Clinicians who specialize in treating chronic pain now recognize that it is not merely a sensation, like vision or touch, but rather chronic pain is strongly influenced by the ways in which the brain processes the pain signals.
Chronic pain can provoke emotional reactions, such as fear or even terror, depending on what we believe about the pain signals. In other cases (such as in sports or another engaging, rewarding activity), chronic pain may be perceived by the individual as merely a nuisance, a feeling to be overcome in order to be able to continue in the activity.
The important role the mind plays in chronic pain is clearly recognized in the medical literature, as well as in the International Association for the Study of Pain’s definition of pain, which states that pain is always subjective and is defined by the person who experiences it.
The corollary is that the brain can also learn how to manage the sensation of pain. Using the mind to control chronic pain, or coping strategies, for managing persistent pain, may be used alone or in tandem with other pain management therapies.
Ideally, use of the chronic pain management techniques outlined in this article can help patients feel less dependent on pain killers and feel more empowered to be able to control their pain.
Managing Chronic Pain
Of course, the first step in coping with chronic back pain or other types of persistent pain is to receive a thorough medical evaluation to determine the cause of the pain.
In some situations, such as a herniated disc in the spine, it may be important to pay attention to the level and type of pain so that it can serve as a warning signal of impending damage.
In other cases, especially when the back pain is chronic and the health condition unchangeable, one goal can be to try and keep the chronic pain from being the entire focus of one’s life.
Whatever the medical condition, there are a number of effective strategies for coping with chronic back pain.
These techniques generally include:
- Relaxation training: Relaxation involves concentration and slow, deep breathing to release tension from muscles and relieve pain. Learning to relax takes practice, but relaxation training can focus attention away from pain and release tension from all muscles. Relaxation tapes are widely available to help you learn these skills.
- Biofeedback: Biofeedback is taught by a professional who uses special machines to help you learn to control bodily functions, such as heart rate and muscle tension. As you learn to release muscle tension, the machine immediately indicates success. Biofeedback can be used to reinforce relaxation training. Once the technique is mastered, it can be practiced without the use of the machine.
- Visual imagery and distraction: Imagery involves concentrating on mental pictures of pleasant scenes or events or mentally repeating positive words or phrases to reduce pain. Tapes are also available to help you learn visual imagery skills.
Distraction techniques focus your attention away from negative or painful images to positive mental thoughts. This may include activities as simple as watching television or a favorite movie, reading a book or listening to a book on tape, listening to music, or talking to a friend.
Hypnosis: Hypnosis can be used in two ways to reduce your perception of pain. Some people are hypnotized by a therapist and given a post-hypnotic suggestion that reduces the pain they feel. Others are taught self-hypnosis and can hypnotize themselves when pain interrupts their ability to function. Self-hypnosis is a form of relaxation training.
All of the above-describe techniques for coping with chronic back pain make use of four types of skills:
Deep Muscle Relaxation
Distraction: moving attention away from the pain signals
Imagery: visual, sound or other pictures and thoughts that provide a pleasant and relaxing experience
Dissociation: The ability to separate normally connected mental processes, leading to feelings of detachment and distance from the chronic pain.
To prepare for any chronic pain coping technique, it is important to learn how to use focus and deep breathing to relax the body. Learning to relax takes practice, especially when you are in pain, but it is definitely worth it to be able to release muscle tension throughout the body and start to remove attention from the pain.
Coping techniques for chronic pain begin with controlled deep breathing, as follows:
Try putting yourself in a relaxed, reclining position in a dark room. Either shut your eyes or focus on a point.
Then begin to slow down your breathing. Breathe deeply, using your chest. If you find your mind wandering or you are distracted, then think of a word, such as the word “Relax,” and think it in time with your breathing…the syllable “re” as you breathe in and “lax” as you breathe out.
Continue with about 2 to 3 minutes of controlled breathing.
Once you feel yourself slowing down, you can begin to use imagery techniques.
Eleven specific imagery and chronic pain control techniques that are effective for pain control include:
1. Altered focus
This is a favorite technique for demonstrating how powerfully the mind can alter sensations in the body. Focus your attention on any specific non-painful part of the body (hand, foot, etc.) and alter sensation in that part of the body. For example, imagine your hand warming up. This will take the mind away from focusing on the source of your pain, such as your back pain.
As the name implies, this chronic pain technique involves mentally separating the painful body part from the rest of the body, or imagining the body and mind as separate, with the chronic pain distant from one’s mind. For example, imagine your painful lower back sitting on a chair across the room and tell it to stay sitting there, far away from your mind.
3. Sensory splitting
This technique involves dividing the sensation (pain, burning, pins and needles) into separate parts. For example, if the leg pain or back pain feels hot to you, focus just on the sensation of the heat and not on the hurting.
4. Mental anesthesia
This involves imagining an injection of numbing anesthetic (like Novocain) into the painful area, such as imagining a numbing solution being injected into your low back. Similarly, you may then wish to imagine a soothing and cooling ice pack being placed onto the area of pain.
5. Mental analgesia
Building on the mental anesthesia concept, this technique involves imagining an injection of a strong pain killer, such as morphine, into the painful area. Alternatively, you can imagine your brain producing massive amount of endorphins, the natural pain relieving substance of the body, and having them flow to the painful parts of your body.
Use your mind to produce altered sensations, such as heat, cold, anesthetic, in a non-painful hand, and then place the hand on the painful area. Envision transferring this pleasant, altered sensation into the painful area.
7. Age progression/regression
Use your mind’s eye to project yourself forward or backward in time to when you are pain-free or experiencing much less pain. Then instruct yourself to act “as if” this image were true.
8. Symbolic imagery
Envision a symbol that represents your chronic pain, such as a loud, irritating noise or a painfully bright light bulb. Gradually reduce the irritating qualities of this symbol, for example dim the light or reduce the volume of the noise, thereby reducing the pain.
9. Positive imagery
Focus your attention on a pleasant place that you could imagine going – the beach, mountains, etc. – where you feel carefree, safe and relaxed.
Silent counting is a good way to deal with painful episodes. You might count breaths, count holes in an acoustic ceiling, count floor tiles, or simply conjure up mental images and count them.
11. Pain movement
Move chronic back pain from one area of your body to another, where the pain is easier to cope with. For example, mentally move your chronic back pain slowly into your hand, or even out of your hand into the air.
Some of these techniques are probably best learned with the help of a professional, and it usually takes practice for these techniques to become effective in helping alleviate chronic pain. It is often advisable to work on pain coping strategies for about 30 minutes 3 times a week. With practice, you will find that the relaxation and chronic pain control become stronger and last longer after you are done.