Chronic pain isn’t just a matter of managing persistent aching, stinging, aching, or burning. It causes physical trauma and stress that can negatively impact your cardiovascular health.
People with chronic pain have a nearly 50 percent higher risk of experiencing heart disease, stroke, heart failure, or cardiovascular-related death than pain-free people, even after adjusting for other risk factors.
Identifying and treating chronic pain early is essential for protecting heart health, says Angela Bohnen, MD, a board-certified neurosurgeon specializing in chronic pain at Neurosurgery One and the chief of surgery at AdventHealth Littleton Hospital in Colorado.
Stress increases the body’s production of hormones made in the adrenal glands, including adrenaline. Adrenaline causes the heart to beat more quickly and increases blood pressure. Too much adrenaline over time can damage your heart.
Cortisol, another stress hormone made in the adrenal glands, can also lead to
higher blood pressure,
blood sugar,
cholesterol, and
triglycerides.
“These stress hormones also lead to arterial stiffening and heart muscle thickening,” says Dr. Bohnen. Stiff arteries don’t expand well and lead to raised blood pressure, resulting in a vicious cycle in which raised blood pressure further hardens arteries, creating more inflammation and calcification.
Chronic pain activates inflammation pathways, increasing the risk of cardiovascular disease over time.
“Chronic pain conditions cause systemic inflammation, affecting blood vessel function throughout the body,” says Bohnen. This inflammatory response promotes fatty buildup in the arteries and damage to the inner lining of blood vessels, both of which directly contribute to heart disease progression, she says.
One study that followed approximately 9,000 middle-aged and older adults for seven years found that those who had the most inflammation had a 25 percent higher risk of heart disease than those with the least amount of inflammation.
Certain medications for chronic pain may raise heart risks. For instance,
nonsteroidal anti-inflammatory drugs (NSAIDS) like ibuprofen are known to exacerbate heart failure risk because of how they affect water and salt retention.
That retention elevates blood pressure and heart strain, says
Randy Gould, DO, a cardiologist at Manhattan Cardiology in New York City.
Meanwhile, opioids appear to contribute to
sleep apnea, with prescription opioid use associated with a significantly higher prevalence of sleep-disordered breathing than that seen in the general population.
Sleep apnea is associated with many heart-related complications, including high blood pressure, heart rhythm disorders,
stroke, worsening heart failure, and metabolic syndrome.
It’s not easy to sleep when you’re in pain. About 50 percent of people with chronic pain experience
insomnia or other clinically significant sleep disturbances.
Poor sleep can hurt your heart health by directly contributing to cardiovascular disease risk factors like
obesity, high blood pressure, and
diabetes, as well as indirectly affecting other factors like mental health and diet that also play a role in heart disease risk.
“Chronic pain prevents deep sleep phases, when cardiovascular repair occurs naturally,” says Bohnen. It can lead to sleep disturbances that compound heart disease risk through elevated inflammation, disrupted hormone regulation, and less efficient blood sugar processing, she says.
Chronic pain and lack of physical activity often go hand in hand, as pain makes it difficult to exercise. Unfortunately, staying inactive only exacerbates pain through decreased range of motion and strength.
The inability to maintain your cardiovascular fitness creates a dangerous spiral in which pain worsens and heart health deteriorates simultaneously, says Bohnen.
Exercise improves your body’s use of blood oxygen (reducing the need for the heart to pump more blood to muscles), reduces stress hormones that negatively affect the heart, slows heart rate and lowers blood pressure, and increases HDL cholesterol while helping control triglycerides.
An analysis of more than 375 studies found that 40 percent of adults with chronic pain also experience clinically significant
depression and
anxiety. Women, younger adults, and people with
fibromyalgia are particularly at risk.
Depression can have a profound effect on your physical health. A study of more than 85,000 people followed for nearly 3.5 years found that people with depression had a 24 percent higher risk of heart attack, stroke, heart failure, or other major cardiovascular events than those without depression and anxiety. People who had both depression and anxiety had a 35 percent higher risk.
Researchers note that this increased risk may be a result of higher activity in stress-related brain regions. This stress is linked to higher levels of nervous system dysfunction and inflammation, two risk factors for heart disease.
There are several lifestyle changes you can make to maintain a healthy heart while you manage pain. “The best approach is to maintain a healthy heart the same way you would if you didn’t suffer from pain,” says Dr. Gould.
Heart-healthy habits include:
- Eat a balanced diet with plenty of whole grains, fruits, vegetables, lean protein, legumes, nuts, and seeds.
- Get 150 minutes of moderate or 75 minutes of vigorous physical activity every week.
- Don't use tobacco products.
- Get 7–9 hours of sleep each night.
- Maintain a healthy weight.
- Manage cholesterol, blood sugar, and blood pressure levels.
Additional steps are often needed to deal with chronic pain, but medication (or a certain type of medication) isn’t always your only choice.
“Try other ways besides medications to control chronic pain, such as physical therapy, yoga, acupuncture, or exercise,” says Gould. “If medication is required for pain control, acetaminophen (Tylenol) is safer for the heart than NSAIDs.” Always speak to your doctor about your risk factors and underlying conditions before starting a new pain medication.
Surgery may also have the potential to alleviate the underlying cause of chronic pain, which can help improve sleep, stress levels, and a person’s ability to exercise, says Bohnen.
