In Recovery and in Pain? You Need to Watch Your Stress

You’ve got enough to deal with just managing chronic pain, the last thing you need is uncontrolled stress in your life, especially since chronic pain + chronic stress = worsened pain, an increased risk of addiction or addiction relapse and an increased risk of serious mental illnesses.

Read on to learn:

• How stress worsens pain.
• How pain worsens stress.
• How both contribute to relapse.
• How to manage excessive stress.

Stress Worsens Pain

When you're stressed-out, pain feels worse, but why is this?

Well, it turns out that excessive stress has direct pain-raising effects over the short and long term, such as:

• Stress increases muscle tension and this can lead to headache and neck, shoulder or back pain.
• Stress decreases blood flow to the digestive system. Excessive chronic stress can cause abdominal pain and diarrhea.¹ Chronic changes to blood flow can also lead to chest pain and painful skin rashes.
• Excessive stress causes a reduction in brain serotonin levels. Low serotonin decreases your pain threshold and worsens pain perception.
• Excessive stress increases cortisol release. In small doses, cortisol inhibits pain, but chronic over-release causes dysregulation – so you have too much at some points of the day and insufficient release at others.²
• Excessive stress reduces immune system functioning. Impaired immune system functioning can worsen symptoms of many diseases (such as arthritis). It may also accelerate disease progression, in conditions like endometriosis.³
  
• Stress leads to inflammation, in part because stress increases the release of inflammatory cytokines. Inflammation leads to pain.⁴

So, stress increases pain through immediate and long-term processes:

1. Unmanaged acute stress leads to short term pain through processes like increased muscle tension and shallow breathing.
2. Unmanaged chronic stress bumps-up discomfort through lasting immune, hormonal and neurochemical imbalances.

Pain Worsens Stress

So we know that stress worsens pain; but unfortunately, pain also creates stress.

• Pain is an uncomfortable sensation. Prolonged pain causes stress.
• Pain causes secondary stresses, for example: medical treatment costs and inability to work can cause financial stresses, or, insufficient social participation can lead to depression and social stress.
  

The Pain/Stress Cycle

So pain and stress combine in a very negative way - pain causes stress -> stress worsens pain -> worsened pain causes worsened stress…

Pain and stress are so closely linked, in fact, that they cause very similar physiological responses in the body. Both lead to:

• Increased muscle tension.
• Quickened respiration rate (breathing gets faster and shallower).
• Increased heart rate.
• Elevated blood pressure.⁵
  

Stress and Relapse

For people in recovery, both pain and stress increase relapse risks.

• Acute pain is a known relapse trigger. For this reason, a doctor might still recommend opiates for acute analgesia - even for people with serious addiction histories.
• Addiction causes lasting changes to the limbic system and prefrontal cortex. One consequence of these changes is disrupted stress management. For people in recovery, stress activates areas of the brain associated with addiction and causes drug or alcohol cravings, even after long periods of abstinence.⁶

It’s very important for anyone in recovery to take a proactive stance on both pain and stress management.

Stress and Other Mental Health Problems

Chronic pain increases the risks of depression and other mental health problems, especially if pain limits mobility and social participation.⁷

Are You Overly Stressed?

With pain it’s easy to let stress build. Be watchful for any of the following signs that may indicate a stress-problem:^{8 9}

• Anxiety, irritability, sadness, lack of focus and lack of motivation.
• Headache, neck pain, muscle tension or chest pain.
• Clenching your jaw or grinding your teeth.
• Fatigue and sleeping problems.
• Changes to sex drive.
• Unexplained rashes, hives or other ‘allergy’ symptoms.
• G.I. problems, such as nausea or stomach upset, heartburn, gas, diarrhea or constipation.
• Overeating or undereating, or excessive, drug, alcohol or tobacco use. 
  

Controlling Stress Reduces Pain

There are 2 primary ways to beat stress and stress-related pain:

1. Prevent it/reduce it.
2. Learn to cope with it.

Preventing Stress

It’s generally easier to prevent stress than mange it after the fact, and this is doubly so for people with chronic pain who must also cope with the increased pain that stress may create.

To prevent or reduce stress:

• Learn to identify what causes you stress, and then avoid these provocations when possible, or, if you can’t avoid exposure, take frequent stress-breaks to limit overload.
• Learn to say no to more than you can comfortably handle. It’s easy to get stressed when commitments leave you exhausted, and likewise, don’t try to please everyone all of the time – it’s impossible.
• Learn to pace yourself so you don’t overdo it. For example, when scheduling your day – it’s as important to schedule in rest periods as it is activity periods. 
• Learn to temper your emotions and avoid overreacting to difficult situations – try to keep things in perspective.¹⁰
• Get organized and avoid last-minute frenzy-stress.
• Avoid drugs and the excessive use of alcohol – These invariably take more than they give.
• Stay social/have fun – Try to work around your pain to maintain a social life. Having fun is important and since with pain you don’t have as much energy for everything as you used to, unless you make an effort to schedule fun activities, they probably won’t just happen.
• Set reasonable goals to work toward – We all need something to work toward; a reason to get out of bed in the morning and a reason to push past minor inconveniences.
• Stay healthy – Get enough exercise and sleep and maintain a healthy diet.
• Get professional help, if needed – For example, If staying independent at home seems impossible, working with an occupational therapist could make things easier.

Coping with Stress 

• Incorporate relaxation exercises into your daily routine and use whenever you feel stress or pain levels creeping up. Relaxation exercises work best when used before pain or stress gets too intense.
• Relax with a music exercise. Background music can soothe your nerves, but you can get more out of the experience through close attention – by turning music listening into a focused relaxation exercise. To do this: choose any music you enjoy, sit comfortably and take three deep breaths and then put on your headphones or stereo and listen very closely to the music. Close your eyes as you do this and try to focus so intently on the music that you block out all other thoughts. Even twenty minutes of this easy meditative exercise can ease stress and pain in a very enjoyable way.
• Mindfulness meditation – A daily meditation habit can reduce current stress, protect you from future stress, increase your ability to cope with pain and improve happiness and well-being – so a pretty impressive list of benefits that come with as little as 20 minutes a day of quiet practice. Read Meditation Benefits for more on how meditation can change your life.
• Deep breathing exercises – These exercises offer stress and pain relief after as little as 2 or 3 minutes of effort. Two of the many possible variations are yoga breathing and 4-square. Yoga breathing is as easily done as sitting straight up with your back supported, relaxing and then breathing in slowly and deeply for a count of 4 and then exhaling slowly for a count of 6 – and repeating this for about 2 minutes. To do a 4-square exercise: breathe in for a slow count of 4, hold for a slow count of 4 and then exhale for a slow count of 4 – and repeat this cycle 10 times.^{11 12}
  
• Guided imagery audio exercises – People who find mindfulness meditation difficult to sustain may have more luck with guided imagery exercises. For these, you find a comfortable spot and close your eyes and relax your body as you follow the instructions from an audio program.
  
• Prayer – You can also listen to audio recordings of spiritual messages you find comforting.
• Aromatherapy – In one study, the scent of vanilla helped people in a stressful situation control heart rate and blood pressure.¹³
• Massage or self massage – By learning self massage techniques you can give yourself a pain-relieving and stress-easing rub-down whenever you feel the need. 
• Biofeeback – By learning relaxation exercises while hooked up to a heart rate monitor, a skin temperature monitor or a muscle tension monitor, you can see in real-time how relaxing changes physiological functioning and you can see which exercises work best for you.
• Venting – communicating your stress lets you process and release it. Healthy ways to vent stress include talking with a good friend, raising your issues at a support group, or journaling.¹⁴
• Positive self-talk – Learn to correct the negative voice in your head with a more balanced perspective. For example, change, “I can’t do this” to, “I’ll try my best.”¹⁵
  
• Hypnosis or self hypnosis

Tips for Success

To get the most stress-busting benefit, remember:

• It’s hard to relax in a hectic environment; if you can, steal a few minutes for yourself in a quiet environment where you won’t be disturbed.
• Get comfortable before you start.
• Controlling your breathing is a key aspect of most relaxation techniques. Slow your breathing rate and your stress will almost always ease-up.
• Don’t get hung-up on worrying about getting into a deep state of relaxation. Focus on doing your exercises and the relaxation will follow.
• Don’t worry if random thoughts keep intruding during meditation or imagery exercises. Let them flow through without chasing them and then return your focus inward.
• Make relaxation exercises a regular habit. You’ll start to see greater benefits as you incorporate these into your daily routine, and the more you practice these exercises, the easier they get.