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Does Stress Cause Chronic Pain?

Did you know that chronic pain affects 1.5 billion people worldwide? That persistent pain is more common as we age?

Or that more Americans are affected by chronic pain than by diabetes, heart disease and cancer combined? These facts are well-documented.

I have been aware of these striking statistics for some time. As a rehabilitation psychologist, I have spent over 30 years helping people with chronic pain and have seen first-hand just how devastating this problem can be.

What Is Chronic Pain?

Let me start with a little clarification. To me, the word chronic means no cure. It means long-lasting.

Chronic pain is long-term pain, lasting more than six months, for which there is no cure. How long-term pain affects people’s lives can be very complicated. But the essence of chronic pain is quite simple – pain, long-term, no cure. 

There are many different types of chronic pain caused by a variety of physical injuries and illnesses. The causes of chronic pain can include everything from migraines, back and neck injuries, arthritis, fibromyalgia and surgeries to cancer and strokes.

All of this is explained in a free eBook I wrote, Why is Chronic Pain So Overwhelming for So Many People?

What Has Stress Got to Do with It?

Scientists have learned a lot over the past 50 years.

The overwhelming consensus is that chronic pain is not a psychological problem and that it is not caused by stress. Chronic pain is never all in your head.

Unfortunately, chronic pain is all too physical and all too real.

In fact, chronic pain is so real that it can lead to serious and permanent losses to a person’s independence, their capacity to work, their capacity to care for their family and their overall enjoyment of life.

Why Is This Idea Still So Common?

Many people are still frightened that their doctors, employers and family members will believe that chronic pain is a stress or psychological problem.

Sadly, this outdated view is still part of everyday life. There is a long history of weak theories that tried to blame physical illness on psychological problems. Migraine headaches used to be attributed to ambitious women that were hysterical or “wound too tight.” This would seem comical if it weren’t so insulting. Multiple sclerosis was thought to be a psychological problem until the MRI was invented.

Turk and Melzack write, in their classic Handbook of Pain Assessment (2010), “The search for a ‘pain-prone personality’ and for ‘psychogenic pain’ has proven to be futile.” The American Medical Association’s Guide to the Evaluation of Permanent Impairment (way back in 1993) clearly stated that chronic pain is not a psychogenic problem.

Although stress is not the cause, it is still important for the understanding and treatment of any medical problem.

2 Ways to Know if Stress Is a Part of Your Chronic Pain

#1: Chronic Pain Is Never Only Physical

If you were to lose your job or your marriage, wouldn’t you have more difficulties coping with any health problem? If that medical problem caused you a lot of pain, wouldn’t that make it even harder?

This is just common sense really.

Of course, stresses, fears and losses all play a role in chronic pain and its effects on your life. Stress can make almost any physical medical problem worse.

We now know that pain signals from our injured body are processed in several parts of our brain and spinal cord. Our bodies and brains are always communicating back and forth and affecting each other.

#2: Pain Causes Stress Which Can Lead to Even More Pain

The truth is that pain causes stress. In fact, for most people, pain is the most stressful type of event that they will ever experience, especially prolonged pain.

To make matters worse, the stress caused by your pain and suffering can aggravate your physical injuries or illness and lead to even higher levels of pain.

In my book, Unbelievable Pain Control, I call this the chronic pain two-step. Pain causes stress, which can lead to even more pain – the two-step. An escalating cycle of pain, stress, more pain, even more stress, then even higher levels of pain can be overpowering.

It is important to understand how stress and physical symptoms, such as pain, make each other worse. This is true for chronic pain, as well as heart disease, diabetes, and hypertension, as examples.

That is why stress management is such a vital part of the treatments for almost all chronic or long-term medical problems.

Do you struggle with your chronic or long-term pain and the many ways in which your life is affected? Can you see how pain and stress can work together? Do you think it would be helpful to discuss all of this with your doctors?

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The Author

Dr. Michael MacDonald is a clinical psychologist and avid hockey player. He is a big fan of and similar charities which promote education and gender equality for girls in low-income countries. Send for a Free ebook, How to Feel Younger in Your Retirement Years, from his website,

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