Chapter 16

Managing stress

Pain and stress go hand in hand. When you’re in pain, you’re less able to handle the stress of everyday life. Common hassles turn into major obstacles. Stress may also cause you to do things that intensify your pain, such as tense your muscles, grit your teeth or stiffen your shoulders. In short, pain causes stress, and stress intensifies pain.

The first step in breaking the pain-stress cycle is to realize that stress is your response to an event, not the event itself. It’s something you can control. That’s why events that are stressful for some people aren’t for others. For example, your morning commute may leave you anxious and tense because you use it as worry time. Your co-worker, however, finds her commute relaxing. She enjoys her time alone without distractions. Understanding that you have control over stress can help you develop positive strategies for dealing with it.

The stress response

Remember that your brain comes hard-wired with an alarm system for your protection. When you encounter stress, your body responds in a manner similar to a physical threat. It automatically gears up to face the challenge or musters the strength necessary to get out of trouble’s way.

This fight-or-flight response results from the release of hormones that cause your body to shift into overdrive. Your heart beats faster, your blood pressure increases, and your breathing quickens and becomes more shallow. Your nervous system also springs into action, causing your facial muscles to tighten and your body to perspire more than normal.

In certain situations this type of protection response is good; in others it’s not. That’s why stress can be both positive and negative:

Positive stress

Positive stress provides a feeling of excitement and opportunity. It often helps athletes perform better in competition than in practice. Some other examples of positive stress include a new job or the birth of a child.

Negative stress

Negative stress occurs when you feel out of control or under constant or intense pressure. In situations such as this, you may have trouble concentrating or you may feel alone. Family, finances, work, isolation and health problems, including pain, are common causes of negative stress.

Too much stress

Too much negative stress on a regular basis can have a negative effect on your health. It isn’t good for your body to always be on high alert. In addition to the strain it puts on your cardiovascular system, the hormone cortisol released during stress can cause other unwanted health effects. It may suppress your immune system, making you more susceptible to infections and disease. Stress can also cause headaches and worsen intestinal problems and asthma.

What are your stress triggers?

Stress is often associated with situations or events that you find difficult to handle. How you view things also affects your level of stress. If you have unrealistic or high expectations, chances are you’ll experience more than your fair share of stress.

Take some time to think about what causes you stress. Your stress may be linked to external factors, such as:

Stress can also develop from internal factors, such as:

Jot down what seem to be sources of stress for you. And then ask yourself if there’s anything you can do to lessen the stress or avoid these stressors. You will likely find that some of your stressors you can control and some you can’t.

Concentrate on stressful events or situations in your life that you can change, such as how you respond to a hectic day at work or how you prepare for a class reunion. Perhaps you can go for a short walk to clear your head or listen to some soothing music.

For events or situations that are beyond your control, such as getting stuck in traffic or an illness in the family, look for ways to adapt — to remain calm under trying circumstances.

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Taking a breather

Evidence suggests that deep (diaphragmatic) breathing performed regularly on a daily basis can help decrease pain. Practice deep, relaxed breathing at least 10 minutes three times a day and use it whenever you feel stressed. To perform diaphragmatic breathing:

You’re breathing correctly when your abdomen — not your chest — moves with each breath. When lying down, place a small book on your abdomen. When you breathe in, it should rise. When you breathe out, it should go down.

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How to stress less

It’s one thing to be aware of stress in your daily life, but it’s another to know how to change it. As you look through your list of stressors, think carefully about why they’re so bothersome. For example, if your busy day is a source of stress, ask yourself if it’s because you tend to squeeze too many things into your day or because you aren’t organized.

The following techniques can help you reduce sources of stress that you can control and better cope with those that you can’t.

Modify your lifestyle

Consider these changes to your daily routine as ways to help alleviate stress:

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Get smart

Here are some stress-reduction goals that follow the SMART formula:

Goal: Use deep breathing to relax tense muscles

When I want to achieve it: Two weeks

How I’m going to do it: At least twice a day, practice deep, relaxed diaphragmatic breathing

How I’m going to measure it: In my journal, track when I use deep breathing and rate my level of stress before and after

Goal: Make time in my day for self-care, including exercise, healthy meals and relaxation breaks

When I want to achieve it: One month

How I’m going to do it: Use time management skills and schedule the self-care activities on my daily calendar

How I’m going to measure it: Track in my journal the days and times I do self-care activities

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How to relax

You can’t avert all sources of stress, such as an unexpected visit from family or a problem at work. However, you can modify how you react to these situations by practicing relaxation techniques. Relaxation helps relieve stress that can aggravate chronic pain. It also reduces muscle tension. Relaxation won’t cure your pain, but it can:

Keep in mind, though, that the benefits of relaxation are only as good as your efforts. Learning to relax takes time.

Techniques to try

There are many ways to relax. A number of relaxation techniques, such as yoga, meditation, massage and tai chi are discussed in Chapter 10. Following are some other simple tools you can use when you feel stressed. Work on these relaxation techniques at least once or twice a day until they come naturally. When you’re beginning, a quiet place and a relaxation app or CD often help. And remember, a wandering mind is normal when you start out. Just keep bringing your attention back to relaxation.

Deep breathing

Deep breathing from your diaphragm is relaxing. It also exchanges more carbon dioxide for oxygen, to give you more energy. Try to incorporate 20 minutes of deep breathing daily, not just when you’re stressed. See “Taking a breather”.

Progressive muscle relaxation

Progressive muscle relaxation is designed to reduce tension in your muscles. Find a quiet place free from interruption. Get comfortable in a chair or lying on the floor. Beginning with your feet and working through your body to your head and neck, tense each muscle group for at least five seconds and then relax the muscles for up to 30 seconds. Repeat before moving to the next muscle group. For maximum benefit, use the technique once or twice a day.

Guided imagery

Also known as visualization, this method of relaxation involves lying quietly and picturing yourself in a pleasant and peaceful setting. You experience the setting with all of your senses as if you were actually there. For instance, imagine lying on the beach. Picture the beautiful blue sky, smell the salt water, hear the waves and feel the warm breeze on your skin. The messages your brain receives as you experience these senses help you relax.