Living a Healthy Life with Chronic Pain (11 page)

Anger and frustration are common reactions to chronic pain. The uncertainty and unpredictability of living with chronic pain may threaten your independence and control. You may find yourself asking, “Why me? It’s so unfair.” This is a normal response to a persistent pain problem that impacts all areas of your life.

You may be angry with yourself, family, friends, health care providers, God, or the world in general. For example, you may be angry at yourself for not taking better care of yourself. You may be angry at your family and friends because they don’t do things the way you want. Or you might be angry at your doctor and other health care providers because they cannot fix your problems. Some people who are depressed or have anxiety disorders express their depression or anxiety through anger.

It is no wonder that people with chronic pain are upset at times. However, anger and frustration, especially when inappropriately expressed, are emotions that can block effective management of pain. Anger can result in lack of motivation, inactivity, hostility toward others, and “acting out” behavior (such as blowing up, shouting, or other more aggressive actions). These behaviors can alienate those who can help you most. This can increase your sense of isolation and lead to more anger and frustration. The first step to self-managing your anger is recognizing and admitting that you are angry. The second step is identifying the reason for your anger. Managing your anger also involves finding constructive ways to express your emotions.

Research now suggests that people who vent their anger actually get angrier. But suppressing anger isn’t the answer either. The angry feelings often smolder, only to flare up later. There are some strategies you can use to reduce hostile feelings including the following:

• Raise your anger threshold—that is, allow fewer things to trigger your anger in the first place.
  

• Choose how to react when you get angry—without either denying your feelings or giving in to the situation.
  

This sounds simple enough, but what gets in the way is our tendency to see anger as coming from outside ourselves—something over which we have little control. We see ourselves as helpless victims. We blame others and say, “You make me so angry!” We explode and then say, “I couldn’t help it.” We see spouses as selfish and insensitive, bosses as snobs or bullies, friends as unappreciative. So it seems that our only choice is an outburst of hostility. But with a little practice, even a seasoned hothead can master a new repertoire of healthy and more effective responses.

There are several things you can do to help manage your anger.

How you interpret and explain a situation determines whether you feel angry about it. You can learn to defuse anger by pausing and questioning your anger-producing thoughts. If you change your thoughts, you can change your response. You can decide whether or not to get angry and then whether or not to act.

At the first sign of anger, count to three and ask yourself the following questions:

• Is this really important enough to get angry about?
  Maybe this incident isn’t serious enough to merit the time and energy. Determine if the issue will really make a big difference in your life. If not, it doesn’t warrant flying into a rage.
  

• Am I justified in getting angry?
  You may need to gather more information to really understand the situation. More information may prevent you from jumping to conclu sions or misinterpreting the intentions or actions of others.
  

• Will getting angry make a difference?
  More often than not, losing your cool does not work and may even be punishing. Exploding or venting increases your angry feelings, puts a strain on your relationships, and potentially damages your health.
  

Any technique that relaxes or distracts you—such as meditating or taking a long walk—can help put out the fire within. Slow, deep breathing is one of the quickest and simplest ways to cool off (see
page 49
). When you notice anger building, take ten slow, relaxed breaths before responding. Sometimes withdrawing and spending some time alone can defuse the situation. Physical exercise also provides a good natural outlet for stress and anger.

One important skill is to learn how to communicate your anger out loud, preferably without blaming or offending others. This can be done by learning to use “I” (rather than “you”) messages to express your feelings. (Refer to
Chapter 10
for a discussion of “I” messages.) However, if you choose to express your anger verbally, know that many people will not be able to help you address the cause of your anger. Most of us are not very good at dealing with angry people. This is true even if the anger is justified.

If you really feel the need to vent, you may find it useful to seek counseling or join a support group. Nonprofit organizations, such as the
various chronic pain, heart, diabetes, arthritis, and other health-related associations, may be useful resources in this area.

You have modified your expectations throughout your life. For example, as a child you thought you could become anything—a fireman, a ballet dancer, a doctor, and so on. As you grew older, however, you reevaluated these expectations, along with your capabilities, talents, and interests. Based on this reevaluation, you modified your plans.

This same process can be used to deal with the frustration of having chronic pain in your life. For example, it may be unrealistic to expect that you will ever be “all better.” However, it is realistic to expect that you can still do many pleasurable things. Changing your expectations can help you change your perspective. Instead of dwelling on the 10 percent of things you can no longer do, think about the 90 percent of things you can still do.

In short, anger is a normal response to having a condition like chronic pain. Part of learning to manage the condition involves acknowledging this anger and finding constructive ways to deal with it.

Stress is a common problem. But what is stress? In the 1950s, the physiologist Hans Selye described stress as “the nonspecific response of the body to any demand made upon it.” Others describe stress as the body’s way of adapting to demands, whether pleasant or unpleasant. You may feel stress after experiencing negative events, such as the death of a loved one, or even joyful events such as the marriage of a child.

Your body is used to functioning at a certain level. When there is a need to change this level, your body adjusts to meet the demand. It reacts by preparing to take some action: your heart rate increases, your blood pressure rises, your neck and shoulder muscles tense, your breathing becomes more rapid, your digestion slows, your mouth becomes dry, and you may begin sweating. These are signals of what we call stress.

Why does this happen? To act, your muscles need to be supplied with oxygen and energy. Your breathing increases in an effort to inhale as much oxygen as possible and to get rid of as much carbon dioxide as possible. Your heart rate increases to deliver oxygen and nutrients to the muscles. At the same time, body functions that are not immediately necessary, such as the digestion of food and natural immune responses, slow down.

In general, these responses last only until the stressful event passes. Your body then returns to its normal level of functioning. Sometimes, though, your body does not return to its former comfortable level. If the stress is present for any length of time, your body begins adapting to it. This chronic stress can contribute to the onset of some chronic conditions and can make symptoms more difficult to manage.

Regardless of the type of stressor, the changes in the body are the same. Stressors, however, are not completely independent of one another. In fact, one stressor can often lead to other stressors or magnify the effects of existing stressors. Several stressors can also occur at the same time. For instance, fatigue can cause anxiety, frustration, inactivity, and loss of endurance. Let’s examine some of the most common sources of stress.

Physical stressors include the physical symptoms of your chronic pain condition, but they also can be something as pleasant as picking up a new baby or going shopping. What do all these stressors have in common? They increase your body’s demand for energy. If your body is not prepared to deal with this demand, the results may be anything from sore muscles to fatigue or a worsening of other symptoms.

Mental and emotional stressors can also be either pleasant or uncomfortable. The joys you experience from seeing a child get married or meeting new friends may induce a similar stress response as your feelings of frustration about your illness. Although this fact may seem surprising, the similarity comes from the way your brain perceives the stress.

Environmental stressors, too, can be both good and bad. They may be as varied as a sunny day, a sandy beach, uneven sidewalks, loud noises, bad weather, a snoring spouse, or secondhand smoke. Each creates a pleasurable or apprehensive excitement that triggers the stress response.

Some sources of stress can be good, such as a job promotion, a wedding, a vacation, a new friendship, or a new baby. These stressors make you feel happy but still cause the changes in your body that we have just discussed. Another example of a good stressor is exercise.

When you exercise or do any type of physical activity, a demand is placed on your body. The heart has to work to deliver blood to the muscles. The lungs are working harder, and you breathe more rapidly to keep up with your muscles’ demand for oxygen. Meanwhile, your muscles are responding to the signals from your brain, which is telling them to keep moving.

As you maintain an exercise program for several weeks, you will begin to notice a change. What once seemed virtually impossible now becomes easier. The same exercises put less strain on your heart, lungs, and other muscles because they have become more efficient and you have become more fit. What has happened? Your body has adapted to stress.

The same can happen with psychological stresses. Many people become more resilient and stronger emotionally after experiencing emotional challenges and learning to adapt to them.

Everyone needs a certain amount of stress. It helps your life run more efficiently. And most of us can tolerate more stress on some days than on others. But sometimes you can go beyond
your breaking point and feel that your life is out of control. Often it is difficult to recognize when you are under too much stress. The following are some of the warning signs:

• Biting your nails, pulling your hair, tapping your foot, or other repetitive habits
  

• Grinding your teeth or clenching your jaw
  

• Tension in your head, neck, or shoulders
  

• Feeling anxious, nervous, helpless, or irritable
  

• Frequent accidents
  

• Forgetting things you usually don’t forget
  

• Difficulty concentrating
  

• Fatigue and exhaustion
  

Some of these are also signs of chronic pain. That’s why chronic pain is like a type of chronic stress.

Of course, there are many things that can make you feel stressed, not just your pain. Sometimes you may catch yourself when you are behaving or feeling stressed. When you do, take a few minutes to think about what is making you feel tense. Take a few deep breaths and try to relax. Also, a quick body scan can help you recognize stress in your body. You will learn how to perform a body scan and other good ideas for coping with stress in
Chapter 5
.

Dealing effectively with stress doesn’t have to be complicated. In fact, it can start with a simple three-step process:

1. Identify your stressors by making a list.
   Consider every area of your life: family, relationships, health, financial security, living environment, and so on.
   
2. Sort your stressors.
   For each stressor, ask yourself two things: Is it important or unimportant? Is it changeable or unchangeable? Then place each of your stressors in one of four categories:
   

3.   
Match your strategy to each stressor.
Different strategies work for different stressors. The following are some strategies to help manage the different types of stressors more effectively.

Also, it is important to know that certain chemicals you ingest can increase stress responses in your body. These include nicotine, alcohol, and caffeine. Some people smoke a cigarette, drink a glass of wine or beer, eat sugary candy, or drink a cup of coffee to soothe their tension, but this may actually increase stress. Eliminating or cutting down on these chemicals can help you feel less stressed.

Consider some situations that you recognize as stressful, such as being stuck in traffic, traveling, or preparing a meal. First, look at what it is about the particular situation that is stressful. Do traffic jams bother you because you hate to be late? Are trips stressful because of uncertainty about your destination? Does meal preparation involve too many steps and demand too much energy?

Once you have determined what the problem is, begin looking for possible ways to
reduce the stress. When you travel by car, can you leave earlier or let someone else drive? Before a trip, can you contact someone at your destination and ask about wheelchair access, local mass transit, and other concerns? When you need to cook a meal, can you prepare food in the morning or take a short nap in the early afternoon?

If you know that certain situations make you stressed, develop ways to deal with them before they happen. Try to rehearse, in your mind, what you will do when the situation arises so you will be ready. After you have identified some possible solutions, select one to try the next time you face the situation. Then evaluate the results. (Recall that this is the problem-solving approach that was discussed in
Chapter 2
.)

Earlier in this chapter, we discussed how you can successfully manage some types of stress by modifying the situation. But sometimes stress sneaks up on you when you don’t expect it. Dealing with unexpected stress involves problem solving just as dealing with other stressful situations does. As noted earlier, important tools for dealing with stress include getting enough sleep, exercising, and eating well. But sometimes stress is so overwhelming that these tools are not enough. These are times when good self-managers turn to consultants such as counselors, social workers, psychologists, or psychiatrists.

In summary, stress, like every other symptom, has many causes and can therefore be managed in many different ways. It is up to you to examine the problem and try to find solutions that meet your needs and suit your lifestyle.