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Section 5
Stress Related to Pain

Question 5 | Test | Table of Contents

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In the last section, we discussed three concepts related to core beliefs.  These three concepts of core beliefs include:  negative life events; self-identification; and culturally influenced core beliefs.

In this section, we will examine three characteristics of stress related to pain.  These three characteristics of stress related to pain include:  spontaneous stress and chronic stress; stress as an automatic thought trigger; and physical manifestations of stress.

Specifically, I have found that stress, or the inability to handle life’s daily stressors, may play an important part in the ebb and flow of fibromyalgia symptoms.  In addition, some researchers have speculated that fibromyalgia could be viewed as "associated with dysregulation of the stress system."  Because of this, I have found it useful to evaluate a client’s stress levels and also to understand exactly how stress affects the client’s pain. 

3 Characteristics of Stress Related to Pain

♦ #1 Spontaneous Stress vs. Chronic Stress
The first characteristic of stress related to pain is spontaneous stress versus chronic stress.  In clients suffering from chronic pain, and especially clients who suffer from fibromyalgia, I have found that I can categorize these clients under two categories:  clients who experience spontaneous stress and clients who experience chronic stress. 

Those clients who experience spontaneous stress are those whose symptoms flare up only sporadically when an outside stressor presents itself.  Chronic stress, however, appears in clients who cannot seem to relax at any time.  Sixteen percent of a group of fibromyalgic clients surveyed stated that they felt stressed all the time, while 52 percent stated they felt stressed most of the time. 

For many clients, this is a "chicken-and-egg" question.  The pain brought on by fibromyalgia can cause stress in the work place and increase levels, but new stressors can also increase the symptoms of fibromyalgia. 

Gina, age 34, stated, "Before my fibromyalgia started up, I was a pretty relaxed person.  I could get through a day without too much stress and I always had a perky attitude.  Now, I just want to scream all the time!  I’m tired, in pain, and I can’t get my work done so that piles up and causes more stress!"  I suggested that Gina explain the situation to her boss, ask for a lighter work load, and think of some relaxation techniques, such as yoga, deep breathing, or aromatherapy, to help cope with any left-over stressors. 

Think of your Gina.  Does he or she suffer from spontaneous or chronic stress?  How does this affect his or her muscle sensitivity?

♦ #2 Stress as an Automatic Thought Trigger
The second characteristic of stress related to pain we will discuss is stress as an automatic thought trigger.  As discussed in section 3, automatic thoughts are recurring mantras that chronic pain clients repeat to try and make sense of the world.  Under stressful conditions, these automatic thoughts become stronger and more powerful in the mind of the client.  Faced with a threat, the client tries to counteract and make sense of the threat that he or she perceives to be facing him or her. 

Joleen, age 62, had chronic, severe arthritis in her hands.  Because of the acuteness of the pain, Joleen had attached herself to the thought, "I’m helpless!"  She stated, "I can’t use my hands anymore, so how am I supposed to live?  I loved to sew and cook and garden, but now I can’t do any of those things!  I’m completely helpless around the house, I can’t do anything for myself!" 

A few weeks later, Joleen was invited to a potluck by one of her friends.  Immediately, Joleen felt herself become pressured to make and bring a fantastic dish to impress all her friends.  She stated, "What am I supposed to do?  If I come with nothing, they will think I am just trying to eat their food, but if I cook something, I know I’m going to be in so much pain!  There is no way out of this calamity!  I’m completely helpless!

Did you notice how her mind jumped straight to her automatic thought?  Have you seen this in your experience? 

To help Joleen with her stress, I suggested we brainstorm about alternative solutions.  For instance, I suggested that Joleen could buy a cake or a box of cookies.  That way, she doesn’t come empty-handed and at the same time avoids unnecessary pain.  Brainstorming is one of my common answers to these kinds of stressors.  I have found that stressors like these tend to shut down a client’s reasoning processes in such a way that he or she cannot see a way out of the situation. 

Think of your Joleen.  Does he or she need some brainstorming exercises at times of great stress?

♦ #3 Physical Manifestations of Stress
In addition to spontaneous and chronic stress and stress as a trigger, the third characteristic of stress related to pain is physical manifestations of stress. 

Have you ever had a client who hates to show any weakness?  What if this client suffers from chronic pain?  I find that male clients have a much more difficult time admitting weaknesses than female clients.  Do you agree? 

When it comes to stress, male clients hide the stressors behind a wall of nonchalance.  They do not wish to expose their emotional vulnerability to the world.  However, an increase in the acuteness of pain, especially in fibromyalgic clients, indicates a higher level of stress, which the client may or may not admit to.  Also, because a lower cognitive awareness also indicates an increase in the level of pain, if a client seems more distracted or inattentive than usual, I may ask him or her if his or her symptoms have flared-up. 

Rick, age 45, was a successful business owner and ambitious entrepreneur.  His late onset fibromyalgia had slowed him down considerably, yet he still attempted to maintain the same level of activity.  He asked me what he could do to reduce his pain and I suggested cutting down on his responsibilities at work.  However, Rick was a workaholic, and although he promised to decrease his involvement with the company, he continued to work late into the night. 

Obviously, his pain worsened and he became more and more easily distracted at work and in our sessions.  Finally, I asked him if he had reduced his hours like I had suggested.  Reluctantly, he stated, "No, I didn't.  And now my pain is even worse."  Eventually, Rick hired a partner to split his work into half.  The first month, he reported much less severe pain flare-ups. 

Think of your Rick.  Is he or she misrepresenting their stress level so as not to appear weak?

In this section, we discussed three characteristics of stress related to pain.  These three characteristics of stress related to pain included:  spontaneous stress and chronic stress; stress as an automatic thought trigger; and physical manifestations of stress.

In the next section, we will examine three concepts related to redefining self-worth in chronic pain clients.  These three concepts related to redefining self-worth include:  poor self-image; grieving; and building the new identity.
Reviewed 2023

Peer-Reviewed Journal Article References:
Akbari, F., Dehghani, M., & Mohammadi, S. (2021). Factor structure and invariance of the pain catastrophizing scale in patients with chronic pain and their spouses. Rehabilitation Psychology, 66(1), 50–56.

Carleton, R. N., Duranceau, S., McMillan, K. A., & Asmundson, G. J. G. (2018). Trauma, pain, and psychological distress: Attentional bias and autonomic arousal in PTSD and chronic pain. Journal of Psychophysiology, 32(2), 75–84.

Ein-Dor, T., Doron, G., Solomon, Z., Mikulincer, M., & Shaver, P. R. (2010). Together in pain: Attachment-related dyadic processes and posttraumatic stress disorder. Journal of Counseling Psychology, 57(3), 317–327.

Noyman-Veksler, G., Shalev, H., Brill, S., Rudich, Z., & Shahar, G. (2018). Chronic pain under missile attacks: Role of pain catastrophizing, media, and stress-related exposure. Psychological Trauma: Theory, Research, Practice, and Policy, 10(4), 463–469.

Rice, D. B., Mehta, S., Serrato, J., Pope, J. E., Harth, M., Sequeira, K., Morley-Forster, P., Shapiro, A. P., & Teasell, R. W. (2017). Stress in patients diagnosed with rheumatoid arthritis compared to chronic pain. Rehabilitation Psychology, 62(4), 571–579.

What are three characteristics of stress related to pain?
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Section 6
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