Living a Healthy Life with Chronic Pain (13 page)

T
HERE IS A STRONG LINK BETWEEN
our thoughts, attitudes, and emotions and our mental and physical health. As one of our self-managers said: “It’s not always mind over matter, but mind matters.” And in chronic pain, mind matters a lot. Brain imaging studies have found that the emotional and thinking regions of the brain are connected not only to each other but to the part of the brain that detects body sensations. And all of these regions are connected to multiple pathways in the nervous system. What you think and feel can lessen or worsen your pain by opening or closing the gate in the spinal cord and influencing the complex network of nerve cells in the brain (see
Chapter 1
).

Although thoughts and emotions do not directly cause chronic health conditions, they can influence many symptoms beyond just pain. Research has shown that thoughts and emotions trigger certain hormones and other chemicals that send messages throughout the body. These messages affect how our bodies function; they can, for example, alter our heart rate, blood pressure, breathing, blood sugar levels, muscle responses,
immune response, concentration, the ability to get pregnant, and even our ability to fight off other illnesses. Both pleasant and unpleasant thoughts and emotions can make our heart rate and breathing increase or slow down. When we feel a strong emotion, we often have a physical response. We may sweat, blush, tear up, and so on. All of us have experienced how the mind affects the body in this way.

Sometimes just a memory or an image can trigger these responses. For example, try this simple exercise: Imagine you are holding a big, bright yellow lemon slice. You hold it close to your nose and smell its strong citrus aroma. Now you bite into the lemon. It’s juicy! The juice fills your mouth and dribbles down your chin. You begin to suck on the lemon and its tart juice. What happens when you imagine this scenario? Your body responds! Your mouth puckers and starts to water. You may even smell the scent of the lemon. All of these reactions are triggered by the mind and its memory of your experience with a real lemon.

This example illustrates the power the mind has over the body. It also gives you a good reason to develop your mental abilities to help manage your symptoms. The mind can greatly help relieve the unpleasantness caused by pain. With training and practice, you can learn to use the mind to relax your tense muscles, calm your nervous system, and improve your breathing. You can also learn to reduce stress, anxiety, and other difficult emotions that are part of the chronic pain experience. Using the mind may even help you depend less on some medications.

In this chapter we describe several ways you can begin to use your mind to manage pain and associated symptoms. These are sometimes referred to as “thinking” or “cognitive” techniques because they involve the use of our thinking abilities to make changes in the body.

As you read, keep the following key principles in mind:

• Symptoms have many causes
  . This means there are many ways to manage most symptoms. When you understand the nature and causes of your symptoms, you are better able to manage them.
  

• Not all management techniques work for everyone
  . It is up to you to find out what works best for you. Be flexible. Experiment. Try different techniques and check the results to determine which management tool is most helpful for which symptoms and under what circumstances.
  

• Learning new skills and gaining control of the situation take time
  . Give yourself several weeks to practice before you decide if a new tool is working for you.
  

• Don’t give up too easily
  . As with exercise and other new skills, using your mind to manage your health condition requires both practice and time. It may be awhile before you notice the benefits. Even if you feel you are not accomplishing anything, don’t give up. Be patient and keep on trying.
  

• These techniques should not have negative effects
  . If you become frightened, angry, or depressed when using one of these tools, do not continue to use it. Try another tool instead.
  

Although you may have heard and read about relaxation as a pain management technique, you may still be confused as to what relaxation is, its benefits, and how to achieve it. Simply stated, relaxation involves using thinking or cognitive techniques to reduce or eliminate tension from both the body and the mind. Relaxation usually results in improved sleep quality, better breathing, and less stress, anxiety, and pain. It often also instills a feeling of calm and well-being.

There are different types of relaxation techniques, each with specific guidelines and uses. Some techniques are used mostly to achieve muscle relaxation, while others are aimed at reducing anxiety and emotional stress or diverting your attention from your symptoms. All of this helps with pain and symptom management.

Relaxation means different things to different people. We can all identify things we do that help us relax. For example, we may walk, watch TV, listen to music, knit, or garden. These methods, however, are different from most of the techniques discussed in this chapter because they include some form of physical activity or require a stimulus such as music that is outside of the mind. The relaxation tools we focus on in this chapter involve using your mind to help relax your body.

The goal of relaxation is to turn off the outside world so that the mind and body are at rest. This allows you to reduce the tensions that can increase the intensity or severity of symptoms.

The following guidelines will help you successfully practice relaxation.

• Pick a quiet place and time
  . Find a time and place where you will not be disturbed for at least 15 to 20 minutes. If this seems too long, start with five minutes. (By the way, in some homes the only quiet place is the bathroom. That is just fine.)
  

• Try to practice the technique twice daily and not less than four times a week
  . These are new techniques, and new techniques take repetition to master.
  

• Don’t expect miracles or immediate results
  . Sometimes it takes three to four weeks of consistent practice before you start to notice benefits.
  

• Relaxation should be helpful
  . At worst, you may find it boring, but if practicing any technique is an unpleasant experience or makes you more nervous or anxious, switch to one of the other symptom management tools described in this chapter.
  

Some types of relaxation are so easy, natural, and effective that people do not think of them as “relaxation techniques.”

• Take a nap or a warm, soothing bath.
  

• Curl up and read or listen to a good book.
  

• Watch a funny movie.
  

• Make a paper airplane and sail it across the room.
  

• Get a massage.
  

• Enjoy an occasional glass of wine.
  

• Start a small garden or grow a beautiful plant indoors.
  

• Do some crafts such as knitting, pottery, or woodworking.
  

• Watch a favorite TV show.
  

• Read a poem or an inspirational saying.
  

• Go for a walk.
  

• Start a collection (coins, folk art, shells, or something in miniature).
  

• Listen to your favorite music.
  

• Sing around the house.
  

• Crumble paper into a ball and use a wastebasket as a basketball hoop.
  

• Watch water move (ocean waves, a lake, or a fountain).
  

• Watch the clouds in the sky.
  

• Put your head down on your desk and close your eyes for five minutes.
  

• Rub your hands together until they’re warm, and then cup them over your closed eyes.
  

• Vigorously shake your hands and arms for ten seconds.
  

• Call up a friend or family member to chat.
  

• Smile and introduce yourself to someone new.
  

• Do something nice and unexpected for someone else.
  

• Play with a pet.
  

• Go to a vacation spot in your mind.
  

The relaxation techniques we discuss in this section, body scan and relaxation response, take a bit longer but are quite effective.

To relax muscles, you need to know how to scan your body and recognize where you are tense. Once you know how to do this, you can learn to release the tension.

The first step is to become familiar with the difference between the feeling of tension and the feeling of relaxation. This exercise allows you to compare those feelings and, with practice, spot and release tension anywhere in your body. It is best done lying on your back, but you can use any comfortable position. You will find a body scan script on
page 81
.

In the early 1970s a physician named Herbert Benson studied what he calls the “relaxation response.” According to Benson, our bodies have several natural states. One example is the “fight or flight” response experienced by people when faced with a great danger. Another is the body’s natural tendency to relax after feeling tense. This is the relaxation response. As our lives become more and more hectic, our bodies tend to stay tense for long periods of time. We lose our ability to relax. The relaxation response helps change this.

To achieve the relaxation response, find a quiet place where there are few or no distractions; then find a comfortable position. You should be comfortable enough to remain in the same position for 20 minutes.

Choose a pleasant word and a tranquil object or feeling. For example, repeat a word or sound (such as the word
one
) while gazing at a symbol (perhaps a flower) or concentrating on a feeling (such as peace).

Adopt a passive attitude. This is of the utmost importance. Empty all thoughts and distractions from your mind. You may become aware of thoughts, images, and feelings, but don’t concentrate on them. Just allow them to pass on.

   To order the Relaxation for Mind & Body CD, go to
www.bullpub.com/catalog/relaxation-for-mind-and-body

To elicit the relaxation response take the following steps:

• Sit quietly in a comfortable position.
  

• Close your eyes.
  

• Relax all your muscles, beginning at your feet and progressing up to your face. Keep them relaxed.
  

• Breathe in through your nose. Become aware of your breathing. As you breathe out through your mouth, say the word you chose silently to yourself. Try to empty all thoughts from your mind; concentrate on your word, symbol, or feeling.
  

• Continue this for 10 to 20 minutes. You may open your eyes to check the time, but do not use an alarm. When you finish, sit quietly for several minutes, at first with your eyes closed. Do not stand up for a few minutes.
  

• Maintain a passive attitude, and let relaxation occur at its own pace. When distracting thoughts occur, ignore them by not dwelling on them, and return to repeating the word you chose. Do not worry about whether you are successful in achieving a deep level of relaxation.
  

• Practice this once or twice daily.