I’ve had reinforced again this week the importance of stress management for people experiencing any type of medical condition. It’s even more important when they have coexisting disorders. People with chronic pain and coexisting addictive disorders have two major reasons to learn effective stress management: (1) to lower the intensity of their pain; and (2) to help them avoid a relapse back to inappropriate medication including alcohol or other drugs.

Stress is a blessing and a curse.  We need stress to motivate us and help us deal with life on life’s terms.  Stress also gives us energy and fuels the fight, flight, or freeze phenomenon.  On the other hand stress can be a curse for someone in early recovery.  Stress is a major trigger for protracted or post acute withdrawal (PAW), and often leads to increased urges and cravings to use alcohol or other drugs. 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.
 
Hormones alter the metabolism of food for fuel and energy for the fight-flight response. In the brain neurotransmitters trigger emotions, such as aggression or anxiety that prompt a person to engage in fight-flight or freeze response to stress.  This leads to self-defeating behaviors.

One of the first steps in effective stress management is to learn how to identify and challenge irrational thinking that leads to uncomfortable emotions and anticipatory pain.  For example if you’re under high stress the thought might be “I can’t stand this… I need a pill.”  This in turn could lead to, fear, anger, anxiety, or even euphoric recall—anticipatory excitement.

The next step is to be aware of and learn how to manage those uncomfortable feelings before they lead to self-defeating urges.  Developing recovery-prone 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.

If those negative urges do surface, it is important to learn how to make healthier decisions before indulging in self-destructive behaviors.  There is a decision point between the urge and the behavior that is almost non-existent when people first get into recovery.  If people keep “reacting” to their impulses instead of thinking and “responding” they very well could relapse.  That is why learning impulse control and delayed gratification is so important.

The final part of stress management is to learn relaxation and stress reduction techniques.  For some people this includes options such as meditation, yoga, Tai Chi, breathing exercises, etc. Some people like to use soothing music to relax.  These relaxation interventions need to be coupled with developing an effective diet and exercise program. 

Yes stress is a blessing or a curse, and if you want to stay serene and reduce your pain learning to identify and manage your stress is very important.  Relapse prevention is an inside job, but that doesn’t mean you have to do it all alone.  Help is out there if you’re willing to reach out.

I’m in Florida this week helping my colleague, and Mentor, Terence Gorski conduct a 44 hour Relapse Prevention Therapy (RPT) Certification School.  We have about 40 participants from the addiction and mental health fields at this event and many of them shared that one of their biggest challenges, as well as a very common relapse issue, is working with people who have chronic pain and addiction issues.

It is very exciting to me to see that people from all over the US are taking the problem of chronic pain and addiction more seriously, and are letting go of judgments about people in recovery who NEED to be on APPROPRIATE medication.  There are two major relapse triggers for someone in recovery for any addictive disorder that also has chronic pain; one obvious trigger is using the “wrong” medication or taking too much of the “right” medication, and the second trigger is not learning more appropriate ways to manage their pain effectively.

As any of you who have looked at other parts of my website know; my philosophy is effective chronic pain management includes a multidisciplinary three part approach.  (1) appropriate medication management in collaboration with an addiction medicine specialist; (2) development of a nonpharmacological treatment plan; and (3) managing the psychological/emotional components of pain using cognitive behavioral and rational emotive therapy interventions.  Effective chronic pain management is possible if people are willing to implement this type of approach.  To read my free download article, Treating People in Chronic Pain, please go to the link below.

http://www.addiction-free.com/articles/articles/view/treating-people-in-chronic-pain

I’ve been living with my chronic pain condition for over 20 years and have learned that pain flare ups are inevitable for me.  This past week we moved back home to Sacramento from the Palm Springs area after spending two years in the desert.  Between all the stress of moving, my wife’s mother dying the day the movers came, and me doing a lot of physical work, I noticed my pain levels started increasing each day.

I was forced once again to “practice what I preached” and had to implement my own pain flare up plan.  As I did this I began thinking that this would be a good time to blog about managing pain flare ups. There’s an exercise in my Addiction-Free Pain Management™ Workbook designed to help people manage pain flare ups. If you’d like to obtain a free copy of this exercise please go to my Contact Us page at http://www.addiction-free.com/contact.html to request my Pain Flare Up Plan and we will be happy to email it to you.
 
I would like to share with you what happened to my pain levels and how I managed them.  Most of the time I’m relatively pain free or at very low levels of pain—say 2-3 on a 1-10 pain scale.  On the day the movers came and we found out my wife’s mother was dying my pain levels increased to 4-5.  By time I met the moving truck in Sacramento my pain was 5-6 and by the time they had the truck unloaded and I had a whole lot of boxes unpacked my pain was now at 7-8.

The first thing I did was lay down and close my eyes and worked on determining how much of my pain was psychological/emotional and stress related.  By doing some deep breathing and progressive muscle relaxation within ten to fifteen minutes I was able to get my pain down to a 5-6 range.  I also took some Advil to help reduce the inflammation.

My next step was slow easy stretching followed by a soak in our hot tub and then some more gentle stretching.  The next step was to lay down with an ice pack for twenty minutes. All of this took about an hour and by that time my pain was now at a 3-4 range for most of the evening.  After a good night sleep I woke up with a 2-3 level of pain and ready to start another busy day of unpacking.