Effective Stress Techniques for Chronic Pain Management

Posted on Tuesday, September the 15th at 12:35pm

Dr. Stephen F. Grinstead, LMFT, ACRPS, CADC-II

In today’s busy world it’s very important to incorporate effective stress management tools into your daily living. We hear it all the time; phrases like “I’m stressed out” or “this stress is killing me.”  This is obviously true for people living with medical conditions like heart disease or diabetes. And, if you’re living with chronic pain, it’s even more important because increased stress leads to increased pain. 

Now stress can be a blessing and a curse. We need some level of stress to motivate and help us deal with life on life’s terms. Stress can also gives us energy and fuels the fight, flight, or freeze phenomenon. For someone undergoing chronic pain management though, stress intensifies the experience of pain. The stress response is a combination of biological, psychological and behavioral factors.

In response to stress the body mobilizes an extensive array of physiological and behavioral changes in a process of continual adaptation. This is an important part of the body’s defenses with the goal of maintaining homeostasis and coping with stress. The body reacts to stress by secreting two types of chemical messengers – hormones in the blood and neurotransmitters in the brain. That is why stress management needs to be an integral part of an effective chronic pain management program.

It is important to understand the connection between stress levels and pain symptoms, as well as recognizing that stress management can decrease the perception of pain. Physically, chronic pain raises stress levels and drains physical energy, while psychologically it affects people’s ability to think clearly, logically and rationally, as well as to effectively manage their feelings or emotions.  Remember, that in most cases when someone can learn to lower their stress levels, they will also experience a decrease in their perception of pain.

Of course before someone learns how to manage their stress, they need to know how to assess their level of stress. It is important to know how to accurately assess stress and then how to implement some simple but effective stress management tools. I like using the Gorski-CENAPS® Stress Thermometer concept for stress identification which proposes ten levels of stress. When people get to the upper moderate to severe levels of stress (6-10 range) their thinking, emotions and behavior are impacted. Below is an example of this stress thermometer for you to review—the goal is to keep a level of stress at six or below as much as possible.

Here are seven simple steps for managing stress that could significantly improve chronic pain management: Understanding Stress; Using Positive Affirmations; Emotional Management; Breath Work; Muscle Relaxation; Meditation; and Exercise and Nutrition.

Step One – Understanding Stress: It’s important to learn about stress and understand the stress scale, as well as to recognize that stress can either be a positive influence or make your life overly difficult. When looking at stress on a 1 to 10 scale, with 1 meaning you are very relaxed and 10 meaning you can’t function or you shut down, the danger zone begins at level 7 — stress overload!  From levels seven to ten you will experience disruptive symptoms. It depends on how you interpret this distress whether you face the situation with confidence or helplessness. At this point, you could shift into survival mode—fight, flight or freeze. Any of those three modes will amplify your pain levels. The fight mode leads to anger and attacking others; the flight mode leads to fear and hiding; and the freeze mode leads to depression and immobilization.

Step Two – Stress Reducing Self Talk and Positive Affirmations: The premise here is if you change the way you think you will automatically start changing the way you feel. For example if you’re under high stress the thought might be “I can’t stand this… I need to escape.” This in turn could lead to, fear, anger, anxiety, or even cravings to use self-defeating behaviors or even inappropriate pain medication for stress relief. You really can talk yourself into feeling better no matter what’s happening around you or to you.

Step Three – Emotional Management: If you are undergoing chronic pain management you may be experiencing many types of uncomfortable emotions such as fear, anger, shame, frustration etc. Emotional management starts with learning to identify which emotions you are feeling and be able to rate them on a 0 to 10 intensity scale. The next step is to develop early awareness of them and then take immediate action to cope with any uncomfortable feelings before they lead to self-defeating urges. Developing healthy feeling management skills is very important. Learning to share with trustworthy people is one way to deal with uncomfortable emotions. If the feelings are too intense or overwhelming, counseling or therapy may be necessary.

Step Four – Autogenic Breathing or Breath Self-Regulation: This is a systematic daily practice of breathing sessions that last around 15 minutes, usually in the morning, at lunch time, and in the evening. One simple exercise is to breathe in deeply to the count of five hold for seven counts and slowly exhale starting from nine to zero. You might consider adding this breath exercise to the next stress tip and practice both three times a day.

Step Five – Progressive Muscle Relaxation: One way to do this is by taking slow deep breaths then hold it while tensing up one muscle group at a time. When you exhale let the muscle group relax. Then move to the next group and keep going until you are tensing and releasing all the muscle groups in your body.

Step Six – Meditation: There are literally hundreds if not thousands of types of meditation. One way is to select a consistent time and a quiet place, either early morning and/or evening. Wear loose comfortable fitting clothing and find a comfortable position that you can stay in for at least 30 minutes. Do deep breathing for a minute or two to help relax the body. Close your eyes and then focus on the point between your eyebrows to help increase your concentration. If your mind wanders be gentle with yourself and just refocus. When you first start meditate for 5-7 minutes then slowly increase your time.

Step Seven – Exercise & Nutrition: A very effective stress management strategy is exercise. In addition to lowering stress levels, regular exercise can also be an important part of a pain management program. Some people with chronic pain find exercising difficult to do, but because it helps reduce overall pain, its benefits will be worth any temporary discomfort. All individuals, particularly someone undergoing chronic pain management, should check with their doctors before beginning an exercise regimen.

You may not be aware, but nutrition and diet can, and does influence chronic pain symptoms. Many people find it extremely difficult to change dietary habits, but reducing or even eliminating nicotine, caffeine, and sugar will go a long way toward developing healthy eating plan that can impact pain symptoms. According to the National Fibromyalgia Association, certain foods aggravate some musculoskeletal conditions; they include dairy products, gluten (found in wheat, oats, barley, and rye), corn, sugar, and members of the nightshade family (potatoes, tomatoes, eggplant, peppers, and tobacco). Seeking out an experienced nutritionist can be very beneficial for both stress and chronic pain management.

These seven steps are just a starting point and I encourage you to learn as many stress management tools as you can. When people are more aware of their stress levels, they feel more empowered to take action to reduce the stress in their lives, which in turn leads to a decrease in their pain symptoms. 

My call to action for anyone undergoing chronic pain management is to implement a proactive and strategic stress management plan. Doing so will improve your health and quality of life and most importantly reduce the severity of your pain symptoms.