Behavioral Management of Pain

Overview

These are skills that help people managing pain and discomfort. Just like learning anything new, practice will improve your response. It takes time to feel comfortable with using new skills and know when to use them.

Counterstimulation

Counterstimulation involves using one of your basic senses to send a signal to your brain that opposes the pain signal, to reduce attention and intensity of focus on the pain signals. Stimulation can be light and relaxing, or stronger to block the pain sensation with another. Practice is important to know what your brain is sensitive to. (Practice 3-5 minutes per session, focus on stimuli that are SIMPLE, STRONG, PLEASANT).

Vision

Focus thoughts on details of a single visual stimulus, letting it go in and out of focus, as it wants. Think of things like details in a picture, focusing on a single color or texture, the inside of your eyelids, how your perception is of the dark when eyes are closed, or something external like a flame or image.

Hearing

With eyes closed, focus thoughts on details of a single sound, letting it get louder and softer with focus. Mundane sounds like a fan, outside noise, metronome, or clock, dissecting more complex sounds like a single instrument or simple melody in music.

Smell

With eyes closed, focus thoughts on details of a single, strong smell, breathing in and out. Think of smells that cannot be ignored like strong lotions, concentrates or essential oils, muscle or vapor rub, other pleasant and strong smells.

Taste

With eyes closed, focus on details of a single, strong taste, not chewing or swallowing but letting it sit on your tongue or melt. Think of strong things like hard candy, spicy mint, ice or frozen fruit, chocolate, frozen-juice cube, lemon or fruit slice.

Touch

With eyes closed, focus thoughts on details of whatever you are touching. Stimulate the sense of temperature or pressure with heat, ice, weight on skin, cool water on your wrists, soaking your feet, squeezing or stretching muscles, focusing on body position and single sensory stimuli like your clothes on your body, your body on your seat, your watch band on your wrist, shoes, etc.

Distraction

Distractions work to keep our minds from focusing on pain, reducing attention given to pain, and relaxing our bodies.

Activities

Hobbies, cleaning, call or visit with a friend, games, drink cool or warm fluids slowly. Listen to soothing, or exciting music, sing, hum a well know song to yourself.

Opposite Emotions

Read a book or watch a movie that is OPPOSITE to current emotion, watch cartoons, seek religious material and music, listen to peppy music.

Pushing Away

Leave the situation mentally, build an imaginary wall between self and situation, put pain “on the shelf” - box it up.

Other Thoughts

Count to 10, color, do puzzles, watch TV.

Cognitive Control

Your brain is a powerful pain-relieving tool. You can use your mind to focus away from pain; since pain is susceptible to attention, controlling thoughts can provide you with pain-free times, lost in your thoughts.

Imagery

Imagine relaxing scenes, imagine a secret room inside yourself and see how it is decorated — go in and close the door, imagine everything going well, imagine pain draining out like water out of a pipe. Imagine your desired outcome — what you are doing, what you are experiencing.

Mindfulness in the Moment

Focus entire attention on what you are doing right now, keep in the very moment you are in, stay in the present, focus all attention on sensations in tasks that require little thinking, such as walking, doing dishes, playing sports, cleaning, be aware of how the body moves, do awareness exercises.

Self-Talk

Cheerlead yourself: "I can handle it!" "It won't last forever"; "I will make it out of this"; "I'm doing the best I can!" "I know what to do to feel better."

Relaxation

Relaxation is a great pain reliever. It results in changes to muscle tension, blood flow, breathing, and thinking patterns that remind your body of its own ability to be comfortable. It is especially responsive to practice.

Progressive Muscle Relaxation

Tense and relax muscle groups starting with hands and arms, then going to top of head and working down. Relax by letting go or tensing, then letting go face, neck, shoulder, and half smile with lips slightly upturned with a relaxed face, teeth apart, serene facial expression. Repeat slowly for 2-3 minutes.

Apps/ YouTube

Having someone help guide you with a script can improve your technique (Search relaxation; pain management; child).

Body Awareness

Be mindful of the position of your body, focus on breath, where the body touches an object, and focus entire attention on a sense of connection. Where are your arms? Legs? Moving as little as possible, let the body sink into the sensation of its position.

Deep Breathing

Lie on your back. Focus on the movement of the stomach. Allow the stomach to rise and bring air into lower half of the lungs. Continue for 10 breaths.

Pace Breathing

Using a metronome or the second hand on a clock, listen with your eyes closed to the "click." As you breathe normally, notice the pace of your breath, do you breathe in for 2 clicks? 3 clicks? In for 2 out for 3? Continue to practice for 1-3 minutes.

Authors & Reviewers

Initial publication: July 2020
Current Authors and Reviewers:
Author: Deirdre Caplin, Ph.D.