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Stress and anxiety (back pain management programme)

Patient information A-Z

Stress and anxiety

Stress is not always bad, a certain amount of stress is motivating and sharpens our perceptions. It is only a problem if it is consistently high over a period of time. Stress does not cause chronic pain, however it can affect it.

When you are under stress your body reacts both physically and psychologically.

Physical symptoms

  • Breathing might change
  • Heart rate increases / heart pounding (palpitations)
  • Muscle tension
  • Sweating
  • Dizziness
  • Sickness

This is called the stress response.

It is sometimes called the ‘fight or flight’ response as in emergency situations it is necessary to ensure our body has the resources to act quickly.

A lot of stress can, however, be generated by ordinary, non-emergency hassles of daily living, for example, waiting for a bus or being late.

The stress response in these situations becomes an unwanted problem and can cause physical symptoms that can be frightening.

Stress levels can rise gradually during the day due to daily hassles.

We don’t tend to notice them until they’re quite high and we start to show symptoms.

Psychological symptoms

Stress also has a psychological response, for example:

  • Poor concentration
  • Irritability
  • Difficulty making decisions or thinking clearly
  • Nightmares
  • Negative attitudes and thoughts
  • Thinking you can’t cope
  • Problems become bigger
  • Being overwhelmed
  • Low self confidence and self esteem
  • Anger
  • Constant worry
  • Depression
  • Frustration


Anxiety is a reaction to stress, it can range from worry to agitation, panic or even terror.

Anxiety is maintained by:

  • The way you behave.
  • Negative thoughts and irrational beliefs about the consequences.

Panic attacks

The reasons some people have panic attacks is not clear, however one possibility is that some people have a tendency to tighten their muscles when they become stressed or anxious. When the muscles of the chest are tightened people react by breathing too frequently and too deeply. This reduces the amount of carbon dioxide in your lungs which sends messages to your brain to breathe quicker. It also creates a lot of physical and psychological symptoms (stress responses), which are unpleasant and can generate feelings of fear.

You can reverse this by either:

  • Using diaphragmatic breathing (see ‘relaxation notes’)
  • Holding a paper bag tightly over your nose so no air can get to your lungs from outside of the bag and breathe in and out a number of times. The symptoms will decrease.

When you have chronic pain, you have this extra stress to deal with. It is not surprising that some people find that they are suffering from the effects of the stress response every day. They find they build up muscle tension without being aware of it. This just makes their pain worse and can become a vicious circle.

Your situation is worse if stress increases your pain.

How do we manage stress?

  • Understand more about stress. Recognise your major sources of stress at present; understand how stress affects you; anticipate and plan for periods of stress; find your optimal level (not too much or too little).
  • Adopt a problem-solving approach. Define your problem specifically; break it down in to manageable chunks; find a practical solution rather than worrying about it; prevent the build up of stress by taking frequent short breaks or relaxation.
  • Recognises and accept your own feelings. Express the way you are feeling openly with others; ask for help and accept when offered; challenge unhelpful thinking.
  • Maintain a healthy lifestyle. Regular physical exercise; healthy balanced diet; deliberately seek out a change of pace and new activities in your life.
  • Make time to relax and enjoy yourself. Set aside time everyday to do something you enjoy; practice relaxation techniques to avoid build up of stress and muscle tension.
  • Set aside time for reflection. Reassess your values, what is really important in your life?

Stress prevention

  • Be flexible
  • Learn to accept things you can’t change
  • Concentrate on what you can control
  • Be thankful
  • Don’t give in to guilt
  • Set aside some quiet time everyday
  • Acknowledge your feelings
  • Develop strategies and a personal anti-stress regime
  • Accept and adapt to change
  • Believe in yourself

We are smoke-free

Smoking is not allowed anywhere on the hospital campus. For advice and support in quitting, contact your GP or the free NHS stop smoking helpline on 0800 169 0 169.

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Cambridge University Hospitals
NHS Foundation Trust
Hills Road, Cambridge

Telephone +44 (0)1223 245151