J Manipulative Physiol Ther 1999 (Jul); 22 (6): 395–398 ~ FULL TEXT
Jennifer Jamison, MB, BCh, PhD, EdD
Department of Chiropractic,
Osteopathy & Complementary Medicine,
Faculty of Biomedical & Health Sciences,
Bundoora Victoria, Australia.
BACKGROUND: Psychosocial stress pervades modern life and is known to have an impact on health. Pain, especially chronic back pain, is influenced by stress. Various strategies have been shown to successfully reduce stress and its consequences.
OBJECTIVE: This study explores stress as a potential disease trigger among chiropractic patients.
METHOD: A descriptive study was undertaken to ascertain the stress perceptions of chiropractic patients. Purposive sampling of chiropractic practices and convenience sampling of patients was undertaken. Patients were allocated to 1 of 4 groups according to their presentation: acute, chronic biomechanical, fibromyalgia, or maintenance care. Participating patients were requested to complete a questionnaire.
RESULTS: Of the 138 patients attending 1 of 10 participating chiropractic clinics, more than 30% regarded themselves as moderately to severely stressed, and over 50% felt that stress had a moderate or greater effect on their current problem. Some 71% of patients felt it would be helpful if their chiropractic care included strategies to help them cope with stress, and 44% were interested in taking a self-development program to enhance their stress management skills.
CONCLUSION: Patient perceptions are known to be important in health care. A number of chiropractic patients perceive they are moderately or severely stressed. Interventions that reduce stress, or even the patient's perception of being stressed, may be construed as valid, non-specific clinical interventions. It may be timely for chiropractors to actively contemplate including stress management routinely in their clinical care protocols.
From the FULL TEXT Article
It has been suggested that “the most important dimensions of illness behavior are the perceptions and interpretations of the patient.”  It is therefore of clinical relevance that about 1 in 3 chiropractic patients in this study perceive themselves to be at least moderately stressed. It is also pertinent that over half the patients in this study perceived that stress contributed, at least moderately, to their present problem. Contrary to the earlier work of Holmes and Rahe,  which assumed that life stresses were cumulative, more recent studies suggest that the relationship of life events to health is in terms of their meaning: “How individuals think about events and life situations, as well as how they respond to difficulties and opportunities, are key to understanding the influence of social conditions upon health status.”  Perceived control is regarded as a significant factor in successfully coping with stress. [26, 27] One approach to enhancing control of stress is to undertake a stress management program.
Almost 3 in 4 patients in this study expressed interest in improving their stress management skills. However, 1 in 4 of these patients was only interested if their chiropractor were to be involved. The extent to which chiropractors may choose to routinely provide stress management counseling is an individual decision. However, when making such a decision, it is worth noting that psychosocial factors are among the best predictors of whether acute pain will become chronic.  Furthermore, patients with a nonorganic cause of chronic low back pain are likely to exhibit greater emotional distress than those with a medically diagnosed cause.  While stress management may be regarded as a non-specific intervention in the chiropractic clinic, such intervention is consistent with competent contemporary chiropractic practice. [30, 31]
A number of chiropractic patients perceive themselves to be moderately or severely stressed. Almost 3 of 4 chiropractic patients in this study expressed interest in their chiropractor helping them cope with their stress. It may, therefore, be timely for chiropractic practitioners to actively contemplate the extent to which they wish to routinely incorporate stress management in their protocol for clinical care.