Manage Your Pain: Practical and Positive Ways of Adapting to Chronic Pain - Michael K. Nicholas, Allan Molloy, Lee Beeston, Lois Tonkin (2012)

Chapter 12. Using Relaxation

Relaxation is a feeling of being calm. In some situations you may feel drowsy when you are relaxed, especially if you are feeling tired. At these times, relaxation can help you go off to sleep. On the other hand, there are times when you can be wide awake, alert and relaxed, as for example, when you are concentrating calmly on something. At these times, relaxation can help you to concentrate better, without getting too tense and distracted.

The ability to relax can be very helpful whether or not you have a pain problem. When you do have a pain problem, relaxation is that much more important. It is important for a number of reasons:

· Relaxation can help to reduce tension and to stop pain getting worse. Getting wound up or tense doesn’t cause chronic pain, but it will often make pain worse. This can lead to a vicious cycle of pain—tension—more pain—more tension.

· Relaxation will help you to calm yourself and to feel more in control despite the pain and other stresses. Pain will often result in distress, irritability, and feelings of helplessness. All these feelings make it harder to cope with pain.

· Relaxation can help you to get to sleep. Getting to sleep when you have pain can be difficult. If you wake up during the night, pain can make it hard to get back to sleep.

Of course, for many people, being able to relax is easier said than done. That is one reason why so many people use tranquillisers and sleeping tablets. But these tablets are really meant for short-term use only. In other words, they are not suitable for people with chronic pain in the long run. Learning to relax is not only better for you, it is also more helpful than long-term use of these tablets.

Relaxation makes you feel good. It has no unpleasant side effects. It helps you to sleep naturally—with no hangovers. The more you use relaxation, the more effective it will be.

Even though you may have found it difficult to relax in the past, that doesn’t mean it’s impossible. It simply means that you’ll have to learn how to do it better and you will have to put aside quite a bit of time to practise it.

Relaxation is really just a skill. Just as driving a car, playing bowls, cooking and speaking a foreign language are skills. No one is born with these skills—we all learn them. To become proficient at these skills you have to practise them. The same goes for relaxation. The actual way you relax doesn’t really matter, just as long as you do it when you need to.

Try to relax:

✵ When you feel yourself getting tense or irritable

✵ When you feel the pain is getting worse

✵ When you want to get to sleep

At ADAPT we use a relaxation technique that you can use anywhere, once you are good at it. If you already have your own technique and you are happy with it, keep using it. You may already have your own way of relaxing, such as having a nice long bath or sitting on a park bench and watching the world go by. This, of course, just shows that even if you feel you can’t relax there are times when you have relaxed. Perhaps you could build on these experiences and get into the same frame of mind at other times?

It is important that you practise relaxing in different places, not just lying on your bed or on the floor. This is because your pain can get worse anywhere and you won’t always be able to lie down at those times or places. If you relax by reading, watching TV or going for a quiet walk, that is also fine and you should keep doing them. But you won’t always be able to do those things when you need to relax. So it’s important for you to learn a relaxation exercise that you can do anywhere.

How to relax

To begin with, you should practise in a sitting or lying position. As you get better at it you should try relaxing when you are standing, walking and even while you are doing other things, like talking and driving. You may feel you have too much on your mind or no time to relax. If so, it will help if you give yourself ‘permission’ to set aside some time to relax. You can come back to those things on your mind afterwards, and your mind might be clearer then.

Step 1

· Make yourself as comfortable as possible. You may close your eyes, but you don’t have to.

· Take a deep breath, hold it a moment and then let it out slowly.

· Let yourself go loose and floppy as you breathe out.

· When you are ready, take another deep breath and let that go slowly.

· Now let your breathing return to normal. Don’t go on deep breathing. This first part is just to loosen you up.

Step 2

· Keep in mind that you must not force yourself to relax, that will only make you more tense.

· Let yourself relax by letting go the tension in your muscles each time you breathe out.

· Imagine that each time you breathe out, the tension is draining away from your body. Even if you think it isn’t, try to imagine it is.

Step 3

Try to keep your mind off the pain and other worries. There are many ways to do this. Here are a few:

· Repeat one or more words over and over in your mind. Do it slowly and without forcing it. For example, you could repeat the words ‘one’ or ‘relax’ or ‘calm’.

· Imagine a relaxing, peaceful or happy scene in your mind, such as a holiday you once had, or one you would like to have.

· Keep your eyes open and focus on a particular part of the room or wherever you are. Keep staring at the spot in a calm, fixed way.

Your mind will still wander, especially to begin with. When you notice it has wandered, gently bring it back to what you were doing. Try not to get annoyed about it, just be patient. Within a week or so this will get easier.

Basically, that’s all there is to it. There are three important points to keep in mind:

1 Make time to practise, but don’t try to relax (don’t force it).

2 Let your muscles go loose each time you breathe out.

3 When your mind wanders, gently bring it back to the task.

Practice makes perfect

As with all skills, the only way to become good at relaxing is to practise it as often as possible. To begin with, practise this relaxation technique at least seven times a day. These practice sessions should include two long sessions (15-20 minutes each) and five short sessions. The short sessions may be anything from 30 seconds to 5 minutes in length. Most importantly, the short sessions should be done in different places throughout the day. Practise the long sessions in a place that is quiet or where you won’t be disturbed. But you should practise the short sessions in all sorts of places, even if they are noisy. If you practise relaxing in one place only, you will find it harder to do it in other places. But if you practise relaxing wherever and whenever you get a moment, you will get better and better at doing it anywhere.

Of course, it is often easier to relax in places that are quiet—but these are not usually the places where you get tense. So, even though it may be more difficult in some places, you should still practise relaxation techniques there. Before long you will notice you are getting better at it.

To help you get into a routine of regular relaxation practice, make a copy of the Relaxation Practice Chart below. Each time you complete a session, tick it off on the chart. Before long, you will find practising is starting to become a habit and you won’t need to continue filling in the chart.

Applications of relaxation

Relaxation Practice Chart

· Be realistic in your expectations. It will take time to become good at relaxing in difficult circumstances. You may never achieve the level of relaxation you would like, but it will help if you can just take the edge off your tension.

· Get in early. Don’t wait until you are feeling really tense or upset before trying to relax. It is much easier to relax when you first start to feel the tension rising.

· Check your level of tension wherever you are. If you’re sitting or standing on a bus or train, or while your car is stopped at the traffic lights, check for signs of tension. It may be a clenched jaw, a tight neck, or the whites of your knuckles while you’re holding the steering wheel of your car. If you notice any tension, start relaxing.

· Relax while you are doing other things. If you can’t stop what you are doing, just try to work on letting the tension go each time you breathe out. In this way you can relax while you are talking, walking, or even when you are driving your car. It doesn’t matter if you can’t ‘switch off’, letting go the tension is the important thing.

· Be ready to relax as often as you need to. Even though you did your relaxation practice in the morning, this won’t stop you from getting tense in the afternoon. If it is a stressful day, you may need to use your relaxation technique many times that day. On the other hand, if it’s a relaxing day you may not need to use your technique at all.