Chronic Pain Management: Self-management

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

Recognize stress

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.

Stress is the neurophysiological and subjective response to stimuli.

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.


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

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IFFGD is a nonprofit education and research organization. Our mission is to inform, assist, and support people affected by gastrointestinal disorders.

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