Introduction

Pain Management: Alternative Treatment Approaches is part 3 in the series: When You or Your Loved One is in Pain. In this article we will explore various mental health and complementary treatment approaches for pain, for example breathing techniques, relabeling, energy work, guided imagery, and pain journaling, etc.

Parts 1 and 2 in this series laid the foundation for this discussion about pain management. It may be helpful to review these articles (click on highlighted links that follow). Part 1, How Do We Sense Pain?, looked at the physical sensations of pain as well as how pain signals travel through the body to the brain…where pain is actually perceived. Part 2, Pain Versus Suffering, highlighted the emotional perception of pain. Part 3, Pain Management: Alternative Treatment Approaches, expands on information from parts 1 and 2, offering practical pain management techniques that complement traditional pain management approaches.

History

A Recap of Acute Versus Chronic Pain

History of Pain Control

Pain management techniques of various types date back from ancient times. Both medical/physical and psychological (alternative) treatments have been utilized throughout history. This article will focus primarily on mental health and complementary treatment approaches.

But before we dig in, it’s interesting to note some contemporary pain management techniques that had their origins in ancient history.

“Morphine, modern medicine’s most effective pain reliever, is derived from opium, which was widely used as an analgesic forty centuries ago by the Egyptians. The ancient Romans relied on a combination of opium and wine. Primitive tribes of India and South Africa employed willow leaves, which are rich in salicylic acid (an ingredient of aspirin), to ease joint discomfort as well as the pain of childbirth.

The Incas chewed on the leaves of the coca plant centuries before cocaine was isolated by a German scientist in 1860. Transcutaneous electrical stimulation – a technique of controlling pain by applying small amounts of electricity – was utilized by Pedanius Discordides, a surgeon with Nero’s armies, who applied a torpedo fish as a source of electricity. Even before that, Plato and Aristotle had written about the numbing effects of the electric fish to treat gout and headaches. However, the mortality rate associated with this procedure was often greater than 50 percent, so understandably, it did not achieve great public acceptance.

Acupuncture, herbs, and various physical therapies (heat, cold, and massage) have been an integral part of Chinese medicine for at least 5,000 years. Acupuncture needles carved from stone have been found in China and have been dated back to the Stone Age.”

Bresler, D., Mind-Controlled Analgesia, from Imagination and Healing, Sheikh, ed., Baywood Press, N.Y., 1984.

Alternative Treatment Approaches

Breathing Techniques

Have you noticed what happens to your breathing when you’re in pain? Does it change? Our breath is our closest companion. We often don’t even pay attention to the fact that we are breathing. But, our breath is our first line of defense when we are in pain.

Dr. Maggie Phillips, in Reversing Chronic Pain, states that “shifting the breath can immediately turn on the restorative, calming branch of the nervous system known as the parasympathetic system. One simple, conscious breath can help close the pain gates, stimulate the brain to create pain-relieving chemicals (such as endorphins), and balance the fight/flight/freeze reactions responsible for transmission of pain through the nervous system. The truth is, learning how to breathe properly, especially at times of increased pain and stress, is the single most important skill you can learn.” (For more information on the concept of pain gates, see How Do We Sense Pain?

When we are in pain we tend to take short, shallow breaths. Sometimes we even hold our breath, especially when we anticipate that we are going to be in pain. This is known as anticipatory pain. We may hold our breath in anticipation of pain, such as when we change positions, say from a sitting to a standing position. When we breathe fully and deeply we are sending our brain the message that all is well. When we hold our breath we are signaling our brain that there is something wrong. Short, shallow breathing (and holding our breath) can increase stress and anxiety…which increases our sensitivity to pain.

Breathing technique #1: When you anticipate pain upon movement, try not to hold your breath. If you know it will hurt when you stand from a sitting position, take a deep breath in before you get up. As you move to a standing position, exhale through your mouth as fully as possible. You may notice less pain upon standing. The key here is to keep breathing!

There are many different breathing techniques that can be helpful to use when you are in pain. What is so fantastic about them is that our breath is right there with us…and it’s free of charge! Andrew Weil, MD is a famous physician who has written many books about health and healing. He is a proponent of breathing techniques for health. You may want to check out his audiobook, Breathing: The Master Key to Self Healing. He describes a variety of helpful breathing techniques in this audiobook.

Breathing technique #2: 4:8 Breathing is a breathing technique that is based on Dr. Weil’s breathing technique called The Healing Breath or 4-7-8 Breathing. I have found that 4:8 Breathing can be very helpful during times of pain and stress, particularly because it can be utilized (after you are familiar with it) for extended periods of time. I’ve included a link to a video I recorded describing this technique: Just Breathe: 4-8 Breathing.

Breathing technique #3: Circular breathing is a technique espoused by Dr. Maggie Phillips in Reversing Chronic Pain. “With this approach, imagine that your breath flows up one side of your body as you inhale and goes down the other side of your body as you exhale. It is usually more effective to link breathing in with the less painful side of your body, and breathing out with the more painful side. For example, if your right shoulder and neck are usually in pain, imagine breathing up the left side of your body, visiting places of relative comfort, and breathing out the right side of your body, imaging that your breath touches areas of discomfort and pain. If this is not effective, reverse the order, breathing up the painful side of the body and exhaling down the more comfortable side. Repeat this for five to ten breath cycles.”

Speed of Pain and Soothing/Kind Touch

In Part 1 of our series, How Do We Sense Pain?, we talked about the concept of the speed of pain. I believe that this concept is fascinating. Different types of pain travel at different speeds through our nervous system before reaching our brain, where it is perceived as pain. Knowing this can provide us with a pain management technique that works through the power of touch.

According to James Dillard, MD in his book, The Chronic Pain Solution, there is some research indicating that “dull pain or itching travels 0.5-2.0 miles per second; sharp or burning pain travels 5-35 miles per second, and soothing touch travels 35-75 miles per second.” This means that the sensation of a soothing touch can out-pace dull pain or itching…and possibly be perceived by the brain faster than sharp or burning pain!

A soothing touch: Sometimes when my leg aches I try to disrupt this pain by rubbing my thigh in wide circular motions with the palm of my hand (a soothing touch). Trying to relax and breathe out the pain at the same time, I have found that the pain will diminish or disappear. If my pain is at night, when I’m unable to sleep, this pain management technique helps to take the edge off the pain just enough to break the pain cycle so that I can go to sleep. This technique works with pain in different parts of your body as well. For example, if I have pain in my feet or my back I can use this approach. I may not be able to place my hands on the painful part of my body, but that is not necessary. The counteracting soothing touch can be done anywhere accessible with your hands, such as your arms/hands, thighs, stomach, etc.

This soothing touch pain management technique can also be done with the assistance of a caregiver, partner, and in some cases, a therapist. The important guiding factor when someone is assisting you with this pain management technique is that you have given your consent for their touch.

A kind touch: Similarly, a kind touch can also relieve pain. Let me explain. Have you ever been in pain and someone puts their hand on your back or shoulder as a gesture of kindness? That type of touch, reassuring and caring, can over-ride more painful sensations. Unlike the soothing touch, the kind touch does not require any movement. The pain-relieving aspect of the kind touch comes from the warmth of the hand, accompanied by the gentle but firm pressure applied through the touch. Clinicians and caregivers, please remember to have your client or loved one’s consent for such touch.

What is also interesting with this type of touch is that it can be a form of self-soothing as well. I’ve used this type of touch when I have shoulder or arm pain. I can hold my opposite hand on my shoulder for a few minutes and gradually move my hand down to my elbow and wrist/hand, a few minutes at a time. That, accompanied by breathing techniques, can be very effective in the short-term alleviation of pain.

So, when you’re in pain, try a soothing touch or kind touch to disrupt the pain. The fastest sensation to the brain wins. Why not race that pain with something faster, like a soothing or kind touch? It’s worth a try.

Four Hugs a Day

Let’s continue on a bit more with our theme of touch to over-ride painful sensations. Enter…the hug. Never underestimate the power of a simple hug. Hugs can have a positive impact on the level and experience of our pain. Please remember, however, that hugs must be given and received with consent. Some therapists even prescribe hugs as homework assignments for their clients. Hence, the term four hugs a day.

Dr. David Bresler writes an interesting story about four hugs a day in his book Free Yourself from Pain. “I give many of my patients a homework assignment: During the upcoming weeks, they are to get and give four hugs a day. I even write out a formal prescription that says simply, ‘Four hugs a day – without fail.’ Don’t ever underestimate how powerful this ‘therapy’ can be, and the role it can play in the healing process. And it’s a safe prescription, too. To my knowledge, no one has ever died of an overdose of hugging. However, as one of my patients told me, ‘It is addicting. Once you start hugging, it’s a hard habit to break!’

Not long ago, I received a call from the husband of one of my patients. To put it mildly he was quite irate. ‘What kind of crazy doctor are you?’ he said. ‘Four hugs a day! What are you people out at UCLA doing anyway? I thought this was a respectable medical school. Who ever heard of telling someone they need four hugs a day to get better!’

‘The only reason I’m not pulling my wife out of your Pain Control Unit is that she really believes this nonsense will help her. I’m going along with it just because she wants me to. But I want you to know that I don’t approve one bit of any of this crazy stuff!’

Five days later, I received a call from the same man. But this time, his demeanor was very different: ‘Hey, Doctor, this is really hard for me, but I just wanted to say I’m really sorry about the way I talked to you the other day. My wife has become a totally different person. She feels so much better. And she’s fun to be around. The last few days have been wonderful. I thought this four-hugs-a-day routine was stupid. But maybe it’s not. I think it works.'”

Relabeling

According to Deidre Davis Brigham, MS, MPH, MA in Imagery For Getting Well, “relabeling is the art of calling a spade a club. Most occurrences in our lives are neutral, yet we create meaning for these events by the labels we give them. For example, a red light is only a clump of metal and glass emitting light waves of a certain length. Nonetheless, the meanings and associations we apply to a red light are varied, but usually negative: “Nothing ever goes right for me!” or “I can’t stand waiting.”

With relabeling you can choose to give a negative label to a situation or you can choose to give it a neutral or positive label.

Imagine that you look out your window this morning and see the rain pouring down outside. It looks like it will most likely rain all day. You live near the beach and you are on vacation from your work. You had planned that today you would relax outside on the beach, laying in the sun and read a book. Your plans are ruined, and you’re frustrated and angry. It’s a horrible day.

Now, imagine that you look out your window this morning and see the rain pouring down outside. It looks like it will most likely rain all day. You live on a farm and you’ve been worried that your crops are not getting enough rain. This rain is most welcome, both for you and your crops. It’s a great day.

It’s raining, whether you live at the beach or whether you live on a farm. The rain is a neutral occurrence. How you perceive that rain is your choice.

How do we relabel pain?

“Pain is a good friend of ours. It lets us know that we have encountered something sharp or hot. Pain is asking for help, and we need to say, ‘Thank you pain for reminding me to send blood flow or white blood cells into that area of my body, or to send love to that place. Thanks unconscious for letting me know that you’re scared so I can comfort you.'”

Norris, P.A. (1992). Creating the Inner Physician. Fourth Annual Conference on Health, Immunity, and Disease, Hilton Head, SC.

Mindfulness

Mindfulness is “the practice of maintaining a nonjudgmental state of heightened or complete awareness of one’s thoughts, emotions, or experiences on a moment-to-moment basis.” (Merriam-Webster) Mindfulness is a therapeutic technique that can help alleviate multiple symptoms, such as anxiety, depression, grief, and negative thinking in general. The experience of pain can be reduced through a variety of mindfulness techniques.

“I have a fox hole in my mind.”

Harry Truman

Below is a YouTube video that does a good job at describing some of the key components of mindfulness. Although the video describes mindfulness techniques for persons with traumatic brain injury, the same principles can be applied to our experience of pain.

When we feel pain, those painful sensations seem to over-ride our ability to think or feel anything other than the pain itself. It’s as if we are caught up in the pain that is ever-present and demanding our full attention. Like we can’t see or conceive of anything other than the pain.

During these times thinking about other things or carrying on conversations with others is very difficult. The pain and our personal experience of it over-shadows everything else. With mindfulness, however, we can find ways to distance ourselves from the experience of the pain. How are we able to find this distance between our thoughts/feelings and the pain?

Imagine if you will that you’re holding a large notebook in your hands. This notebook symbolizes your pain. When your nervous system signals that you are in pain, take that notebook and place it close to your face, so that it obscures your vision. It’s as if pain is all you can see. Often, when we’re in pain we can’t seem to see beyond that notebook close to your face.

But with mindfulness, we are able to see beyond that pain. Let’s continue to imagine that notebook (pain) is still right in front of you. At this point you can make a choice to remove the notebook from your face, and instead, place it on a table that’s nearby. The notebook is still there, but you are now looking at it from a distance. You can see beyond the notebook (pain) and make better decisions as to how you are going to choose to manage it. Your pain is still there, but it does not have control of you. You have control of it. Sometimes just knowing that you have the ability to look at and manage your pain from a distance makes a world of difference in how you perceive that pain.

Overenergy Correction

An alternative pain management technique known as overenergy correction utilizes information from the emerging fields of energy medicine and energy psychology. Energy work is based on the Eastern perspective, which focuses on harmony in the mind-body system and on energy flow and transformation. Dr. Maggie Phillips writes in Reversing Chronic Pain: “When you have chronic pain, one of the common reactions you may encounter is connected to your own fears. When your pain increases suddenly and you cannot identify a reason or trigger for this change, a natural response is to feel scared and out of control. These types of fears can lead you to ‘catastrophizing’ about your pain levels. If you are catastrophizing as a coping mechanism, your inner dialogue might go something like this: ‘Oh no. This pain increase proves how miserable my life is becoming… Pretty soon I’m going to be in this pain all the time. I will run out of things that can help, and then what will I do?’ You are probably already aware of how destructive this type of negative thinking can be. The problem is, how do we stop catastrophizing? Although there are many ways to interrupt this type of thinking pattern, one of the easiest strategies is to focus your mental attention on increasing positive energy and vitality levels.”

Sometimes it is a matter of having too much energy or over-stimulation. “When we experience severe pain or high stress, we may be in a situation where too much energy is trying to flow through our energy meridians or energy pathways. You can easily feel this happening if you experience panic or intense fear. If the energy system becomes chronically disorganized (through trauma hyperactivation, for example), symptoms can develop that lead to serious imbalance in mental clarity, resilience, and overall health functioning. One of the conditions related to energy disorganization is that the nervous system scrambles and misinterprets nerve impulses. This has important implications for chronic pain conditions, so it is crucial to correct for ‘overenergy,’ even if you don’t think you have this problem!”

Below is a video of the Overenergy Correction Exercise, which can be very helpful when feeling overwhelmed or extremely stressed. It may feel strange at first to try this exercise, but please give it a try. I have found it to be incredibly calming and relaxing to my nervous system. And when I am relaxed and calm, I have less pain!

“Imagination is not the talent of some men, it is the health of every man.”

Ralph Waldo Emerson

Seeds for Imagery for Pain

Our ability to connect with our emotions, creativity, and imagination is key in developing powerful and effective pain management skills. Imagery can be utilized to focus on positive, healing thoughts while distracting us from the pain that we are experiencing. Remember, pain is only experienced in the way that the brain perceives it. If we can over-ride pain with alternative, positive thoughts and images, then we can be less aware of and focused on our pain.

These images don’t need to be detailed or technical to be effective. Here are a few examples of seeds for imagery for pain written by B.M. Dossey (1988). Imagery: Awakening the inner healer. In B.M. Dossey, et.al. (Eds.), Holistic nursing. Rockville, MD: Aspen:

Seeds for Imagery Example #1: “Scan your body . . . gather any pains, aches, or other symptoms up into a ball. Begin to change its size . . . allow it to get bigger . . . just imagine how big you can make it. Now make it smaller . . . See how small you can make it . . . Is it possible to make it the size of a grain of sand? (Change the size several times in both directions). Now allow it to move slowly out of your body, moving further away each time you exhale . . . Notice the experience with each exhale . . . as the pain moves away.”

Seeds for Imagery Example #2: “See yourself sitting on a bed of luxuriously soft grass beside a beautiful, deep pond. The water is a deep indigo blue. Slip into the cool, soothing waters and swim slowly about the pond. Feel any pain being drawn through your skin into the water, being trapped there, and falling to the bottom of the pond. Swim around until you are completely relaxed and comfortable, then swim back to the edge of the pond and walk out.”

Guided Imagery

“Imagination is more important than knowledge.”

Albert Einstein

Guided Imagery uses your imagination to help your mind and body deal with difficulties (for example, pain) or trauma, gain understanding about perplexing issues, develop new habits, and achieve your goals. It is done while in a state of relaxed but very focused concentration, much like what is seen in meditation practices. Guided Imagery then utilizes all of your senses for your imagery experience. This technique can be used with the help of a clinician or guide (in person or through audio recordings) or on your own.

I’ve written and recorded a more in-depth explanation of Guided Imagery and the Guided Imagery process. To learn more, click on the link What is Guided Imagery?

Dr. David E. Bresler, PhD, LAc (in Practical PAIN MANAGEMENT, Sept/Oct 2005) has developed a list of What every contemporary pain therapist should know about guided imagery:

1. “Historically, more people have been treated using guided imagery than by any other therapeutic intervention.
2. Patients (and pain therapists) use imagery all the time.
3. Imagery has powerful physiological consequences.
4. Words can evoke healing or hurting images.
5. Guided imagery is a low risk, low cost alternative for helping patients control painful symptoms.
6. Guided imagery can greatly enhance pain tolerance.
7. Guided imagery can help better prepare patients for surgery or invasive procedures.
8. Guided imagery can enhance compliance with treatment recommendations. Guided imagery can help motivate and track progress of patients in rehabilitation.
9. Guided imagery is most effective when utilized interactively.”

Let’s explore two examples of how Guided Imagery can be used for pain management:

Evocative Imagery: Evocative Imagery is used to strengthen a positive thought or feeling as well as to enhance coping skills. When utilized for pain management purposes, the invitation for imagery may look something like this:

Imagine a time when you were in pain and handled it very well. Where were you? What were you feeling? What was going on? How did you handle the pain? Were there any specific techniques that were helpful? How did you feel when the pain eased? What were you thinking as the pain went away? Imagine yourself now in this same place, using the same pain management techniques that were so very helpful to you in the past. Try to make this experience and feeling as vivid as possible…fully imagining this scene with all of your senses. Take some time to relax in this feeling of release from your pain.

Symptom Dialogue: Symptom dialogue is typically done in an Interactive Guided Imagery(sm) format, where the imagery experience utilizes a guide (clinician) and, unlike traditional Guided Imagery, the guide and the participant carry on a dialogue during the exercise. Symptom dialogue can also be used as a solo technique once you are more familiar with the Guided Imagery process.

When I was in training for my Interactive Guided Imagery(sm) certification, I participated in a symptom dialogue exercise regarding my experience of chronic pain. It was a remarkably enlightening experience. I learned a lot about my physical pain, which I imagined looked like a burning-hot ball, the size and weight of a bowling ball. Here’s an excerpt from this experience:

Prior to beginning this exercise, my guide and I discussed what questions I wanted to ask about my pain. I was interested in knowing as much as I could. Why did I experience pain? What was it’s purpose? How could I break free from my pain? First, I was asked to imagine an image of my pain. Almost immediately this burning-hot, heavy ball appeared in my mind’s eye; black with orange flames shooting from it’s surface, almost like spikes of fire. With the help of my guide I was able to begin an inner dialogue with my pain. What I learned was very surprising. I had assumed that my pain was something separate from me that was torturing me on almost a daily basis. I had assumed that it was the “enemy.” But what I learned was that this ball of fire was a part of me, and that it didn’t want to cause me pain. It wanted to be a peaceful part of me, and that I needed to start paying better attention to my body. I was too sedentary in my work, and had spent too many years sitting still on a desk chair while I provided counseling to others. It also told me that to relieve my pain I needed to do two things: 1) spend time in the water and 2) ride my bicycle. Both the water and the bike riding resonated with me in a very deep place in my heart. And, since then, I have found these two things remain true. I am very happily back exercising in the water. I feel safe and free and alive in the water. Although I’m not back on my bike yet…I’m making plans to make that happen too! And my pain? Well, it’s still there, but it is greatly reduced in it’s intensity.

I’d like to invite you to explore Guided Imagery pain management techniques further. Below are links to Guided Imagery Resources (one book and several Guided Imagery meditations). Some of the meditations are free for you to listen to and some are available for purchase and download.

• Staying Well with Guided Imagery by Belleruth Naparstek (book – includes Guided Imagery scripts)
• A Guided Meditation to Help Ease Pain by Belleruth Naparstek
• A Guided Meditation to Help Relieve Headaches by Belleruth Naparstek
• Guided Meditations to Relieve Stress by Belleruth Naparstek
• A Guided Meditation to Help With Fibromyalgia and Chronic Fatigue by Belleruth Naparstek
• Progressive Relaxation by Glenda Cedarleaf
• Transforming Pain and Discomfort by Glenda Cedarleaf

Pain Journal

I’ve included a pain tracker for you to download and use to help manage your pain. (Note: this form was developed based on a compilation of information from Reversing Chronic Pain by Dr. Maggie Phillips). This tracker has areas to include both your physical pain level and your emotional response level before and after pain management treatment. You can describe your pain and note what type of pain management treatment approach you use. Finally, there is a spot to note any possible triggers for your pain or general observations.

Keeping a record of your pain is valuable over the long-term, as you can compare your general level of pain prior to initiating specific pain management techniques versus levels of pain after using these techniques on a consistent basis. This information can help you determine what pain management techniques work best for your pain. Click on this link to receive your free printable: PAIN TRACKER

Conclusion

Well, we have come to the end of our 3-part series, When You or Your Loved One is in Pain. We have looked at how we perceive pain, the difference between pain and suffering, and alternative treatment approaches to pain management.

Although the list of alternative treatment approaches to pain management was far from complete in this article, it is my hope that you have been given some ideas for pain management techniques that may be helpful to you, your loved ones, or your clients. I would also encourage you to take a deeper dive into this subject by following the various resource links I have provided. There is much we can do to manage pain. As always, your feedback is appreciated!

This post contains Amazon affiliate links AND nonaffiliate links to additional resources (highlighted in blue above.) “As an Amazon Associate I earn from qualifying purchases.”