Alex Simotas, MD

Hospital for Special Surgery
Board Certified Physiatrist
Specializing In Spine & Sports Medicine

Home > Wellness & Exercise > Wellness Strategies > Stress, Fear & Pain

Stress, Fear & Pain

Lets face it: stress is a part of life. Why does it seem to cause pain, or at least make pain worse when we are having it? Some people might think: Well, stress is always a part of life, but pain…that’s a separate problem. Others might think: If I can get rid of my stress, then everything would be fine.

Life is full of problems, deadlines, frustrations, and demands. Perhaps modern day life has become more stressful than ever. Perhaps…

More likely modern life has compartmentalized the way we view and the way we experience stress: Our physical stress and pain on one end and emotional stress and pain on the other. Our livelihoods have divided our physical lives from our sedentary lives. We sit at work and exert our bodies elsewhere. Perhaps we exert our bodies at work and are idle at home.

Modern medicine thus far views our body and mind in small separate compartments. We see the anatomy of the spine, brain and foot on different MRI scans. We analyze our feelings and stress by the interpretations of psychiatrists, Freudian theorists and others.

How can stress and pain be connected? Should we stress out less and hope to have less pain? Stress is an important part of daily living. Clearly having less of it and still feeling fulfilled and accomplished is key. Living in a dark cave with not stress at all offers little satisfaction to most of us.

Obviously internalizing less stress, while accomplishing more is a goal. Some people seem to be better at coping with certain types of stress than others. Often a balance somewhere is important. How about stress and pain. Do we need to lessen stress to lessen pain?

There are many different types of stress. Stressors are the potential sources of stress and can be viewed as internal or external. Demands or deadlines at work, financial problems, children, family, relationships might be external factors, while adaptive qualities such as adjusting expectations realistically, perfectionism, assertiveness, planning, positive attitudes, and ability to tolerate some uncertainty might be more internal factors.

Adapting to and managing stress are obviously important factors in maintaining a sense of well-being. However, with regards to pain itself, acknowledging the connection between stress and pain may be even more important defusing the connection between two.



Studies support the conclusion that stress and pain are often closely linked and that what happens in the brain— depression, anxiety, being stressed out—can increase pain. Pain can increase depression and anxiety. The fear of pain appears to be the greatest potential generator of this connection. Each one can have an impact on the other, creating a vicious cycle. So, part of getting pain relief is learning how to better manage stress, and more specifically pain-related stress. You may be great at handling stress in various situations (at work, in competitive environments etc.) and still be handcuffed by poor concepts of pain, fear of pain, pain-stress trauma and the like.



Pain is regulated by the nervous system thus making the brain is a key player in how we perceive pain. The brain filters pain signals based on experience, knowledge, and sensory perceptions. So if you’re stressed, the brain’s filter system will be adversely affected. During stress experiences, the brain is already bombarded with signals of adversity and distress that martial its defenses.

The nervous system has its own army of defenses that it can rally. Through its arms of control in the sympathetic nervous system it can speed up our heart rate, increase the pumping of the heart, increase our rate of breathing, sweating. Sympathetic tone may lower our pain threshold in distressed areas of the body (see “the pain system and our spine”). All these factors can increase the experience of pain.



When someone feels threatened or overly anxious or under severe stress, their nervous system responds by releasing a flood of stress hormones, including adrenaline and cortisol. These hormones rouse the body for emergency action.

The heart pounds faster, muscles tighten, blood pressure rises, breath quickens, and your senses become sharper. These physical changes increase your strength and stamina, speed your reaction time, and enhance your focus— preparing you to either fight or flee from the danger at hand. This response to stress is the body’s way of protecting you. When working properly, it helps you stay focused, energetic, and alert. In emergency situations, stress can save your life—giving you extra strength to defend yourself. The stress response also helps you rise to meet challenges. But beyond a certain point, stress stops being helpful and starts causing major damage to your health, your mood, your productivity, your relationships, and your quality of life.



The field of neuroscience and modern technology such as the Magnetic Resonance Imaging machine has given us the ability to look inside our bodies to see where pain and stress actually reside. A study from Northwestern University Institute of Neuroscience found that people suffering with chronic back pain demonstrate abnormal brain chemistry, and actual brain shrinkage (The Journal of Neuroscience, November, 2004).



The situations and pressures that cause stress are known as stressors. We usually think of stressors as being negative, such as an exhausting work schedule, money problems, or a troubled relationship. However, anything that puts high demands on you or forces you to adjust can be stressful. This includes positive events such as buying a house or receiving a promotion.

What causes stress depends, at least in part, on your perception of it. For example, a morning driving commute to work may make you anxious and tense because you worry that traffic will make you late. Others allow more than enough time and enjoy listening to music while they drive and find it relaxing.



  • Support network: friends and family members usually are supports against life’s stressors. Loneliness and isolation can make you more vulnerability to stress.
  • Sense of control: confidence in yourself and your ability to influence events and persevere through challenges.
  • Attitude and outlook: Having an optimistic attitude helps reduce stress.
  • Dealing with emotions: You’re extremely vulnerable to stress if you don’t know how to calm and soothe yourself when you’re feeling sad, angry, or afraid. The ability to balance emotions helps confront adversity.
  • Insight and preparation: The more you know about a stressful situation, including how long it will last and what to expect, the better. For example, if you go into surgery with a realistic picture of what to expect, the postoperative recovery will be less traumatic.