Chapter 13

Awareness of Your Stresses

Stress is a normal and inescapable fact of life. And not all stress is bad. In fact, stress is part of what makes life interesting, challenging, stimulating—up to a point. It’s only when stress exceeds a certain threshold that it starts to cause wear and tear. The well-known symptoms of that wear and tear include these:

•Low energy

•Headaches

•Widespread aches and pains

•Muscle tension

•Loss of sexual desire and performance

•Frequent colds and infections

•Upset stomach and disrupted digestion

•Depression and anxiety

•Decreased concentration and attention

•Anxious or racing thoughts

•Eating too much or too little

•Withdrawing from others

•Nervous habits such as nail biting or tooth grinding

•Sleeping too little or too much

By now you should understand that the approach of integrated medicine does not make a sharp distinction between so-called physical and psychological factors. Physical events change our psychological responses, and psychological events lead to physiological changes at the cellular level. Keep in mind that stress is both physical and psychological.

In my previous book, Trust Your Gut, I listed various categories of stress (with examples) that can affect you:

•Environmental stress—The sights, sounds, and smells around you in your home, workplace, your school, and your community

•Physical stress—Chronic pain, illness, surgery, and undergoing invasive diagnostic procedures

•Emotional stress—Anxiety, depression, despair, and PTSD

•Spiritual stress—Feelings of alienation, isolation, and challenges in one’s spiritual faith

•Pharmaceutical stress—The negative side effects of many medications, as well as the related depletion of nutrients that can occur

•Dietary stress—Food allergies, adverse food reactivity, and nutritional deficiencies

•COVID-19 pandemic stress—This is a new one that everyone has struggled with in the past few years, which consists of the numerous stresses caused by the COVID-19 epidemic; these include frustration, feelings of isolation, disruption of daily routines, economic challenges, and coping with COVID symptoms

Stress can cause excessive inflammation in the body. Inflammation is helpful at first, because it is the body’s way of fighting infection by increasing your temperature and causing swelling. But, like stress, inflammation that becomes chronic is harmful. Chronic inflammation increases pain and the breakdown of tissues in the body. Unchecked inflammation can also impair the immune system and render it less effective in protecting us from illness.

Excessive stress can even harm the DNA in our cells. Exposure to chronic stress and stress hormones such as cortisol can decrease the health and length of the protective casings at the ends of strands of DNA (telomeres). These casings are necessary for appropriate cell regeneration. As telomeres deteriorate, cells are impaired, or may become pro-inflammatory. This can increase chronic pain and accelerate the aging process.

Ultimately, poorly managed stress can maintain and worsen chronic pain. Stress commonly increases depression, anxiety, sleep disturbance, and relationship problems—all of which heighten the experience of pain. The chronic inflammation that is increased by stress renders nerve and muscle tissue more vulnerable to increased pain. Stress can increase dysregulation of your autonomic nervous system and heighten central sensitization, two of the big drivers of chronic pain.

Stress is a part of life—there’s no avoiding it. That is why it is important to learn to recognize stress, observe it, and have strategies to respond to it.

For chronic pain sufferers, stress is anything but a neutral term. Most chronic pain patients have gone through a long, exhausting journey through multiple diagnostic tests with numerous health professionals who didn’t solve their problem. When they hear the “S-word,” many become very defensive, combative, or hopeless. Stress becomes a code word for “You’re crazy,” “Your pain isn’t real,” or “It’s all in your head.”

Let me reiterate a useful definition of stress for our purposes:

Stress is the perception that your capacity to cope has been exceeded.

Of course, the perception of stress varies widely for different people, as do the things they find to be stressful. We can illustrate this diversity by comparing the cases of two individuals who were treated in a pain center at a major metropolitan hospital.

Joe was a forty-seven-year-old narcotics officer. As a routine part of his job, he would raid crack houses. Every morning he would wake up, put on his bulletproof vest, and be ready to go. He had done this for so many years that he never even thought about it. No big deal. Until one day, when his squad raided a crack house...and Joe found his daughter there! At that moment, Joe’s capacity to cope was exceeded. Soon after, his chronic low back pain flared up and Joe went to the pain clinic.

Cynthia was a fifty-eight-year-old multi-millionaire living in Southern California. She had significant symptoms of obsessive-compulsive disorder (OCD). She lived in an enormous mansion in Beverly Hills—so enormous that it had over 175 windows! Driven by her OCD, Cynthia was preoccupied with the cleanliness of these windows. She had all 175 of them professionally cleaned—every day! One week she decided to host a big party. And so, she had all the windows professionally cleaned, with extra emphasis to the cleaners to do an especially careful job, since there would be many guests. After the window cleaners left, and before the first guests arrived, a bird flew by and—splat!—it pooped on one of the freshly cleaned windows. That bird’s dirty work exceeded Cynthia’s capacity to cope. The thought of a party guest seeing that window caused a flare-up of her migraine headaches. They worsened in intensity and frequency, so she reported to the pain clinic.

Joe and Cynthia, two vastly different people, felt the effects of two vastly different kinds of stress. This shows how highly unique each individual’s perception of stress can be. What these cases have in common is that there are two factors that determine the intensity of the stress—the stressful event itself and the perception of the event. Whether a tree falls on your car or you have a big argument with your supervisor, it’s how you react to the event that determines its ultimate physiological impact. The same holds for your chronic pain, one of the major stressors in your life.

Please recall our discussion of the HPA axis (in the “Science of Chronic Pain” section) to get a reminder of how stress affects your brain and body. Your stress-response system does not care what caused the stress. It only responds to the intensity of your perception of stress, and then it automatically floods your body with stress hormones.

Once You’re Aware of Your
Stresses, Then What?

Happily, many of the strategies you’ll learn in the ABC method will help you with reducing the psychophysiological effects of stress. Virtually all the strategies listed in the next few chapters will help you fill your resource tank and will reduce the negative effects of stress.