Intro to Mind/Body Techniques That Relieve Chronic Pain

Clinicians in all settings can teach their patients to use relaxation, meditation, hypnosis, guided imagery, and other techniques that utilize the mind-body connection to achieve relief from chronic pain conditions. The key for providers is to build a good rapport with their patients, be aware of the power of suggestion and the language that they use when creating expectations in patients, and to practice what they preach when it comes to these techniques.

Daniel F. Cleary and Michael B. Ellner, Cht, MSH, began their presentation, titled “Introduction to Mind/Body Techniques That Relieve Chronic Pain,” by asking the audience to repeat the phrases “I feel good,” “I feel great,” and “You are great” to illustrate the relaxing effect of self-affirmation and demonstrate the power of language and the effect it can have on patients’ state of mind.

Cleary reminded attendees that "the mind-body connection is an amazing interaction that has been known for thousands of years.” It is only recently that science has finally caught up to tradition. Now, there is growing evidence to support what “everybody has always known intuitively: when patients feel better, they heal better,” Cleary said. “The benefits of guided self-help modalities in addressing pain relief have been documented for years. Evidence suggests that these adjunctive approaches have the potential to improve every aspect of living or working with painful conditions or diseases.”

Effective treatment for pain starts with establishing a good rapport with the patient and being cognizant of the fact that “you’re not dealing with a disease; you’re dealing with a person,” said Cleary. He also reminded the audience that all medical professionals have “hypnotic relationships” with their patients in that “their words are very powerful and can be effective tools for healing.” But, he warned, language can also be destructive and present barriers to effective care if providers are not paying attention to how they are presenting information. Cleary said that when speaking with patients, it is important for clinicians to remind them that “they are not the diagnosis; they are still the same individual they were before tests came back positive.

"Pain changes the way a patient’s brain is processing their experiences, affecting everything from their experience of the pain itself to their activities of daily living. When people are dealing with chronic conditions, it affects every aspect of their life because the pain is in control. Cleary said that chronic pain “takes over a person’s life. They live in its shadow and forget the things they enjoy and that give them pleasure. Changing any aspect of the patient’s perception of their pain changes their experience of that pain. Changing their experience returns a sense of control. Even 10% relief can bring 100% improvement in the patient’s life.”

Cleary described pain as “a set of signals that our brain tells us how to respond to” and said that “patients’ perception of their pain is their experience of that pain signal.” Therefore, the goal for clinicians who are treating patients suffering from chronic pain is to “take the suffering out of these painful conditions even if you are powerless to change the cause of these signals.”

When these pain signals “are no longer accurate, patients can learn to bypass the response. Meditation and self-hypnosis are powerful ways to bypass the natural reaction to these ‘mistaken’ signals. The best way to teach your patients these approaches is to learn and practice them in your own life. When we learn and practice some form of meditation or self-hypnosis, we become experts in relating the benefits of these approaches to patients,” Ellner said.

Ellner also noted that the biggest obstacle with chronic pain “is learned helplessness and hopelessness.” He also noted that it’s common with chronic pain patients that “everything they’ve done up to that point hasn’t worked,” so they often come to the office visit “expecting that whatever you are going to do will also not work. They’ll do anything to get relief from their pain.”

A key part of providing that relief involves utilizing the mind-body connection to promote healing. “You need to capture your patients’ attention and use the power of language to engage their imagination in pain relief,” said Ellner. He told the audience that as medical professionals, they are the “authority on whatever the patient has come to you to address. You have their attention.” Providers can capitalize on that to teach patients mind-body techniques that can accelerate or utilize the body’s natural healing powers in ways that will benefit or create conditions for optimum health.

These techniques can include hypnosis, breathing and relaxation, and guided imagery exercises. “Any clinician can learn the skills needed to help patients use guided imagery and develop their creative self-help skills. You don’t have to be a hypnosis professional or certified hypnotist to use imagery to help alleviate patients’ pain.” Helping patients raise what Ellner referred to as their “hypnotic IQ” starts with talking to them about their pain and listening to their descriptions of their pain. Even this simple step utilizes the mind-body connection to promote pain relief because when patients are asked to describe their pain, “they begin to dissociate from it by becoming observers,” Ellner said. He recommended that providers ask patients to describe their pain experience using the five primary senses: vision, hearing, touch, taste, and smell. Providers should also guide patients by suggesting imagery they can use to visualize and describe their pain; “ask them to think about it as a red-hot ball, and then ask them to think about it becoming smaller and changing color to cooler shades,” said Ellner. He reminded the audience that “imagination and memory have great influence over your physiology. Remembering or visualizing pleasant or happy images produces endorphins” that promote pain relief.

Cleary said that even a small amount of pain relief can greatly improve patients’ lives. He described what he calls his “10% solution” that starts by asking patients about the effect pain has on their lives and the activities of daily living that their pain impacts or prevents them from doing. “Then I ask them about prior efforts at pain control, what worked and what didn’t. Then I create within their minds the expectation of successful pain relief by asking how great an impact a 10% reduction in their pain would have on their lives.” Then he has the patients focus on their breathing. “When we breathe more deeply, we get more oxygen in blood and the muscles begin to relax,” he said. This simple technique (basically counting down 3-2-1 and taking a deep breath) is powerful and effective because it exceeds the expectations of patients who may have grown accustomed to failing at their efforts at pain relief. “Now you have their attention and they’re back in control over their pain,” said Cleary.

It’s all about creating the expectation of success, according to Cleary: “Talk to patients about what is possible and what will work.” Clinicians should use positive and proactive language. “You don’t want to create the expectation that ‘this is going to hurt,’ because if you tell them it’ll hurt, it will. And never use negative phrases like ‘You are going to have to learn to live with the pain.’”

The bottom line, said Ellner, is that when you use these techniques to help your patients be more effective, they’ll heal better. He reminded the audience that another way to accomplish this is to take a lighthearted approach when talking to patients about their pain. “Don’t forget: ‘seriosity’ killed the cat. Helping patients lighten up their encounter with you will improve their experience immensely,” he said. If clinicians can remember the power and impact of the language that they use and incorporate into their practice guided imagery, relaxation, and other techniques that leverage the mind-body connection to promote healing, Ellner and Cleary said that they can break the negative feedback cycle of pain leading to tension and stress leading to more pain, and help patients regain control over their pain and their lives.