Pain Management with Relaxation Techniques

  By Dr. Lois Nightingale
For centuries many cultures have relied on relaxation techniques, trans-states, and altered consciousness to help people control chronic and acute pain. Today we tend to rely on quick and easy solutions such as pain medication. Most of us have lost the ability to control and manage our discomfort ourselves.
The pathways that conduct pain impulses in the brain can be overridden by different methods. These neurological pathway disruptions are the means by which hypnosis works and some theories regarding acupuncture.
While it is easier for most people to learn to deeply relax with the help of a therapist or biofeedback technology, it is possible for individuals to learn these techniques on their own. Self-hypnosis, guided imagery or deep relaxation (all essentially the same thing) can be practiced by individuals until they have mastered the ability to control the automatic responses in the body to resist and tighten against the sensation of pain, and interrupting the pathways that convey a sense of pain to the brain.
When the brain registers discomfort there are unconscious and automatic changes that take place in the body. These include the releasing of stress chemicals and the tightening of muscle groups. Both of these events can increase the sensation of pain.
While learning to relax and manage pain may do nothing to directly address the cause of the pain, the relief felt by most people who successfully learn these skills is enough to give them a break from pain for awhile, and even disrupt the tension/pain cycle (where pain leads to increased stress and tension in the body which leads to even more pain in the body.)
One of the primary tools in relaxation for pain management is using the breath. When we experience pain our first reaction is to breathe shallowly and brace ourselves against the sensation of pain. Breathing deeply and completely exhaling can help the body relax and can release carbon dioxide, which when built up in cells can create even more feelings of discomfort.
“Re-Lax” Breathing
A good way to begin practicing deep breathing is to inhale through the nose feeling the cooler air entering the body and filling the lungs from the bottom up, and exhaling through the mouth, feeling the warmer air leaving the body, emptying the lungs completely from the top down. An added focus point during this deep breathing can be to say silently to yourself “re-lax”. “Re” during the inhalation and “lax” during the exhalation. 
Your mind may tend to wander while you are practicing this breathing technique. Gently direct your mind back to the exercise and continue. Try to be compassionate with yourself and kindly redirect your thoughts back to the in breath and then the out breath. This easy redirecting of your thoughts and concentration back to your breathing is one of the best ways to learn to focus and relax. 
But just like learning to swim, your attempts may seem ungraceful at first. Be patient with yourself. As you practice and your mind finds you are not going to scold it for “doing it wrong,” you will find that it becomes easier and easier. As relaxation becomes more familiar, you will begin to experience the benefit of relaxing and the reduction of the sensation of pain. 
Color Imagery for Pain
Another exercise that is very helpful for the management of pain is one that involves colors. This technique starts with the above deep breathing and centering with a focus on your breath. Once you feel calm and have even in and out breathing, you can picture a color to represent your pain. Many people choose red or orange, but any color that adequately represents your pain for you will be sufficient.
Then as you envision this color with your eyes closed, try to make the color a shade just slightly darker and more brilliant than its original shade. Then breathe deeply again and bring the color back to its original shade. Take another beep breath in and completely exhale, feeling the tension leave your body as you let the air gently exhale. While you are doing this, once again picture the color a slight shade lighter, maybe barely noticeably different, but just a bit. Breathe again and let any extra tension once again leave your muscles and joints. 
Keep picturing the color representing your pain a slight shade lighter until you feel the pain dissipating. It is important to first picture the color darker, because our mind instinctively is bracing against any further discomfort. Allowing the pain to be ever so slightly increased allows the mind to believe you can change the pain’s intensity with the changing of the intensity of the color.
This exercise also takes practice and it is important to give time to any exercise you wish to accomplish. The benefits of being able to decrease pain without medication (or to be able to use less medication with similar effect) are worth the time and energy it takes to become proficient at these skills.
Finding the Center of Your Pain
Another very effective relaxation technique for pain management is to try to find the exact center of your pain. This may seem easy at first. But once again, after you are very relaxed and breathing deeply and are very centered, focus your attention on the exact pinpoint spot of the center of your pain. Keep breathing, do not hold your breath. What you may notice is that the point moves. When you feel you have found that exact spot and you breathe into it, it may seem to move ever so slightly. 
Take your time when you do this. It is not easy to do. We instinctively try to push our thoughts away from our pain and resist against it. But when we sit very still and look for the exact center of our pain, to our amazement it doesn’t stay in one place. 
Breathing into the spot that feels like the center of pain and then exhaling, picturing the tension and discomfort leaving the body in the exhalation can help ease discomfort. But what may be noticed most is that this center may seem to travel. That’s fine, follow it. Gently and calmly, breathing into the next center of the pain and releasing it as well. Some people even find with practice they can put the pain in a different location in their body for awhile.
Having a Conversation with Your Pain
It may seem strange to become friends with one’s pain, but many more options are available when we stop pushing so hard to avoid and distract ourselves from pain. Sitting still and asking our pain what lessons it has for us can be a life changing experience. 
Noticing what information our pain brings to us and respecting that information can make the difference between pain that is unbearable and pain that is annoying but with a purpose. Our body is very wise. Respecting that it may have valuable information for us is an important aspect of pain management.
Sit with a journal and write down a couple questions for your pain. Such as, “What do I need to know about you?” “What have I avoided that you need to be so loud?” “If I knew what you needed me to know what might change?” “What have you been trying to tell me before you got this intense?” “What would I need to have you be lessened?”
Then once again go into a deep state of relaxation (it is much like the feeling you have just before falling asleep or just before you are fully awake in the morning). Be sure you are in a setting where you will not be disrupted or you are listening for sounds to which you may have to attend (doorbell, children, phone, etc.) Breathe in deeply and completely exhale. 
Thank your pain for being open to giving you information and then ask the questions you wrote down. Notice any changes. There may be changes in your pain, you may see changes with your eyes closed or you may just intuitively have some answers. You may even have more questions. 
Open your eyes and write down your experiences. Write any ideas you might have or further questions you may have found. Be sure to take note of any details you may wish to follow up with in future sessions of conversing with your pain.
Do this exercise everyday for one week. Look over your notes and look for any themes. You might want to go over your notes with a friend or a therapist and see them from another perspective as well. 
This dialogue with your pain is not meant to create any blame or guilt. There is no fault involved. It is for the purpose of self-exploration and learning with the curiosity of a child. Wondering what else you might find and learn about yourself. If you find a lot of self-criticism when you do this exercise you may want to start off with a conversation with yourself that everyday of your life you made the best decisions you could see to do at the time. At no time in your life did you consciously make a decision for the sole purpose of making your life more complicated or to cause you or someone else pain. 
Profound answers in dialoging with your pain come from a place of forgiveness and not blaming yourself or others. Helpful answers are available when we are really curious and want to explore for the sake of exploration and knowledge. Be very kind to yourself and have fun with this exercise.
Redirecting your Focus
Another effective relaxation technique for managing pain is to refocus on another sensation. One that is easy for most people to accomplish is to increase the sensation of warmth. 
To begin this exercise sit comfortably with your eyes closed and your feet flat on the floor (preferably without shoes). Place your hands open with palms down on your thighs. 
Breathe in deeply and visualize the tension leaving your body through your exhalation. Any muscle groups that seem to be a bit tight, take an extra moment to breathe specifically into those areas of your body and picture the tension dissolving. Feel the muscles in those areas loosen and become just a little bit longer and looser. 
Once you are comfortable bring your attention to your open hands and the area where they touch your legs. Picture the space between your hands and your legs (even though there is none because they are touching). Picture this space becoming warmer. It may help to envision red or orange light around your hands, or imagine you have them in warm dishwater or feeling the radiant heat from a crackling campfire. Any image that helps you to bring warmth to the area between your hands and your legs increases the blood flow through the capillaries and will help raise the temperature of your hands.
When we feel anxious, tense or are bracing ourselves against pain or perceived danger the blood flow in our extremities (including fingers and hands) becomes restricted because of the restriction of the capillaries. When we find ways to increase this circulation we are able to lower the results of this stress in our bodies. Increasing the temperature of your hands has a direct impact on relaxation and the letting go of tension in the rest of your body.
After you have practiced this exercise many times and are proficient at cresting warmth between your palms and your legs, you may be able accomplish this when you are actually doing other things, such as talking with other people or riding in a car. 
There are many relaxation techniques that you can learn and use to reduce the sensation of chronic pain. The more familiar you become with the state of deep relaxation the more you will be able to use this state of consciousness to minimize the feelings of discomfort in your body. But remember, any skill worth learning takes practice, and very few people are extremely proficient at anything they do the first few times.
Be patient with yourself and allow yourself uninterrupted practice time. Be especially aware of any progress you make. Keep a journal of when and for how long you practice relaxation each day (2-4 times a day is recommended). Keep notes about sensations you noticed in your body, how long you could hold your concentrations and which exercises produced the best results for you. Rate your pain on a scale of 1-10 before a nd after each relaxation session. You may want to have a “relaxation buddy” to talk about which exercises are easy for you to do and which ones seem more difficult. Having a friend to process your progress with will also keep up your commitment level to practicing.
Look back over these notes weekly. Pay close attention to the days you practiced the way you were committed to and the days you were distracted from practicing. Notice which days the pain responded the most to your exercise, and give yourself lots and lots of credit!
Dr. Lois Nightingale psychologist  lic# PSY9503