Week 1: Understanding chronic pain

Week 4: Healthy thinking, healthy self

Week 5: Balancing your activity patterns

Week 6: Maintaining your gains and staying well

Relaxation techniques

Earlier, we talked about the importance of relaxation and how it differs from rest. People with chronic pain may rest more than others, but they often find it difficult to relax. Their rest is rarely restorative and is often accompanied by strong feelings of frustration, guilt and the urge to be doing something else. Chronic pain has been linked to an overactive stress response, making the need for relaxation even stronger. Many people with chronic pain are caught in a cycle of persistent stress and worsening pain.

As we discussed above, relaxation is beneficial for health on many levels. It can reverse the body’s fight or flight response, reduce the intensity of pain, and improve your quality of life. Relaxation is a great way to manage stress, both physical and psychological. Sounds good, right? Most people would answer “yes”, but some hold negative perceptions about relaxation. They may believe it isn’t ‘strong’ or ‘medical’ enough for their symptoms or that it sounds like a waste of time. 

If you hold these views too, that’s ok. However, we suggest that you test out your assumptions by giving it a go anyway. Try to approach relaxation in the same way as you would a new medication. Take your daily dose, tolerate any temporary minor side-effects (e.g., frustration, inconvenience), and give it a chance before expecting major improvements. The evidence for relaxation is strong and you may be surprised at how powerful these simple techniques can be. Below we discuss strategies to help you introduce relaxation into your daily schedule. 

Before moving on, take a moment to think about your own attitudes towards relaxation and any other psychological approaches to managing your pain. If you feel a sense of hesitance towards these approaches, try to uncover where this comes from. What is holding you back from taking action? See if you can set aside your doubts and give the following exercises a go. 

Deep breathing

Taking slower and deeper breaths is a great way to calm your body and let go of tension. When you’re stressed, your breathing gets faster and shallower. You can test this out by placing one hand on your belly and another one on your chest. Take a few fast breaths, followed by some slow, deep ones. As you do this, notice which hand moves more. Shallow breaths often come from the chest, whereas deeper breaths come from the belly. With that said, it’s best to aim for slow, deep breaths as much as you can. 

Without even realising it, you may be breathing inefficiently most of the time. This can reduce the amount of oxygen in your body and trigger the stress response. As such, it can help to slow your breathing down. You can use the following tips to help you:

  • Find a relaxed position sitting or lying down.
  • Breathe in through your nose and out through your mouth.
  • If you like, count the length of your inhale and exhale and try to make your exhale longer.
  • As you inhale, take the air right down into your lungs, so that you can see and feel your lower belly rise up.
  • After you inhale, pause for a moment before exhaling.
  • On your exhale, allow your body to relax and let go of any tension and stress.
  • After you exhale, pause for a moment before inhaling.
  • As you breathe deeply, try to focus on the sensation of your breath entering and leaving your body.
  • Repeat this breath cycle for 5 to 10 minutes. When you’re done, notice if you feel physically or emotionally lighter than when you first started.

As you practice the exercise, you may want to repeat some affirming statements to yourself to help you relax:

  • With each breath, I feel my body let go of tension
  • With each breath, I feel myself entering a state of calm
  • With each breath, I feel my body melt and relax into the chair/floor/bed
  • With each breath, I feel myself becoming more connected to my body
  • With each breath, I feel the soothing rhythm of my body as it rises and falls 

Slowing down your breathing can signal to your brain to switch off the fight or flight response, reduce physical tension and slow the release of stress hormones in the body. There are different ideas about how long your in- and out-breaths should be. For example, some suggest a count of 4 (in) and 6 (out), with a pause of about 2 seconds after each inhale and exhale. Play around and see what works best for you. If you get distracted often during the exercise, there are many guided breathing exercises freely available online that can help. 

Progressive muscle relaxation (PMR)

Stress builds up and is often stored in the body as physical pain and tension. A technique called progressive muscle relaxation (PMR) can help with this. Studies have shown that PMR can effectively decrease stress, tension and anxiety. PMR involves deliberately tensing and relaxing different muscles in your body. Like deep breathing, this is another way to reverse the fight or flight response. Speak to your doctor before trying this out to avoid exacerbating your chronic pain.

Here’s how you can practice PMR:

Step 1: Find a quiet place with no distractions. 

Step 2: Find a comfortable position. Ideally, lying on your back with your body parts uncrossed. 

Step 3: For each muscle group, gently tense your muscles for 5-10 seconds and then release for 5-10 seconds. Notice the feeling of tension and the sense of relaxation that follows. One at a time, work your way through all the major muscle groups in your body. Never tense your muscles to the point of pain or extreme physical discomfort. You can skip any particularly painful areas or injured parts of the body.  

The major muscle groups include your: 

  • Face (frown, close your eyes tightly, scrunch your nose, clench your teeth)
  • Neck and shoulders (shrug your shoulders up towards your ears)
  • Arms (make fists, tense your muscles as though you’re trying to lift something)
  • Back (arch your back and pull your shoulder blades together)
  • Stomach (clench stomach muscles by pulling them towards your spine)
  • Legs (point your toes, clench your thighs, squeeze your buttocks together).
  • Feet (clench your toes, point your feet and turn them inwards to face each other). 

The main aim of tensing and releasing is that you learn to recognise the difference between tension and relaxation. PMR also creates a general state of mental calm and deep physical relaxation. When people are chronically stressed, their muscles are often so tense that they have forgotten what a relaxed state feels like. Of course, physical tension goes hand in hand with pain. As you get more skilled, you will be able to relax your muscles automatically to reduce tension before it becomes too great. All up, this exercise should take no longer than 10-15 minutes. 

Schedule some ‘time out’

Take time out to do things that give you a sense of relaxation and pleasure. Make a list of activities that interest you. Think about things that you don’t usually do, perhaps because you don’t think they’re important enough. What do you say “no” to? Are there things you used to enjoy, but no longer do? Are there new things you’ve been meaning to try, but haven’t made time for? Write them all down, even if you feel like you can’t do them yet.

For example, Carla’s list looked like this:

  • Go for a massage
  • Listen to relaxing music
  • Pet my cat
  • Paint my nails 
  • Take a bubble bath
  • Have a hot tea and do a crossword puzzle
  • Light a scented candle 
  • Do some yoga

Once you have your list of activities, don’t stop there. Pick one to get started with and schedule it into your week. Without scheduling a specific date and time, it’s unlikely you’ll follow through. Make sure you allow yourself enough time to really relax and enjoy the activity. This way, you’ll get the most benefit from it. Don’t delay getting started, try scheduling something in the near future and treat it like an important meeting or appointment that can’t be cancelled. 

Some other ideas for relaxation include doing something creative (e.g., painting, craft), hanging out with pets, listening to music, spending time in nature, doing a puzzle, listening to a guided meditation, and massage therapy. Making time for relaxing activities during the week can be enough to slow things down and introduce some calm into your life. This can have a profound effect on your stress levels and reduce an overactive fight or flight response. It is also a good way to achieve balance in your life and prevent chronic pain from taking over. 

For example, Carla had been suffering from chronic pain for years. Her life revolved around pain flares, which left her unable to move. During a pain flare, Carla spent most of her time in bed and on the couch. However, this wasn’t relaxing or restorative rest, because she spent the time stressed and worrying about what she should have been doing instead. When Carla was not disabled by her pain, she worked extra hard to catch up on what she’d fallen behind on. 

Desperate for change, Carla started to schedule some time out during her symptom free periods. She practiced guided meditation before bed each night and allocated Saturday and Sunday mornings for relaxing activities. Although she technically had less time to catch up on work, she found that she was more productive. She also felt less physical tension and was lighter in her mood. Over time, Carla also noticed that her pain started to bother her less.