The Mind Body Approach to Pain Management – Pathways
The Mind Body Approach to Pain Management
You might have heard about mind body treatments and wondered what they actually are! This article guides you through the details and the range of mind body therapies available.
Ann-Marie D’arcy-Sharpe February 13, 2020
The connection between our mind and body is a powerful one. Our brains control all our bodily processes, including chronic pain! This doesn’t mean that your pain is ‘all in your head’ or not real. All pain is created by our brains, even acute pain. Our brain sends out pain messages to make us feel pain when there is an outside threat. For example, if you touch something too hot, your brain sends out a pain message to let you know you need to move your hand because you’re in danger.
When it comes to chronic pain, your brain has learnt to continue sending out pain signals, even though they aren’t needed. You can even continue feeling pain long after an injury has healed. It’s like a faulty alarm system. This is also known as central pain sensitization. The good news here though, is that as much as your brain can learn to produce chronic pain, it can learn to stop producing those pain signals.
The mind body approach to pain management utilizes this connection between our minds and bodies to the patient’s advantage.This approach follows the biopsychosocial approach to treating chronic pain, meaning it treats the patient as a whole. This way of treating pain has been around for a long time but is coming increasingly to the forefront of pain management as more research is done and a greater understanding of the complex connections between our mind and pain is gained.
How can our mind influence our pain levels?
Apart from central sensitization which we mentioned earlier, our mind can also influence our pain levels in other ways. How we perceive our pain can worsen or improve our pain levels. By perceiving our pain in a negative way, for example thinking that we are always going to be in pain, we are actually reinforcing the pain pathways in our brain. This study explains that, “general and situation specific perceptions of uncontrollability and feelings of helplessness were more predictive of greater pain severity and disability than any disease-related factors.”
The actions we take in accordance with the way we view our pain can either be maladaptive (unhelpful) or adaptive (helpful). In our example, when we think that we are always going to be in pain, we are unlikely to seek treatment or keep up with medications, because there seems to be no point. This contributes to worsening our pain levels. Whereas if we believe that we can improve our symptoms and we feel empowered, we are more likely to keep up with treatments and actively look at ways we can cope more effectively.
Our emotions have a big impact on our pain levels. Our body is not designed to be in a prolonged state of stress, so when our stress levels are high it contributes to our pain levels. Equally, being in chronic pain can cause stress, and this becomes the pain and stress cycle.
When our mood is low, for example if we suffer from a comorbid mental illness like depression, we are less likely to keep up with treatments and healthy coping strategies. Depression can contribute to fatigue and mean that we are more likely to withdraw from activity, which in turn can contribute to deconditioning. Mental illness and chronic pain even share many of the same neural pathways within our brains, meaning that they can actively influence each other, as this in depth study explains.
Many pain patients become hypervigilant about their pain. This means that they are constantly aware of their pain, considering it almost constantly in every action they take. This can have a serious impact on pain levels by increasing stress and contributing to central sensitization.
Hypervigilance often leads to catastrophizing, meaning that the patient is worrying excessively about their pain to a point that it is highly detrimental to their lives. Of course, this high state of worry perpetuates the pain and stress cycle and increases chronic pain symptoms.
This hypervigilance and catastrophizing can also lead to being fearful about your pain. Many pain patients will start to avoid activity and movement because they are frightened it’s going to worsen their pain. This is natural and totally understandable. However, this fear avoidance is detrimental. Avoiding activity can lead to deconditioning, meaning that the body becomes less fit and the muscles become weaker because they are not being used. This can increase pain levels when the patient does try to be active. Fear avoidance also reinforces to the brain that it should continue producing pain messages in response to the situations the patient fears.
How can our body influence our mind?
Just as our mindset and the way we perceive our pain can influence our pain levels, so our body can influence our mind. Chronic pain can have a big emotional impact, often leading to depression and anxiety in patients. As we mentioned earlier, chronic pain can increase levels of stress as well as contribute to hypervigilance, catastrophizing and fear avoidance.
How we treat our bodies also has a big impact on our mind. If we exercise regularly, it’s not only good for our physical health but also our mental health! Endorphins are released which contribute to mental wellbeing and serotonin levels (which contribute to a stable mental state) are increased.
Exercise doesn’t just contribute to our mental health, but also to our cognitive health. When we exercise regularly, we increase the size of our hippocampus which is the area of the brain which controls memories. This study on the topic found that, “Exercise training increased hippocampal volume by 2%”. The blood to our brain also increases during exercise which helps to strengthen nerve connections.
What we put into our bodies even has an effect on our minds. When we have a healthy diet, our brain is more likely to function well and have less cognitive issues, as explained in this article from Harvard Medical School.
If we sleep well, our minds function more optimally. Sleep allows our bodies and minds the time to regenerate. The right amount of sleep allows us to process memories, to concentrate properly and to think clearly. This report from the National Institutes of Health explains that recent findings suggest sleep plays another important role for our mind: “sleep plays a housekeeping role that removes toxins in your brain that build up while you are awake. “
A great example of how our bodies and minds influence one another is muscle tension. When we’re stressed, our muscles become tense. If we exercise and stretch our muscles, we can relax them and in turn become more relaxed mentally.
How does mind body treatment work?
Mind body treatments make use of this complex and deep connection between our minds and bodies to treat a variety of conditions, including chronic pain. These treatments follow the biopsychosocial approach to pain management, meaning that they consider all factors which affect a patient’s life and treat the person as a whole.
Mind body treatments may focus on using the body to relax the mind, for example relaxing muscles and relieving tension to also promote greater mental wellbeing. Other mind body treatments focus on relaxing the mind to in turn relax the muscles and reduce pain symptoms. This detailed study on mind body therapies explains that, “Mind–body therapies emphasize engaging both the mind and body to promote stress reduction and well-being by changing the manner in which individuals respond to their environmental or internal stressors.”
You can access mind body treatments online, through our pain management app, through your doctor or privately. Some of these treatments may be accessible through local classes, for example those which revolve around exercise and movement. In a face to face setting, mind body therapy may be done in groups or one to one. Many treatments integrate mind body concepts to provide a multimodal approach to chronic pain management.
Once you learn the tools to calm your mind and body, you can begin to implement them into your daily life. In time, these new skills can become part of your dayto-day life resulting in a healthy habit that allows you to tackle your chronic pain, increase your functioning and improve your quality of life. This study concluded that, “The recognition of the automatic and largely unconscious nature of much stress reactivity (such as the “fight-or flight” response) may, in turn, facilitate the development of greater control and mastery over such reactivity and expand the range and repertoire of possible responses to stressful life events.” It’s about you being in control of your chronic pain, rather than it being in control of you!
What type of mind body treatments are available?
A variety of mind and body treatments are available so that you can find what feels right for you.
You will no doubt have heard about mindfulness for treating chronic pain. It’s a treatment which is getting more attention all the time, not just for pain but for mental health and general physical health. Mindfulness revolves around the concept of being present in the current moment, without judgement, and without worrying about the past of future. This ability to ground yourself and focus only on what is happening right now has many benefits.
Mindfulness can aid with relaxation, promoting good cognitive health and enabling participants to have greater control over their emotions. Mindfulness also equips patients with the tools to regulate their internal processes, such as calming their breathing and heart rate. With proven results for chronic pain patients, mindfulness is far more than just a fad.
There are various types of mindfulness which may be used as mind body treatments:
Meditation can be done alone, or it can be guided. Guided mindfulness meditations can be found online or through an app like ours. They can also be found in meditation classes or through a therapist either individually or in a group.
Often during guided meditation, visualization will be used. The therapist will guide you through visualizing specific situations or images, in order to help you to achieve a deeper state of relaxation. Often breathing exercises are utilized which focus on slowing your breathing, often while imagining inhaling calm energy and exhaling stress.
This detailed study on mind body treatments concluded that after mindfulness meditation in particular, “the emotional and cognitive components of the pain experience appear to be significantly diminished, resulting in less suffering and distress.”
- Mindful movement
Moving mindfully involves slow, flowing movements. You stay in the moment by focusing on these movements and on your breathing. This can be more relaxing for some people who may struggle with sitting meditation. Mindful movement also has the added benefit of exercising and stretching your body! Exercises like yoga and tai chi are mindful movements.
- Progressive Muscle Relaxation (PMR)
During PMR, the therapist will guide you into a meditative state and then one by one instruct you to tense and relax each muscle group in your body. This can relieve tension physically and mentally. Once the skill is learned, it can be used in your daily routine to deal with stress and even to help you get to sleep at night!
- Daily mindfulness
Once you have learnt the skills of mindfulness, you can apply it to your everyday life. You can use mindfulness when you’re walking to the shops or even when you’re doing day-to-day tasks like taking a bath or doing the housework!
- Interdisciplinary therapies
Many therapies will incorporate aspects of mindfulness in order to bring the best results for the patient. For example, Mindfulness Based Stress Reduction (MBSR) focuses on using mindfulness techniques to lower stress levels, often incorporating yoga, stretching exercises and mediation.
During biofeedback, a medical professional uses monitors to make the patient more aware of their biological processes. For example, using a heart rate monitor so that the patient can learn to recognise when their heart rate increases. By learning to be aware of these processes, the patient can learn how to control them, for example using calming techniques to slow their heart rate. This tackles stress and the effects of stress on the body, in turn reducing pain symptoms as this study explains.
Cognitive Behavioural Therapy (CBT)
CBT is a talking therapy which can teach patients how to replace negative thoughts and the behaviours that often follow, with positive thoughts and helpful behaviours. For example, replacing a negative thought such as: ‘There’s nothing I can do about this pain’, with a positive, empowering thought such as: ‘I can beat this, things can improve’. These adaptive (positive) thoughts and behaviours allow patients to have better control over their symptoms and to manage their chronic pain in a much more effective way.
Acupuncture is performed in a calming environment. During the treatment very thin needles are inserted into specific points of your body. These needles are thought to induce the body’s natural pain-relieving chemicals. The experience is not painful and is designed to relax the patient.
Various types of creative therapies can be used. They give patient’s another outlet for their feelings. They can promote relaxation and distraction, as well as being highly enjoyable for a lot of patients. This type of therapy can be beneficial physically as well as mentally, putting patients in a more positive state of mind and relieving the physical effects of stress.
Art therapy is a popular choice, usually done in groups but occasionally done in one to one sessions depending on the aim. Art therapy may entail painting, drawing or other crafts. Music therapy usually entails writing songs, playing instruments, singing or listening to music. Dance is another form of creative therapy, with the added benefits that come along with exercise. Aspects of creative therapies can also be integrated into pain management at home, to help the patient control their emotions and distract them from stressful situations.
During hypnotherapy, the therapist will typically ask patients to sit or lie back in a comfortable position. Usually you will close your eyes, but some patients prefer to just relax their eyes, typically having them partially shut and looking down, so that they aren’t focused on anything in particular. The hypnotherapists office will usually be very relaxing and comfortable.
Once the patient is positioned comfortably, the therapist guides the patient through visualisation and breathing exercises to induce a state of complete calm with the patient. This is also known as a hypnotic state. During this state you are never out of control of your body. The hypnotherapist cannot make you do anything you do not want to do. However you are less inhibited and more open to suggestion during a hypnotic state, so the hypnotherapist may take you through specific scenarios to help you to deal with problems in your life, or to aid you in putting more adaptive pain management behaviours in place. Hypnotherapy can also be done at home through audio found online.
Through therapeutic massage, the therapist not only physically relaxes the patient’s muscles but in turn through this muscle relaxation, also relieves stress and enables the patient to be in a much more relaxed state overall.
With many approaches to mind body treatment available and many of these concepts being introduced into other therapies, medical professionals are beginning to realise that treating the patient as a whole is the key to improving quality of life. This study on mind body therapies (in particular mindfulness) and their effects on chronic pain concludes for us nicely. They found that mind body therapy, “appeared efficacious in reducing pain, symptom severity, depression, and anxiety, and improving quality of life.”
- Australian Family Physician, Hassed C, (2013), “Mind-body therapies–use in chronic pain management”
- Neural Plasticity, Jiyao Sheng, Shui Liu, Yicun Wang, et al, (2017), “The Link between Depression and Chronic Pain: Neural Mechanisms in the Brain”
- Clinical Journal of Pain, Volume 20, Number 1, John A. Astin, PhD, (2004), “Mind–Body Therapies for the Management of Pain”
- Pain Medicine, Volume 15, Issue S1, Pages S21–S39, Courtney Lee, MA, Cindy Crawford, BA, Anita Hickey, MD, (2014), “Mind–Body Therapies for the Self-Management of Chronic Pain Symptoms”
- Public Library of Science, Shaheen E. Lakhan, Kerry L. Schofield, (2013), “Mindfulness-Based Therapies in the Treatment of Somatization Disorders: A Systematic Review and Meta-Analysis”
- PNAS, Kirk I. Erickson, Michelle W. Voss, Ruchika Shaurya Prakash, et al, (2011), “Exercise training increases size of hippocampus and improves memory”
- Harvard Medical School, (2020), “Foods linked to better brainpower”
- National Institutes of Health, National Institute of Neurological Disorders and Stroke, (2019), “Brain Basics: Understanding Sleep”