A 7-part Series on Chronic Pain

by Josh Meyers, PT, DPT, OCS

Pain is good. It helps one to avoid danger, survive an injury, and protect oneself when confronted by physical or emotional threats. The problem arises, however, when pain persists after a danger is removed, an injury heals, or a threat is no longer present. Medical providers call this persistent type of pain chronic pain, and it is the leading cause of disability in America.

Hope, however, lies in the fact that chronic pain is treatable. Through this series, readers will learn how chronic pain develops, recognize common symptoms, and understand how chronic pain is treated. Our goal is to empower readers to take action and regain control of their pain. Comments at the end of each post are welcome. Be sure to ask questions and share experience to help others with similar symptoms.

Part 7: Stress and Sleep

While education and movement are the first lines of defense to combat chronic pain, good management of stress and sleep produces positive changes in chronic pain as well. Managing one or two of these factors starts to change chronic pain, but to manage chronic pain well, one must address all of these factors.


The body releases the hormone cortisol in response to stressful situations. Normally, cortisol decreases when stressful situations resolve. When individuals experience chronic stress, however, cortisol remains elevated and increases the sensitivity of the nervous system. As a result, chronic stress perpetuates chronic pain. By managing stress well, one can limit cortisol release and positively influence chronic pain.

Just like movement exposure helps to restore pain-free movement, intentional “relaxation” of an extra-sensitive nervous system lowers cortisol levels and helps an over-excited nervous system heal. Some accomplish this by mediation, some by breathing, some by listening to music. Others use writing or guided imagery to relax. Regardless of the method, the goal of relaxation is to lower the excitability of the nervous system and decrease pain.

All of the above methods of relaxation contain an underlying component of mindfulness as well. Mindfulness simply means that one devotes full attention to what one is doing. Another way to say this is “Be in the moment.” When one is mindful about specific situations throughout the day, it reduces stress by decreases the need to multi-task. Research shows that mindfulness contributes to health, happiness, work productivity, and relationship building as well.


Among many other benefits, sleep is essential for healing. When one sleeps, the brain releases chemicals and hormones that help tissue rebuild and recover after stress or injury. Sleep also helps maintain normal cortisol levels. Since sleep loss or poor sleep elevates cortisol levels the next evening, sleep loss contributes to pain.1 In order to reap the benefits of healing from sleep and minimize excessive cortisol levels, consider the follow the following tips – providers call this sleep hygiene.

Sleep Hygiene Tips2

Maintain a regular sleep routine. Go to bed at the same time. Wake up at the same time. Ideally, your schedule will remain the same (+/- 20 minutes) every night of the week.

Avoid naps if possible. Naps decrease the ‘Sleep Debt’ that is so necessary for easy sleep onset. Each of us needs a certain amount of sleep per 24-hour period. We need that amount, and we don’t need more than that. When we take naps, it decreases the amount of sleep that we need the next night – which may cause sleep fragmentation and difficulty initiating sleep, and may lead to insomnia and sleep deprivation.

Don’t stay in bed awake for more than 5-10 minutes. If you find your mind racing, or worrying about not being able to sleep during the middle of the night, get out of bed, and sit in a chair in the dark. Relax in the chair until you are sleepy, then return to bed. No TV or internet during these periods! That will just stimulate you more than desired. If this happens several times during the night, that is OK. Just maintain your regular wake time, and try to avoid naps.

Don’t watch TV or read in bed. When you watch TV or read in bed, you associate the bed with wakefulness. The bed is reserved for two things – sleep and sex.

Drink caffeinated drinks with caution. The effects of caffeine may last for several hours after ingestion. Caffeine can fragment sleep, and cause difficulty initiating sleep. If you drink caffeine, use it only before noon. Remember that soda and tea contain caffeine as well.

Avoid inappropriate substances that interfere with sleep. Cigarettes, alcohol, and over-the-counter medications may cause fragmented sleep.

Exercise regularly. Exercise before 2 pm every day. Exercise promotes continuous sleep. Avoid rigorous exercise before bedtime. Rigorous exercise circulates endorphins into the body which may cause difficulty initiating sleep.

Have a quiet, comfortable bedroom. Set your bedroom thermostat at a comfortable temperature. Generally, a little cooler is better than a little warmer. Turn off the TV and other extraneous noise that may disrupt sleep. Background ‘white noise’ like a fan is OK. If your pets awaken you, keep them outside the bedroom. Your bedroom should be dark. Turn off bright lights. If you are a ‘clock watcher’ at night, hide the clock.

There is Hope

Chronic pain is treatable. When one understands how chronic pain develops and what factors influence it, hope exists. From there, it is up to the individual to take the first step of the journey to learn about pain and find ways to influence it. Education is important to calm fears and movement is essential to decrease pain. Stress and sleep management help to decrease sensitivity as well. One’s mindset needs to change from being a “victim of pain” to “one who has learned to control their pain.” Be self-advocate and take the first steps toward recovery.


Let’s Hear From You

What are your experiences with pain? How have stress, sleep issues, or diet affected your pain? Share your experience in the comments below.


Need Help?

If you suffer from chronic pain, there is hope. Call us today to find out how physical therapy can help treat your chronic pain.




  1. Leproult RCopinschi GBuxton O, et al. Sleep loss results in an elevation of cortisol levels the next evening. Sleep. 1997 Oct;20(10):865-70.
  2. American Sleep Association. Sleep Hygiene Tips. August 24, 2018.