I received a great question from a patient recently: She had read somewhere that stress and emotions were the cause of back pain, and wondered if I agreed or if it was true. Here is the majority of my answer.
While not the only cause of pain, the relationship between mental/emotional complaints or stress and how they lead to various physical conditions has long been known. The technical term for it is “psychosomatic,” or “psychogenic,” and refers to physical complaints being caused by mental/emotional problems. As our world has gotten busier and busier, and we have gotten away from stress-reducing activities in our daily life, these psychosomatic conditions have become much more widespread. Unfortunately, addressing psychosomatic conditions is difficult for several reasons.
First, psychosomatic complaints can be varied in their expression. Some people experience headaches when stressed, while others will develop back pain. Still others will suffer from indigestion… or high blood pressure… or neuropathy… or constipation… panic attacks… etc. Because of this highly variable presentation, it is difficult to determine exactly when our conditions are psychogenic in nature or when there is a true underlying disease process. In addition, there are no real tests that can be performed or evaluated to definitively diagnose psychosomatic conditions. Therefore, we are often in a position where we must run a multitude of tests and evaluations to rule out more serious complications or underlying disease processes. When these tests, inevitably, show no evidence of other causes, by exclusion the only plausible remaining diagnosis is “psychosomatic.” However, the very process of so many tests, the costs associated with these tests, and the continual disappointment of another test without an answer… only adds to the stress that is ultimately the underlying cause!
Second, when we have confirmed that stress is either the primary underlying cause or just a complicating factor, it is extremely difficult to get patients to comply with our recommendations on how to reduce that stress. Regardless of whether a physician is involved or not, a person who recognizes that stress is the culprit will often be unwilling (or unable) to take the necessary steps to correct their situation. How many of us can change occupations at will? Which of us can rapidly make money problems disappear? Who among us chooses when to deal with a dying parent? Which of us set our own work hours? And on and on… However, there are a great many things that we can do, but are often unwilling. For example: How many of us turn the television off and read a book in the evening? How many of us go to bed early with some soft, soothing music? How many of us choose nutritious snacks instead of sugary, carbohydrate-rich junk? Who do you know that closes their eyes and rests for fifteen minutes at lunch instead of checking in on Facebook? How many of us go for a walk in the evening instead of watching American Idol? Stress is largely a direct effect of the choices we make, our response to the consequences of those choices, and our willingness or ability to change those choices.
Third, our traditional Western medical system is not designed to properly address or correct psychosomatic conditions. If you look at the above complaints we noted above, think about how those conditions are primarily treated. Headache? Take Excedrin. Back pain? Take Alleve. Indigestion? Take Prevacid. High blood pressure? Take Toprol. Neuropathy? Take Gabapentin. Constipation? Take Maalox. Panic attacks? Take Prozac. Are you seeing the pattern here? And don’t blame this entirely on doctors or the pharmaceutical companies… Nearly every one of the conditions I’ve listed are lifestyle-related. In other words, choices the patient has made have led to the conditions with which they are suffering. By extension, patients demand and choose a treatment alternative that allows them to go on making the same ill-fated choices. Unfortunately, our Western medical system is largely geared towards symptom control… not dysfunction correction.
So, can mental or emotional stress cause pain? Absolutely. It can cause a great many things other than just pain, so it is important to make stress-reduction a regular part of your daily life.
Dr. Gray's Straight Talk 