Stress and Relaxation (Living Beyond Pain Podcast)

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Stay tuned for [Army] Capt. Tracy Beegen, of the “Living Beyond Pain” podcast, produced
by the Defense Health Agency. [music] [Army Capt. Beegen] Welcome back to
the “Living Beyond Pain” Podcast. Today, we’re going to be discussing the impact
of stress on how we experience chronic pain. I know our listeners are no stranger to experiencing
stress in their daily lives, but when you have a chronic pain condition, it really can
be amplified. Joining us today is [Army] Maj. Cara Cox-Coleman. She’s a clinical health psychologist completing
her fellowship at Tripler Army Medical Center. Welcome, Maj. Cara Cox-Coleman. [Army Maj. Cox Coleman] Hello. How are you? [Beegen] I’m doing great. Thank you so much for joining us today and
sharing your knowledge and experience about stress and how it impacts our body. So imagine you feel great and you’re getting
ready for the day, and all of a sudden, you move just wrong and you experience a pain
flare-up. Now your thoughts start racing about all the
things you have to do and how you’re going to get through your day managing your pain. Can you tell us a little bit about, when that
happens, what’s going on in our bodies when we’re feeling those sensations? [Cox Coleman] Yeah, that’s a great example. We have a nervous system in our body. There’s several parts to that nervous system. One part of the nervous system is called our
autonomic nervous system. And those nerves supply our internal organs
like our blood vessels, our stomach, lungs, our heart, and our sweat glands, just to name
a few things. When we experience a stress response, it impacts
this particular nervous system. There are two parts to this nervous system. One is called the sympathetic nervous system,
which is also known as our fight-or-flight system. And it can also be thought of as the accelerator
in our body. The second system is called our parasympathetic
system, which is also known as our rest-relax-and-digest system. And this can be thought of as the break. So when we experience stress, that sympathetic
nervous system, the button can get pushed to on, if you will, or that accelerator can
get pushed down and it can get activated. And obviously, as the name suggests, fight-or-flight,
it’s preparing us to deal with stressful situations or emergent situations. And it does that by increasing our heart rate,
increasing our respiration and our blood pressure. It moves blood from our extremities into our
muscles and increases muscle tension. It also increases our sweat production and
decreases our digestion, and as well as increasing our blood sugar levels. That’s preparing us to fight or flight. The other piece is the parasympathetic nervous
system, which controls kind of the ordinary everyday processes when we’re just relaxing. And those processes can get muted when we’re
stressed out. So, that takes care of things like decreasing
our heart rate, decreasing our blood pressure, increasing our digestion, and decreasing our
blood sugar levels. [Cox Coleman] So again, when we’re stressed,
that first system, the accelerator, is active. And the second system, the brake, is a little
bit less active. With chronic pain or pain in general, that
sympathetic nervous system gets activated, and we are kind of in this state of arousal. And that starts to become a problem when you’re
experiencing that more often than not. [Beegen] And from what you’re sharing with
us, when we’re in that state of fight-or-flight, that muscle tension can really increase that
sensation of pain that patients might feel if they have a chronic pain condition. [Cox Coleman] Yeah. Absolutely. So pain impacts a lot of areas of our lives. So when we look at chronic illness or chronic
pain, we recognize that it impacts the way that we think about things, feel, and behave,
and that those experiences can intensify our pain experience. The flip side to that, though, is that the
way that we think about things and behave around things and feel about things can increase
that sympathetic nervous system response. So, it can end up being this vicious cycle
that really enhances or intensifies our pain experience. [Beegen] Something that some of my patients
have shared with me is that they really do feel stuck in that cycle. And they hear the word “autonomic nervous
system”, and they feel like they don’t really have control over it, “Well, I can’t help
it. It just automatically clicks on.” But for patients that are experiencing chronic
pain, just like you said, the parasympathetic nervous system, there’s actually tools we
have that can help activate that parasympathetic nervous system. So it really is about being aware of those
things, you know, “Am I starting to feel an increased heart rate? Am I noticing more muscle tension in my body? OK, wait a second. That means that I’m feeling stressed out and
I’m feeling that stress in my body and I’m having a reaction to it.” So what are some things that our patients
and our listeners can do to trigger their parasympathetic nervous system, to turn that
stress response off, so to speak? [Cox Coleman] Yeah. Absolutely. That’s a great question. First of all, like you said, it’s really important
for patients, and really for us all, to be more aware of what’s going on in our bodies
and to pay attention to what’s going on because we can’t change what we don’t recognize is
going on. So beginning to get into a practice of just
noticing what’s happening inside your body is a great place to start. And once you notice what’s going on, then
you can kind of use some different techniques to help to increase that parasympathetic drive,
if you will, like you said. So if you can practice counting to four on
the inhale, sing pause to yourself, and counting to four on the exhale and sing pause to yourself,
you end up getting a breath rate of about six breaths per minute, which really, again,
reinforces that relaxation response. [Beegen] So could you walk us through that
exercise for our listeners to experience now? Because, like you said, it can seem so simple,
but what would that look like? Can you guide me through that? [Cox Coleman] Sure. Absolutely. Let me do two things. The first is I recommend some apps. If you have a smartphone, then there’s a plethora
of apps. But “Tactical Breather” is one app that
we recommend, as well as “Breathe2Relax”. And so those are both great if you need a
little bit of extra assistance or something to follow along with in terms of your breathing. If you are not an app person, that is totally
fine. What I would recommend is laying down, putting
your hand on your stomach or where your diaphragm is. So this is called deep breathing, and not
necessarily because of the depth of the breath, but you’re getting that breath down deep into
your stomach as opposed to chest breathing. So you’re just going to put one hand on your
stomach, making sure that when you inhale, that hand is rising; and when you exhale,
that hand is going down. And so, again, I just recommend that you take
an inhale, noticing how your breath feels going in through your nostrils and down the
back of your throat, into your belly where your diaphragm is. And you count to four as you do that. And then just say pause to yourself, in your
head, and begin to slowly exhale through your mouth, noticing what that feels like for that
breath to escape. And just count to four on the exhale, and
then say pause. And then I want you to repeat that. Now, obviously, practicing this is going to
be really important. When you’re having acute pain flare-ups, it
can be hard to get your breathing under control. And so practicing this a minimum of 20 minutes
a day. We recommend just breaking it into some manageable
sessions throughout the day so that it becomes part of your routine and part of your pain
management plan. And just practicing that repeatedly so that
you have it throughout the day and when you really need it. [Beegen] Those are some great resources that
you mentioned with the “Tactical Breather” and the “Breathe2Relax”. We also have a Mindfulness podcast that is
being developed. There is some really great resources in our
show notes that I would encourage our listeners to also check out and see if they work. You brought up a really great point of it
takes practice. It’s not just a one-time and that should make
things better. It’s really about developing that practice
and being consistent. [Cox Coleman] Yeah. Absolutely. People that have chronic pain, they’ve been
to a lot of practitioners and providers to try and fix their chronic pain. And really, when it comes to chronic pain,
we want people to remember that it may be a lifelong condition that you’ll want to gain
mastery over. And part of gaining mastery over it is, again,
becoming aware of what your body is doing and applying lots of different tools and techniques,
giving them a fair chance, which means going home and practicing them, to see if they work
for you. Not everything works for everybody, but breathing
and deep breathing in general works for most people because it really is impacting our
physiology. One of the other techniques that we talk to
folks about is utilizing progressive muscle relaxation. Again, there are apps and scripts out there
that can help you walk through that. But again, essentially, you’re going to start
at the top of your head, working your way down to the bottom of your feet, tensing – so
holding, tension – and relaxing. Sometimes we forget what it feels like to
be relaxed, and so we have to tense and relax to kind of reset ourselves and reset our nervous
system. And again, that helps to increase the drive
of our parasympathetic nervous system. One of those things, again, that you really
want to go home and practice and make it part of your lifestyle, just like you would make
nutrition, sleep, and movement part of your lifestyle. [Beegen] Those are really great points, and
I want to encourage our listeners to check out the other segments in the Living Beyond
Pain series, where we talk about mindfulness, we talk about sleep, and we also talk about
movement and pacing and how, just like you said, those are really important aspects to
integrate, that this is really a holistic approach. It’s not just a one-size-fits-all or just
trying one thing. It’s about really gaining that mastery and
coming at your chronic pain from different angles so that our listeners can have more
control and feel like they’re in control of their lives versus their pain being in control
of their lives. [Cox Coleman] Absolutely. [Beegen] Can you tell us a little bit about
what the long-term health effects are if someone is in a sustained state of stress? [Cox Coleman] Yeah. Absolutely. So the most recognizable impact is a decreased
immune system. So people will notice that when they’re under
stress for long periods of time, they seem to perhaps get colds more frequently or flus
more often. It also impacts your sleep. It can impact, again, blood pressure, cholesterol,
all things that can become a chronic issue on top of an already chronic problem. And so, unfortunately, that’s what we see,
is that there are a lot of disorders that go hand-in-hand with each other. And part of that may be because that fight-or-flight
system is continuously being activated and rammed up without addressing it and spending
a little bit more time in that rest-relax-or-digest system. [Beegen] Something that I’ve heard about stress
quite a bit, and if you google it, you know, stress, you hear about the stress hormone,
cortisol. What does the impact of cortisol have on our
bodies? [Cox Coleman] So cortisol is great, right,
when you’re in an emergent situation and you need to get away, you need to fight. But cortisol is not great when it’s constantly
being produced in your body. I once heard it said that the overproduction
of cortisol is like bathing your body in poison when it’s being produced for long periods
of time. And so again, all things in moderation can
be helpful, but we want to be sure that when we don’t need things like cortisol to be produced,
that we’re doing what we can do to decrease that. [Beegen] So, for example, if I hear my alarm
clock going off and I might feel like, “Oh no, I’m late,” or I rush out of bed because
maybe my alarm clock didn’t go off, and kind of that rush that we feel, kind of that extra
boost of, “Oh, I have to get going and I have to move fast.” That’s kind of an indication that there’s
some cortisol that might be pumping out in our bodies. Is that correct? [Cox Coleman] Yes. Absolutely. Not necessarily anxious feeling in the way
that we perhaps think about anxiety as a bad thing, but, like you said, that surge of energy
or that– yeah, the surge of energy could be an indication that not only cortisol but
other types of hormones are being produced in our bodies. [Beegen] Sometimes, I think of it, and I’ve
had it explained to me, that it’s kind of like when our bodies downshift to pass somebody,
we need that extra boost to move ahead or to get where we need to go. [Cox Coleman] Yeah. Absolutely. That’s a great way of talking about that and
it’s really kind of in keeping with our accelerator and brake analogy from earlier. [Beegen] But, just like you said, if we have
that sustained, right, and if you keep driving in that lower gear, you’re going to burn out. [Cox Coleman] Yeah. That’s one of the things that we find, right,
is that increased fatigue. When it comes to the fight-or-flight response
or that alarm response, your body can really only sustain that for a certain amount of
time before it goes into exhaustion. [Beegen] Well, Maj. Cara Cox-Coleman, thank
you so much for sharing your knowledge and your experience with us and just giving our
listeners some really practical tools on how we can flip the switch and turn on our parasympathetic
nervous system and that relaxation response in our bodies. And again, for our listeners, I want to encourage
you, check out the resources in our show notes, just like you stated, the apps that we have
with the “Tactical Breather”, the “Breathe2Relax”. There’s also some great resources in the Virtual
Hope Box app. As we close out the show, are there any helpful
tips that you want to leave our listeners with for how to get into that routine of being
intentional about working in relaxation exercises into part of their daily routine? [Cox Coleman] Yeah. Absolutely. So, realizing that chronic pain is a stressor
on our body and it does impact our fight-or-flight response, it increases that. I always encourage people to spend a little
bit more time in that rest-relax-or-digest phase. And in order to do that being very intentional,
so scheduling time, perhaps, to just sit and work on your breathing, or to sit and just
notice what’s going on in your body so that you can use some of the wonderful techniques
that you’ve gotten to enhance your quality of life. So making a decision that this is going to
be a lifestyle practice and that you’re going to investigate and collect data as to how
these different things work for you in your body is a great place to start, being curious
and willing. [Beegen] Those are such great tips and so
helpful and practical for our listeners. So thank you again for joining us and spending
your time with us today. And for our listeners, we want to encourage
you, check out some of the other episodes that we talked about on mindfulness, on pacing,
on sleep, to give you some extra tools or additional tools to help you gain mastery
over your pain. Again, we want to encourage you to check out
those show notes and those great resources. Until next time, be well. [Beegen] [music] Join the “Military Meditation
Coach” podcast, to try a variety of meditation and relaxation exercises and engage in fitness
for your mind. Each exercise is led by an expert in a military
health system. The “Military Meditation Coach” podcast,
made for the military, but good for everyone.


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