Prologue

How we experience stress and pain is so deeply personal that sorting through possibilities to find relief, or to find that professional medical advice is needed, can use a helping hand. I’ve written this post because I’d like to add my perspective to what we hear from experts giving us general information to help us deal with stress and pain.

I have no academic credentials to discuss stress or pain. What I believe has been learned living a stressor filled life, including the stress caused by my episodic pain from Rheumatoid Arthritis and other maladies as well as sharing my wife’s journey with chronic pain, interaction with medical professionals and research. My battle rages on, but I am able to function well and enjoy the activities of daily life.

Our strategy is to deal with our conditions in a way that maximizes our ability to function in the activities of daily lives. In my real world experience, there are three main tactics: Distraction, Disease Modification, and Disease Masking.

Decades ago, my doctor curtly informed me that I am actually the source of most of my stress. “You could shovel manure in a horse stall and it would be the most stressful job on earth! You know that, don’t you?” quoth he. I didn’t know that and I haven’t fixed myself, but I do (now) know myself in that regard. Those helping you, be they friends, family, or professionals will be more gentle than Dr. Bill was with me. Bill knew me well. Know yourself better. Don’t despair – there are many, many people with the same problems that you have. You are not alone.

Shell game

Most are familiar with the shell game, quite often a con involving magic, where an item, a peanut or other object is placed under a half-nutshell or half-sphere and multiple empty shells, usually for a total of three, are also placed on the table. The proprietor scoots all of the shells around and among each other for the player to guess the shell under which the object lies. In the con version, a bet is placed, the proprietor has palmed the object, no guess is correct, and he wins showing the object under the shell of his choice. One magician did this stunt to show us how astute parrots were. The parrot caught him with the peanut his his pocket and not under any shell.

Dealing with stress and pain is like that shell game, except that we use three shells each providing some level of relief and, hopefully, the combination of all three make life tolerable. And the parrot, like Monty Python’s famous skit, is dead.

The most important ingredient in a magic trick and in stress & pain management is the same: Distract the audience. Distract the sufferer. Distraction.

Distraction

That which allows us to focus our minds elsewhere, to escape existential reality and suffering while being able to snap right back into it when something needs attention, are distractions.

Entering a space where we are not thinking about our stress is very effective in managing it. Most of us learned as a child how much more a minor burn hurts if one sits there and thinks of the burn, and how quickly it goes away when we play. If you talk to a pain management specialist, they will tell you this, and for stress in general this seems quite true to me. A movie, a walk observing nature, a talk about a different subject, these are all distractions. My favorite distraction is playing the piano – I ain’t great but it gives me time to think about different things. My second favorite is writing. And every day closes with an hour of study of ancient literature.

The most prevalent distractions in our modern world are perhaps food, video games, and television. Shopping is another. So is being active in an organization, a cause, those sorts of things. There are lots of good distraction techniques that can also add fun and even add value to others. By the way, you don’t snap back from alcohol and such things; they are not distractions.

And we must acknowledge the darker side of distraction. Sexual promiscuity, hedonism, sadism, and masochism are distractions. Controlled self inflicted pain, such as cutting, inserting objects under the skin that can cause pain on demand, and the like are distraction techniques. Oddly, pain can distract from stress and stress can distract from pain. In the end, these things create a new world that adds to stress and medical issues. My advice is to steer clear of the darker side of distraction.

Disease modification

If the distraction tactic ignores the enemy, the disease modification tactic attacks the enemy head on to limit the damage done or completely route our foe. This tactic includes things that impact the source of the stress and pain to decrease it or cure it. For instance, when you’re suffering from Rheumatoid Arthritis (RA), swelling often displaces joints leading to much pain. NSAIDs like Ibuprofen decrease the inflammation and swelling, modifying the course of the disease and giving some relief. Tylenol, on the other hand, is a Disease masking agent, a pure analgesic – it treats the symptom of pain, not the cause of the pain. Other more effective disease modifying medications with more side effects and higher costs such as Enbrel can be used for RA. Medications are available that modify / treat other sources of pain, as well as anxiety and disproportionate stress. In most cases, as the efficacy of the curative regime increases, so do the potential side effects and risks.

For stress, the first line of attack is avoiding stressors not required to accomplish the activities that you see good and fit to engage in. For example, it may be helpful to focus on things with direct impact such as the weather far more than on the political upheaval in the world. On the other hand, participation in politics can be an excellent distraction. Know thyself.

One often hears of list making as a strategy to reduce stress through showing a plan and accomplishments towards that plan, modifying the condition rather than distracting from the stressor. The problem is that the list in and of itself is yet another source of stress so care must be taken in making such lists. On this front, set yourself up for success, not failure. Spend time concentrating on elemental things that can be done rather than large tasks. For instance, “go shopping” could reduce to “pick up eggs and milk” and “get two pair white socks” – make the list things that you are certain can get done in far less than a day. For paying bills, pick a few and put that as a task on the list, not just every bill. For taxes, pick a topic, one topic or part of one topic, and put that on the list. This makes for longer lists, so make sure that you’ve got it time phased so that you only consider the goals for a day or two, not a month or a year. And for heaven’s sake, don’t overfill the list of the day, be realistic about the interruptions of your time by others and your needs.

If your stress level and your feelings cause chronic symptoms, and it seems that you are different than others in similar situations, have a chat with your doctor. It may be that something is a bit off in the old noggin’s chemistry. It’s okay, I’m a bit off in my chemistry too, lots of people are. Remember: normality is a statistical computation; no one is normal.

Your doctor may be able to help with certain medications, such as antidepressants, that seek to restore chemical balance in one’s brain. Stress, anxiety, clinical depression, and lots of other things are tightly bound in the human experience and very slow acting agents like SSRIs (I take Lexapro) may indeed help quite a bit, if you have that sort of problem, as do I. Only your doctor can determine if medication is an appropriate tactic for your situation, and if they do, be prepared to try several over several months to get the right one for you and your amazing body chemistry. This medical strategy does not make a person feel euphoria or “a high”; our strategy is activities of daily life improvement, not making us unable to participate in activities of daily lives!

Some of the medications used here can have serious side effects, including suicide, and that’s a fact. It’s odd that people don’t consider this too much when having an adult beverage, but anything that is actively changing your noggin’s chemistry can elude detection by the person whose chemistry is being changed. Remember that the action of these modifying tactical agents, unlike adult beverages, is slow and that you should note changes in thoughts and activities along the way. Be in contact with your doctor and some people that you know. If the tactic is making things worse, get help.

Disease Masking

This tactic is the least understood yet the most commonly used. From a medical perspective, disease masking agents temporarily remove the source of the affliction. Analgesics turn down the volume on the pain, for instance, and this is the primary use for opioid preparations such as morphine. Commonly prescribed analgesics are Tylenol, Oxycontin, Hydrocodone, and so forth an so on. Note that while NSAIDs like Ibuprofen, Naproxin (Aleve), Asprin, and so forth do decrease pain and fever, they actually decrease the impact of the underlying condition so I’ve included that as part of the disease modifying tactic.

The tactical goal of using disease masking agents is to suppress the root cause of the disease in terms of cognitive perception that it exists. The primary goal is to decrease the experiential level of the condition by masking such that distraction and disease modification strategies are generally able to overcome the remaining problematic disease interference with the activities of daily life. We should duly note that that cognitive perception decrease is not due to euphoria from taking opioids; people on stable opioid doses do not experience euphoria; the cognitive perception decrease is due to decrease in pain transmitter efficacy (turning the volume down). Our bodies are built well; the volume of pain can be turned down while at the same time the control of our muscles can be turned up by the old noggin which does not turn up the pain volume. That’s why some of these agents can be effective on pain without significant impairment.

For chronic pain certain stimulator devices (implants) that scramble or otherwise decrease neural pain transmission to the brain are sometimes employed to decrease or eliminate the need for pharmaceutical agents. Certain surgeries such as rhizotomies that damage transmitting nerves, and so forth and are employed on the battle field, as are implants to directly place chemical agents on the nerve responsible for pain lessening the systemic impact of the agents. Only you and your doctor can determine if any of these tactics is right for you.

With both stress and pain, there is quite often a normal background level that is controlled by certain modifying agents such as SSRIs or masking agents such as Morphine or stimulators, coupled with break-through levels of trauma that are dealt with using shorter term masking agents such as Xanax or clonazepam for stress and Hydrocodone for pain.

Almost every masking tactic has side effects; even overuse of Tylenol can result in permanent liver damage or death. We should always work with medical professionals to understand short and long term side effects and weigh them against the benefits and dosages of masking agents. That advice goes for over the counter supplements as well.

Self Medication

A discussion of strategic stress and pain management cannot be complete without acknowledging the most commonly occurring methods: self medication with alcohol, cannabis, and other substances legal and illegal. I myself smoke tobacco.

How many times in a movie or a TV show to we hear of “someone needing a drink”? Far too many, in my view. This is a break-through event masking tactic using alcohol to diminish the perception of the reality. The same could be said for smoking, except that nicotine is one of the most addictive substances known to man. I know, I recently tried, and failed, to quit. While I had pneumonia.

The problem with these agents and tactics is that, generally speaking, they result in more harm than good. A night out on the town is an excellent distraction. However, embellishing it with chemical agents may result in very negative consequences such as an arrest for DWI, arrest for public intoxication, fights, arrest for possession of the chemical agents, and so forth. And those negative consequences interfere with the activities of daily life making these tactics ineffective and perhaps disease worsening events such as picking a fight with someone you know will beat you to to a pulp. The strategy needs to be at the forefront when we pick tactics to achieve our goals.

My advice is this: when considering the use of a chemical agent that will alter your perception of reality, including alcohol, know not only yourself but those whom you will be with. Don’t take such things on a lark and know exactly what it is that you’re about to do. Cannabis, at high dosages – and since it’s been legal in certain states, very high dosage plants are available – causes anxiety and paranoia and even psychotic breaks. Know also that claims made are most often not backed up by clinical evidence. Until recently, the AMA and even my doctor hawked the health benefits of red wine. Of course, we now know that Alcohol always has negative consequences on bodily function, however, it certainly has some benefits for masking stress and pain. That notwithstanding, I don’t consume alcohol, nor do I self medicate other than smoking.

The best strategy is to have sufficient self-knowledge to determine when you need a strategy. Whatever you do, do so with safety and with a reasonable likelihood of knowing the results, preferably with professional medical advice. Don’t take a dive into an empty swimming pool.

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