Chronic Pain Linked to Stress

Chronic pain that persists after a traumatic event may be caused more by stress and other psychological factors rather than a lingering injury, according to a new study.

Researchers at the University of North Carolina School of Medicine say they’ve also identified a genetic risk factor for chronic pain after a stressful event such as a sexual assault or motor vehicle collision.

“Our study findings indicate that mechanisms influencing chronic pain development may be related to the stress response, rather than any specific injury caused by the traumatic event,” said Samuel McLean, MD, assistant professor of anesthesiology and senior author of the study published in the journal Pain.

“In other words, our results suggest that in some individuals something goes wrong with the body’s ‘fight or flight’ response or the body’s recovery from this response, and persistent pain results.”

bigstock-Stressed-hispanic-man-sufferin-26569859The study assessed the role of the hypothalamic-pituitary adrenal (HPA) axis, a physiologic system that controls the body’s response to stressful events.

The study evaluated whether the HPA axis influences the severity of musculoskeletal pain six weeks after a car accident. Researchers found that a variation in the gene for the protein FKBP5, which plays an important role in regulating the HPA axis, was associated with a 20 percent higher risk of moderate to severe neck pain. The same genetic variant also predicted increased pain six weeks after a sexual assault.

“Right now, if someone comes to the emergency department after a car accident, we don’t have any interventions to prevent chronic pain from developing,” McLean said. “Similarly, if a woman comes to the emergency department after sexual assault, we have medications to prevent pregnancy or sexually transmitted disease, but no treatments to prevent chronic pain. This is because we understand what causes pregnancy or infection, but we have no idea what the biologic mechanisms are that cause chronic pain.”

“Chronic pain after these events is common and can cause great suffering, and there is an urgent need to understand what causes chronic pain so that we can start to develop interventions. This study is an important first step in developing this understanding.”

A researcher at Stanford University’s Division of Pain Medicine thinks the study findings could have wider applications to other types of chronic pain, including post-traumatic stress disorder (PTSD).

“People who acquire post-traumatic stress disorder following exposure to a traumatic stressor have major negative changes in thoughts, mood, and behavior. PTSD is associated with dyregulation of the HPA axis, and people with PTSD are at greatly increased risk for chronic pain, even if their initial trauma did not involve physical injury,” said Beth Darnall, PhD, Clinical Associate Professor, Stanford Systems Neuroscience and Pain Laboratory.

“While the current study did not examine people with a formal diagnosis of PTSD, the findings suggest that a genetic predisposition to HPA dysregulation plays a role in the persistence of pain following trauma. It will be very interesting for future studies to examine associations between childhood trauma and FKBP5, as well as whether FKBP5 more strongly predicts risk for fibromyalgia, a pain condition commonly associated with adrenal insufficiency.”

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3 Responses

  1. BeeM says:

    I hear you loud and clear. I want out so bad I am getting severely suicidal. I am so tired of no sleep, so tired of the pain. I just want to live, but the pain is too much to go on. It stops me from doing things I like, it doesn’t let me sleep, when I do fall asleep (usually due to pure exhaustion), I am like a zombie (don’t hear alarms, nothing…). I can’t think straight, can’t concentrate, can’t focus. I am suicidal because I just don’t want to live like this any more…the pain just won’t stop. Gabapentin brought it down to where I don’t want to immediately throw myself in front of a train because now the pain doesn’t cause my muscles to twist and (feel like they) tear, but it doesn’t remove the pain and I don’t want to take narcotics (for obvious reasons – sleeplessness makes me groggy enough, I don’t need more of that, and I don’t want to spend my life like an addicted zombie, either, it would be a step in the wrong direction, making things worse, not better). I am in so much pain, I constantly think about how I could end it, I am starting to obsess about it, wondering how I can put myself out of my misery. I used to be happy, cheerful, full of hope…now I am failing to see how I can escape this black pit of pain. And the worst part?-Nobody can help and some don’t believe you. I am 50, my pain has made me incontinent, I am in a wheelchair cause I can’t bear the pain of walking and I pray for God to come take me home. I am overwhelmed and exhausted all the time. This is not depression talking, this is inability to deal with the pain any longer, pure frustration at the lack of sleep, any relieve and absence of help…wish I could turn back the clock and prevent my injuries, they have taken my life from me!

  2. donna maisak says:

    I had a brain tumor ,actually a cystic lesion, removed from my brain back in 1993. The lesions was 7cm in size. It was completely wrapped around the brain stem and went up the left side of my head into my ear follow up my head to behind my eyes.

    I sent my scans all over to find a doctor who could remove this from inside of me. I was told it could not be removed without killing me or paralyzing me. I was told my nerves were like over- cooked spaghetti and that they would break as soon as someone tried to go in. I did find a doctor to do surgery in Washington, d.c. at the university. He did a super job,only today I have chronic pain in my head. I get steroid shots every 4 months to alleviate the pain. I went through the gamma ray knife 1 1/2years ago. Never again.

  3. em Zabeth says:

    Childhood trauma is bad. Adult traumas are like going through nightmares no one else sees. You hurt so bad inside, and then you have life losses, like my whole family, double mastectomy, pets, a female flood that wipes out the gardens you work in for years and comes thru front door. So you keep working hard till two knee operations, 2 disc problems, torn partial, pulled proposals, bi-lateral carpal tunnel surgeries, surgeries and you hurt all the time and I think I must be a hypochondriac, but the records are all there and you find programs for kids and vets, but white single women who suffered and transcended to lose everything before I am 50 , no programs, no funding, no empathy, just sick in my my world where everything hurts, body and soul, having to defend on what the govt will allow when all you want to do is live free, unafraid of anyone, and depend on your God given talent to support me without the body pain and mental poisonous pedagogy I was taught rears its ugly head from a past you can’t break free from. I just wish someone would see the me s out there who don’t fit the mold and are not addressed. We are slowly dying and there is no where to turn when you can’t even take yourself to the doctor, let alone get out of bed cause you are trapp ed in mental or physical pain. I’m no victim. I want out. This is a horrible quality of life. I can remember it was good, but so much and hitting your knees no longer relieves.

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