How To Manage Pain Without Medication
In this article we will discuss specific techniques on how to manage pain without medication. In our previous “Alternative Pain Management Techniques” article we explored the numerous benefits of managing pain without medication. We also covered what pain is and how the sensation can be manipulated by your brain. Now you have all the context to understand how to do that.
You remember the process from stimulus to sensation was:
- Transduction (at the site where the stimulus occurs)
- Transmission (from the starting site to the brain)
- Perception (within the brain)
- Modulation (from the brain down to the stimulus site)
Let’s jump to the perception part and explore more in-depth how it works.
How The Brain Perceives Pain
When the brain processes the received signals it needs to “decide how” you should feel them (e.g. how localized, with what intensity). To do so it uses psychological processes that involve cognitive components (e.g. focus) and emotional components (e.g. mood). Let’s look at these processes in further detail. You can manipulate the processes, so you can also manipulate your perception of pain. This means you can decrease its impact, the resulting sensation, and your body reaction.
Attention: Does Thinking About Pain make it worst?
Attention is a very interesting and powerful mechanism your brain uses continuously to process the reality around you. Think for example at how many things you see, hear, smell, or touch in every single moment. The brain needs to make sense of all of them in real-time. Then it will isolate what’s relevant to you and discard the rest.
Take a look for instance at all that is around you right now. How many things did actually catch your attention since you got here? Just a few, right? This is because your attention automatically focuses only on things that you should care about. For instance, if you’re walking down a street with hundreds of cars passing by you might not focus on any. But if you are shopping for a car you might notice the models you are most interested in buying.
How Attention Works In Pain Management
There are many interesting repercussions of how attention works on our behaviors. For instance, you might immediately notice things that do not match the pattern of the environment they are in. If you’re brain interprets them as a risk, you will avoid getting close to them. Like someone dressed in a winter coat on a beach, or a car moving too fast compared to others.
Salient things naturally attract your attention because your brain wants to keep you safe. If you stay away from cars that are zig-zagging it decreases your chances to crash into them. This may seem very obvious, but you can now get a hint on how this will apply to pain.
Pain is intrinsically salient. It’s function is to tell you to stop or modify a certain behavior to avoid damaging your body. This immediately puts it on the top of the list of the things your brain makes you pay attention to.
Most importantly, studies on how attention can influence the perception of pain demonstrated that “directed attention enhanced pain intensity” and “attentional distraction reduces pain-related activations”. In other words, if you focus on the pain, the pain sensation will be amplified. If you focus on something else other than the pain, you reduce the pain sensation.
How does this help you? Well, we said your brain directs your attention automatically, but you can also change it voluntarily. For example, you don’t need to remember to breathe but you can breathe slower or faster if you want to.
How To Manage Pain Diverting By Your Attention
Your pain naturally draws your attention and the human mind is not really good at focusing on “nothing”. Thus the easiest way to divert the focus from pain is to give your brain something else to focus on.
Depending on your environment and the situation, you might engage in any of the following activities.
1. Watch a Movie
Watching a movie involves several of your senses. If you watch a movie that “absorbes” you in the story, you might get some relief. And maybe you can use it when the pain is more intense during the day.
In choosing the movie also remember how emotions and pain are related. Avoid movies that evoke negative feelings or emotions (e.g. horror), sad stories, or movies depicting people suffering (e.g. war, diseases).
Favor instead stories with positive outcomes, inspirational movies or documentaries. Maybe choose a comedy, if your pain is not amplified by the contractions experienced when laughing!
Lastly, at risk of stating the obvious, choose a movie that you will probably like and keep you really engaged. This will be better than something “too light” that allows your mind to travel back to pain shortly after.
2. Play a Video Game
Research on the subject of using games to distract you from pain showed that people “had more enjoyment, less anxiety and greater reduction in pain with active distraction (i.e. gaming) than with passive distraction” (i.e. TV).
Games have the ability to let you evade your reality. They also require you to perform tasks that involve several areas of your brain. Of course, you also need focused attention to complete them successfully.
Smes suggestions apply as for the movies recommendation above. Especially, stay away from games that will keep you in an overly tense state, rather than a playful environment.
The beauty of meditation is that all you need is… your brain! This means it doesn’t matter if you are quietly lying in bed or standing in a busy and noisy room. If you are not performing an activity that requires your attention for safety (e.g. driving), you can evade pain by placing your attention somewhere else.
If you are new to meditation you might use some help from guided meditations that are designed to hold your hand as your consciousness steps into a new reality. And if you are a seasoned meditator you can focus your attention away from problems in a more spontaneous way.
There are plenty of books on meditation, online courses, and videos online, as well as mobile apps. At MindFlow we have developed interactive experiences that will keep your attention even more engaged. That’s because the meditation flows move at the pace of your feelings.
This makes a profound difference because it will help you keep focused. It will also adapt the experience to what you need in that very moment. Also by requiring your interaction it will keep you even more actively focused which increases its effectiveness.
Meditations to Manage Pain
Here are a few ideas you can use to meditate by yourself or using an app:
- Box Breathing. Focus on breathing in for 4 seconds, hold for 4, breathe out for 4 and finally hold for 4. Then just repeat. Your breath is always present so you can use it to stay focused. Our Pranayama Box Breathing flow allows you to choose from different variants based on your level of experience. The most advanced variant is also designed to lower your heartbeat and activate the vagus nerve. This in turn can create an anti-inflammatory effect.
- Imagine being on a nice beach. The sound of the waves breaking on the shore offers a nice way to connect with nature and feel like you are there. Our Melt with the Ocean flow does this, allowing you to pick the pace of the waves. If you also have an Apple Watch (series 5 or above) it will even automatically regulate the rhythm of the waves to follow your heartbeat. This way your mind will ease naturally into the new peaceful environment at your pace.
- Recall a nice memory: first take a few moments to breathe deeply and relax. Then you can think at any happy moment and relieve it in your mind as many times as you like. Make sure to connect with all the senses and the positive emotions and feel grateful for such a good time. This exercise will not only keep your mind focused on something positive, but it will also stimulate those parts of the brain that release neurotransmitters associated with positive emotions. This combination will actually make you feel better.
Cognitive Appraisal: is pain tolerance mental or physical?
Research shows that your subjective perception of pain from an actual (or potential) harm will change how your brain modulates it. In other words, you can think (consciously or subconsciously) for example that the tightness in your muscles during yoga is:
- a sign that you are getting injured
- a sign that you are becoming more flexible
Based on which of the two options you elaborate on, your brain will react differently. This difference may happen because two separate areas of the brain process
- pain intensity (somatosensory cortex)
- pain unpleasantness (cingulate cortex)
Elaborating one option of the two above instead of the other will make a change in pain unpleasantness even if the intensity is the same. To clarify this a little bit more, you can think of the sensation of heat on your skin. In the first case the water is coming from the kitchen tap on your hand and is unexpectedly hot. In the second case it’s the water of the spa you have been waiting to get in for the whole week. You might feel the same intensity of heat, but the unpleasantness will likely be higher in the first case. This might seem logical when explained like this, but in your day to day life you usually don’t spend a lot of time thinking about how you perceive things. You just perceive them.
Aside from how fascinating this is, it opens an opportunity for you to cope with pain in a better way. How does this work?
How Expectations Can Affect You Manage Pain
Interestingly enough your expectations here play a very critical role in activating (or deactivating) an area of your brain (ventrolateral prefrontal cortex) that can affect how unpleasantly the pain will be perceived.
Specifically, your expectation of being able to cope with pain will automatically make it more tolerable. For example, if you are running and you feel your muscles getting tired and you think “it’s ok, I can run a lot longer before it becomes a problem” this will help you perceive less pain. If instead your thought is “my legs really hurt, I should stop before my muscles break” your brain might give you a different feeling.
As always, this is a subjective call and sometimes is not even something you consciously thin. It just happens because your brain has to react to it in a way or another. In the case of a runner, the risk is to actually get injured if pushing too hard. But think about the case where you have been already told by a doctor to cope with pain temporarily. It could be for instance, because you are waiting for surgery, or that the pain will go away by itself. These are cases where you could help your brain (and yourself) to reduce its the unpleasantness you feel.
This process is sometimes called “reframing”. Think of it as if the pain was a fact, but you can choose which story you are telling yourself. This will, in turn, help you get back control over how you feel.
Reframing: Manage Pain By Changing Yours Story
For example, if you know you did not actually injure your lower back (e.g. because the doctor told you that you are fine) you can choose to think:
- Nobody understands how bad I feel and this is not fair or
- Great. This has to be some lingering feeling of my body readjusting to be stronger than before
You see how nothing changes in the intensity of what you feel per se. Though the more you repeat to yourself the second story and you get convinced of it, the better you will feel quicker than you expect. And this is not because of something you are reading in a blog, but because of how your brain works.
If you need help organizing your thoughts and reframe your mental stories to become positive ones, I designed a Flow that can help you with it. It is also used for changing bad behaviors.
And now that you have learned this “brain trick”, you can consider thinking negative thoughts to be the bad behavior. Then you can explore ways to come up with positive stories that will help you feel better. For example you can use the Change a Bad Behavior Flow which will guide you through it step by step.
Emotional Reaction: can emotions affect you physically?
When you are experiencing pain you might find yourself experiencing negative thoughts tied to corresponding emotions. For instance:
- anger: “why is this happening to me, it’s not fair”
- sadness: “my life is not as good as it used to be any more”
- fear: “my body is severely damaged”
- helplessness: “I don’t think I will ever recover from this”
- anxiety: “I can’t deal with this now, I just can’t handle all this”
By now you know that these thoughts have a negative impact on your willingness to find a way to reduce, cope and deal with pain. But to make it worst, there are also body responses tied to them (i.e. autonomic, endocrine, and immune) that may amplify pain. For example, a prolonged coupling of the presence of pain with some of the emotions above (e.g. anger, fear) can engage the natural brain “fight or flight” instinct resulting in increased blood flow to the muscles which can aggravate the original injury.
Negative Emotions: How They Interfere With Pain
Moreover, the parts of your brain activated by negative emotions (e.g. amygdala, anterior cingulate cortex, and anterior insula) also play a role in focusing your attention towards pain and its unpleasantness. They will aggravate the effects of pain, as you saw in the two prior sections.
Lastly, these negative emotions interfere with the area of your brain (prefrontal cortex) which is the one helping you reappraise pain and perceive that you can deal with it.
This shows you how important it is to manage your emotions and keep a positive attitude. Not only for your psychological well-being, but also to really avoid these emotions becoming a pain amplifier.
Certainly, emotions are not something that you normally plan consciously. You are obviously not actively thinking “now I will have negative thoughts about my situation” and then go ahead and think of them. It’s probably more like the narrating voice in your mind wispering some of the sentences listed before for each of the negative emotions. That will result in pain increasing which in turn will trigger more negative thoughts resulting in a negative spiral.
So how can you break the cycle, substitute negative emotions with positive ones that will reduce pain, and start a virtuous cycle to reduce pain?
How to stay positive when in chronic pain?
Reacting to pain is a choice. And if you choose to do so here are some practical techniques you can start apply literally right now.
Shawn Achor, from Harvard, spent years investigating the science of happiness and came up with a few actions that will turn your thoughts to be positive if you commit to these simple 5 steps every day:
Write down 3 new things you are grateful for
This will focus your attention on what is good in your life rather than the opposite. And now that you know how much the “attention“ plays into your mind and body’s wellbeing, you are probably more clear on its benefits. If you struggle to find something, start from the basics: you can breathe, you are alive, you can read this article that will make your life better. Start small and grow from there.
Journal about a positive experience you had in the last 24h
This is similar to the prior one, the difference is that here you are targeting an actual experience you will have to recall it from your memory. This will bring back the good emotions attached to it so you can relive them again. You can see it as another positive emotion boost that you get “for free”. Think of even small things, a slight improvement from the day before, a positive thought about your own life, or a brief connection with a stranger.
Exercise to whatever extent your body allows you to
Exercising results in your body producing substances (e.g. endorphins, dopamine, norepinephrine, and serotonin) that play an important role in regulating your mood. And now that you know the positive cascade of events that happens in your brain for being in a good mood, you realize how this is a good tool to use. Most importantly this one is completely under your control. You only need to decide to do it and do it.
If a part of your body is injured in a way that prevents you from doing some exercises you could still find practices that will use only your healthy parts, which is still much better than no exercise at all.
Meditate every day
You see how this is a recurring theme that is being used more and more not only in the research of happiness and pain management but also in performance improvement. And by performance we include both intellectual and physical, helping people from world-class professionals to amateur athletes. Here are a few meditations that we have created at MindFlow to help you start the day with the right foot and specifically to manage pain:
- Dawn of the mind is a quick journey to help you start the day with the right intention
- Physical Pain Relief is a slow-paced flow using several of the techniques above to keep your mind away from discomfort and even keep it like that after the flow ends
Make a random act of kindness
This might sound disconnected from the rest of the suggestions. You may think that the one who benefits from an act of kindness is the person receiving it. This is often true, what is also true is that if you perform a random act of kindness your brain will exhibit a special response to it.
For example, it has been discovered that “in altruistic individuals, increased activity in the posterior superior temporal cortex has been reported (when compared with less altruistic individuals). […] Individual acts of kindness release both endorphins and oxytocin, and create new neural connections”. An act of kindness does not need to be anything complicated or planned in advance. It could be something as simple as sending a thank you note. If you are not sure who to sent it to, think at that person who helped you long ago and you have not been in touch with for a while.
If you do all these things every day for at least 21 days you will experience the change in the way your brain operates. And all the mechanisms you now know will decrease pain perception as a result. Not only that, you will feel much better overall and the people around you will start to notice it as well. So you will improve not only your life but also the lives of the ones around you.
Examples of Behavioral Responses to Pain
Last but not least, aside from what happens inside your brain, another important factor capable of determining if the pain perception is reduced or amplified is your behavior.
For instance, if you are suffering from low back pain you might be bracing and sighing. Those signs are interpreted by people around you who might react showing sympathy, generosity, and tolerance.
Another example is that in order to avoid pain you might decide to not engage in some activities you used to in the past. And you might have given them up even if you could partially do them or participate with the additional appropriate precautions.
In both cases, your brain might interpret the absence of pain that results from your behaviors as a good thing (i.e. positive reinforcement). As a result, you might find yourself behaving in the same way even after the pain is reduced or completely gone. Even worst, it can instill the fear that going back to normal life will bring the pain back, and you see how that is a very dangerous path. This is because it might result in functional disability. Which in turn might lead to all the negative emotions we discussed before. Which will end up amplifying pain in case you experience a similar injury or illness in the future.
How To Avoid Pain With Your Brain
What can you do then? After all, you are avoiding certain movements because you are in pain. And your body is feeling better if you don’t make them. This all seems to just make sense. The key factor to break the negative spiral is small and safe progressive checks.
Your doctor can tell you what you can and cannot do, which is a good starting point. He will also suggest what are the common recovery times so you have an idea of when starting your checks in complete safety.
Also as time goes by possibly the therapies you are undergoing are supposed to show some results and you can progressively increase your activity. Doing this carefully and in small steps will ensure that you avoid the risk of making things worst. And will also give you some good evidence when things are indeed going better. For example, as research shows increase in activity through exercise has been resulting in significant benefits in pain, disability, physical impairment, and psychological distress for low back pain patients.
Improvements You Can Implement to Manage Pain
To make sure you don’t accept pain passively, but rather see it as the starting point to work towards improvements you can:
- Maintain self-awareness of your behaviors looking for changes in what you used to do or not do before the pain started. You could also ask people you are close with if they have noticed some of those changes so they help you identify them
- Always follow what your doctor or physician suggests
- Try to push yourself a little bit and in small safe steps to understand your pain threshold when moving or exercising
- Increase your mobility gradually as pain decreases
- Watch out and avoid behaviors that foster negative emotions (e.g. isolation) and modify activities you like when possible, rather than giving up on them completely. This will help you keep your life to be as close as possible to when the pain was not an issue
- Review all the tactics and strategies proposed in this articles that you liked. Identify a few might give a try to because you know they are under your control (e.g. practice gratefulness and meditation)
Remember, pain is not something that is simply happening to you. By now you have at least a couple of things you can see yourself putting into practice to manage pain. I am looking forward to hearing about how they make a difference to make your life better. Let us know in the comments section below!