Pain is in our body and our brain, but we can use our mind, our actions, and our spirit to help control pain even when it is not possible to cure it.
For this reason, much of the psychological research in pain has focused on what are effective and ineffective coping strategies – how we respond to difficult or unwanted situations. It is clear from this research that active coping strategies (such as exercising, seeking out information, and planning ahead for possible flare-ups) are key ingredients in successful pain management.
Passive strategies (such as rest, hoping the pain will go away, or waiting for a doctor to find an answer) are typically associated with poorer outcome and increased suffering. Some important positive and active coping strategies for pain are:
- Recognize stress
- Use a relaxation technique
- Progressive relaxation: breathing method
Many of us are very good at ignoring our level of stress. This may be adaptive in many circumstances, but given the close relationship between pain and stress it is very important for patients with pain problems to become better observers of their own stress levels.
Symptoms such as fatigue, irritability, sleep problems, decreased concentration, or lack of interest in formerly pleasurable activities are signs of stress. Recognition of them will help you take positive action to better control stress.
Use a relaxation technique
Since pain is so strongly connected to the stress system, we can usually decrease the severity and especially the bothersomeness of pain through changing our physiological and psychological stress response. Relaxation exercises, yoga, meditation, and other approaches for decreasing the physiological arousal in our body have been shown to be powerful pain management strategies if done regularly. Relaxation exercises can break the cycle of pain and discomfort in which increased muscle tension leads to increased pain.
Several of the most effective relaxation techniques (such as diaphragmatic breathing and progressive muscle relaxation) are very simple to learn and use. Although ideally they are taught to patients in one or two individual or group sessions, some individuals have had good success in learning them from a written description.
Progressive Relaxation: Breathing method
Typically, our breathing is either shallow and irregular (chest or thoracic breathing) or deep and regular (abdominal or diaphragmatic). Shallow chest breathing is often associated with muscle tension and distress. Deeper abdominal breathing, on the other hand, is associated with reduced muscle tension and relaxation.
Here is one simple relaxation technique that uses breathing; allow about 10–15 minutes.
Find a quiet place. Sitting upright or lying on your back with your arms at your side and your palms facing up, close your eyes and remain motionless. Breathing through your nose, take several slow, deep breaths. Turn your attention to your breath and imagine it going deep inside, flowing through your body.
Imagine that each inhalation captures tension, and each exhalation carries it away. Feel the breath go into your abdomen so that it gently rises with your inhale and falls with your exhale.
Breathing this way, turn your attention to progressively relaxing every part of your body. Start with your feet, and slowly work your way up through your legs, pelvic area, stomach, chest, back, arms, shoulders, neck, face, and head; consciously think about each area of your body while letting go of muscle tension there.
Just let the chair or mat completely support you while you let each area of your body let go and relax. When you feel the muscles relax in one area of your body, move on to the next.
After you have finished, remain still and breath quietly for several minutes. Enjoy the calm feeling of relaxation, before slowly opening your eyes.
Other Things You Can Do to Help Manage Chronic Pain
Patients with a variety of pain problems are told to rest, because the best response to many acute injuries is rest. However, prolonged rest and inactivity is almost always detrimental. This is because prolonged rest, even in healthy individuals, leads to significant protein and calcium loss, decreased efficiency of the cardiovascular system, and even changes in the nervous system and immune function. In short, as human animals we are built to move and regular, vigorous movement is essential to keep the systems of our body functioning.
It is interesting to note that several studies by Dr. Wendy F. Sternberg and colleagues from Haverford College in Pennsylvania have scientifically documented what many of us already believed; vigorous exercise leads to decreased pain sensitivity (probably by activation of our own pain control system described above).
The opposite is probably also true, namely that very low activity levels increase pain sensitivity and therefore increase the level of discomfort in patients with an ongoing pain problem.
Regular exercise is also an excellent way to help decrease depression and anxiety, and help with weight loss. You will need to pace activities if you have a pain problem that makes exercise difficult.
Swimming, walking, and riding an exercise bicycle are safe ways to increase fitness and decrease stress. As discussed below, several traditional forms of exercise such as yoga, tai chi, or chi gong may also be of significant benefit for patients with pain.
Be positive but realistic
Research on coping has shown that catastrophizing or focusing only on the worst possible outcome is a common roadblock to patients taking positive control over their problems. In pain management we often ask patients to challenge common but irrational automatic thoughts such as, “I will never be able to … again,” or “My life is now meaningless.” It is also not helpful to tell oneself that “Everything will be fine” because that may not be true.
Instead, substitute a more positive and rational thought such as, “I am having a difficult time but I have survived similar bad periods” or, “There are still some options to try.”
In a similar way, you should more clearly define what in your life you can and cannot control. Increased worry and focus on things we cannot control is usually not productive. Instead, efforts should be aimed at those aspects of our condition we can influence or change.
Try to improve sleep
People with chronic pain report sleep as their number one problem. While there are a variety of medications that help improve sleep temporarily, most (with the exception of some of the antidepressant medications) are not useful on a chronic basis. Sleep hygiene is critical for anyone with sleep problems. This includes:
- Having a period of time of relaxation before going to bed
- Keeping a specific wake up time even if you did not sleep well during the night
- Not staying in bed for more than 20 minutes without sleeping (get up and do something relaxing until you feel sleepy again)
- Turning the clock away so when you awake you cannot focus on the time
- Using the bed only for sleep (or sexual activity) and not for reading, watching TV, or eating
- Avoiding food or drinks with caffeine for at least 4 hours before bedtime
Daytime activities also affect sleep, so regular exercise and avoidance of napping can greatly improve nighttime sleep.
Seek out social activities and support
Unfortunately, many people with chronic pain withdraw from their social world and even their family. This is often a gradual process that needs active attention to reverse. Many times it is necessary to force oneself to participate in social events even if you do not feel like it.
Complementary and alternative medicine (CAM)
CAM generally refers to modalities, practices, techniques, and systems of healing that are used together with (“complementary to”) or instead of (“alternative to”) conventional medicine.
Among the modalities that are usually included as CAM are:
- Massage therapy
- Mind-body techniques (e.g., biofeedback, guided imagery, yoga, and meditation)
- Some forms of nutritional therapy
- Dietary supplements (including herbs)
- Naturopathic medicine
- Various forms of energy healing
- The indigenous healing systems of the many ethnic groups in the United States
Over the past decade, several nationwide surveys have documented a substantial and growing usage of CAM practices and products by the American public. These surveys have found that most CAM users seek out conventional medical treatment first, and then turn to CAM practitioners. Most people appear to use CAM in conjunction with, not as a replacement for, conventional medical therapy, and many seek out care that integrates the best of a variety of approaches.
Up to 42% of the population may use CAM methods. And even higher use of CAM therapies have been found among people with chronic and life-threatening conditions and chronic pain. For example, a study at a major cancer center indicated that 69% of patients included CAM approaches as part of their cancer care.
Scientific study of CAM techniques is still in its infancy. For example, in 1997 the National Institutes of Health issued a consensus statement on the use of acupuncture, one of the most common CAM modalities. While there have been hundreds of studies using acupuncture, most were of such poor scientific quality that the panel could only find clear evidence for the effectiveness of acupuncture on various forms of nausea and only one pain condition (postoperative dental pain). Acupuncture is thought to stimulate our internal pain control system and production of endorphins, but this has also not been clearly demonstrated.
Many other CAM modalities have been reported to have significant benefit for chronic pain but even less scientific data exists to inform patients regarding their efficacy and safety. It is clearly time to embark on serious study of ancient and alternative medical approaches using the tools of modern science. It is promising and exciting that recent data on mind-body interactions support the fundamental basis of most CAM approaches, namely that the mind, brain, and body are best treated as an integrated whole.
Efforts are underway to promote the development of new models of medical care and provide a scientific basis for integrative medicine. At present, decisions on whether to try CAM techniques for pain control or which techniques might be most appropriate must be made by each person without the benefit of clear scientific data.
If you are considering a CAM approach, it will be important to gather as much information as you can about the methods and especially the provider. As with any provider, look for his or her credentials, number of years experience, and ask direct questions on what to expect and possible side effects from the treatment.
Learn more about Understanding Chronic Pain
Adapted from IFFGD Publication #140 by Bruce D. Naliboff, PhD, Clinical Professor of Medical Psychology in the Dept. of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, Los Angeles, CA; Co-director, UCLA Center for Integrative Medicine; and Chief of the Psychophysiology Research Laboratory, West Los Angeles VA GLA Health Care, Los Angeles, CA