Stress to Chronic Pain: Closing the Access Gap

Authored by: Rhea Josyula

Art by: Sandy Kong

A staggering 20.9% of US adults suffer from chronic pain, a condition that can significantly impact everyday activities and quality of life [1]. Chronic pain is defined as an unpleasant sensory experience leading to potential tissue damage that is present for three or more months. This can span a variety of types including neuropathic, nociceptive, inflammatory, and mechanical. In addition to its detrimental physical effects like tissue damage, it can lead to adverse mental health effects such as depression, suicidal tendencies, and decreased quality of life [2]. There is a large degree of overlap between chronic pain and stress as 12% of US individuals report feeling high levels of both, and 28% report experiencing moderate levels of both. These numbers are nearly double in lower socioeconomic status populations with less than $35,000 in income [3]. This is in part due to stressful working conditions like manual labor, combined with decreased access to adequate food and shelter. Without affordable and accessible healthcare solutions, the discrepancy is further exacerbated and individuals are not able to seek the proper care that they need.

During an acute stress response, the hypothalamic-pituitary-adrenal (HPA) axis is activated and hormones like cortisol are released. When this stress response is prolonged, there is a constant release of cortisol which can lead to dysfunctions in memory, emotional regulation, and immune function. Over time, this dysregulation can sensitize the nervous system by lowering the threshold for pain, which leads to ordinary, daily stimuli causing pain sensations. These additional pain stimuli can lead back to chronic stress, creating a vicious cycle that patients cannot escape. Both chronic stress and chronic pain can have detrimental effects on the limbic system, comprising the hippocampus, amygdala, and ventromedial prefrontal cortex [4]. Due to the comorbidity of chronic stress and pain, treatment that targets one or the other is not sufficient in breaking patients out of this cycle. Instead, therapies and pharmacological treatments should focus on addressing both issues.

Despite the large scale of this problem, there is a large market for high-cost pharmacological treatments and a lack of affordable and accessible treatments, especially for individuals with lower socioeconomic status. A 2024 NHIS survey showed that lower income individuals experience a higher incidence of chronic pain and stress and are overprescribed strong medications like opioids compared to higher income groups [5]. This disparity is largely due to the greater degree of physical job strain, which leads to a greater incidence of pain and stress. These individuals in turn have limited access to specialized care or financial aid. This limits the alternative care treatments available to these individuals, leading to an overprescription of the cheaper solution: opioids [6]. Overprescribing opioids, however, can lead to a dangerous cycle of addiction and long-term dependency. In contrast, higher income groups do not experience great financial burdens and have the ease of access for non-invasive treatments like yoga and meditation.

Due to the strong tie between socioeconomic status and access to proper care, it is critical to consider and devise therapies that are both cost-effective and widely accessible. One such therapy is music therapy, which can directly target the neurological mechanisms underlying chronic pain and chronic stress. Studies have shown that exposure to music can increase the rate of neurogenesis in the hippocampus, the memory center of the brain that is often damaged from increased cortisol levels. Additional research suggests that listening to music increases cerebral plasticity which offers promise in improving pain and healing brain damage [7]. Simultaneously, amygdala activity is dampened which leads to increased regulation of the release of stress hormones and a decrease in stress levels [8]. Music therapy is currently being used in the treatment of Alzheimer’s disease and to enhance brain development in children, showing its promise in neurological development and treatment across age groups and populations [9, 10]. Additionally, without a need for prescriptions and its low-cost community led nature, it is applicable to lower-income populations looking for easy access and affordable treatments. By bringing the community together to produce and enjoy music, the quality of life of these individuals will simultaneously increase, decreasing their stress levels.

This multifaceted issue requires a multifaceted solution and it is critical to also increase education for both providers and patients about the value and accessibility of alternative therapies such as music therapy. Increasing awareness can reduce the stigma and increase the acceptance and credibility surrounding non-pharmacological options and creative solutions. For providers, this would look like incorporating music therapy into curriculums and training physicians on the importance and effectiveness of this solution. On the other hand, community health workers should be aware and educated on the neuroscience behind music therapy and be encouraged to recommend this therapy form to patients. Though this therapy form is low-cost, costs would further decrease if insurance companies were exposed to this therapy form and encouraged to cover it in healthcare plans for chronic diseases. By improving education at both the provider and community levels, and further decreasing cost of treatment, we can promote this equitable and targeted approach to chronic diseases. While this solution alone will not bridge this access gap, it has promise in devising forms of care that are more equitable and holistic.

References

1. Rikard, S. M., Strahan, A. E., Schmit, K. M., & Guy, G. P. (2023). Chronic pain among adults — United States, 2019–2021. MMWR. Morbidity and Mortality Weekly Report, 72(15), 379–385. https://doi.org/10.15585/mmwr.mm7215a1 

2. Stretanski, M. F. (2025, September 28). Chronic pain. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK553030/#:~:text=Continuing%20Education%20Activity,suicide%2C%20and%20other%20adverse%20outcomes 

3. Rios, R., & Zautra, A. J. (2011). Socioeconomic disparities in pain: The role of economic hardship and daily financial worry. Health Psychology, 30(1), 58–66. https://doi.org/10.1037/a0022025 

4. Mbiydzenyuy, N. E., & Qulu, L.-A. (2024). Stress, hypothalamic-pituitary-adrenal axis, hypothalamic-pituitary-gonadal axis, and Aggression. Metabolic Brain Disease, 39(8), 1613–1636. https://doi.org/10.1007/s11011-024-01393-w 

5. NCHS Data Brief ■ no. 518 ■ November 2024. (n.d.). https://www.cdc.gov/nchs/data/databriefs/db518.pdf 

6. Shaw, W. S., Roelofs, C., & Punnett, L. (2020). Work environment factors and prevention of opioid-related deaths. American Journal of Public Health, 110(8), 1235–1241. https://doi.org/10.2105/ajph.2020.305716 

7. Fukui, H., & Toyoshima, K. (2008). Music facilitate the neurogenesis, regeneration and repair of neurons. Medical Hypotheses, 71(5), 765–769. https://doi.org/10.1016/j.mehy.2008.06.019 

8. Music & Mental Health: What’s the link? (n.d.). https://www.lucidtherapeutics.com/blog/music-mental-health-what-is-the-link#:~:text=Music%20can%20moderate%20brain%20structure,the%20increased%20release%20of%20endorphins 

9. Matziorinis, A. M., & Koelsch, S. (2022). The promise of music therapy for alzheimer’s disease: A Review. Annals of the New York Academy of Sciences, 1516(1), 11–17. https://doi.org/10.1111/nyas.14864 

10. Wan, C. Y., & Schlaug, G. (2010). Music making as a tool for promoting brain plasticity across the life span. The Neuroscientist, 16(5), 566–577. https://doi.org/10.1177/1073858410377805