Stress = Pain = Stress

Stress and pain are intimately related.

In our case, often, being stressed causes pain AND/OR pain causes stress. Psychological therapies – including hypnosis, meditation, and relaxation – may help break the cycle.

For pain therapists, these treatments, which focus on the relationship between the mind and body, are considered mainstream.

For other health professionals, they may be considered alternative or complementary therapies.

And for the layman, they may be considered hocus pocus!

Regardless of how they are labelled, there is evidence that for many people they work.

Hypnosis

fate2For many, hypnosis brings to mind a parlour game or nightclub act, where a man with a swinging watch gets volunteers to walk like a chicken or bark like a dog. But clinical or medical hypnosis is more than fun and games. It is an altered state of awareness used by licensed therapists to treat psychological or physical problems.

During hypnosis, the conscious part of the brain is temporarily tuned out as the person focuses on relaxation and lets go of distracting thoughts. The American Society of Clinical Hypnotists likens hypnosis to using a magnifying glass to focus the rays of the sun and make them more powerful. When our minds are concentrated and focused, we are able to use them more powerfully. When hypnotized, a person may experience physiologic changes, such as a slowing of the pulse and respiration, and an increase in alpha brain waves. The person may also become more open to specific suggestions and goals (such as reducing pain!) In the post-suggestion phase, the therapist reinforces continued use of the new behaviour.

Benefits of Hypnosis

Research has shown medical hypnosis to be helpful for acute and chronic pain. In 1996, a panel of the National Institutes of Health found hypnosis to be effective in easing cancer pain. More recent studies have demonstrated its effectiveness for pain related to other conditions. An analysis of 18 studies by researchers at Mount Sinai School of Medicine in New York revealed moderate to large pain-relieving effects from hypnosis, supporting the effectiveness of hypnotic techniques for pain management.

If you want to try hypnosis, you can expect to see a practitioner by yourself for a course of 1-hour or half-hour treatments, although some practitioners may start with a longer initial consultation and follow-up with 10- to 15-minute appointments. Your therapist can give you a post-hypnotic suggestion that will enable you to induce self-hypnosis after the treatment course is completed

To find a hypnotherapist, speak to your doctor.

More reading on Hypnosis: Look into my Eyes

Find a licensed Hypnotherapist:

The American Society of Clinical Hypnosis

American Psychotherapy and Medical Hypnosis Association

Mind Motivations – For US, UK and Australia

Therapy Tribe – for US, UK, Canada and Australia

Meditation

Meditation involves using a number of awareness techniques to help quiet the mind and relax the body. The two most common techniques are:

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  • Transcendental meditation. The patient repeats a single word or phrase, called a mantra, and is taught to allow other thoughts and feelings to pass.
  • Mindfulness Meditation. The person focuses all of his or her attention on thoughts and sensations. This form of meditation is often taught in stress-reduction programs. Want to give this a try?

meditationBenefits of Meditation

Studies suggest that meditating can increase pain tolerance, activity levels, and self-esteem and decrease anxiety, stress, depression, and use of pain medications.

Mindfulness meditation has been used successfully in programs to reduce pain and improve mood in patients with chronic pain from a variety of conditions, including headache, low back pain, chest pain, and gastrointestinal pain.

Because there are varied forms of meditation and opinions about requirements for training, there is no formal certification or licensing process for instructors. Training requirements differ widely by institution. If you would like to find a meditation instructor, speak to your doctor or a friend, who may be able to recommend one.

To practice meditation, repeated meetings with the instructor may not be necessary. A recent study examining the perception of pain and various mental training techniques has found that relatively short and simple mindfulness meditation training can have a significant positive effect on pain management.

Relaxation Therapies

Relaxation therapies include a range of techniques with the goal of reducing stress. In addition to meditation, the major types of relaxation techniques are:

  • Progressive muscle relaxation: Also known as systematic muscle relaxation and Jacobson relaxation, this technique involves slowly tensing, briefly holding, and then releasing each muscle group in a systematic fashion, starting with the muscles in the toes and moving upward. During this exercise, the person should notice the differences between tension and relaxation.

MINI-RELAXATION PROCEDURE (for those on a tight schedule!)

For relaxation to be of the most benefit, you need to learn how to relax and calm yourself instantly upon your awareness of tension or irritability. While a 20-30 minute relaxation period is great, and very pleasant, you cannot escape and listen to your tape or do your long practice when you are tense in traffic or irritated with your family or co-workers.

A mini-relaxation is done as follows:

  1. Take a deep breath and raise your shoulders slightly (until you can feel increased muscle tension).
  2. Starting at the top of your head, focus on letting go of muscle tension (beginning with the muscles across your forehead). Allow sensations of relaxation, release, and heaviness to flow downward from your forehead, downward through your face, shoulders, arms, torso, and legs and imagine all the muscle tightness and tension draining right out your feet. Exhale as you allow the tension to drain away, and use your “key word” as you do so (this may be Relax, Peace, Calm, Serene, Ocean or any other word or phrase that denotes deep relaxation to you). Be certain that your deep breath was a deep diaphragmatic breath.
  3. This whole procedure should take no more than about 30 seconds (and can be done in as little as 10 seconds if that’s all the time you have). At the end of this period, go about your business regardless of how relaxed you feel.
  4. Repeat this process many times during the day, at least 20. Use the coloured dot procedure to remind yourself to do a mini-relaxation, preferably several times an hour. Place coloured dots in places you will see them often: your telephone, kitchen faucet, refrigerator, bathroom mirror, the door frame of doors you walk through frequently, your notebook or appointment book that you consult frequently, and even cut a small part of the coloured dot to place on your watchband. Whenever you see the coloured dot that is your reminder to do a mini-relaxation: deep breath, raise shoulders, let go of muscle tension as you breathe out and drop your shoulders, while repeating your ‘key word.’ You will notice that you become better and better at producing sensations of relaxation in a very short period of time, as you practice this over days and weeks. Do not extend your mini-relaxation more than one minute. If you are still tense, continue with what you are doing, and do another mini-relaxation the next time you see a dot, or the next time you are aware of feeling annoyed.

NB: A note of caution regarding relaxation if you are driving your car: Never practice long periods of deep relaxation while driving. Never listen to a deep relaxation tape while driving. Frequency is the key! The more you practice relaxation, or mini-relaxation, the better you will become at releasing stress and tension quickly and effectively.

Autogenic training: This technique uses visual imagery and body awareness to achieve relaxation. The person imagines being in a peaceful place and then focuses on different physical sensations, such as heaviness of the limbs or a calm heartbeat. People may practice on their own, creating their own images, or be guided by a therapist. Patients may also be encouraged to see themselves coping more effectively with stressors in their lives.

Breathing: Breathing techniques teach people to breathe effectively to relieve stress. While placing one hand on the chest and another on the belly, the person is instructed to take a slow, deep breath, taking in as much air as possible. During this, the belly should press against the hand. After holding their breath for a few seconds, patients are instructed to slowly exhale.

Benefits of Relaxing

According to a 1996 National Institutes of Health report, there is strong evidence to support the effectiveness of relaxation techniques for reducing chronic pain related to a variety of medical conditions. Other benefits may include reduced muscle tension and insomnia and increased activity level.

chronic comic 167The best way to learn relaxation techniques is with the help of a trained practitioner (although you can find many guided meditations, etc. on the Net). Usually these techniques are taught in a group class and then practiced regularly at home.

There is no widely accepted license for practicing relaxation therapy. However, it is often practiced by therapists and psychologists. Ask your doctor for a recommendation.

More reading on Relaxation: Relax

Risks of Mind-Body Therapies

Although mind/body therapies don’t have the risks of medical or surgical therapies, there have been rare reports of adverse reactions from them.

  • If you have poorly controlled cardiovascular disease, experts recommend avoiding progressive muscle relaxation, because abdominal tensing can cause increased pressure in the chest cavity, slowing of the pulse, decreased return of blood to the heart, and increased venous pressure.
  • If you have a history of psychosis or epilepsy, you may wish to speak with your doctor before trying meditation. There have been reports of some people having further acute episodes following deep and prolonged meditation.
  • Hypnosis or deep relaxation can sometimes worsen psychological problems in people with post-traumatic stress disorders or a susceptibility to false memories. Its use should be avoided in patients with borderline personality disorder, dissociative disorders, or with patients who have histories of profound abuse. Because competent hypnotherapists are skilled in recognizing and referring patients with these conditions, only appropriately trained and experienced practitioners should undertake hypnosis.

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Treat Your Pain, Too.

Back in early May, I wrote a post called Treat Yourself – that gave you an idea about creating your own treatment plan. This is an extension of that post.

Although there is no cure is available, a large number of FM treatment options exist. Treatment options vary wildly in effectiveness from individual to individual. What may work very well for one person may not work at all for another. Research suggests that the most effective strategy is likely to be multi-modal involving diet, exercise, drugs, dietary supplements, and various treatment therapies. Both symptoms focused and causal focused treatment approaches should be combined and managed.

FibroMAGICians must strive to validate what works best for them as an individual. This typically involves a process of trial and error. Evaluating various treatment options and building an effective treatment approach can be a complex process, one typically improved through utilizing a team approach. Fibromyalgia patients are well served by a care team made up of doctors, therapists, specialists and a strong support group.

Available Treatments

No single approach works best. The best course of action when considering treatment options is to combine a traditional medical approach with other available remedies. Over time, you can validate what works best to alleviate your pain. A number of lifestyle changes and other treatment methods can have a cumulative positive effect on the pain you experience.

Here is a list of some commonly used treatment options:

  1. Conventional medicines — Your doctor will work with you to discover what prescription medicines may work best for you. Options are many including pain and antidepressant medicines.
  2. Nutrition and diet — Some researchers believe that the foods you eat can affect FM symptoms.
  3. Dietary Supplements — Vitamins and minerals play important roles in health and maintenance of the body.
  4. Exercise — Exercise helps relieve joint stiffness and can help alleviate some of the pain as well. Short workouts have been proven to help many fibroMAGICians. Pain may initially increase, but then gradually decreases. Hydrotherapytai-chi and yoga are excellent forms of exercise. These forms of exercise incorporate relaxation and meditation techniques. Deep breathing and slow movement will reduce your stress level and increase your fitness.
  5. Physiotherapy  — A physiotherapist can help you with stretching and good posture. Stretching will reduce joint and muscle stiffness. This therapist can also  help you with relaxation techniques, another powerful FM treatment option.
  6. Relaxation therapy — Stress aggravates FM. Reducing stress will provide you with a more restful sleep, improving symptoms.
  7. Massage therapy — This is another great relaxation technique.
  8. Over-the-counter drugs — You will need to work with your doctor. Always talk to your doctor about any over-the-counter medications you plan to take.
  9. Herbal remedies — Many herbs have medicinal healing powers. Again, you must talk to your doctor when using herbal remedies
  10. Chinese medicine — Consider exploring Chinese medicine which places great emphasis on herbal remedies and incorporates life energy healing techniques.
  11. Homeopathy — Visit a homeopathic specialist. They specialize in natural remedies to illnesses.
  12. Acupuncture — Modern adherents of acupuncture believe that it affects blood flow and the way the brain processes pain signals. Studies have shown this may be effective for FM.
  13. Chiropractic care—Chiropractors specialize in spinal problems, which can be a major source of pain for some people.

Building a Customised Fibromyalgia Treatment Program

Through an ongoing process of trial and error, using a mixture of the above treatments (and many others), it is possible to develop a treatment program that can be validated as effective – for the individual patient.

This process is made more effective when the patient embraces the concept of “Self-Management” – an ongoing process through which the patient recognizes and assumes responsibility for leading their own treatment efforts. An effective self-management process focuses on the collection, analysis and utilization of patient data such that the trial and error process is better empowered to yield tangible results.

RELAX!

I took the bold step the other day of declaring Saturday 5 May as Fibromyalgia Isolation (a.k.a. Treat Yourself) Day.

All I wanted to do was allow everyone some time for themselves – it didn’t actually have to be the whole day. Instead, I received a heap of excuses as to why people couldn’t give themselves some time.

Here’s what I say:

To ‘I wish’ – just do it!

To ‘unfortunately those of us with young children can’t partake’ – find a family member, friend, neighbour to take the kids to the park for an hour!

To ‘going out to dinner with friends’ – spend a couple of hours getting ready, have a candle-lit bath, listen to soothing music…

It is so important to take time out for yourself and relax (not time out to think about what you should be doing but can’t; about what you could be doing; or about what you would be doing, if you weren’t relaxing). Symptoms of FM are often exacerbated by the emotional and physical strain that the condition causes, leaving many of us stressed and unable to carry on with our daily routines. To help relieve your stress levels as well ease your symptoms, consider using relaxation therapy.

(Please play the following music while you read the remainder of this post)

How Does Stress Affect the Body?
Both physical and emotional stress can really take its toll on your body. When you sense stress, your body engages in a ‘fight or flight’ response – this means that your body has to decide whether to fight the source of its stress or escape from it. As a result, your body starts to undergo a variety of physical changes to prepare for reaction. These reactions can include:

  • increased heart rate
  • quick, shallow breathing
  • increased blood supply
  • increased blood pressure

You may even notice that you start to sweat, feel nauseated, or even want to faint as a result of your body’s reaction to stress. FM sufferers may also notice an increase in their symptom severity.

How can Relaxation Restore the Body?
By relaxing both your physical body and your mind, you can actually help to reduce the effects of stress. This is known as the relaxation response. Relaxation helps to lower blood pressure and heart rate, and also helps to slow down breathing. Additionally, it promotes oxygen flow throughout the body, helping to heal damaged areas.

Effects of Relaxation Therapy on Fibromyalgia
Relaxation therapy can also be extremely helpful in reducing the many symptoms caused by fibromyalgia. Meditation and progressive muscle relaxation techniques help to reduce insomnia and other sleep disorders. They promote the production of melatonin in the body, which is essential for deep sleep.

Relaxation therapy has also been proven to moderately reduce anxiety and depression, which are also symptoms of fibromyalgia. Moreover, all relaxation therapies have proven effective in minimizing the intensity and duration of migraines.

What is Relaxation Therapy?
Relaxation therapy helps to provide a person with physical, emotional, and spiritual relaxation. It actually involves numerous techniques that reduce stress and fatigue and work to invigorate the mind and body. Most relaxation techniques involve using both the body and the mind together; they often pair concentration with specific bodily movements or breathing exercise to achieve deep relaxation.

There are a number of different types of relaxation therapy including deep breathing, meditation, yoga, and progressive muscle relaxation. Many relaxation therapy techniques can be performed at home, while others can be performed under the guidance of an instructor at a relaxation therapy clinic. Relaxation therapies are very effective because they are accessible, easy to do, and rewarding on all levels.

Relaxation Techniques
There are a wide variety of different techniques that can be used to help promote relaxation.

Deep Breathing
Deep breathing is one of the most basic forms of relaxation therapy. It is a type of relaxation breathing that helps to melt away stress by providing your body with more oxygen. Without oxygen your body cannot function efficiently, and you will feel very painful.

Deep breathing techniques require you to focus on your inhalation and exhalation. Sit or stand comfortably and place your hands firmly on your stomach. Slowly inhale through your nose. As you inhale, you should notice that your stomach begins to expand outwards – this is a sign that you are inhaling as much oxygen as possible. Hold your breath for a few seconds before you begin to exhale. Purse your lips and slowly release all of the air you have just taken in. Repeat for 10 minutes, three or four times daily.

Meditation
Meditation is a technique that helps to relax the body and settle the mind at the same time. Meditation has been used for thousands of years to achieve spiritual and physical oneness. It is now commonly used to help minimize stress and alleviate chronic pain.

One form of meditation uses focused concentration in order to achieve relaxation. Either by repeating a word or sound, or by focusing on your breathing, you can clear your mind and achieve complete relaxation. Sit in a chair or on the floor, and close your eyes. Concentrate on inhaling and exhaling or repeating a special word. Try to sit as still as possible as you focus your concentration. Aim to continue this process for about 20 minutes.

Yoga
Originating in India, yoga is both a physical and mental practice that can help you to achieve complete relaxation. It is a low-impact workout, which focuses on stretching and relaxing all major muscle groups in the body. This makes yoga an excellent choice for fibromyalgia patients, as it helps to increase muscle mass and strength. Yoga relaxation therapy also teaches you how to control and monitor your own breathing, allowing you to relax and focus as you complete the workout.

There are different types of yoga, but Hatha yoga is among the most popular for fibromyalgia sufferers. Hatha yoga uses specific poses and movements to help centre the mind and body. Yoga can be done in the privacy of your own home with the assistance of books or videotapes, or you can attend one of the many yoga classes that are now widely available.

(You can check out my experience with yoga, too)

Progressive Muscle Relaxation
Progressive muscle relaxation is an excellent choice for fibromyalgia patients because it is so easy to do. You can do it while sitting in a chair or when lying in bed, whichever is the most comfortable for you. Progressive muscle relaxation works on all major muscle groups in the body. It helps to reduce tension and work out your muscles at the same time. Progressive muscle relaxation requires no equipment and can be done by all age-levels and abilities.

This technique reduces stress and tension by helping you to focus on particular muscles in your body. You begin by tensing the muscles in your feet. Hold this contraction for 8 seconds or so. Then release the tension and relax. Continue tensing all the major muscles in your body, right up to your head. By the time you have finished, you will be completely relaxed.

Personal Sanctuary

MY ultimate sanctuary

Escaping to a positive stress-free environment when you are tense is a great way to induce relaxation. You can create your own ‘personal sanctuary’ in your home. This may mean going to your garden, or creating a special corner in your bedroom that is filled with all of the colors and happy items you like and enjoy. By simply spending a few moments in your special space, you’ll be amazed at how rejuvenated you will feel.

MINI-RELAXATION PROCEDURE (for those on a tight schedule!)

For relaxation to be of the most benefit, you need to learn how to relax and calm yourself instantly upon your awareness of tension or irritability. While a 20-30 minute relaxation period is great, and very pleasant, you cannot escape and listen to your tape or do your long practice when you are tense in traffic or irritated with your family or co-workers.

A mini-relaxation is done as follows:

  1. Take a deep breath and raise your shoulders slightly (until you can feel increased muscle tension).
  2. Starting at the top of your head, focus on letting go of muscle tension (beginning with the muscles across your forehead). Allow sensations of relaxation, release, and heaviness to flow downward from your forehead, downward through your face, shoulders, arms, torso, and legs and imagine all the muscle tightness and tension draining right out your feet. Exhale as you allow the tension to drain away, and use your “key word” as you do so (this may be Relax, Peace, Calm, Serene, Ocean or any other word or phrase that denotes deep relaxation to you). Be certain that your deep breath was a deep diaphragmatic breath.
  3. This whole procedure should take no more than about 30 seconds (and can be done in as little as 10 seconds if that’s all the time you have). At the end of this period, go about your business regardless of how relaxed you feel.
  4. Repeat this process many times during the day, at least 20. Use the coloured dot procedure to remind yourself to do a mini-relaxation, preferably several times an hour. Place coloured dots in places you will see them often: your telephone, kitchen faucet, refrigerator, bathroom mirror, the door frame of doors you walk through frequently, your notebook or appointment book that you consult frequently, and even cut a small part of the coloured dot to place on your watchband. Whenever you see the coloured dot that is your reminder to do a mini-relaxation: deep breath, raise shoulders, let go of muscle tension as you breathe out and drop your shoulders, while repeating your ‘key word.’ You will notice that you become better and better at producing sensations of relaxation in a very short period of time, as you practice this over days and weeks. Do not extend your mini-relaxation more than one minute. If you are still tense, continue with what you are doing, and do another mini-relaxation the next time you see a dot, or the next time you are aware of feeling annoyed.

NB: A note of caution regarding relaxation if you are driving your car: Never practice long periods of deep relaxation while driving. Never listen to a deep relaxation tape while driving. Frequency is the key! The more you practice relaxation, or mini-relaxation, the better you will become at releasing stress and tension quickly and effectively.

Relaxation is a skill, just like playing tennis or the piano. You cannot expect to be immediately skilled at these techniques. But you will definitely get better the longer and more often you practice. Set aside some time on Fibromyalgia Isolation (a.k.a. Treat Yourself) Day to practice (please!)