I was going to call this article “Stress and Chronic Pain” but I don’t think the word stress fully encapsulates what this is about. Stressors can absolutely trigger chronic pain, but not just perceived stress. Some of the lifestyle decisions we make can lead to something called HPA axis dysfunction, which dysregulates cortisol. From there, many systems of the body are impacted and we stay in a chronic state of pain. Have you ever noticed that pain increases following a poor night's sleep? This article will explain the mechanism. 

Let’s work backwards on this. I think we all know that swelling can cause pain. It is common to use cortisone cream or get a cortisone injection to manage pain. Cortisone is basically the synthetic version of cortisol, the stress hormone. Cortisol is a strong anti-inflammatory. There is a good reason for this. When the sympathetic nervous system is activated, cortisol is released. There are systems of the body we need to prioritize when in this fight or flight mode. We need energy, so cortisol liberates glucose into the blood to be used for energy. That’s why it is sometimes called glucocorticoids. There are systems that get down regulated because they aren’t high priority when in a fight, such as the immune system. So cortisol inhibits the inflammatory response which is handled by the immune system.

Most of us are in a chronic sympathetic state. Want a quick assessment of what state you are in? Take a deep breath in. What rises first? Your chest or your belly? Chest first breathing is correlated to the sympathetic state. (Hint: you can trigger the parasympathetic by switching to belly first breathing). 

Earlier I mentioned something called HPA axis dysfunction. This is a huge topic and I won’t cover the nitty gritty in this article, I’ll just give an overview. The HPA axis stands for hypothalamus-pituitary-adrenal axis. This is the hormonal response system for stress. It starts in the brain, and tells the adrenal glands to secrete cortisol.Under normal circumstances, there is a diurnal pattern to cortisol secretion. It peaks in the morning with exposure to light, then declines, with a second small rise in the afternoon. It then descends as the sun goes down. When you are chronically spiking it, this pattern can become dysregulated. If you drink four cups of coffee a day, it stops having the same effect on you. It’s similar to this; it basically flatlines and you can have low cortisol levels all day. That means that you are missing out on the anti-inflammatory effect of cortisol. So that swelling in your knee will never go down. 

So HPA axis dysfunction is definitely something you want to avoid. If you develop this dysfunction, you can’t supplement or exercise your way out of it. You have to eliminate the stressors. There are 4 categories of HPA axis stressors: perceived stress, circadian disruption, glycemic dysregulation, and inflammatory signals. 

Perceived stress is what you think it is. Mental/emotional/financial stress. You have to identify the stress and eliminate it or find a way to mitigate it. Some tips include learning how to say no, avoiding negative people, going on a ‘news fast’, and stopping useless internet debates. Seeking parasympathetic activities such as walking in nature, massage, meditation, and breathwork can all be good ways to mitigate stress. 

Circadian disruption generally occurs because of two reasons; either not enough exposure to natural light, or too much exposure to blue light from electronics. Keeping your cell phone out of your bedroom should be a priority in the evening. If you want to watch tv at night, getting blue light blocking sunglasses may help. Getting 15-30 minutes of natural light, without sunglasses is important. Particularly in the morning. Going for a morning walk would take care of this. 

Blood sugar dysregulation is a massive problem in the United States, and is mostly related to diet. The expression, ‘what gets measured, gets managed’ applies here. Probably the best thing to do is get a continuous glucose monitor, even for just a month. This will give you real time data on how foods spike your glucose. For example, I learned that jasmine rice spikes my blood sugar, but basmati does not. You’ll also learn what activities may help reduce it. Most will find that exercise and ice baths reduce blood sugar. For more on this, read here.

Inflammation is a bit of a two way street. It triggers HPA axis dysfunction, and HPA axis dysfunction allows inflammation to fester. So it’s a bit of a death spiral. There are a lot of triggers for inflammation so you have to identify the source and eliminate that. Some triggers that are often overlooked include food sensitivities and exposure to molds or toxins. 

The bottom line is that pain is complicated. You have to dial in the diet and lifestyle factors before you can eliminate pain for good.