Stress
5 Steps To Manage Pain When Your World Is Upside Down
How to handle stress and pain—simultaneously.
by Evan Parks Psy.D.THE BASICS
Since the onset of the COVID-19 pandemic, anxiety and stress levels have skyrocketed. A recent Harris Poll reported that 41% of survey participants were more concerned about their level of anxiety than their inability to pay bills, reduced work hours, or even losing their job. Unfortunately, with increased anxiety and stress comes increased chronic pain. Learning to manage pain and stress is key to coping during this time of global crisis.
With 68% of Americans feeling that everything is out of control, how do people with existing health problems like chronic pain rise above their circumstances to find balance? After all, we are living in a time that demands that we find ways to manage stress and anxiety—our very lives depend on it, in fact.
Predictably, since the beginning of the pandemic, crisis hotlines have seen a 40% increase in calls from people looking for mental health assistance. Recognizing and then managing stress is more critical to our health and well-being than ever before.
The Stress and Chronic Pain Connection
I regularly talk with people who are unaware that their chronic pain is influenced by their reactions to stressful life events. Plenty of science exists to explain the importance of the relationship between the mind-body connection, stress, and chronic pain; yet, often times the self-care advice that accompanies it can feel more like empty platitudes than constructive therapeutic techniques.
Stress-management suggestions like, “Get at least eight hours of sleep each night!” are sound ideas, but honestly, if we could get eight hours of restful sleep—we are probably not battling that much stress to begin with. When your mind will not stop spinning with problems and fears brought on by anxiety, sleep will be disrupted, and you will feel drained even if you do sleep.
Stress increases muscle tension and activates the immune system—resulting in increased inflammation throughout the body. This tension and inflammation of tissue throughout the body can lead to headaches, backaches, and neck pain, triggering widespread pain and fatigue. While this scientific explanation can be helpful for some, facts alone are not as transformative compared to experiencing the mind-body connection.
Use Simple Biofeedback
To demonstrate the mind-body connection with patients, I use a simple tool: a skin temperature thermometer. First, we get a baseline temperature reading from a patent placing the thermometer between their thumb and index finger while we talk about a neutral topic, like the weather. Then I lead them through a simple breathing exercise for three to four minutes. The patient sees immediately that the temperature of their hand has increased significantly, which for some, correlates to a decrease in pain.
What causes these changes? The slowed rate of the patient’s breathing turns down the heightened—but often hidden—stress response the patient is constantly experiencing.
Next, before the patient has enough time to contemplate this moment of discovery, I ask this question: “Please tell me about a recent event that occurred where you did not have control, felt threatened, or were engaged in interpersonal conflict.” After a brief moment of reflection, they begin to their share a story of stress and anxiety. As their faces shift from relaxed to distressed, the building tension in their body is quite visible.
As the story concludes, I ask them to look again at their skin temperature reading. Now the temperature has dropped significantly below their baseline. This is due to the activation of the fight, flight, or freeze response. In fact, patients report that both their hands and feet feel cold and that their pain has increased. For those that were not aware of the mind-body connection before, they are certainly convinced now.
Five Steps To Better Stress and Pain Management
The beginning of any personal change always begins with awareness. Using biofeedback—even through a tool as simple as a thermometer—helps people recognize the physical changes in their bodies that result from thoughts. We cannot change what we do not notice.
Indeed, we can only tame that which we can name.
Of the following five steps, paying attention to what is going on inside our mind and body is the crucial first step—the step upon which everything else rests. We cannot tame our stress and pain without first identifying the different elements of our response that need to be addressed.
1. Notice What is Happening
First, we must recognize the connection between the symptoms we experience and what triggers them. For example, if you have tight shoulders, a stiff neck, dizziness, or find yourself waking up in the night unable to breathe, you need to stop and think about what is bothering you, not just how.
Often, it is difficult to precisely identify where the pressure is coming from. It may be one issue or many cumulative, smaller problems. We need to take an intentional pause to inventory where the pressure may be coming from and how we are feeling as a result. By naming emotions, it helps to put the thinking part of the brain in charge of what is going on, in turn reducing the influence that the emotional part of the brain has.
Ask yourself these four questions regularly:
- What pressure am I under right now and where do I feel that pressure in my body?
- What has recently changed that requires some kind of adjustment in my life?
- What is missing from my life that serves as a source of loss?
- What is coming in the future that I do not want to face?
2. Actively Manage Pain and Stress
There are two approaches to manage pain and stress—active management and passive management. People with chronic pain are apt to manage their stress and pain symptoms passively. This can show up as a reliance on medications, injections, surgeries, or simply staying in bed or sitting on the couch all day. This passive approach leads to weakness, muscle loss, bone loss from repeated steroid use, and many other health-related problems from overuse of medications that are not effective in managing chronic pain.
Active pain management, on the other hand, is based on the understanding that most types of pain do not lead to harm. Just because something hurts, it does not mean that damage is being done if and when you move. When you are under stress, your body is prepared for action due to the fight or flight response; being physically active gives an outlet to that heightened physical response. Gentle movement, stretching, strength conditioning, and endurance training are all needed for both pain and stress management. The key to reducing inflammation in the body is calming down the stress response.
3. Decide How You Are Going To Respond
When we wake up in the morning, we must consciously decide upon the kind of attitude we are going to employ as we go about our day. However, when a person has chronic pain, often the first thing on their mind is their current pain level—and their projections about what they may or may not get accomplished that day. A simple way to circumvent this: consider instead changing the focus of that first thought to what can be done for others.
When we get out of bed and interact with our family, our co-workers, and our friends, we need to decide what kind of person we are going to be. Are we going to be calm, caring, compassionate, and in-control? Or are we going to be focused solely on ourselves? We get to decide what kind of impact we will have on others and what we are going to stand for.
4. Let Go of the Struggle
You may not have noticed, but your mind is terrible at solving problems—especially when pain and stress show up. Your mind will run through 100 different “What if…” questions, spinning stories about what will happen and who you will become in your life. In an effort to regain control, your mind will then create dozens of random rules you need to follow.
Like boisterous wild animals, our thoughts jump around, and prove impossible to control. Rather than taking part in this fruitless ritual, try referring to your mind as a “monkey mind.” Challenge yourself to let go of controlling the “word machine” of your mind; realize that what the mind is coming up with is generally not useful.
To quiet a mind busy with frantic thoughts, tell it something like this, “Thank you, Mind, for reminding me that everything is terrible. If I need your help, I will let you know.” Learn to observe your thoughts from a distance and ask the question, “Are these thoughts, feelings, and judgments useful—or, not useful—in helping me move forward?”
If they are not useful—just thank your mind for its input and relegate its crazy thoughts to the backseat as you move forward with your life.
5. Invest in Purpose and Meaning
Viktor Frankl wrote, “Life is never made unbearable by circumstances, only by lack of meaning and purpose.”
Have you ever asked yourself, if pain and stress were not interfering with your life, how would you envision living it? If you do not have a ready answer to this question, take time to discover precisely how you define a rich and meaningful life.
Don’t wait for your life to become perfectly balanced before you do what is important to you. You can be anxious and have pain and still do the things that are important to you—you do not need to get rid of your distress first.
Everything (and everyone) important to us requires investment, struggle, and sacrifice. When you put the people and principles you care about first in your life you will see how this helps you view your stress from an entirely different perspective