Stress and Pain

  • Catherine StoneyEmail author


Chronic pain can affect every aspect of life, from functional disability to social isolation, financial problems, and stress and psychiatric disorders such as depression and anxiety. However, there are enormous individual differences in how those with pain function; while many chronic pain patients experience relatively low levels of daily functioning, others are able to adapt and function well. For these reasons, an understanding of individual differences in coping strategies, background or consequent psychological stress, and environmental and social resources may help to understand how stress and pain are related. Because pain incorporates both a sensory and emotional component, it is important to understand both when considering assessment and treatment of pain. This chapter will focus specifically on the relationship between pain (both chronic and acute) and psychological stress, but the fundamental message of what follows is that the comorbidity between stress and pain requires careful assessment of psychological, social, and environmental factors when assessing patients in pain and when planning a treatment strategy. Whether the pain specifically increases stress or whether similar amounts of stress are induced by illness in general, stress can increase the experience and perception of pain, the mode and degree of success in coping with the pain, the degree to which patients and healthcare providers can effectively work together, and adherence to and success with treatment.



Cognitive behavioral therapy




Functional magnetic resonance imaging




Magnetic resonance imaging




Perceived Stress Scale


Post-traumatic stress disorder


Socioeconomic status



The views expressed in this manuscript are those of the author and do not necessarily represent the views of the National Heart, Lung, and Blood Institute, the National Institutes of Health, or the US Department of Health and Human Services.


  1. Abbott, F. V., & Fraser, M. I. (1998). Use and abuse of over-the-counter analgesic agents. Journal of Psychiatry & Neuroscience, 23, 13–34.Google Scholar
  2. Adler, N. E., & Ostrove, J. M. (1999). Socioeconomic status and health: What we know and what we don’t. Annals of the New York Academy of Science, 896, 3–15.CrossRefGoogle Scholar
  3. Åkerblom, S., Perrin, S., Rivano, F. M., & McCracken, L. M. (2017). The relationship between posttraumatic stress disorder and chronic pain in people seeking treatment for chronic pain: The mediating role of psychological flexibility. The Clinical Journal of Pain, 34, 487. Scholar
  4. Amit, Z., & Galina, Z. H. (1986). Stress-induced analgesia: Adaptive pain suppression. Physiological Reviews, 66, 1091–1120.CrossRefGoogle Scholar
  5. Arena, J. G., Blanchard, E. B., & Andrasik, F. (1984). The role of affect in the etiology of chronic headache. Journal of Psychosomatic Research, 28, 79–86.CrossRefGoogle Scholar
  6. Arena, J. G., Sherman, R. A., Bruno, G. M., & Smith, J. D. (1990). The relationship between situational stress and phantom limb pain: Cross-lagged correlational data from six month pain logs. Journal of Psychosomatic Research, 34, 71–77.CrossRefGoogle Scholar
  7. Arguelles, L. M., Afrai, N., Buchwald, D. S., Clauw, D. J., Ferner, S., & Soldbert, J. (2006). A twin study of posttraumatic stress disorder symptoms and chronic widespread pain. Pain, 124, 150–157.CrossRefGoogle Scholar
  8. Bai, M., Tomenson, B., Creed, F., Mantis, D., Tsifetaki, N., Voulgari, P. V., Drosos, A. A., & Hyphantis, T. N. (2009). The role of psychological distress and personality variables in the disablement process in rheumatoid arthritis. Scandanavian Journal of Rheumatology, 38, 419–430.CrossRefGoogle Scholar
  9. Bair, M. J., Robinson, R. L., Katon, W., & Kroenke, K. (2003). Depression and pain comorbidity: A literature review. Archives of Internal Medicine, 163, 2433–2445.CrossRefGoogle Scholar
  10. Bakhshani, N. M., Amirani, A., Amirifard, H., & Shahrakipoor, M. (2015). The effectiveness of mindfulness-based stress reduction on perceived pain intensity and quality of life in patients with chronic headache. Global Journal of Health Science, 8, 142–151.CrossRefGoogle Scholar
  11. Bazzichi, L., Maser, J., Piccinni, A., Rucci, P., Del Debbio, A., Vivarelli, L., et al. (2005). Quality of life in rheumatoid arthritis: Impact of disability and lifetime depressive spectrum symptomatology. Clinical and Experimental Rheumatology, 23, 783–788.PubMedGoogle Scholar
  12. Bevans, K. B., Gardner, W., Pajer, K., Riley, A. W., & Forrest, C. B. (2013). Qualitative development of the PROMIS® pediatric stress response item banks. Journal of Pediatric Psychology, 38(2), 173–191.CrossRefGoogle Scholar
  13. Bondy, B., Baghal, T. C., Minov, C., Schule, C., Schwarz, M. J., Zwanzger, P., Rupprecht, R., & Moller, J. J. (2003). Substance P serum levels are increase in major depression: Preliminary results. Biological Psychology, 53, 538–542.CrossRefGoogle Scholar
  14. Broderick, J. E., DeWitt, E. M., Rothrock, N., Crane, P. K., & Forrest, C. B. (2013). Advances in patient-reported outcomes: The NIH PROMIS(®) measures. eGEMS, 1, 1015.CrossRefGoogle Scholar
  15. Cairns, M. C., Foster, N. E., Wright, C. C., & Pennington, D. (2003). Level of distress in a recurrent low back pain population referred for physical therapy. Spine, 28, 952–959.Google Scholar
  16. Campbell, C. M., Witmer, K., Simango, M., Carteret, A., Loggia, M. L., Campbell, J. N., Haythornthwaite, J. A., & Edwards, R. R. (2010). Catastrophizing delays the analgesic effect of distraction. Pain, 149, 202–207.CrossRefGoogle Scholar
  17. Chambers, C. T., Taddio, A., Uman, L. S., McMurtry, C. M., & HELPinKIDS Team. (2009). Psychological interventions for reducing pain and distress during routine childhood immunizations: A systematic review. Clinical Therapeutics, 31(Suppl B), S77–S103.CrossRefGoogle Scholar
  18. Chang, H. C., Yu, C. H., & Huang, K. F. (2015). The effcts of music listening on psychosocial stress and maternal-fetal attachment during pregnancy. Complementary Therapies in Medicine, 23, 509–515.CrossRefGoogle Scholar
  19. Clauw, D. J. (2009). Fibromyalgia: An overview. The American Journal of Medicine, 122, S3–S13.CrossRefGoogle Scholar
  20. Cohen, S., & Williamson, G. (1988). Perceived stress in a probability sample of the United States. In S. Spacapam & S. Oskamp (Eds.), The social psychology of health: Claremont symposium on applied social psychology. Newbury Park: Sage.Google Scholar
  21. Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, 385–396.CrossRefGoogle Scholar
  22. Corcoran, L., Roche, M., & Finn, D. P. (2015). The role of the brain’s endocannaboinoid system in pain and its modulation by stress. International Review of Neurobiology, 125, 203–255.CrossRefGoogle Scholar
  23. Croft, P. R., Papageorgiou, A. C., Ferry, S., Thomas, E., Jayson, M. I., & Silman, A. J. (1995). Psychological distress and low back pain: Evidence from a prospective study in the general population. Spine, 20, 2731–2737.CrossRefGoogle Scholar
  24. Crosbie, T. W., Packman, W., & Packman, S. (2009). Psychological aspects of patients with Fabry disease. Journal of Inherited Metabolic Diseases, 32, 745–753.CrossRefGoogle Scholar
  25. Damush, T. M., Kroenke, K., Bair, M. J., Wu, J., Tu, W., Krebs, E. E., & Poleshuck, E. (2016). Pain self-management training increases self-efficacy, self-management behaviours, and pain and depression outcomes. European Journal of Pain, 20, 1070–1078.CrossRefGoogle Scholar
  26. Demitrack, M. A., & Crofford, L. J. (1998). Evidence for and pathophysiologic implications of hypothalamic-pituitary-adrenal axis dysregulation in fibromyalgia and chronic fatigue syndrome. Annals of the New York Academy of Science, 840, 684–697.CrossRefGoogle Scholar
  27. Driban, J. B., Morgan, N., Price, L. L., Cook, K. F., & Wang, C. (2015). Patient-Reported Outcomes Measurement Information System (PROMIS) instruments among individuals with symptomatic knee osteoarthritis: A cross-sectional study of floor/ceiling effects and construct validity. BMC Musculoskeletal Disorders, 16, 253.CrossRefGoogle Scholar
  28. Flor, H. (2008). Maladaptive plasticity, memory for pain and phantom limb pain: Review and suggestions for new therapies. Expert Review of Neurotherapeutics, 8, 809–818.CrossRefGoogle Scholar
  29. Flor, H., Fydrich, T., & Turk, D. C. (1992). Efficacy of multidisciplinary pain treatment centers: A meta-analytic review. Pain, 49, 221–230.CrossRefGoogle Scholar
  30. Gallo, L. C., & Matthews, K. A. (2003). Understanding the association between socioeconomic status and physical health: Do negative emotions play a role? Psychological Bulletin, 129, 10–51.CrossRefGoogle Scholar
  31. Geva, N., Pruessner, J., & Defrin, R. (2014). Acute psychosocial stress reduces pain modulation capabilities in healthy men. Pain, 155(11), 2418–2425.CrossRefGoogle Scholar
  32. Gill, K. M., Carson, J. W., Porter, L. S., Scipio, C., Bediako, S. M., & Orringer, E. (2004). Daily mood and stress predict pain, health care use, and work activity in African American adults with sickle-cell disease. Health Psychology, 23, 267–274.CrossRefGoogle Scholar
  33. Gracely, R. H., Feisser, M. E., Fiesecke, T., Grant, M. A. B., Petzke, F., Williams, D. A., & Clauw, D. J. (2003). Pain catastrophizing and neural responses to pain among persons with fibromyalgia. Brain, 127, 835–843.CrossRefGoogle Scholar
  34. Hartman, J. M., Berger, A., Baker, K., Bolle, J., Handel, D., Mannes, A., Pereira, D., St. Germain, D., et al. (2006). Quality of life and pain in premenopausal women with major depressive disorder: The POWER Study. Health and Quality of Life Outcomes, 4, 2–6.CrossRefGoogle Scholar
  35. Hasenbring, M., Marienfeld, G., Kuhlendahl, D., & Soyka, D. (1994). Risk factors of cronicity in lumbar disc patients: A prospective investigation of biologic, psychologic, and social predictors of therapy outcome. Spine, 19, 2759–2765.CrossRefGoogle Scholar
  36. Heim, C., Newport, D. J., Bonsall, R., Miller, A. H., & Nemeroff, C. B. (2001). Altered pituitary-adrenal axis responses to provocative challenge tests in adult survivors of childhood abuse. The American Journal of Psychiatry, 158, 575–581.CrossRefGoogle Scholar
  37. Hoffman, B. M., Papas, R. K., Chatkoff, D. K., et al. (2007). Meta-analysis of psychological interventions for chronic low back pain. Health Psychology, 26, 1–9.CrossRefGoogle Scholar
  38. Holmes, T. H., & Rahe, R. H. (1967). The social readjustment rating scale. Journal of Psychosomatic Research, 11, 213–218.CrossRefGoogle Scholar
  39. Jensen, M. P., Turner, J. A., Romano, J. M., & Karoly, P. (1991). Coping with chronic pain: A critical review of the literature. Pain, 47, 249–283.CrossRefGoogle Scholar
  40. Kanegane, K., Penha, S. S., Munhoz, C. D., & Rocha, R. G. (2009). Dental anxiety and salivary cortisol levels before urgent dental care. Journal of Oral Science, 51, 515–520.CrossRefGoogle Scholar
  41. Koushede, V., Holstein, B., Andersen, A., Ekholm, L., & Hansen, E. H. (2010). Use of over-the-counter analgesics and perceived stress among 25–44 year olds. Pharmacopeidemiology and Drug Safety, 19, 351–357.Google Scholar
  42. Lazarus, R. S., & Folkman, S. (1989). Hassles and uplifts scales. Palo Alto: Consulting Psychologists Press.Google Scholar
  43. Li, X. (2015). Pain and depression comorbidity: A preclinical perspective. Brain and Behavior Research, 276, 92–98.CrossRefGoogle Scholar
  44. Lipton, R. B., Buse, D. C., Hall, C. B., et al. (2014). Reduction in perceived stress as a migraine trigger: Testing the “let-down headache” hypothesis. Neurology, 82, 1395–1401.CrossRefGoogle Scholar
  45. Mayer, E. A. (2000). The neurobiology of stress and gastrointestinal disease. Gut, 47, 861–869.CrossRefGoogle Scholar
  46. McBeth, J., Siolman, A. J., Gupta, A., et al. (2007). Moderation of psychosocial risk factors through dysfunction of the hypothalamic-pituitary-adrenal stress axis in the onset of chronic widespread musculoskeletal pain: Findings of a population-based prospective cohort study. Arthritis and Rheumatology, 56, 360–371.CrossRefGoogle Scholar
  47. McLean, S. A., Clauw, D. J., Abelson, J. L., & Liberzon, I. (2005). The development of persistent pain and psychological morbidity after motor vehicle collision: Integrating the potential role of stress response systems into a biopsychosocial model. Psychosomatic Medicine, 67, 783–790.CrossRefGoogle Scholar
  48. Melzack, R. (1999). Pain and stress: A new perspective. In R. J. Gatchel & D. C. Turk (Eds.), Psychosocial factors in pain (pp. 89–106). New York: Guilford Press.Google Scholar
  49. Melzack, R. (2001). Pain and the neuromatrix in the brain. Journal of Dental Education, 65, 1378–1382.PubMedGoogle Scholar
  50. Melzack, R., & Wall, P. D. (1965). Pain mechanisms: A new theory. Science, 150, 971–979.CrossRefGoogle Scholar
  51. Nilsen, K. B., Sand, T., Westgaard, R. H., et al. (2007). Autonomic activation and pain in response to low-grade mental stress in fibromyalgia and shoulder/neck pain patients. European Journal of Pain, 11, 743–755.CrossRefGoogle Scholar
  52. Ohayon, M. M., & Schatzberg, A. F. (2010). Chronic pain and major depressive disorder in the general population. Journal of Psychiatric Research, 44, 454–461.CrossRefGoogle Scholar
  53. Quale, A. J., & Schanke, A. K. (2010). Resilience in the face of coping with a severe physical injury: A study of trajectories of adjustment in a rehabilitation setting. Rehabilitation Psychology, 55, 12–22.CrossRefGoogle Scholar
  54. Rios, R., & Zautra, A. J. (2011). Socioeconomic disparities in pain: The role of economic hardship and daily financial worry. Health Psychology, 30, 58–66.CrossRefGoogle Scholar
  55. Sarason, I., Johnson, J., & Siegel, J. (1978). Assessing the impact of life changes: Development of the life experiences survey. Journal of Consulting and Clinical Psychology, 46(5), 932–946.CrossRefGoogle Scholar
  56. Shobeiri, F., Khaledi, S., Masoumi, S. Z., & Roshanaei, G. (2016). The effect of music therapy counseling on sleep quality in pregnant women. International Journal of Medical Research and Health Sciences., 5, 408–416.Google Scholar
  57. Simavli, S., Kaygusuz, I., Gumus, I., Usluogulları, B., Yildirim, M., & Kafali, H. (2014). Effect of music therapy during vaginal delivery on postpartum pain relief and mental health. Journal of Affective Disorders, 156, 194–199.CrossRefGoogle Scholar
  58. Simone, D. A. (1992). Neural mechanisms of hyperalgesia. Current Opinion in Neurobiology, 2, 479–483.CrossRefGoogle Scholar
  59. Skinner, M. A., Zautra, A. J., & Reich, J. W. (2004). Financial stress predictors and the emotional and physical health of chronic pain patients. Cognitive Therapy and Research, 28, 695–713.CrossRefGoogle Scholar
  60. Stasio, M. J., Curry, K., Sutton-Skinner, K. M., & Glassman, D. M. (2008). Over-the-counter medication and herbal or dietary supplement use in college: Dose frequency and relationship to self-reported distress. Journal of American College Health, 56, 535–547.CrossRefGoogle Scholar
  61. Staud, R., Craggs, J. G., Robinson, M. E., et al. (2007). Brain activity related to temporal summation of C-fiber evoked pain. Pain, 129, 130–142.CrossRefGoogle Scholar
  62. Sternke, E. A., Abrahamson, K., & Bair, M. J. (2016). Comorbid chronic pain and depression: Patient perspectives on empathy. Pain Management in Nursing, 17, 363–371.CrossRefGoogle Scholar
  63. Stewart, W., Scher, A., & Lipton, R. (2001). Stressful life events and risk of chronic daily headache: Results from the frequent headache epidemiology study. Cephalalgia, 2, 279.Google Scholar
  64. Turk, D. C., Audette, J., Lecy, R. M., Mackey, S. C., & Stanos, S. (2010). Assessment and treatment of psychosocial comorbidities in patients with neuropathic pain. Mayo Clinic Proceedings, 85(Suppl), S42–S50.CrossRefGoogle Scholar
  65. Vlaeyen, J. W. S., & Linton, S. J. (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art. Pain, 85, 317–332.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.National Heart, Lung, and Blood InstituteThe National Institutes of HealthBethesdaUSA

Personalised recommendations