Mind-Body Strategies for Pain
Relaxation, meditation, imagery, and redirection strategies (such as distraction) may be helpful at reducing pain. These mind-body techniques can help you consciously relax your body, slow your breathing, reduce your blood pressure, and improve your sense of well-being. These techniques can also help you shift your focus to other things besides your pain. For more in-depth information, read HPRC’s InfoReveal on “Mind-body strategies for pain.”
A printable version of this information is here [PDF].
Pain is usually quite stressful, and stress causes muscles to tense, which makes pain worse—creating a cycle of pain. Mind-body techniques such as relaxation, meditation, guided imagery, and redirection release tension, reduce negative thoughts about pain, and may cancel out some of the negative effects of stress. They also are used to calm emotions and improve sleep—both of which can also improve pain.
The good things about mind-body techniques are that they can be done virtually anywhere, take only a short amount of time, and can be used along with other pain treatments.
What We Know
The National Center for Complementary and Alternative Medicine (NCCAM) "Relaxation Techniques for Health" web page describes relaxation techniques as “a number of practices such as progressive muscle relaxation, self-hypnosis, and deep breathing exercises. The goal is similar in all: to consciously produce the body's natural relaxation response, characterized by slower breathing, lower blood pressure, and a feeling of calm and well-being.” There is some evidence that relaxation techniques may be helpful for reducing pain (as part of a larger treatment plan), specifically pain from tension or migraine headaches, abdominal pain, and surgery pain.
- The American Chronic Pain Association has a guided relaxation script and audio/video.
- Recordings provided by the Veterans Health Administration offer guided relaxation in Relaxed Breathing, Passive Muscle Relaxation, Progressive Muscle Relaxation, Visualization, and Mindfulness and Meditation.
HPRC has a video on Breathing Exercises for Optimized Performance that demonstrates three breathing strategies for human performance optimization: Deep Breathing, Alternate Nostril Breathing, and Fast-Paced Breathing. Or you can download a written instruction sheet that will take you through each step by step.
The War Related Illness & Injury Center (WRIISC) has a handout on two types of controlled breathing: alternate nostril breathing and ocean breath.
The Defense Centers of Excellence has three mobile relaxation apps—T2 Mood Tracker, Breathe2Relax, and Tactical Breather—designed to reduce stress.
RealWarriors.net offers a relaxation script.
Meditation can be defined and practiced many ways. In general, meditation trains you to have a focused and calm mind and rhythmic breathing. It may sound easy, but it requires practice. The payoffs are improved well-being, reduced pain, and relaxation. Meditation is believed to reduce pain by reducing stress, but more research is needed to gain a better understanding of how meditation impacts chronic pain.2
Mindfulness meditation is a type of meditation that often is researched as a pain management tool. Mindfulness meditation helps you focus on what is happening in the present. The idea is that you can gain a better understanding of your body, your thoughts, and your surroundings as a way to accept the world. Mindfulness Based Stress Reduction (MBSR) is a structured form of mindfulness meditation. This type of meditation can improve your sense of well-being and reduce stress, depression, and pain.3 Shamatha meditation, or mindfulness meditation, can significantly reduce pain intensity.4
Here are some meditation resources you can try at home:
- RealWarriors.net has some meditation guidelines.
- The University of Michigan has a few meditation audio files.
- UC San Diego has MBSR audio files available for download.
Imagery is a method in which you visualize activities or places that stimulate your senses; there are various methods, including guided imagery, creative imagery, and motor imagery. Many people try to imagine things with all five senses. You can use either a practitioner or a recording to guide your imagery session. Or just simply sit quietly and let your mind go free. Also, listening to a recording of a happy personal memory three times per week (as a guided imagery activity) for three weeks can be helpful for migraines and other headaches.5
Here are some examples of imagery you can try out:
- A Guided Imagery Exercise from Kansas State University (text or audio file).
- The University of Michigan has guided imagery audio you can download to an MP3 player.
- Creative imagery from the Association for Applied Sport Psychology.
Redirection methods such as distraction help you find something to focus on other than your pain. Things such as engaging in your favorite hobby, watching a movie, playing a game, or conversing with friends can all distract you away from pain and refocus on things you enjoy.
Virtual reality and video games are cutting-edge techniques that show promise as redirection methods for decreasing pain.6,7 Burn, chronic, phantom, and post-surgical pain especially may benefit from virtual reality.8 Other forms of redirection also may reduce pain in children as well as adults.9,10 Here are a couple distraction tools you can try out:
- The Positive Activities Jackpot (mobile app) can help you find things to do wherever you and your GPS-equipped phone may be.
- Combat and Operational Stress Control has a list of activities that you can do to help reduce stress.
Mind-body techniques do have a few side effects. Some people become bored or sleepy during some of these techniques, but there are enough options that you should be able to find one that suits you. Mind-body practices also may increase symptoms of depression, anxiety, agitation, or mild confusion in some people. Also, motor imagery (that is, visualizing specific movements) should be used with caution, as it can actually make complex regional pain syndrome worse.11
Mind-body techniques can be done virtually anywhere (a plus for on-the-move service members), often take only a short amount of time, and can be used along with other pain treatments. You can do them alone or with other people and with or without the help of a professional. The military and VHA are actively looking for ways to use mind-body techniques for many health conditions, including pain management. For instance, this video shows how the DoD is providing meditation for a variety of health concerns. Free and low-cost meditation classes for Warfighters and veterans are available around the country; ask your local DoD/VHA healthcare providers for referrals. Also, here is a radio program about the use of meditation to treat the mental health concerns of service members. For more technical information, the Defense Centers of Excellence report “Mind-Body Skills for Regulating the Autonomic Nervous System” reviews the evidence on mind-body skills and discusses their military relevance.2
Note: This InfoReveal is educational overview that describes the use of mind-body techniques as a strategy for pain management; it is not a comprehensive review of the current state of the research.
This InfoReveal was created in collaboration with the Defense & Veterans Center for Integrative Pain Management.
- Kwekkeboom KL, Gretarsdottir E. Systematic review of relaxation interventions for pain. Journal of Nursing Scholarship. 2006;38(3):269-77.
- Moore M, Brown DG, Money NN, Bates M. Mind-Body Skills for Regulating the Autonomic Nervous System. Silver Spring, MD: Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; June 2011 2011.
- Marchand WR. Mindfulness-based stress reduction, mindfulness-based cognitive therapy, and Zen meditation for depression, anxiety, pain, and psychological distress. Journal of Psychiaric Practice. 2012;18(4):233-52.
- Zeidan F, Martucci KT, Kraft RA, Gordon NS, et al. Brain mechanisms supporting the modulation of pain by mindfulness meditation. The Journal of Neuroscience. 2011;31(14):5540-8.
- Abdoli S, Rahzani K, Safaie M, Sattari A. A randomized control trial: the effect of guided imagery with tape and perceived happy memory on chronic tension type headache. Scandinavian Journal of Caring Sciences. 2012;26(2):254-61.
- Li A, Montaño Z, Chen VJ, Gold JI. Virtual reality and pain management: current trends and future directions. Pain Management. 2011;1(2):147-57.
- Primack BA, Carroll MV, McNamara M, Klem ML, et al. Role of video games in improving health-related outcomes: a systematic review. American Journal of Preventive Medicine. 2012;42(6):630-8.
- Maani CV, Hoffman HG, Morrow M, Maiers A, et al. Virtual reality pain control during burn wound debridement of combat-related burn injuries using robot-like arm mounted VR goggles. The Journal of Trauma and Acute Care Surgery. 2011;71(1 Suppl):S125-30.
- Downey LVA, Zun LS. The impact of watching cartoons for distraction during painful procedures in the emergency department. Pediatric Emergency Care. 2012;28(10):1033-5.
- Van Ryckeghem DM, Crombez G, Eccleston C, Legrain V, et al. Keeping pain out of your mind: The role of attentional set in pain. European Journal of Pain. 2013;17(3):402-11.
- Moseley GL, Zalucki N, Birklein F, Marinus J, et al. Thinking about movement hurts: The effect of motor imagery on pain and swelling in people with chronic arm pain. Arthritis Care & Research. 2008;59(5):623-31.