Relaxation techniques for pain management

Stress can occur as a result of pain, but it can also worsen pain resulting in a vicious cycle. Consequently, stress management skills and relaxation techniques can play an important role in the management of chronic pain.

When you are stressed your sympathetic nervous system (SNS) triggers the fight or flight response and the hormones adrenalin and cortisol are released. Among other physical effects, this can cause tension in your muscles and inflammation in the body resulting in elevated levels of pain.

Relaxation techniques are strategies you can use to reduce stress and the impact it has on your body. They work by activating your parasympathetic nervous system (PSNS) which slows down the sympathetic response by reducing stress hormone production. Typically, the sympathetic and parasympathetic systems work in opposition to each other and you can think of the sympathetic response as the accelerator and the parasympathetic response as the brakes.

Relaxation techniques are a method of triggering your parasympathetic system into action, thus reducing the stress response and the effects it has on your body and experience of pain.

Throughout this booklet we will outline some different relaxation techniques that you can try. Depending on personal preference and your health condition, some techniques might be easier than others, so do not be disheartened if some techniques do not work so well for you. Also, remember that these techniques take practise and they will become easier the more that you practise them.

Square breathing is a technique that helps you to slow down and regulate your breathing pattern.

How to do it

Start by picturing a square in front of you.

Take your index finger and slowly trace the top edge of the square whilst breathing in through your nose for four seconds.

Then trace your finger down the right edge of the square whilst holding your breath for four seconds.

Now trace your finger along the bottom of the square whilst slowly breathing out through your mouth for four seconds.

Finally, trace the last edge of the square whilst holding your breath for a further four seconds.

Repeat this process for around five minutes or until you begin to feel calm.

Diaphragmatic breathing (sometimes called belly or abdominal breathing) is a deep breathing technique that involves taking long, slow and deep breaths from the diaphragm. It can be used in a variety of situations to help relieve symptoms of stress and anxiety.

Often when we are anxious we take shallow breaths from the chest in quick succession. This can signal a stress response to the body causing the SNS to kick in. However, when we are relaxed, we tend to take slow, deep and even breaths.

We can trigger the PSNS and relaxation response by altering our breathing to mimic one that is typical of when we are in a relaxed state.

How to do it

Get into a comfortable position and place one hand on your chest and the other on your stomach.

Take some breaths and notice which of your hands move as you breathe. If the hand on your chest moves the most, you are not using the lower part of your lungs/diaphragm.

Take a deep breath in through your nose. You should notice the hand on your stomach move outwards as your stomach expands. As you breathe in, imagine the air passing from your nose, down past your throat and chest into your stomach.

Take a deep breath in through your nose. You should notice the hand on your stomach move outwards as your stomach expands. As you breathe in, imagine the air passing from your nose, down past your throat and chest into your stomach.

Repeat this process for 5-10 minutes.

PMR is a deep muscle relaxation method that helps you to relieve tension by systematically tensing and relaxing different muscle groups in the body. When we are anxious or stressed, we tend not to realise that we are holding tension in our muscles, which can aggravate pain. By practicing this technique it helps you to realise when your muscles are tense.

How to do it

Find a comfortable position either sitting or lying down.

Focus on a specific part of the body (e.g. your feet).

Breathe in and tense the muscle group for 10 seconds (e.g. curl your toes tightly together). Focus on the tension you can feel in the muscles.

Breathe out and relax the muscle group (e.g. uncurl your toes). Pay attention to the sensation of the tension melting away.

Repeat this process for the muscle group a few times or until the muscle group feels relaxed.

You can then move onto another muscle group of your choice. By starting with your toes you can systematically work upwards and target every major muscle group in the body (e.g. feet, legs, stomach, arms, back, shoulders and neck).

 
Feet: Curl your toes downwards and tightly together.

 Lower legs: Flex your feet pointing your toes towards you, feeling the tension in your calves.



 Upper legs: Flex your feet and straighten your legs feeling the tension in your thighs.



 Buttocks: Clench your buttocks together.

 Stomach: Pull your stomach in and tighten your abdominal muscles.
 

Hands: Clench your hands tightly making a fist.

 Arms: Flex your biceps by bending your forearm towards your shoulder.

 Upper back: Pull your shoulders back.



 Chest: Take a deep breathe in and hold.



 Neck and shoulders: Shrug your shoulders up towards your ears.



 Jaw: Open your mouth as wide as comfortably possible.

 Eyes: Squeeze your eyes tightly shut.

 Forehead: Tightly frown.

Calming imagery is a relaxation technique that relies on your imagination to take you to a place where you feel calm, peaceful and content. This can be used in isolation or alongside some of the techniques mentioned previously. Calming imagery can be used in a variety of situations but works best in an environment free from distractions.

How to do it

Make yourself comfortable, close your eyes and take a few deep breaths.


Imagine a setting where you feel calm, tranquil and relaxed. This should be personal to you but a few common examples include a beach, forest, open field or a favourite location from your childhood.

Turn your attention to your senses. What can you see, hear, smell, feel and taste? Imagine each sense in detail. Can you hear wildlife in the trees? Can you taste the salt in the sea air? Can you feel a breeze across your skin?

Turn your attention to your senses. What can you see, hear, smell, feel and taste? Imagine each sense in detail. Can you hear wildlife in the trees? Can you taste the salt in the sea air? Can you feel a breeze across your skin?

After 5-10 minutes of visualisation or once you feel ready, open your eyes and bring your attention back to the present.

Remember how you felt during the visualisation and try to carry this back with you into the present, remembering you can return to your scene at any point.
 

Use audio tracks to help relax your body and mind and build your confidence.

Breathing exercises, relaxing music and games to help calm your mind and change negative thoughts.







Use breathing techniques to help you relax more, worry less and feel better

For more information: www.nhs.uk/apps-library/category/mental-health/