The effect of stress on persistent pain: 5 tips to help re-centre yourself.

“I’m just under the pump at work at the moment. The last thing I need is this neck pain slowing me down!”

We as physio’s hear some version of this pretty much everyday in the clinic. An episode of pain (whether its neck, back shoulder – whatever) associated with an acutely stressful situation. So did stress cause this episode of pain? Well sometimes yes and sometimes it’s there playing a supporting role.

Firstly what actually is pain?

Might seem like a silly question to ask we’ve all experienced it but understanding how it actually works is often poorly understood. Perhaps surprisingly, pain is not a fixed experience, meaning you can’t really measure it against some sort of standard to compare your pain to someone else’s. This is because pain is a unique experience to each individual.

That means that everyone’s experience of pain is different and can be influenced by a variety of factors. Stress is just one of those factors that can influence your pain.

Pain as a protector

A useful way to think of pain is as part of your body’s protection system. You’ll feel pain if your brain believes there’s a credible threat to you.

In the same way you’re heart rate spikes and your pupils dilate if you turned the corner and came face to face with a rabid dog. Heart rate increases, blood flows to your moving muscles, eyes dilate and you narrow your visual fields – you’re getting ready to defend yourself or run away. All these things happening in your body are ways your body reacts to protect you against a perceived (whether real or not) threat.

Stress influences our threat detection system

Stress is perceived by the body as a threat – so stress can both elevate our heart rate and influence our pain experience (make it feel more intense or become more constant).

Essentially pain is your body trying to protect you from danger – whether or not the danger is physical (think the rabid dog) or perceived (think looming work deadline or anxious thoughts about a relationship). Its your alarm system ringing.

Pain is your body trying to protect you.

And this is a really good thing. It alerts us to things that we might need to avoid or be alert too. But sometimes it becomes over protective (especially with people suffering from persistent or chronic pain).

So if pain is your body’s response to perceived threat then decreasing threat in the body (or promoting a sense of safety) is a good way to manage pain.

Promoting safety in your body doesn’t just mean being safe from physical dangers (our modern lifestyles make this fairly easy to achieve) but also our emotional or cognitive state (our thought life). Promoting safety in the body is you turning down the volume on your pain response.

Stress management strategies

Here are some commonly useful ways to decrease stress and promote safety in the body:

  1. Breathe – long slow exhales or box breathing techniques (breathe in for 4 seconds – hold for 4 seconds – breathe out for 4 seconds – hold for 4 seconds) help reduce heart rate and decrease our body’s stress response.
  2. Journal your thoughts – writing things down is a good technique to create distance from you and the situation. Creating space can help you to see things from another perspective.
  3. Move your body – movement can be an effective way to regulate your emotional state, reduce stress and alleviate pain. But what movement is best? This differs for each individual – there’s no one size fits all. The best approach for you may differ from day to day. A good starting point is to start gentle and easy going (walk, dance, easy cycling). But sometimes our bodies need something a bit more vigorous. Higher intensity bouts of exercise is a great way to bring calm to your body. Best way is to listen to your body and and give it what it wants on any given day.
  4. Get into a green space – ‘Forest bathing’ is a term commonly used for this. Being in a leafy space or near the water reduces our stress response. This works with awe as well – being at the foot of a mountain or looking out over a valley can incite a sense of awe in us and has shown to reduce stress.
  5. Experience ‘awe’ – Going somewhere or doing something that causes an experience of awe can help. Think of that feeling when you stand at the foot of a massive mountain, listen to a live orchestra or look down a valley from up high. Being somewhere, reading something, listening to something that makes you feel small can help re-centre you.
  6. Combine things – to make these stress reduction activities more potent you can stack them together. For example: Do some breathing exercises after having done some exercise in a green space. By combining these things together you can increase their impact


These are just 6 examples – and there’s no wrong answers here.

What would you add to your list?

Tim Cathers

Book an online appointment with one of our team today!

Equip Physiotherapy is here to help reduce your pain & manage injuries! Booking through our online appointment form is the most convenient way to lock in the team member & time you want.