When Stress Hurts: The Psychology of Pain

SerraDosOegaos_EN-US952673641Psychological factors that play a role in the onset of physical pain are the subject of this, the fourth post in the series on the close association between psychological stress and psychogenic pain.

Likely Causes of Psychogenic Pain

Negative interaction with one’s spouse has been correlated with the sudden appearance of pain symptoms in otherwise healthy individuals (Campbell, 2002; Hughes, Medley, Turner, & Bond, 1987). Numerous studies show that the appearance of pain is often closely associated with the onset of psychological stress, financial problems, job dissatisfaction (Melin et al., 1997), unemployment, and with other less severe but long-lasting life stressors (Bennett et al., 1998). Covington (2000) speaks of a continuum of suffering of pain and stress and suggests the terms “psychologically augmented pain” (p. 292) to describe physical suffering that appears to be at least partially caused by psychological factors.

Chronic stress in adults, especially over many years and of particular severity, often results in alterations in the allostatic control system, which in the case of gastrointestinal disorders can lead to an exacerbation of symptoms (Bennett et al., 1998). Earlier in life, significant stressors in an infant’s life have been shown to produce a permanent upward modification in the levels of Corticotrophin Release Factor secretion and in the overactivation of the locus ceruleus (Ladd, Huot, Thrivikraman, & al., 2000). Moreover, prolonged abuse or neglect at any stage of life has been linked to a permanent alteration of the HPA axis response to stressors (Heim, Newport, & Heit, 1999).

Certain life stressors have been positively linked with the onset and persistence of gastrointestinal disorders, including inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), functional gastrointestinal disorder (FGD), and gastro-esophageal reflux disease (GERD). Research has also established a correlation between acute stress in adults (such as rape or combat situations) or early life stressors (such as child abuse) and the later onset of these gastrointestinal disorders (Mayer, 2000).

Stress-related Muscle and Bone Pain

Pain in the muscles and joints is often associated with stress. Musculoskeletal pain localized in the lower back, shoulders, and arms appears frequently to be unrelated to any disease and thus bear all indications of having psychological causes (Harkness, Macfarlane, Silman, & McBeth, 2005). Researchers postulate that an increase in this type of pain observed in data collected by the Arthritis Research Campaign over a 40-year span may be due to “an increase in the proportion of the population who are psychologically distressed”  (Harkness et al., 2005, p. 893).

Other research suggests that musculoskeletal pain may be caused by multiple factors such as psychosocial environment, individual personality, specific behaviors, and mental stress. A study by Melin and colleagues (1997) on several hundred factory workers, assembly line workers, and supermarket cashiers suffering from musculoskeletal pain showed that the telltale signs of strong HPA axis activation, i.e. urinary catecholamines and cortisol, salivary cortisol, blood pressure and heart rate, and norepinephrine output all increased due to psychological stress.

Stress, Mental Health and Pain

Physiological pain and psychological disorders such as depression often coexist. Blackburn-Munro & Blackburn-Munro (2001) reported that while approximately 30 percent of individuals who report pain are diagnosed with clinical depression, 75 percent of patients diagnosed with depression also suffer from physical symptoms, including pain. Drossman (1982) provided evidence that individuals who seek medical help for irritable bowel syndrome are significantly more likely to present with psychiatric disorders, abnormal personality patterns and greater life stress.

Katon et al. (2001) in their extensive review of large epidemiological studies found that headache and other variously localized pain are associated with approximately 50% of visits to primary care physicians, and that most of the time, no clear medical explanation of the pain symptom is found. Stressful life events, anxiety and depressive disorders, childhood and adult trauma, and specific personality traits have all been found to be associated with multiple physical symptoms. Kroenke & Mangelsdorff (1989) reviewed over 1,000 patient records and noted 567 new complaints of chest pain, fatigue, dizziness, headache, edema, back pain, dyspnea, insomnia, abdominal pain, numbness, impotence, weight loss, cough, and constipation, and that an organic etiology was demonstrated in only 16% of these cases.

Finally, data from the World Health Organization’s study of psychological problems in general health care was used by Gureje and colleagues (2001) to examine the course of persistent pain syndromes among 3197 randomly selected primary care patients in 14 countries, which evidenced a strong and symmetrical relationship between persistent pain and psychological disorders.

Previously in this series:


  • Fibromyalgia, Severe Headaches and Other Stress-Related Misery
  • Medical and Non-Medical Treatments for Stress and Psychogenic Pain