May 27th, 2009

Pain Management Class No. 2

Pain Management Class No. 2


In today's pain management class we learned about the stress response and the relaxation response.  The stress response engages the sympathetic nervous system, which automatically raises the heart rate, pulse, blood pressure, muscle tension and shallow breathing to prepare the body for "fight-or-flight."  In contrast, the relaxation response engages the parasympathetic nervous system, which undoes all the stress responses fired up by the sympathetic nervous system -- heart rate, pulse, blood pressure and muscle tension are all lowered, and deep, abdominal breathing increases.

When stress increases, nervous system activity increases, which leads to a pain increase as well.  Pain itself is a stressor, so it becomes a vicious circle of ever-escalating pain and stress in a self-perpetuating feedback loop.

So there is a need to break that feedback loop somehow, to interrupt the stress response and moderate the pain.  Of all the physiological reactions going on in the stress response, the only one that is under conscious control is breathing.  During this week we are supposed to practice some deep, abdominal breathing every couple of hours throughout the day, inhaling for a count of 5, holding for 1, exhaling for 5, holding for 1, etc.  Ideally our mental focus during this exercise is not on any pain we may be having at the moment, but on something neutral or positive.  If we are having pain at that moment, we are not supposed to go into denial about it, but we can choose not to focus on it at that particular moment.  Practicing and cultivating this relaxation response should enhance our self-control over our internal physical, cognitive and emotional functioning, regardless of external pressures.

I am beginning to see the role that mental focus can play in this complicated system.  That's not to say that anyone can "think" their pain away; far from it, because our pain is not all in our head.  It is not imaginary, it is not "wrongthink," and so it cannot be dismissed by mental effort alone.  So it's more than just mind over matter.  It's a complex interplay of body and mind, which this class will explore further in the coming weeks.