LAS VEGAS—Stress and anxiety are critical elements of the human pain response, and these can be quantified not only with functional imaging but simply by measuring sympathetic response in the clinic. Most important, said R. Norman Harden, MD, of the Center for Pain Studies at the Rehabilitation Institute of Chicago, Northwestern University, Chicago, IL, to PAINWeek 2014 attendees is that after stress is identified in patients, as clinicians, “we are not helpless.”
Patients can easily be treated with brief psychotherapeutic techniques in the clinic, such as taking 10 deep breaths, after which it is almost physiologically impossible to remain stressed or anxious.
“Stress is just part of being human,” he said; “what’s critical is response to stress.”The mind/body cannot be separated in the study of stress, which can lead to, cause, and exacerbate development of diseases such as cancer and diabetes and other metabolic disorders.
Genetics can influence a person’s response to stress, which in turn affects mood, diet, and weight. As people age, they become less flexible and experience greater stress.“Ultimately, stress may affect and degrade all hormonal systems,” he said.
The approach to managing stress associated with chronic pain is patient-centric, with treatment necessitating an interdisciplinary team approach in which psychologists take the lead, working in concert with physicians, nurses, social workers, and physical, occupational, and recreational therapists.
Dr. Harden said he writes out a prescription for patients for Jon Kabat-Zinn’s book, Full Catastrophe Living, which is subtitled, “using the wisdom of your body and mind to face stress, pain and living.” He asks patients to read a chapter a week, in part to help them understand they need to determine what mitigates the causes of stress in their own lives.
Clinicians also have a plethora of anxiolytics available, including tricyclic antidepressants, SSRIs (selective serotonin reuptake inhibitors), and SNRIs (serotonin–norepinephrine reuptake inhibitors), as well as opioids. The caveat is that while such agents are potent at calming patients down and helping them sleep, they can also cause end-of-dose rebound effects. For that reason, they are not appropriate for the chronic treatment of stress and their use should be considered only temporary.