Physical symptoms can be your body’s way of letting you know you aren’t coping with stress well. Easy stress management may help patients feel better.
David Schechter, MD, is a family physician in private practice in Culver City, California. He has authored several books (including Think Away Your Pain) that explain the connection between stress and persistent or unexplained physical symptoms, such as back pain. In addition, he is the author of The MindBody Workbook, which has helped thousands of people process emotional tension by writing about it (journaling).
Dr. Schechter completed his residency at the University of California, Los Angeles (UCLA)/Santa Monica Hospital Family Medicine Residency Program and has a Certificate of Added Qualifications (CAQ) in sports medicine. He has been named a “Top Doctor” by a number of publications, including Men’s Health, U.S. News & World Report, Hollywood Reporter, and Los Angeles Magazine.
Stress affects everyone. Some stress can be caused by good things in your life, such as an interesting project, a new baby, or an upcoming vacation. Other times, stress is caused by difficult situations, such as losing your job or getting divorced.
No matter what causes it, too much stress can wear you down. This makes you more likely to get sick and feel irritable or depressed. You may develop emotional symptoms or unexplained physical symptoms that don’t seem to go away, such as:
- Back pain
- Constipation or diarrhea
- High blood pressure
- Trouble falling asleep or staying asleep
- Shortness of breath
- Stiff neck or jaw
- Upset stomach
- Weight gain or loss
As a family doctor, I sometimes see patients whose physical symptoms are actually caused by stress. When I suspect that this is the case, I carefully review the patient’s medical history and perform a physical exam. I want to be sure that I rule out any other causes for the symptoms. In some cases, I may do the following:
- Order lab tests (for example, a blood test or a urine test)
- Order imaging tests (for example, an x-ray, an ultrasound, or a magnetic resonance imaging [MRI] scan)
- Consult with a subspecialist, when appropriate
- In addition to these steps, I try to understand what is going on in the patient’s life. It’s helpful to ask whether the patient is dealing with challenges such as work pressures, relationship issues, teenage children, aging parents, or a loved one’s illness.
A few months ago, a patient named Jane (not her real name) made an appointment because she had foot pain that wouldn’t go away. Jane is a 34-year-old woman who is otherwise healthy. She had previously seen a podiatrist, but he wasn’t able to make a clear diagnosis. Jane’s X-rays and MRI scan were normal. They didn’t show anything that would cause her foot pain.
During Jane’s visit with me, I asked about her symptoms and activity. She said that she couldn’t remember doing anything to injure her feet. Next, I reviewed her medical history and did an exam. The exam didn’t find any problems with Jane’s nerves, spinal cord, or brain function that would cause her foot pain. I noticed that Jane said her pain moved from one foot to the other. Sometimes, she felt pain on the bottom of her foot. Other times, the pain was on top.
I asked Jane some questions about what was going on in her life. Her answers made it clear that she was under a lot of work-related stress. She said her boss was difficult to work for, and her husband’s job situation was unstable. She was burned out by Friday and barely felt better by Sunday morning. On Sunday evening, thinking about returning to work made her feel anxious. Jane was also unhappy that she didn’t have more time to spend with her young daughter.
After listening closely as Jane described her work-related stress, I told her I was sorry she was in a difficult situation. I explained that her foot pain might be her body’s way of letting her know that she wasn’t coping with stress effectively. She agreed that she needed help in managing her stress. I suggested some simple things that she could try:
- Schedule time for a small amount of exercise at least 3 times per week
- Spend 5 to 10 minutes per day writing about her feelings
- Focus on “square breathing” at least twice a day. Square breathing is breathing in slowly for a count of 4, holding your breath for 3 counts, and then breathing out slowly for 5 counts. Repeat this 4 to 5 times per minute for 3 to 5 minutes.
When Jane came back for a follow-up visit 2 weeks later, she was doing a little better. She was less focused on her feet and felt minimal pain. She told me that she had tried the stress management methods I recommended, including square breathing. She was journaling daily and trying to find more opportunities to be physically active. Jane also reported that she had an interview for a new job scheduled. Overall, she felt less overwhelmed and more hopeful.
If you’re feeling overwhelmed by stress, talk to your family doctor. Don’t be embarrassed about how you’re feeling. Tell your doctor about all of your physical and emotional symptoms. He or she can recommend stress management methods, support groups, counseling, or medicine to help you feel better.