Pain and stress go hand in hand. When you're in pain, you're less able to handle the stress of everyday life. Common hassles turn into major obstacles. Stress may also cause you to do things that intensify your pain, such as tense your muscles, grit your teeth and stiffen your shoulders. In short, pain causes stress, and stress intensifies pain.

The first step in breaking this pain-stress cycle is to realize that stress is your response to an event, not the event itself. It's something you can control. That's why events that are stressful for some people aren't for others. For example, your morning commute may leave you anxious and tense because you use it as worry time. Your co-worker, however, finds her commute relaxing. She enjoys her time alone without distractions. Understanding that you have control over your stress can help you develop positive strategies for dealing with stress.

When you encounter stress, your body responds in a manner similar to a physical threat. It automatically gears up to face the challenge or musters the strength necessary to get out of trouble's way. This fight-or-flight response results from a release of hormones that causes your body to shift into overdrive. Your heart beats faster, your blood pressure increases and your breathing quickens and becomes more shallow. Your nervous system also springs into action, causing your facial muscles to tighten and your body to perspire more.

Stress can be negative or positive:

• Positive stress provides a feeling of excitement and opportunity. Positive stress often helps athletes perform better in competition than in practice. Other examples of positive stress include a new job or birth of a child.
• Negative stress occurs when you feel out of control or under constant or intense pressure. You may have trouble concentrating, or you may feel alone. Family, finances, work, isolation and health problems, including pain, are common causes of negative stress.

Continued stress can have a negative effect on your health. In addition to the strain it puts on your cardiovascular system, the hormone cortisol released during stress may suppress your immune system, making you more susceptible to infection and disease. Stress can also cause headaches and worsen intestinal problems and asthma.

Stress is often associated with situations or events that you find difficult to handle. How you view things also affects your level of stress. If you have unrealistic or high expectations, chances are you'll experience more than your fair share of stress.

Take some time to think about what causes you stress. Your stress may be linked to external factors, such as:

• Community
• Unpredictable events
• Environment
• Work
• Family

Stress can also come from internal factors, such as:

• Irresponsible behavior
• Poor health habits
• Negative attitudes and feelings
• Unrealistic expectations
• Perfectionism

Jot down what seem to be sources of stress for you. And then ask yourself if there's anything you can do to lessen or avoid them. There are some stressors you can control and some you can't. Concentrate on events you can change. For situations that are beyond your control, look for ways to adapt — to remain calm under trying circumstances.

It's one thing to be aware of stress in your daily life, but it's another to know how to change it. As you look through your list of stressors, think carefully about why they're so bothersome. For example, if your busy day is a source of stress, ask yourself if it's because you tend to squeeze too many things into your day or because you aren't organized.

The following techniques can help you reduce those sources of stress you can control and better cope with those you can't.

Consider these changes to your normal routine:

• Plan your day. This can help you feel more in control of your life. You might start by getting up 15 minutes earlier to ease the morning rush. Do unpleasant tasks early in the day and be done with them. Keep a written schedule of your daily activities so that you're not faced with conflicts or last-minute rushes. Because a pain flare-up can happen at any time, have a backup plan — decide what you can do now and what can wait.
• Simplify your schedule. Prioritize, plan and pace yourself. Learn to delegate responsibility to others at home and at work. Say no to added responsibilities or commitments if you're not up to doing them. And try not to feel guilty if you aren't productive every waking moment.
• Get organized. Organize your home and work space so that you know where things are. Keep your house, car and personal belongings in working order to prevent untimely and stressful repairs.
• Take breaks. Take time to relax, stretch or walk periodically during the day.
• Exercise regularly. Regular physical activity helps loosen your muscles and relieves emotional intensity. Try to exercise for a total of at least 30 minutes most days of the week.
• Get enough sleep. This can give you the energy you need to face each day. Going to sleep and awakening at a consistent time also may help you sleep more soundly.
• Eat well. A diet that includes a variety of foods provides the right mix of nutrients to keep your body systems working well. When you're healthy, you're better able to control stress and pain.
• Change the pace. Occasionally break away from your routine and explore new territory without a schedule. Take a vacation, even if it's just a weekend getaway.
• Be positive. There's no room for "Yes, but .... " Avoiding negative self-talk can be difficult. It helps to spend time with people who have a positive outlook and a sense of humor. Laughter actually helps ease pain. It releases endorphins — chemicals in your brain that give you a sense of well-being.
• Stay connected. Recognize when you need the support of family and friends. Talking about your problems with others can often relieve pent-up emotions and lead to solutions you hadn't thought of on your own.
• Be patient. Realizing that improvements in your health may take time can help reduce anxiety and stress.

You can't avert all sources of stress, such as an unexpected visit from family or friends or a problem at work. But you can modify how you react to these situations by practicing relaxation techniques. Relaxation can help relieve the stress that aggravates chronic pain. It also helps prevent muscle spasms and reduces muscle tension.

Relaxation won't cure your pain, but it can:

• Reduce anxiety and conserve energy
• Increase your self-control when dealing with stress
• Help you recognize the difference between tense muscles and relaxed ones
• Help you physically and emotionally handle your daily demands
• Help you remain alert, energetic and productive

Keep in mind, though, that the benefits of relaxation are only as good as your efforts. Learning to relax takes time.

There are many ways to relax, so pick the ones that work best for you.

• Deep breathing. Unlike children, most adults breathe from their chest. Each time you breathe in, your chest expands, and each time you breathe out, it contracts. Children, however, generally breathe from their diaphragm — the muscle that separates their chest from their abdomen. Deep breathing from your diaphragm — which adults can relearn — is relaxing. It also exchanges more carbon dioxide for oxygen, which gives you more energy. Try to incorporate 20 minutes of deep breathing every day for good health, not just when you're stressed.
• Progressive muscle relaxation. This technique involves relaxing a series of muscles one at a time. First, raise the tension level in a group of muscles, such as in a leg or an arm, by tightening the muscles and then relaxing them. Concentrate on letting the tension go in each muscle. Then move on to the next muscle group. Be careful, though, not to tense muscles near your pain sites.
• Word repetition. Choose a word or phrase that is a cue for you to relax, and then repeat it. While repeating the word or phrase, try to breathe deeply and slowly and think of something that gives you pleasant sensations of warmth and heaviness.
• Guided imagery. Also known as visualization, this method of relaxation involves lying quietly and picturing yourself in a pleasant and peaceful setting. You experience the setting with all of your senses, as if you were actually there. For instance, imagine lying on the beach. Picture the beautiful blue sky, smell the salt water, hear the waves and feel the warm breeze on your skin. The messages your brain receives as you experience these senses help you relax.

The following tips will help you grow accustomed to relaxing:

• Practice. If relaxation is new to you, you may not notice immediate benefits. In fact, you may feel uncomfortable at first. Work on your relaxation skills at least once or twice a day until they come naturally. When you're beginning, a quiet place and a relaxation tape often help.
• Get comfortable. Loosen tight clothing and remove your shoes and belt, if necessary.
• Vary your schedule. Practice relaxation at different times throughout the day. The idea is to learn how to relax whenever you need to.
• Be patient. A wandering mind is normal when you start out. Just keep bringing your attention back to relaxation.