Releasing Pain Through Relaxation

Releasing Pain through Relaxation

At first glance, it may surprise you to see a chapter about meditation in a book about a rather mundane, nitty-gritty disease like arthritis. Like most Americans, your parents and teachers probably taught you to believe that what happens in your brain (or spirit) has little to do with the rest of your body. Arthritis, after all, directly attacks the joints and connective tissues while meditation, on the other hand, involves only the brain and the breath.

Fortunately, a new understanding of the major role that emotions play in our physical lives has begun to emerge, even from the most hard-core modern medical centers. Indeed, we now know that the way we feel, on an emotional and spiritual level, affects everything from the ability of the gastrointestinal tract to digest food properly to the intensity and frequency of the inflammatory response within our muscles and joints. In this chapter, we'll show you ways to harness the wonderful healing power you hold within your own heart and mind. First, though, we want to give you a better understanding of what pain is, and how its vicious cycle might be working to undermine your emotional and physical health.

Mapping the Pathways of Pain

There are two basic types of pain: acute and chronic. Acute pain is a warning, a message from the body that something is wrong and needs attention. When you put your finger on a hot stove, for instance, the ensuing pain causes you to pull back, protecting yourself from becoming seriously burned. Acute pain eventually resolves itself when the danger has passed and the trigger has been released. Another example of acute pain might involve an elbow joint already severely damaged by osteoarthritis. Hitting a squash ball using a racquet held by that arm would cause great pain because the bones of the arm now rub together instead of being cushioned by healthy cartilage and lubricated by synovial fluid. The pain would cause you to stop playing squash, and thus you would avoid further injury to your elbow joint. That's why it's so important that we listen to our pain and heed its warning signal.

Chronic pain, on the other hand, continues for long periods of time and, apparently, serves no useful physiological function. With a long-lasting and variable condition like arthritis, you can literally become "stuck" within the pain, caught in a cycle of frustration, fear, and exhaustion. You hurt your elbow playing squash. The next day it still aches. You become afraid of straining it further, so afraid that you try not to move it at all. Whenever you do, it seems to hurt even more. Every movement becomes a struggle, a struggle that finally undermines your confidence and energy. Eventually, you become stuck within this cycle, unable to free yourself from the psychological damage that the initial pain and injury wrought.

This is not to say that chronic pain is any less real or serious than acute pain. In fact, chronic pain may point to deeper, more intractable physical and emotional problems, problems that require more, not less, attention and commitment on the part of the individual and his or her practitioner to treat. And, acute or chronic, pain is a very individual and personal matter. No two people experience pain or find relief from it in exactly the same way. Although a fracture of the wrist bone or a cavity in a molar appears to do the same amount of damage in any two individuals, the way pain is perceived by each of them may be completely different: One might be in agony while the other complains of only minor discomfort. This makes the treatment of pain a particular challenge.

Keep in mind that the word "perception" is an important one when it comes to a discussion of pain and our response to it. That's because the pathway from stimulation (injury) to response (ouch!) is not a straight one. When you burn your finger on a stove, for instance, the sensation of pain travels along a series of nerve fibers from your finger to the brain. And there are many ways that the pain message may be altered or even canceled along the route. Have you noticed that when you're in a hurry or preoccupied, stubbing your toe is only a minor interruption, while on other days, perhaps when you're more (or less) relaxed, the same minor injury feels excruciating? Such differences in our own perception of pain point to the complexity of the pain pathways.

Perhaps the most important way that the body protects itself against pain is by producing substances called endorphins. Endorphins are chemicals produced in the brain, spinal cord, and elsewhere in the body in response to the perception of pain. Once released, these chemicals are able to attach to certain receptors in the brain and other sites in the body, thereby dulling the perception of pain. In fact, opiates such as morphine and heroin have a chemical structure similar to that of endorphins, which accounts for their painkilling capacities.

The brain produces endorphins under a number of different conditions, including exercise, meditation, and the stimulation of acupuncture points. In addition, certain emotions and emotional responses appear to either trigger or hinder the release of endorphins. Some studies indicate that depression, a common side effect of chronic pain, for instance, decreases endorphin production, while laughter increases production.

Self-esteem is an extremely important, and often overlooked, aspect of health. Those who feel that they are destined to fail (and thus have no control over their lives) or are unworthy of the success they do achieve, tend to feel stress and pain more acutely than others with more confidence in themselves and their ability to alter their environments. Indeed, our emotional lives have a direct bearing on all aspects of our physical health, including the state of the muscles, tendons, and nerves.

Arthritis and Stress: The Connection

Once your brain perceives pain of any kind, several different hormones are produced that stimulate a number of physical and emotional reactions. When you are frightened by the pain or what caused it, for instance, your palms may begin to sweat, your heart rate and blood pressure to rise, and your muscles to contract. Known as the "fight-or-flight" response, this is an automatic reaction meant to keep you safe from any situation that you perceive of as dangerous. It prepares us to either stay and fight the "enemy," in this case whatever triggered the pain, or to flee. When this response is triggered over and over again by chronic pain, the end result may be more harmful than protective, however. It is, in fact, another form of stress that can weigh heavily on your mind and body.

One branch of the nervous system, called the autonomic nervous system, is particularly important in the fight-or-flight stress response. The autonomic nervous system regulates bodily functions like the heartbeat, intestinal movements, muscular contraction, and other activities of the internal organs. It is divided into two parts that work to balance these activities: The sympathetic nervous system speeds up heart rate, raises blood pressure, and tenses muscles during times of physical or emotional stress, while the parasympathetic nervous system works to slow these processes down when the body perceives that the stress has passed.

Indeed, the two parts of the autonomic system represent a perfect example of the balance we know of as health. (In Chinese medicine, the sympathetic nervous system is the "yang" and the parasympathetic system is the "yin" of the body and its responses.) Bringing your body into harmony during and after stressful periods by triggering your parasympathetic nervous system is as important to your health as is reacting immediately, through the sympathetic nervous system, to the perceived threats known as stressors.

Two of the most powerful stress-related hormones are called norepinephrine and epinephrine. These hormones stimulate the sympathetic nervous system to raise blood pressure and heart rate, to make you breathe in more oxygen, and to cause your muscles to tense up. If you remain under constant pain, the muscles that support your joints and the joint tissues themselves may become chronically and abnormally contracted and thus achy or subject to spasm.

At the same time, the more stress and pain you feel, the more likely it is that you will engage in high-risk behaviors, such as smoking and drinking, overeating, and exercising too little. Although you may feel that these habits help to relax you, they are, in fact, increasing the stress on your body by forcing you to cope with the ill effects of these substances and behaviors.

The good news, however, is that within our bodies we have powerful weapons that can fight against chronic pain and stress. In short, we are naturally able to both boost our production of the natural painkillers called endorphins and, often at the same time, reduce the amount of debilitating, pain-producing "fight-or-flight" responses.

Controlling Pain through Stress Reduction

Although you may be under the impression that what you need to alleviate your arthritis is ever more powerful drugs, it is unlikely that medication will ultimately solve your problem if you remain under high levels of emotional and physical stress. At the same time that you undergo other treatment for your pain, you may want to examine some of the stress-related factors that may well be causing, or at least contributing to, your condition.

Is job stress undermining your health? What about your relationships? Your lack of physical activity? Do you live in a hostile environment, either physically or emotionally? If you can answer yes to any of these questions, you might want to consider ways to change your life in order to eliminate or at least alleviate these problems. Is it possible to change your job? Could you spare the time and money to receive family therapy to improve the way you relate to those close to you? Can you make stretching and strengthening exercises such as those that were described in Chapter 5 a regular part of your life? Although making such fundamental changes may take a great deal of time and commitment on your part, the impact on your general state of fitness and health is likely to be enormous.

In the meantime, there are several other—perhaps more practical—methods of stress reduction available to help you to bring your body back into balance quickly and efficiently during times of stress. In essence, you can learn to counteract the "fight-or-flight response" by activating your parasympathetic nervous system—your yin to counteract the overactive yang sympathetic nervous system—to attain a more peaceful and relaxed internal harmony. Biofeedback, hypnotherapy, guided imagery, meditation, and progressive relaxation are just a few of the many techniques known to help release physical and emotional tension. You should try a few different methods, each one for a week or two, before deciding which ones work best for you.

BIOFEEDBACK

Biofeedback is a time-tested, scientific method for exploring and utilizing the mind-body connection. It is especially helpful for chronic pain sufferers, like the majority of people with arthritis, who can learn to use the power of their own mind to control and release their pain. The underlying premise behind biofeedback is that anyone can learn to modify his own vital functions—including heart rate, blood pressure, and muscle tension—by using his conscious mind. In other words, when properly trained, you can learn to relax your muscles and release the stress such tension can cause your joints whenever you feel tightness and constriction beginning to take hold.

Scientists first developed biofeedback after conducting studies that showed how animals could control bodily functions once thought to be completely automatic by being given a reward or a punishment. Physicians adapted those findings to design ways for humans to control unconscious functions through conscious thought. For thousands of people with arthritis and others with chronic pain, this technique has spelled the end to years of frustration and pain.

Although there are several biofeedback methods, they all have three things in common: one, they measure a physiological function such as muscle tension; two, they convert this measurement to an understandable form such as a computer-generated graph or chart, a blinking light, mercury levels in a thermometer; and three, they feed back this information to the patient.

As with all aspects of health care, it is important that you receive biofeedback therapy from a qualified practitioner. Generally speaking, that means someone with a firm grasp of both physiology and psychology who has been certified by the Biofeedback Certification Institute of America.

HYPNOTHERAPY

Hypnosis, or hypnotherapy, is a technique named for Hypnos, the Greek god of sleep. Since 1958, when the American Medical Association officially approved hypnotherapy as a tool for treating back pain, thousands of people have benefitted from its physically relaxing and emotionally releasing effects.

The goal of hypnotherapy is to bring your body and mind into a deeply relaxed state in order to make you more open to suggestion. Usually, a hypnotherapy session begins with the therapist asking you to close your eyes and think relaxing thoughts. With a soothing voice, the therapist guides you down a path of deeper and deeper relaxation by asking you to focus your attention on a word or an image. By doing so, the therapist hopes to quiet your conscious mind and to make the unconscious mind more accessible by blocking all outside thoughts and stimuli. Because the unconscious mind is less critical, suggestions have a better chance of taking effect than they would if you remained in a normal, alert state.

Once you are completely relaxed, the therapist may suggest that you experience your joint and muscle pain in a different, more pleasant way, or that you picture the pain flowing out of your body in a stream. The therapist may also plant posthypnotic suggestions—ideas about your pain and pain relief that take effect after you return to full waking consciousness. These suggestions are designed to help you release the pain whenever it occurs. In the end, the ultimate goal is to give you a greater sense of control over your own discomfort and frustration.

When choosing a hypnotherapist, you should ask your doctor for suggestions as well as check with national training and licensing institutions, such as the American Institute of Hypnotherapy and the International Medical and Dental Hypnotherapy Association.

GUIDED IMAGERY

Another form of treatment for chronic pain, called guided imagery, uses the power of the human mind as its basic tool. The human imagination—that part of our hearts and minds that can picture and sense images and feelings—is one of the most potent health resources we have available to us. By utilizing the power of the mind, we can help evoke a physical response in our bodies in order to relax our muscles, stimulate (or depress) our immune systems, and reduce pain. In fact, guided imagery is now being used to treat any number of conditions in addition to arthritis, including chronic back pain, high blood pressure, gastrointestinal disorders, allergies, and premenstrual syndrome.

In addition to helping you relax your body, guided imagery also helps to access your emotions. By visualizing your arthritis pain as a red and angry monster that you imagine banishing from your kingdom, for instance, you may learn to better understand how frustrated and sore the pain has made you feel, and how powerful and in control of your body you can be if given the chance to break the cycle.

Although it is possible to conduct your own guided imagery session, it is best when learning to have a trained professional, preferably someone who has experience with your particular type of arthritis, develop a program for you and guide you through the steps until they become familiar. Talk to your doctor about finding a qualified therapist for you.

MEDITATION

Like biofeedback, hypnotherapy, and guided imagery, meditation is a mental exercise that affects body processes. The purpose of meditation for relaxation is to gain control over your thoughts so that you can choose what to focus upon and thus to let the stress flow out of your body. Meditation for relaxation requires no special training, and can be done at any time of day and in any comfortable space. All it takes is about 15 minutes of uninterrupted quiet.

Meditation is effective both in reducing general stress and in helping to relax muscles and joints made tense by anxiety or worry. When you meditate, you quiet the sympathetic nervous system, thereby reducing the heart rate and state of muscle contraction. In addition to its physical benefits, meditation can help you psychologically by allowing you to focus on the cause of your stress and find ways to change the way you respond to the challenges you face. Researchers have found that meditation is related to an internal locus of control, greater self-actualization, more positive feelings after encountering a stressful situation, improvement in sleep behavior, and even an increased ability to quit smoking.

There are many good books on meditation available on the market that go into great detail about the proper sitting positions, what to expect, even what to chant, if you want to chant. And there are schools of meditation that train both doctors and lay people in the intricacies of the meditative process. But the basic elements of meditation are very simple, and can be mastered by anyone willing to set aside a few minutes a day. An easy meditation exercise follows:

Basic Meditation Exercise

This is a simple meditation exercise that can help you relax and focus your attention away from the things that cause stress in your life. Start by sitting a few minutes—perhaps just 5 to 10—until the practice becomes comfortable to you. (If you are interested in learning more about meditation, see Natural Resources, page 168.)

1. Make sure you are wearing comfortable, loose, nonbinding clothing. Sweatpants or shorts and a T-shirt are ideal.

2. Find a quiet place where you will not be disturbed. Try not to sit any place where you might be easily distracted, such as in front of a window.

3. Sit on the floor in a comfortable position. If you aren't comfortable sitting on the floor, sit in a straight-backed chair.

4. Allow your hands to rest on your legs.

5. Lower your gaze so that your eyes are almost, but not quite, closed.

6. Take a deep breath and let it out slowly.

7. The easiest way to begin meditation is to count your breaths. Inhale, count one. Exhale, count two. Inhale, count three. Exhale, count four. Do this to ten, and then start again with one.

8. Sit for about 5 minutes the first week or so (try timing yourself with a kitchen timer so that you don't have to keep track of the time). Gradually increase the time you meditate to 15 to 30 minutes a day.

PROGRESSIVE RELAXATION

Progressive relaxation is a technique used to induce nerve-muscle relaxation. It was developed by Edmund Jacobson, M.D., a physician who designed the technique for nervous hospital patients. It involves tensing one muscle group, then relaxing it, slowly moving from one muscle group to another. The purpose of first contracting the muscle is to teach people to recognize more readily what muscle tension feels like. The idea is to sense more readily when we are muscularly tense and then learn to relax the muscles. Progressive relaxation has psychological benefits as well. Studies show that self-esteem is raised, depression lessened, and sleep problems alleviated in people who practice this relaxation method over a period of several weeks.

Usually, a progressive relaxation session begins by tensing then releasing the muscles of the feet and legs, then moves slowly upward, to the hips, abdomen, lower back, upper back, neck, and arms. After you have more experience with progressive relaxation, you should be able to relax individual muscle groups—the muscles that support the knee or hip joint, for example, or those that control the joints of the fingers. The following exercise will help get you started:

Progressive Relaxation Exercise

1. Stretch out on the floor with your knees slightly bent; make sure that the small of your back is on the floor so that you do not risk straining the lower back. If you like, support your head with a small pillow.

2. Take a deep breath and tighten the muscles of your feet by clenching your toes.

3. As you relax your feet, exhale. Notice the difference in the way your feet feel.

4. Breathe in again, and tighten the muscles of your calves. Hold the exertion for a few seconds.

5. As you exhale and release your calf muscles, say to yourself, "I feel relaxed."

6. Continue the process, with your knees, thighs, stomach, chest, arms, shoulders, neck, and face. Each time you tighten and release the muscles, feel yourself sink deeper and deeper into a state of relaxation.

7. When you have finished the process, breathe steadily and deeply for 5 minutes, enjoying the sense of relaxation.

8. Repeat the exercise daily.

As you learn more about your body and the way it reacts to stress, you may be able to attain the relaxed state more quickly and directly. For example, you may be working at your desk and notice that your shoulder joints are beginning to ache. To relax them you can tense them further, and then let them relax. When you focus on the warm, relaxed sensation of your shoulder muscles, you may feel your entire body, and spirit, relax as well.

No matter what method of relaxation you choose, try to make relaxing seem to be a release and a joy rather than a chore. These simple hints are meant to help you find peace and avoid frustration:

Plan to relax. When you know a deadline is coming up, or that the week is going to be particularly busy and stressful, try to schedule some time—even just a few minutes—during each day to perform one of the relaxation methods described above or to simply take a walk to relieve the pressure. Chances are, you'll return to the task at hand feeling rejuvenated and better able to focus your attention.

Increase your sense of self-esteem and control. Learning that you have power and control over your internal environment and realizing that you can make successful, positive changes in your physical and mental health will automatically raise your self-esteem and give you a new sense of self-confidence. With patience and dedication, these habits may well become a favorite part of your daily routine.

Remember to laugh. Although it may have become a cliché to say so, laughter truly is one of the best medicines. Humor provides a healthy balance to all the hostility, anxiety, and tension we feel every day. If you can look at the world and yourself with a bit of humor and a touch of whimsy, you'll find that your mind is not as cluttered, your stress is not so great, and your aches and pains are less intrusive and debilitating.

If you learn to meditate at the same time that you begin to improve your diet and exercise habits, you're well on your way to taking control of your life, limiting the damage arthritis can do to your joints, and improving the state of your general health and well-being. Along with the diet and exercise recommendations given to you in the previous two chapters, we'll take you on a journey to the East, in Chapter 7 to show you how another culture and medical tradition views arthritis and its treatment.