Fight-or-Flight Series (Part 3): Understanding Chronic Pain

Fight-or-Flight Series (Part 3): Understanding Chronic Pain

This is Part 3 of our series on the fight-or-flight response, and we’re here to continue with an in-depth look at the way chronic pain is connected to an overactive stress response. If you missed parts 1 and 2 or need to refresh your memory, check out Fight-or-Flight Series (Part 1): What is the Fight-or-Flight Response? and Fight-or-Flight Series (Part 2): What Happens During an Overreaction to Stress and 4 Ways to Prevent It.



Doesn’t it seem as though stress has become part of our daily routine? In fact, its existence has almost normalized to the point where we find it difficult to step away from the many stressors of daily life. 

While this realization may be slightly concerning, you should feel assured in knowing that stress is a normal part of life. In fact, stress is the brain’s way of making us aware that there is a situation that needs our immediate attention or response. Essentially, stress functions as a warning system that says, “Deal with this now.” Over the years, it has evolved from the protective mechanisms in our brain that keep you alive to a sensitive trigger that picks up on even the subtlest of threats. 

But what happens when stress seems never-ending? 

Even though stress can play a positive role, when it is ongoing and persistent, your body enters a prolonged state of heightened arousal and gets “stuck.” As we discussed in Parts 1 and 2, the body is not meant to be in fight-or-flight mode for long periods of time. So, let’s dig into what chronic stress can do to your body and how it is related to chronic pain patterns. 

What does chronic stress do to the body?
Refer to Fight-or-Flight Series (Part 1): What is the Fight-or-Flight Response? to revisit what happens to the body during an acute stress response. 

Recall that the fight-or-flight response is triggered by any number of perceived stressors, which will differ slightly for everyone. In addition to the rush of adrenaline, the fight-or-flight response may resort to the release of cortisol, also known as the stress hormone. Cortisol is a naturally-occurring hormone in the body that is regularly released throughout your day. It is an important regulator of blood flow, blood sugars, and inflammation in the system. 

Under normal circumstances, stress causes an increase in the release of cortisol to prepare the body for action. Unfortunately, prolonged periods of stress trigger constant releases of cortisol that, in turn, cause inflammation throughout the body. When this happens, the fight-or-flight response is perpetuated and exacerbated, causing mental, physical, and emotional effects.

How do stress and chronic pain influence each other?
The relationship between stress and chronic pain is far more intertwined than you might suspect. Both are considered to be chronic cycles that can fan one another’s flames. 

Simply put, chronic heightened levels of stress can lead to or exacerbate pain. Changes in muscle tension that result from the fight-or-flight response can cause lingering pain, like tension headaches or jaw pain. Also, chronic releases of cortisol can create widespread inflammation within the body that leads to fatigue and pain. 

Similar to stress, pain functions as a warning sign to alert us of immediate danger. While it seems simple in context, as you know, chronic pain can be much trickier to explain. 

Some cases of chronic pain may be related to problems in the body itself, such as issues within the body tissues, muscles, joints, or bones. More often than not, however, pain is the result of a faulty nervous system that is related to a persistent fight-or-flight response. In this state, the brain continues to see these faulty messages as a cry for help and, in response, will release cortisol, which amplifies the pain cycle. 

This cycle eventually results in:

  • High sensitivity within the nervous system
  • Low pain thresholds
  • Increased heart rate
  • High blood pressure
  • Slowed breathing rate
  • Digestion problems
  • Muscle tension

Sound familiar?

With this understanding, it’s hard to deny the connection between chronic stress and chronic pain. Historically, medical professions were quick to dismiss the mind-body connection, but more and more experts have arrived at the conclusion that they are truly interrelated. 

The linkage becomes clear when you are in a constant state of pain, and the fight-or-flight response releases more stress hormones to attack the potential threat. This cycle continues and, eventually, you become stuck in a state of persistent pain and anxiety with no relief of your symptoms.

How can you break this cycle?
The first step to breaking this cycle is to understand how it works. Oftentimes, learning about the pain and stress cycles can improve your perception of pain and individual triggers. 

Finding ways to release endorphins in the brain is an excellent way to combat the chronic pain/stress cycle. Endorphins have the opposite effect of the stress hormones and can potentially stop pain signals under the right circumstances. The best ways to release endorphins are to: (1) lower your external sources of stress, (2) laugh, (3) sing, or (4) engage in aerobic exercise. We are big supporters of “E, all of the above.” 

In people with a history of trauma or mood disorders, cognitive behavioural therapy and mindfulness strategies can also help to diminish persistent pain. These therapies are effective because they change the way your brain processes thoughts and emotions. Theoretically, it pivots negative thoughts to positive ones in order to regain control over an amygdala hijack (see Fight-or-Flight Series (Part 2): What Happens During an Overreaction to Stress and 4 Ways to Prevent It). 

If your chronic pain is related to myofascial tightness, postural problems, or injury, then physical therapy is your best option for non-pharmaceutical relief. Techniques such as myofascial release and craniosacral therapy can help release restrictions in the fascia and soft tissues that may be contributing to pain patterns. Related: learn more about fascia and how to take care of it.

Lastly, breaking these cycles can be challenging to do on your own. Having support has been shown to reduce fear, apprehension, and anxiety, especially in new environments. With family or friends, you are more likely to do your favorite activities without fearing the repercussion of persistent symptoms. Some studies have even suggested that loved ones distract your attention from pain, thus, allowing you to enjoy your activity or environment. 

Still with us? Parts 4 and 5 will conclude this series by focusing on the nutritional aspects of the fight-or-flight response, chronic pain, and fighting off inflammation. We hope you are enjoying this series and want to hear from you. What has been the most surprising fact about the fight-or-flight response that you recently learned? What other questions do you have?

Written for Fitness Blender by Kayla C, PT, DPT
Board-Certified Neurological Clinical Specialist