Relaxation Training / Common Problem of Pain

Relaxation training is one of the most effective treatments for pain. For certain types of pain, e.g. tension headache, it is at least as effective as drugs, without any adverse side effects. Relaxation training has many other benefits as well, including a pleasant experience, a greater degree of self-control, less difficulty falling asleep, decreased blood pressure, less irritability, and a more positive outlook on life.

The reason relaxation training is so effective is because it works on the Emotional component of pain - our natural tendency to fight or escape from the Sensation of pain. This attempt to fight or escape is unpleasant itself, and it causes profound physiological changes that intensify the Sensation of pain. Thus we end up caught in a "spiral of agony", in which the Emotional component of pain intensifies the Sensation component, and vice versa.

The interaction of the Emotional and Sensation components is particularly evident in the most common types of pain, lower back pain and headache. When a person has back pain, the normal tendency is to fight the pain and to try to protect against it.  Unfortunately, this creates a lot of muscle tension, which makes the pain much worse. The muscle tension puts more pressure on disks and nerves, and is also a primary cause of pain as the muscles fatigue and cramp. Because the back pain sufferer wants to escape from the pain, there is a desperate attempt to turn attention away from the source. Thus the poor victim cannot tell that an additional cause of pain is the muscle tension - the sufferer is not paying attention. With headache pain there is a similar reaction. The headache sufferer attempts to brace and defend against the pain, but this creates muscle tension, along with blood vessel and hormonal changes that pour gasoline on the fire of suffering.

One way to break this spiral of agony is to reduce the Emotional component of pain by learning to relax at will. Relaxation is the opposite of the fight or flight defensive reaction. Relaxation feels good, while fight/flight feels bad. When you are relaxed, you are content with things the way they are - you are not struggling to change them. Relaxation is also a reposed state that conserves energy, whereas the intensity of the fight/flight reaction wastes energy.

It is very difficult for many people to relax. It is particularly difficult if you are unaware of how stressed you are. Relaxation training involves learning to become aware of how much you are stressed or tense. It also involves learning to relax your muscles, and to lower your general state of nervous arousal. With practice, most people can learn to become aware of their state of stress, and to relax when needed.

Relaxation is particularly effective as a preventative measure for certain types of pain, including headache, backache, and TMJ (temporomandibular joint pain, or jaw pain). By learning to relax and de-stress before you experience pain, you can prevent its onset. Relaxation can also be used to break out of the spiral of agony after the pain has started, but this takes much more practice because it is more difficult to employ. It takes great skill to relax completely in the face of an assault of pain.

The most common type of relaxation training is progressive muscle relaxation. In this technique you go through the body, tensing and relaxing major muscle groups in turn. For example, you start with your lower body, tensing the muscles in the calves, and then releasing them. Then you move up the body, tensing and relaxing the muscles in the upper legs, and so on. The reason for tensing the muscles first is so that you become aware of the difference between tension and relaxation. This awareness is key in learning to detect when you are stressed, so it is crucial that you pay attention to the difference in feeling between tension and relaxation.

Below is a script you can use to learn progressive muscle relaxation. You can record this on tape, or you can simply perform the exercise as you read it. After doing it a few times you will remember the procedure. There are a few general guidelines for learning this technique. First, choose a warm, comfortable place. Second, always breathe deeply through your abdomen, not your chest. This takes practice. When you are stressed or engaged in fight/flight, your stomach tightens and your breathing is shallow. To counteract this, soften your belly and breathe deeply. Place your hand over your abdomen and take a deep breath in and out. Let the air flow in low. Your stomach should rise and fall with your breathing. Your chest and shoulders should be relaxed. Finally, make sure you allocate enough time to do it. You should spend at least a minute on each body part, and you should do it when you are not rushed or preoccupied with other things. It only takes about ten minutes. Practice at least twice a day. First thing in the morning and the last thing at night are ideal. This technique will help you start the day relaxed and refreshed, and will also help you fall asleep at night. It is normal for busy thoughts to intrude while you are learning this technique. This problem will lessen as you continue to practice. Do not get frustrated by these intrusive thoughts - simply return to your practice when the thoughts are over.

Here is a script that also includes a bit of relaxing imagery:

Find a place that's comfortable and quiet, and sit or lie down. Make sure you are warm, and cover your legs and feet if you need to.

Close your eyes (if you are not reading this) and relax. Just let go.

Now let's take a couple of deep breaths. Start with an exhale, gently emptying the air from your lungs. Push out as much air as you can while still remaining relaxed. Now breathe in, letting the air expand your tummy. Keep your chest relaxed, and breathe in as much as you can. Hold the air in your lungs while you count to three (one, two, three).  Now exhale with a sigh. Relax, and let go of all your tensions. One more deep breath in, hold it for a count of three (one, two, three).  Now exhale with a sigh. Feel the tension leaving with your out-breath. You feel more relaxed with every breath.

Bring your awareness down to your feet. As you breathe slowly and deeply,stretch out your toes. Now flex them back. Feel the tension in your feet. Now breathe out slowly, and let go of all tension in your feet.Your feet are relaxed now. Feel that relaxation. Your feet feel heavy and warm.

Bring your awareness to your legs, buttocks, and stomach. As you breathe in slowly and deeply, press your legs down and squeeze your buttocks together. Now lift up on your legs and tighten your stomach. Feel the tension in your legs, buttocks, and stomach. Now breathe out, and let go of all tension. Exhale all the air. Imagine your legs melting like butter in the sun. Be aware of the feeling in your lower body. It is relaxed and warm now.

Bring your awareness to your lower back and stomach. Exhale and squeeze your stomach in tightly. Now as you inhale deeply, push your stomach out and arch your lower back. Feel the tension in your stomach and back. Now breathe out slowly and let go. Your stomach and back are relaxed now. Feel the relaxation.

Bring your awareness to your upper back and shoulders. As you breathe in, shrug your shoulders tightly up against your ears. Now squeeze your shoulder blades back and together. Feel the tension. Now breathe out slowly and let go of all tension. Exhale all the air. Be aware of the feeling in your shoulders and upper back. They are relaxed now. Your arms feel like they are sinking in warm water. Your hands feel heavy and very warm.

Bring your awareness to your jaw, face, and temples. As you inhale deeply, close your eyes and jaw tightly, and squeeze up your face. Now open your jaw and tense your neck. Feel the tension. Now breathe out slowly and let go of all the tension. Your head and neck are relaxed now. Feel the relaxation.

Imagine a cool breeze gently blowing across your face. Your head feels cool and light. Your whole body is relaxed and calm.

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Pain - The Most Common Problem

Pain is the most common medical problem, and it accounts for the most trips to medical professionals. Headache is the most common pain complaint if we combine all types of headache, for example, migraine, cluster, tension, etc. Chronic lower back pain alone is the most frequent cause of visits to physicians' offices, with the exception of the common cold.  Estimates are that from 60%-80% of the population will suffer from lower back pain at some time in their lives. Twelve percent of all sick leave is taken because of lower back pain, and lower back pain accounts for 25% of all compensatable disabilities in the workplace. Fortunately, psychological intervention is very effective in relieving pain in these areas. Several modern studies have found that conventional psychological approaches are at least as effective as drugs.© 2020 by Dr. Ken Pfeiffer