I think your real problem is stress,' the doctor said when I complained that the muscle injections he was giving me hadn't relieved my neck and shoulder pain. 'You can't blame me for everything that's hard in your life,' he said.

　　My bursting into tears only seemed to confirm his diagnosis.

　　It's not like I hadn't heard this before. During earlier bouts of low-back pain, irritable-bowel syndrome and temporomandibular joint disorder, plenty of doctors have used the stress word with me. And each time, I've become indignant. It sounded like 'it's all in your head' or 'you're malingering.'

　　That's an outdated view, says Christopher L. Edwards, director of the Behavioral Chronic Pain Management program at Duke University Medical Center. Decades ago, when doctors said a condition was psychosomatic, it was the equivalent of saying it wasn't real, since there was little evidence that the body and the brain were connected. 'Now, we recognize that what happens in the brain affects the body and what happens in the body affects the brain,' he says. That knowledge gives us the tools to try to manage the situation, he adds.

　　Dr. Edwards says his pain-management program in Durham, N.C., is seeing a rise in patients amid the current economic crisis: 'There's a very strong relationship between the economy and the number of out-of-control stress cases we see.'

　　Psychological stress can turn into physical pain and illness in a number of ways. One is the body's primitive 'fight-or-flight' mechanism. When the brain senses a threat, it activates the sympathetic nervous system and signals the adrenal glands to pump out adrenaline, cortisol and other hormones that prime the body for action. Together, they make the muscles tense up, the digestive tract slow down, blood vessels constrict and the heart beat faster.

　　That's all very useful for outrunning a mastodon. But when the threat is a tanking stock portfolio or an impending layoff, the state of alarm can last indefinitely. Muscles stay tense and contracted, which can make for migraine headaches, clenched jaws, knots in the neck and shoulders, and pangs in the lower back. Some of those body parts are already under pressure from long hours at the computer, restless sleep, grinding teeth and poor posture.

　　The digestive tract has its own extensive system of nerve cells lining the esophagus, stomach and intestines -- known as the gut brain -- that are extremely sensitive to thoughts and emotions. That's what creates the feeling of butterflies in the stomach. When anxiety persists, it can set off heartburn, indigestion and irritable-bowel syndrome, in which the normal movement of the colon gets out of rhythm, traps painful gas and alternates between diarrhea and constipation.

　　'Stress does not necessarily cause pain, but it exacerbates the [physical] situation that may already be there. It diminishes your ability to cope,' Dr. Edwards says.

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