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Pain relief without drugs or surgery By Harvard Health Letters
Proven techniques to be used to your advantage
In addition to the standard pain medications, and surgical repairs of specific problems, patients and their clinicians also have access to a wide range of nondrug therapies for pain.
Mind-body relaxation techniques have become well accepted as stress-reducing strategies and are commonly used at hospital-based pain clinics and recommended by mainstream health care providers and integrative medicine specialists. There are a number of techniques and philosophies, but, when used for treating pain, most have some basic themes in common.
First, chronic pain conditions can rob people of a sense of control over their bodies and, thus, their lives. Eventually a person who suffers with chronic pain may become defined largely by the pain, planning his or her entire life around it. Therapies that address the whole person, including the mind and emotions, can help restore a sense of self-control and self-efficacy. For example, cognitive behavioral therapy (CBT) is a form of psychotherapy that seeks to break counterproductive thought and behavior patterns that may exacerbate pain.
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A common goal of many relaxation techniques and programs is to turn off what is known as the "fight-or-flight response" or the "stress response." This is the reaction you feel when confronted with something frightening, like a bus veering in your direction.
The hypothalamus, pituitary gland, and adrenal glands work together to release a stream of stress hormones that cause your breathing and heartbeat to quicken, your senses to sharpen, and your reactions to speed up to get you out of the way of the bus quickly. That's good, but if a source of long-term stress keeps stimulating the stress response, a variety of problems, including the exacerbation of chronic pain, may occur.
Relaxation techniques emphasize a strong connection between the mind and the body and can calm revved-up muscle, metabolic, and hormonal responses.
The relaxation response is the opposite of the stress response. Using a relaxation technique such as meditation, you can elicit the relaxation response at will to create a state of profound peace and rest. The relaxation response is a physiologic shift that puts the brakes on the biological stampede of hormones and metabolic changes of the stress response.
When you practice relaxation response techniques, your heartbeat and breathing slow and your body uses less oxygen, according to Harvard professor of medicine Herbert Benson, whose several decades of research described this response.
Achieving the relaxation response is the goal and the theoretical basis for many relaxation, meditation, and mindfulness techniques. Benson explains that there are two basic parts to achieving the relaxation response: first, you focus on a word, sound, sensation, or muscle activity that is repetitive and rhythmic, and second, you observe but do not react to or judge intruding thoughts.
Below are descriptions of commonly employed relaxation techniques. You can choose from or, you can simply learn a few techniques to use whenever your plain flares up.
1. MEDITATION AND MINDFULNESS
Mindfulness is the opposite of multitasking. It has its roots in Buddhist practices and teaches us to live each moment as it unfolds but without judging what we are feeling and perceiving. It involves letting go of the past and future in your mind. Mindfulness is a component of many other relaxation techniques, including yoga, deep breathing, tai chi, massage, reflexology, journaling, and prayer.
Mindfulness is now being examined scientifically and has been found to be a key element in happiness. Professor emeritus Jon Kabat-Zinn, founder and former director of the Stress Reduction Clinic at the University of Massachusetts Medical Center, helped to bring the practice of mindfulness meditation into mainstream medicine and demonstrated that practicing mindfulness can bring improvements in both physical and psychological symptoms as well as positive changes in health attitudes and behaviors.
Scientists have discovered the benefits of mindfulness techniques to help relieve stress, treat heart disease, and alleviate conditions such as high blood pressure, chronic pain, sleep problems, and gastrointestinal difficulties. Mindfulness meditation may help control people's pain by breaking anxious and depressive thought patterns and restoring some sense of control over their condition.
In several research studies, Kabat-Zinn demonstrated that mindfulness meditation could provide dramatic and lasting pain relief in a variety of conditions. He showed that meditation can be a valuable add-on therapy to drug treatment.
In one study, he taught mindfulness meditation to half of a group of 42 patients who were being treated with medications and physical therapy at the University of Massachusetts' pain clinic. The meditation boosted these patients' pain relief by 36 percent, while also improving their mood and reducing psychological distress.
More recently, in a Wake Forest University study, 15 healthy volunteers were taught mindfulness meditation and then monitored by MRI while a pain-inducing heat device was applied to their leg for six minutes. The meditation reduced pain unpleasantness by more than half (57 percent) and pain intensity by 40 percent. The study also showed that mindfulness meditation affected pain-processing areas of the brain such as the primary somatosensory cortex, the anterior cingulate cortex, the anterior insula, and the orbitofrontal cortex.
2. PROGRESSIVE MUSCLE RELAXATION
You can coordinate progressive muscle relaxation with your breathing--tightening your muscles as you inhale and relaxing them as you exhale. As with other relaxation therapies, progressive muscle relaxation can help lower the stress and anxiety that accompanies pain, helping you regain some control over your response.
3. BREATHING EXERCISES
One of the essential aspects of breathing exercises is concentrating, in a calm way, on your inhalation and exhalation, an activity that you ordinarily take for granted but that is crucial to your survival. You can improve your breathing by relaxing your stomach and shoulders and taking deeper, slower breaths. Breathing exercises are designed to teach you to draw oxygen deep into the lungs, expanding the belly as well as the chest with each breath.
4. HYPNOSIS THERAPY
Therapists use a variety of techniques to help their patients acquire the self-control and confidence to visualize, realize, and achieve goals such as reducing sensations of pain. Therapists often teach their patients self-hypnosis methods that they can employ on their own to reinforce and continue the process at home.
Hypnosis has been used to relieve pain and influence behavior for more than 150 years. Evidence-based research on the use of hypnosis to relieve pain is limited, but a large, well-designed study did boost its credibility as a useful and cost-saving pain relief method for hospital procedure rooms.
Published in The Lancet in 2000, the study evaluated the effectiveness of hypnosis--termed "nonpharmacologic analgesia"--in easing pain and anxiety in people who were having minimally invasive surgical therapies such as angiograms, angioplasty, simple kidney procedures, or liver biopsies, during which they remain conscious. Patients participated in a self-hypnosis relaxation session that involved deep-breathing and concentration techniques.
Researchers found that these patients required less than half the amount of painkilling drugs used by those receiving standard treatments. Procedures also took less time for the hypnosis group, and they had lower levels of anxiety and pain at both one hour and four hours into the procedure.
In addition, a review of 13 studies of chronic pain published in the International Journal of Clinical and Experimental Hypnotherapy in 2007 found that hypnosis consistently reduced pain and was more effective than physical therapy and educational efforts. Clinical research shows that hypnosis can be effective in treating fibromyalgia and migraine headaches.
(Excerpted from the Harvard Health Special Report, "Pain Relief without Drugs or Surgery,"prepared in collaboration with the editors of Harvard Health Publications and Diana Post, M.D. assistant professor of medicine, Harvard Medical School; physician, Department of Medicine, Brigham and Women's Hospital, Boston, Mass.)
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© 2012, PRESIDENT AND FELLOWS OF HARVARD COLLEGE. ALL RIGHTS RESERVED. DISTRIBUTED BY TRIBUNE MEDIA SERVICES, INC.
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