carson, J. W., Porter, L. S., Scipio, C., Bediako, S. M., & Orringer, E. (2004). Daily mood and stress predict pain, health care use, and work activity in African American adults with sickle-cell disease. Health Psychology, 23, 267–274.CrossRefGoogle Scholar
  24. Gracely, R. H., Feisser, M. E., Fiesecke, T., Grant, M. A. B., Petzke, F., Williams, D. A., & Clauw, D. J. (2003). Pain catastrophizing and neural responses to pain among persons with fibromyalgia. Brain, 127, 835–843.CrossRefGoogle Scholar
  25. Hartman, J. M., Berger, A., Baker, K., Bolle, J., Handel, D., Mannes, A., Pereira, D., St. Germain, D., et al. (2006). Quality of life and pain in premenopausal women with major depressive disorder: The POWER Study. Health and Quality of Life Outcomes, 4, 2–6.PubMedCrossRefGoogle Scholar
  26. Hasenbring, M., Marienfeld, G., Kuhlendahl, D., & Soyka, D. (1994). Risk factors of cronicity in lumbar disc patients: A prospective investigation of biologic, psychologic, and social predictors of therapy outcome. Spine, 19, 2759–2765.PubMedCrossRefGoogle Scholar
  27. Heim, C., Newport, D. J., Bonsall, R., Miller, A. H., & Nemeroff, C. B. (2001). Altered pituitary-adrenal axis responses to provocative challenge tests in adult survivors of childhood abuse. The American Journal of Psychiatry, 158, 575–581.PubMedCrossRefGoogle Scholar
  28. Hoffman, B. M., Papas, R. K., Chatkoff, D. K., et al. (2007). Meta-analysis of psychological interventions for chronic low back pain. Health Psychology, 26, 1–9.PubMedCrossRefGoogle Scholar
  29. Holmes, T. H., & Rahe, R. H. (1967). The social readjustment rating scale. Journal of Psychosomatic Research, 11, 213–218.PubMedCrossRefGoogle Scholar
  30. Jensen, M. P., Turner, J. A., Romano, J. M., & Karoly, P. (1991). Coping with chronic pain: A critical review of the literature. Pain, 47, 249–283.PubMedCrossRefGoogle Scholar
  31. Kanegane, K., Penha, S. S., Munhoz, C. D., & Rocha, R. G. (2009). Dental anxiety and salivary cortisol levels before urgent dental care. Journal of Oral Science, 51, 515–520.PubMedCrossRefGoogle Scholar
  32. Koushede, V., Holstein, B., Andersen, A., Ekholm, L., & Hansen, E. H. (2010). Use of over-the-counter analgesics and perceived stress among 25–44 year olds. Pharmacopeidemiology and Drug Safety, 19, 351–357.Google Scholar
  33. Lazarus, R. S., & Folkman, S. (1989). Hassles and uplifts scales. Palo Alto: Consulting Psychologists Press.Google Scholar
  34. Mayer, E. A. (2000). The neurobiology of stress and gastrointestinal disease. Gut, 47, 861–869.PubMedCrossRefGoogle Scholar
  35. McBeth, J., Siolman, A. J., Gupta, A., et al. (2007). Moderation of psychosocial risk factors through dysfunction of the hypothalamic-pituitary-adrenal stress axis in the onset of chronic widespread musculoskeletal pain: Findings of a population-based prospective cohort study. Arthritis and Rheumatology, 56, 360–371.CrossRefGoogle Scholar
  36. McLean, S. A., Clauw, D. J., Abelson, J. L., & Liberzon, I. (2005). The development of persistent pain and psychological morbidity after motor vehicle collision: Integrating the potential role of stress response systems into a biopsychosocial model. Psychosomatic Medicine, 67, 783–790.PubMedCrossRefGoogle Scholar
  37. Melzack, R. (1999). Pain and stress: A new perspective. In R. J. Gatchel & D. C. Turk (Eds.), Psychosocial factors in pain (pp. 89–106). New York: Guilford Press.Google Scholar
  38. Melzack, R. (2001). Pain and the neuromatrix in the brain. Journal of Dental Education, 65, 1378–1382.PubMedGoogle Scholar
  39. Melzack, R., & Wall, P. D. (1965). Pain mechanisms: A new theory. Science, 150, 971–979.PubMedCrossRefGoogle Scholar
  40. Nilsen, K. B., Sand, T., Westgaard, R. H., et al. (2007). Autonomic activation and pain in response to low-grade mental stress in fibromyalgia and shoulder/neck pain patients. European Journal of Pain, 11, 743–755.PubMedCrossRefGoogle Scholar
  41. Ohayon, M. M., & Schatzberg, A. F. (2010). Chronic pain and major depressive disorder in the general population. Journal of Psychiatric Research, 44, 454–461.PubMedCrossRefGoogle Scholar
  42. Quale, A. J., & Schanke, A. K. (2010). Resilience in the face of coping with a severe physical injury: A study of trajectories of adjustment in a rehabilitation setting. Rehabilitation Psychology, 55, 12–22.PubMedCrossRefGoogle Scholar
  43. Rios, R., & Zautra, A. J. (2011). Socioeconomic disparities in pain: The role of economic hardship and daily financial worry. Health Psychology, 30, 58–66.PubMedCrossRefGoogle Scholar
  44. Sarason, I., Johnson, J., & Siegel, J. (1978). Assessing the impact of life changes: Development of the life experiences survey. Journal of Consulting and Clinical Psychology, 46(5), 932–946.PubMedCrossRefGoogle Scholar
  45. Simone, D. A. (1992). Neural mechanisms of hyperalgesia. Current Opinions in Neurobiology, 2, 479–483.CrossRefGoogle Scholar
  46. Skinner, M. A., Zautra, A. J., & Reich, J. W. (2004). Financial stress predictors and the emotional and physical health of chronic pain patients. Cognitive Therapy and Research, 28, 695–713.CrossRefGoogle Scholar
  47. Stasio, M. J., Curry, K., Sutton-Skinner, K. M., & Glassman, D. M. (2008). Over-the-counter medication and herbal or dietary supplement use in college: Dose frequency and relationship to self-reported distress. Journal of American College Health, 56, 535–547.PubMedCrossRefGoogle Scholar
  48. Staud, R., Craggs, J. G., Robinson, M. E., et al. (2007). Brain activity related to temporal summation of C-fiber evoked pain. Pain, 129, 130–142.PubMedCrossRefGoogle Scholar
  49. Turk, D. C., Audette, J., Lecy, R. M., Mackey, S. C., & Stanos, S. (2010). Assessment and treatment of psychosocial comorbidities in patients with neuropathic pain. Mayo Clinic Proceedings, 85(Suppl), S42–S50.PubMedCrossRefGoogle Scholar
  50. Vlaeyen, J. W. S., & Linton, S. J. (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art. Pain, 85, 317–332.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2013

Authors and Affiliations

  1. 1.National Heart, Lung, and Blood DiseasesThe National Institutes of HealthBethesdaUSA

Personalised recommendations