Often, people who are injured in an accident don’t just have trauma symptoms, they also have (chronic) pain, or even concussion symptoms. Anxiety or trauma symptoms can show up as central nervous system arousal. In plain terms, this means that when you feel anxious or scared, your body muscles can tense up, and your nervous system is “on alert”.
When your body is “on alert”, it can make concussion or pain symptoms worse. This is because the stress your body feels can add to the way that your brain perceives pain. This is because your pain is processed in your brain, not in the part of your body that is injured. I am not saying that “your pain is all in your head”, but rather, that the way that you experience pain can be significantly influenced by your thoughts and feelings at that moment. If you have thoughts such as “the pain will never get any better” “Why did this happen to me, I don’t deserve this” or “I hate whoever did this to me”, then those thoughts will drive feelings of anxiety or anger, which will magnify the way that your brain perceives that pain signals that are sent from the injured part of your body to your brain.
If you doubt this idea, reflect on the times in the past week when your pain was at its worst. Did you feel stressed, angry, or scared during those times? Was it after a fight with an insurance company, a family member, or due to an approaching work deadline? I’m willing to bet that it was, at least most of the time. Whenever I ask my patients this question, a light bulb goes in, and they inevitably agree with me. I often ask them what the lowest their pain was from 0 to 10 in the past week, was and what was the highest. If their range is from 6 to 9/10, I tell them that when their central nervous system is aroused, it can take their pain from a 6 to an 8 or 9/10.
So, how do you relax your central nervous system when this happens? Basic relaxation strategies are one way to help relax yourself when you feel stressed out, as simple as they seem. One easy way is by checking in with your body to see where your muscles are tensed. Once you identify where your muscles are tensed, you can voluntarily clench them for 10 seconds, hold, and then release, and notice the difference. The basic idea here is to shift your attention to your unconsciously tensed muscles, and then notice the difference when you relax them. You would be surprised at how much you are unconsciously tensing your muscles daily; I often have to check on my shoulders when I am sitting at my desk, and voluntarily relax them. There are many videos that can guide you through this process, and you can find them on YouTube by searching for “Progressive Muscle Relaxation”.
Another easy way is to slow down your breathing and pay attention to it. Box breathing is a technique in which you imagine a box in your mind. Each of the four sides represents a stage of the breathing process:
- Taking a deep breath in
- Holding your lungs full
- Exhaling out slowly
- Keeping your lungs empty
If you can, stop reading this, close your eyes, and try this. If your mind wanders, do not get upset with yourself, just notice that your mind has wandered, and then gently redirect your attention back to your breath. It is normal, that your mind will wander, especially if you have symptoms of trauma or worries about the future.
If you have done this exercise for a minute, you will have noticed two things. One, your body is more relaxed because you are breathing slower. This is because when you breathe slower, you relax your central nervous system. When you see anxious people in media, how do they breathe? Rapid, shallow breaths. You can voluntarily change the rate at which you breathe at any time. Also, breathing slower changes carbon dioxide and oxygen levels in your blood. Again, in the media is this why you see people breathing into a paper bag when they are having a panic attack, to increase the carbon dioxide that they inhale.
Secondly, what were you thinking of as you were focused on the four stages of your breath and the box? For many patients, they report that for a brief time, they were not thinking of the past or the future, they were just trying to follow the above instructions. I tell them that for a brief time, they were “mindfully breathing”. I explain that mindfulness is just paying attention to whatever is happening in the present moment, be it their breath, or any other bodily sensation, such as how food tastes, or hot water when they take a shower.
The benefit of being mindful is that you break the link between the thoughts that drive fear, anger, or sadness, and this can change how your brain processes the signals of pain from your body. When you are relaxed, and in the moment, you can remove the portion of your pain that comes from your negative emotional states. This doesn’t change the fact that you need physical treatment or medication, it just means that your emotions are no longer adding to your pain perception. And that’s it. A brief explanation of how your emotions, such as anxiety or trauma, can affect your pain, and how to manage it.