The pain needs be considered as a manifestation of the interaction of cognitive, emotional, motivational, behavioral and physical components. The commonsense notion that ‘too much stress makes you sick’ might hold more than a grain of truth. The second of two large-scale epidemiological and medical studies among civil servants in the UK, known as the Whitehall studies, found that workers in low-level jobs, in which they have high stress and little autonomy, have more than twice the risk of developing metabolic syndrome, a precursor of heart disease and diabetes compared with employees in higher-level jobs. Researchers also found that stress affects the autonomic nervous system and neuroendocrine function. There is no real division between mind and body because of networks of communication that exist between the brain and neurological, endocrine and immune systems. Other studies have shown that depression and anxiety increase the production of the cytokines IL-6 and TNF-α, which have a pro-inflammatory effect that has been linked to cardiovascular disease, arthritis, type 2 diabetes, osteoporosis and some cancers. More recently, has been showed that stress increases the pro-inflammatory response in caretakers of Alzheimers’ patients.

Stress/Anxiety/Depression and MSK pain:

In a recent study of Burston J. et al., has been shown that higher anxiety scores, but not depression scores, are significantly associated with higher pain sensitivity in individuals with knee OA (1). Both anxiety and psychosocial stress should be considered in the assessment and treatment of patients with musculoskeletal pain. Financial security is often compromised by job loss, work disability, and high health care expenses; lower income is associated with more pain problems. Persistent low back pain also increases the risk of developing depressive symptoms. Low back pain has also consistently been shown to be associated with depression in adults across observational studies, with research suggesting that people experiencing depression are approximately 60% more likely to develop back pain in their lifetime versus non-depressed people.

Prevention and treatment:

Cognitive-behavioral therapy has established efficacy for anxiety. To prevent these symptoms, we recommend to do a moderate and regular sport activity and also Meditation in fact it appears to be effective for Post Traumatic Disorder (PTSD), anxiety, and depression symptoms. In 2012, some research demonstrated with the use of functional magnetic resonance imaging (fMRI), which not only takes pictures of the brain, as a regular MRI does, but also records brain activity occurring during the scan, that changes in brain activity in subjects who have learned to meditate hold steady even when they’re not meditating. These fMRI has been taken before-and-after scans of subjects who learned to meditate over the course of two months, scanned them not while they were meditating, but while they were performing everyday tasks. The scans still detected changes in the subjects’ brain activation patterns from the beginning to the end of the study, and these changes were detected in a part of the brain called the amygdala, which is connected to the emotions.

Also, another effective method to improve your mental health condition is the Progressive Muscles Relaxation (PMR), in fact has been shown that PMR resulted in significant improvements in depression–anxiety–stress symptoms, sense of coherence, and well-being compared to the control group. Deep breathing, which is also known as diaphragmatic breathing, is a technique that is based on the notion that mind and body integration produces relaxation. The technique requires participants to contract the diaphragm, slowly inhaling and exhaling. Deep breathing appears to amplify blood oxygen levels, massages the inner organs located in or close to the abdomen, and possibly stimulates the vagus nerve (3).


  1. Burston JJ, Valdes AM, Woodhams SG, Mapp PI, Stocks J, Watson DJG, Gowler PRW, Xu L, Sagar DR, Fernandes G, Frowd N, Marshall L, Zhang W, Doherty M, Walsh DA, Chapman V. The impact of anxiety on chronic musculoskeletal pain and the role of astrocyte activation. Pain. 2019 Mar;160(3):658-669. 
  2. Hilton L, Maher AR, Colaiaco B, Apaydin E, Sorbero ME, Booth M, Shanman RM, Hempel S. Meditation for posttraumatic stress: Systematic review and meta-analysis. Psychol Trauma. 2017 Jul;9(4):453-460.
  3. Toussaint L, Nguyen QA, Roettger C, Dixon K, Offenbächer M, Kohls N, Hirsch J, Sirois F. Effectiveness of Progressive Muscle Relaxation, Deep Breathing, and Guided Imagery in Promoting Psychological and Physiological States of Relaxation. Evid Based Complement Alternat Med. 2021 Jul 2;2021:5924040

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