Stress, Worry & Pain
What is Stress? What is Anxiety?
Stress means different things to different people. “Stress” can refer to the stress response, a series of automatic physical changes that occur in the body when a person is under pressure. It’s sometimes called the ‘fight or flight’ response, and we’ll talk about this more below. “Stress” can also refer to a state of physical, mental or emotional strain or tension – most of us have at least some stress in our lives at any one time.
Anxiety on the other hand, is “an emotion characterised by feelings of tension, worried thoughts and physical changes like increased blood pressure” and is usually experienced when we anticipate some upcoming challenge, or experience a situation that makes us feel afraid. You can see from these definitions that stress and anxiety are closely related, and it’s normal to have both stress and anxiety around the time of surgery!
Stress and anxiety are a normal part of life. It’s actually good for us to have a little bit of stress or anxiety, as it often motivates us to push ourselves, learn new things or work hard (imagine if students didn’t have any assignments or tests – although these cause stress, the stress can motivate the students to study and learn). However too much stress or anxiety can have a negative effect on our health, as we’ll see below.
Stress & the Body: The ‘Fight or Flight’ Response
Stressful situations lead to changes in the body - commonly referred to as the ‘fight or flight’ response. When we encounter stress, adrenaline moves through the body causing the heart to beat faster to get blood to the muscles, blood pressure increases, and the muscles tense, ready for action. Small airways in the lungs open up, and the person starts to breathe more quickly, which can lead to having a dry mouth. The brain becomes more focussed on looking for any threat or danger. Senses like sight and hearing become heightened, also looking for signs of danger. The adrenaline also releases sugar and fats which supply extra energy to the body. This response lasts about 20-30 minutes. If the stress goes on for longer, then the body releases more hormones to keep the nervous system on alert for longer. Think about a time when you were stressed and try to recall the effects on your body – how many of the effects below did you experience?
Typical ‘Fight or Flight’ Symptoms:
• Racing or pounding heart
• Rapid or shallow breathing
• Muscles tense
• Dry mouth
• Sweaty palms
• Heightened senses (vision, hearing)
• Mind alert, looking for danger
• ‘Butterflies’ in the stomach
• Bladder relaxes
Why do our bodies do this?
The stress response protects us from danger, by preparing the body to either escape from threatening situations or fight predators. The extra energy, alertness and strength help people to move quickly to escape or fight, hence it is called the ‘fight or flight’ response.
How helpful is the stress response?
The stress response is very helpful if you’re in a situation where you need to escape, like a situation of physical danger. However (thankfully) most of us don’t have a lot of those in our day-to-day lives anymore. Instead the things that cause stress in our society are often long-term stressors like finances, relationships or health problems. One stress which you will be familiar with is the stress of living with a knee problem and waiting for surgery. Other day to day frustrations might activate the fight or flight response to some degree many times a day, such as traffic, deadlines or queues. Because these demands don’t go away, our stress response system never gets the chance to properly ‘switch off’, and whilst many of us might not experience a full-blown feeling of ‘fight or flight’ very often, many people have symptoms of long-term stress, such as high blood pressure, increased heart rate, muscle tension and shallow breathing patterns. Stress can also lead to changes in mood, worrying, and difficulty concentrating, as well as physical symptoms such as headaches, chest pain, tummy pain, diarrhoea.
Have a think about your own signs of stress and complete the checklist in your “My Knee Surgery Plan” document.
Stress, Surgery & Pain
We now know from research that being in a state of stress or anxiety is not helpful at the time of surgery, although of course going through surgery is often stressful and obviously cannot be avoided! People with higher levels of stress, tend to heal more slowly, and people with higher anxiety are more likely to have surgical complications and a longer stay in hospital.
We’re interested in is helping people to manage pain after surgery. Although many people think that pain after surgery should be related to medical factors like the severity of their arthritis or the type of surgery they received, research shows that these medical factors are not good predictors of pain. If you think back to the previous chapter on pain science, this won’t be so surprising, because although pain tells us about the state of the nerves and the nervous system, it’s actually not a good indicator of what’s happening in the bones, joints and muscles. Scientists from around the world, including those at WDHB and AUT, have done research to work out the things that can increase pain after surgery. These studies tell us is that when people feel anxious, and/or worried about pain, they are more likely to have pain after surgery and a harder recovery. This does not in any way mean that people are imagining their pain or that it’s not real, as we’ll discuss below.
How do stress and anxiety affect pain?
There are several reasons why stress or anxiety can increase pain. The first is that, as you might remember from the last chapter, the spinal cord and brain can either reduce or increase pain signals that are sent around the body, and in a state of stress or anxiety, our brains tend to increase the pain signals rather than decrease them. In fact, the areas of our brain that are activated by pain are very similar to the areas activated by stress and anxiety, and the two can reinforce each other. Stress can also affect things like sleep (it’s hard to sleep when you’re worried), and poor sleep makes the nerves more sensitised. Finally, stress or worry can interfere with exercise and rehabilitation. If people feel worried about their knee joint, they may be more reluctant to exercise and this can influence pain, surgical recovery and how well people can function.
So I hope you are convinced that it’s truly worthwhile to try and enter surgery in a calm and relaxed manner, as free from stress and anxiety as is possible. But you might ask: how? Of course no one is intentionally stressed, and people can’t always ‘magic’ their stress or worries away. However, keep reading and we’ll discuss some techniques everyone can learn to counteract the physical effects of stress.