Top 5 Pain-management Techniques, According to Pain Science

Living with chronic pain is challenging. It can impact, well … everything. But did you know that only a fraction of people living with pain actually have specialist care? This means most people aren’t getting the help they need, so here are some alternatives to medication and surgery that can help people manage pain.

The biopsychosocial approach to better pain management

Given the title of this article, you might think we are going to try and point you to the latest potion, supplement, or magic cure. Nope. We play the long game, and are committed to providing people with methods backed by science, not to fads, false promises, and expensive short-term fixes. We favor methods that give you control, that target improving your biological, psychological, and social well-being.

For the word lovers, we call this a ‘biopsychosocial approach’ – an approach that considers mind, body and lifestyle.

Why are there so many supposed treatments for pain, and how are we supposed to know which ones really help? There are several reasons, but one of the main ones is something called the placebo effect. This is where a treatment that doesn’t actually do anything (a sugar tablet, a fake cream, a salt-water injection, a pretend surgery, a machine that isn’t even switched on) has a pain reducing effect.

Placebos are extraordinary, and in a bizarre twist, some placebos are more effective than others, even though they are all fake. See here: The power of the placebo effect - Emma Bryce. Basically, the more fancy, and the more build up, the more a supposed treatment will relieve pain, the more it will essentially work because people believe it to be “legit”.

Perhaps we’ll go into the science of placebo in another article, but what is important for now is that placebo-based interventions are unlikely to be helpful in the long-term.

So why am I telling you this?

Well the only way we can know if something really works, is to compare it to a placebo or another known treatment in a scientific study. The only way to know which treatments really work is to conduct a test where one group of people get the treatment of interest, and the other gets a placebo (fake treatment), then you compare what happens to each group. Only if the treatment of interest performs better than the placebo can it be declared helpful.

At MoreGoodDays® we only use and share treatments that have gone through this process, those that are evidence-based.

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What does the pain research tell us?

In general, the research tells us that treatments that most consistently help people with chronic pain get back their physical ability and have reduced pain are those we would describe as ‘active treatments’ (see Figure below). These work, because when you do something with your mind or your body, you stimulate your body, immune, and nervous systems in ways that can trigger them to adapt.

You’re always adapting (this is part of being alive!) but the important thing is to make sure you are adapting in the right direction through healthy behaviours and attending to your mental and physical well-being (and not the wrong direction) over the long-term. Treatments classified as ‘passive strategies’ can be helpful if used properly and at the right time, but shouldn’t be the focus of your long-term efforts.

Diagram showing passive therapies (medication, avoidance, rest, supplements, manual therapies such as massage and acupuncture) compared to active therapies (movement, understanding your pain, psychological therapies such as meditation and CBT, and social engagement).

Let’s explore some of these active therapies (movement, understanding your pain, psychological therapies and social engagement), but don’t be overwhelmed. Part of the journey is finding the best ones for you, and sometimes this comes down to your own enjoyment.

Top 5 different ways to manage pain without the use of drugs

1. Let’s get physical

For some people, worrying about damaging their bodies or provoking pain prevents them from doing physical activity. Rest can be useful to recover from acute injury or in a major flare-up, but for the most part, keeping your body active with regular movement is your best bet. We like to say that motion is lotion.

Gentle activities such as walking, yoga, swimming or even cycling can help keep muscles moving. Muscle deconditioning is what happens when you stay inactive for a while; and it can make you weaker and more vulnerable to ongoing aches and pains. You may want to consider a slow and steady build up, especially if you have been inactive for a long time (learn more about pacing). Physical activity can boost endorphins – your brain's feel-good neurotransmitters – so, when you get moving, there can be the extra benefit of improved mood (bonus!).

If you want to take the movement outside, this can be helpful as well (even being close to nature has been shown to lessen pain intensity). It can be worth experimenting to find the right amount of movement for your body and pain condition. Having a trained physiotherapist or exercise physiologist to help guide you through a series of movements designed to preserve or improve your strength and mobility might be just the place to start.

2. Let’s learn about pain science

One of the things driving my relentless cycles through the medical roundabout in the early years of my chronic pain journey was a desperate need to find a reason for my pain. No-one could tell me what was causing it. When I attended a hospital-based pain management clinic and learned about central nervous system sensitization and how pain can become persistent, it was a game changer.

Finally, I understood what was going on inside my body, and crucially, I learned there was no danger – nothing was broken, damaged, injured. This helped ease my worry that things were going to get worse, and helped me understand why I needed to stop focusing on my ‘injury’ and pay more attention on improving my own mental and physical wellbeing. And we now also know that how we understand pain influences the way pain-related information is processed in the brain.

You may want to read that sentence again: “how we understand pain influences the way pain-related information is processed in the brain”. This is pretty huge!

So changing your understanding of pain can even change pain itself. This understanding of pain is the basis of an approach to pain called ‘Pain Reprocessing Therapy’ as well as several pain education approaches,. We include pain education and pain reprocessing therapy in the MoreGoodDays® program not just because it is a great and necessary pathway to other psychological and physical health approaches, but because it might very well change your nervous system in a very positive way. For more information about pain reprocessing therapy.

Evidence-based, multidisciplinary programs offered in hospital clinics or community health settings (often with long waiting lists) often have heavy pain science education components.. Perhaps you could speak to your medical professional about joining the MoreGoodDays® program to help understand your pain condition, reduce symptoms, and improve emotional well-being – all from the comfort of home.

3. Let’s get to know ourselves (mindful awareness)

A pretty common approach to living with pain can be to ignore it, push through, and fight against the pain. I sure did this – for years!

When I was introduced to mindfulness over ten years ago, it allowed me to turn towards my pain experience with self-compassion and greater understanding, which has led to more ease and acceptance. Mindfulness is now a non-negotiable part of my day, both on the cushion in formal meditation, and sprinkled throughout the day with mindful pauses and the simplest mindful activity: a deep, conscious breath!

Why not try it right now? Get free access the SOS toolbox in the MoreGoodDays® app and learn how three-part breathing.

Mindfulness is essentially about cultivating awareness of what’s happening. This can help people living with chronic pain to gain perspective and choice, and address the crippling impact of the real bad guy… excessive worrying. You could learn a few meditations via some free apps (and this can be a great place to start) but evidence suggests that therapeutic programs such as Cognitive Based Therapy, Acceptance and Commitment Therapy, and Mindfulness-Based Stress Reduction, all with aspects of mindfulness, can lead to decreases in the impact pain can have on the lives of those experiencing it.

Let’s take a look at them in more detail.

3a. Cognitive Behavior Therapy (CBT)

CBT is probably the most common psychological approach to treating chronic pain. CBT is an umbrella term for approaches that target the way you think (cognitions) and the way you respond (behave). The point is that sometimes, and unintentionally, the way we think and act can actually maintain our problems. The best example of this is that pain makes us move less, and do less. But then in moving and doing less, we can make the problem worse.

CBT aims to identify what we are doing that is contributing to the problem, and to flip these parts of our thinking and responding around in our favor.

Working with a trained therapist to identify when your thoughts get hijacked, especially by excessive worry about future anticipated pain, gives an opportunity to investigate the impact of those thoughts on your mood and pain levels as a way to modify behavior. It can also highlight how easily thoughts spiral from something quite harmless, to toxic. For example, a thought such as “I am starting to feel sore now” can quickly spiral into “Oh no, here we go again”, “I will never be free of this pain”, “I am letting everyone down”, to “I am a terrible person”.

Identifying, then finding alternatives/changing negative thoughts and their subsequent behaviors, can develop better coping skills, even if the actual level of pain stays the same.

3b. Acceptance & Commitment Therapy (ACT)

For many years I ignored pain, pushed beyond my limits, and I had a constant battle with my body. I ignored pain, hoping it would just go away. Guess what? It didn't, in fact, it just got worse. There’s a great analogy in Russ Harris’s classic book on ACT, The Happiness Trap, where he explains trying to control a situation (for example, my attempt to ‘control’ pain by ignoring it).

“It's like holding a ball underwater. As long as you keep holding it down, it stays underwater, but eventually your arm gets tired, and the moment you release your grip, the ball leaps straight out of the water.”

Acceptance and Commitment Therapy brings mindful awareness to situations to develop a flexible mind-set. This means you are more able to adapt to situations with awareness, openness and focus, so you can bring a more accepting attitude as well as take effective action, guided by your values. The connection to values is important as it provides guidance and motivation so you can make important changes.

3c. Mindfulness-Based Stress Reduction (MBSR)

Mindfulness is about practicing staying in the present moment. When we get constantly stuck worrying about the future or ruminating over the past, we can miss the small moments of joy right in front of us. We’ve all had those moments, right? You’re caught up watching something beautiful like a clear blue sky, or listening to the contagious giggle of a baby, or lost in an activity you love, in “flow”. By practicing mindfulness, we can learn to stretch out these moments of present-focused awareness. We can also learn to identify situations, thoughts and behaviors that trigger pain, and this opens up more choice.

Created by Jon Kabat Zinn in the late 70s, the 8-week MBSR program outlines formal and informal practices to help understand your common responses to stressful situations (and living with chronic pain, we acknowledge you certainly have a BIG stressful situation going on). Developing a different relationship to stressors in your life can help with reducing pain symptoms (or reducing your allostatic load).

4. Let’s nourish our bodies

Diet as a medical intervention can be subjective. It seems every person and their dog will suggest a new fad diet you just have to try. One area where diet can play a role, is in reducing inflammation in the body. Inflammation is a normal process, but when it is increased, we are more sensitive.  Studies show that diet alone can reduce pain by a whole 1 point out of 10. And if you are living with elevated pain levels, a single point can make a real difference!

At the same time, a healthy diet also can reduce the risk of various diseases and conditions such as diabetes, arthritis and cardiovascular disease, which are all linked to chronic inflammation. So all up, modifications to your diet could provide a valuable option in your overall plan.

Okay, so you’re telling me healthy eating reduces systemic inflammation, but what exactly does that look like?

The key factors in an anti-inflammatory diet include sticking to more wholefoods, especially those with anti-inflammatory properties such as fruits, vegetables, healthy fats, antioxidants, while also decreasing inflammatory foods which may include gluten, sugar and processed foods. Low-carbohydrate diets and Mediterranean diets have been shown to be especially promising dietary interventions. A dietician or nutritionist can suggest the right diet for your lifestyle and pain.

5. Let’s harness the vibe of the tribe

Remember that biopsychosocial model of pain management?

Well, for our last technique, we harness the ‘social’ power of this model. Pain is present in your lifestyle, including during your social life, right? So, while the techniques above tackle the mind and body parts, this one is all about the social parts of living with pain.

Pain can impact how you interact with the world around you. Perhaps you start avoiding social gatherings, worried they will increase your pain, or because you have overwhelming feelings of not being understood or supported by those around you. Withdrawal is a common reaction to living with chronic pain. A pain support program in a group setting may help address these concerns.

By working together with other people living with chronic pain, group-based pain management programs teach various self-management strategies to aid and enhance active coping skills. They’ve been shown to reduce pain intensity, enhance function, decrease negative psychological or emotional symptoms, and improve quality of life. In such settings, people living with pain can find relief in knowing they are not alone – other people in the group understand exactly what they are going through.

The group can share experiences and goals, supportive feedback, inspiration and accountability. For example, maybe you commit to trying something new or building on your previous walking distance, and when you show up to the group the next time, you know that everyone is going to ask: did you do it? This can be a pretty motivating factor in your commitment to pain management strategies.

A bit of a caveat on groups. We are talking about the supportive, solutions-focused ones, not the whinge fests. Yes, it can help to share the challenges, but have you heard of the saying where the mind goes, energy flows? If you spend the entire group hearing tales of woe and comparing stories of how hard it is living with pain, without any solutions, you could end up feeling more deflated than when you began. Choose your group with care.

If you want to join an online group, feel supported and learn from the latest research and evidence about living well with fibromyalgia, perhaps consider joining our *new* Facebook Community.