Low-Energy Pain Management Techniques

Here are some low energy strategies for managing chronic pain. Not all of the strategies will work for everyone. Find the things that help YOU, even if only by 10%. Experiment. Stack techniques. Go easy on yourself.

Cognitive Strategies

1. Grounding - finding a way to bring yourself back to the present moment if you start drowning in #pain or getting caught in negative thought spirals can be hugely helpful. There are millions of ideas for how to ground yourself on the internet (here are some of the ones I like). It’s worth it to experiment and find a few that work well for you.

2. Unbracing - if you’re in pain (or under stress of any kind, for that matter), odds are you’re bracing yourself against it somehow. Take a quick scan of your body and see if you can identify any areas of tightness. See if you can release that tightness. (Some muscles are harder to release than others - but even just unclenching your jaw and dropping your shoulders is a start). Your body will inevitably tighten up again, but the more frequently you consciously reverse it, the quicker your nervous system will get the message that “hey, wait, maybe I don’t need to keep these muscles so damn tight.”

3. Mindfulness meditation – there's a reason #mindfulness is all the rage - being able to observe thoughts and sensations in the moment without judgment can make a huge difference to mental well-being, especially when you are dealing with chronic pain. Mindfulness is a good thing to work on in therapy, but there also are written prompts and guided audio you can find online that can help you develop your mindfulness "muscle". There also are a variety of apps, many of which have free content (e.g., Headspace, InsightTimer, Calm).* There are even many pain-specific mindfulness meditations out there. But if meditation is not your thing, no problem, there are many other ways to develop the mindfulness muscle that we can discuss.

4. Distress tolerance/distraction – finding something(s) that can hold your attention when you're in pain, even briefly (e.g., puzzles, reading, video games) is what Dialectical Behavior Therapy #DBT refers to as developing "distress tolerance," and it's another simple but useful skill to build. Try to find something that you really enjoy and find engaging (i.e., that might hold your attention despite the pain, even if only for a few minutes) but that also doesn't require a ton of energy. There are a few suggestions below, but it’s really best if ideas come from you and what you have enjoyed in the past.

5. Turning towards - really focusing in on your pain and its sensory qualities (e.g., location, intensity, and quality). Although it seems counterintuitive, sometimes turning towards your pain and paying close attention to it is the best (and sometimes only) option. Be curious. Often it helps to shift things. Alternating attention between a painful area and an area of your body in less pain (if you can find one) also can start to shift things.

6. Guided imagery – mentally picturing peaceful, calming scenes. If you are a visual person, it can help to create a mental “calm space.” Escaping into an imaginary space can absolutely impact your real world physiology. Developing this space with someone else (like a therapist) seems to work particularly well because it really helps you flesh out the sensory details.

7. Cognitive reframing – changing negative thought patterns about pain. This is a core Cognitive Behavioral Therapy #CBT approach, and is more of a long-term project to work on (e.g., in therapy). But in the moment, at least trying to check yourself if you find yourself catastrophizing, can be a good place to start. The body is meant to interpret a pain signal as danger, but when pain is chronic that often is not the case. Noticing and naming the pain loops can be a way to de-link the automatic pain=threat association and turn down the harm alarm (e.g., “this is just my shoulder getting angry about me doing that weeding, it's not a real threat”). This can be easier said than done at times, for sure.

8. Acceptance & Commitment Therapy #ACT – accepting pain while committing to values-based action. Again, this is more of a longer term project that often works best with the help of a professional. But in the moment, remembering your values can help you to commit to staying engaged and working towards your goals even in the face of pain.

9. Mental storytelling – imagining pain as a character or force that you dialogue with, or getting creative in some other way (e.g., drawing your pain) can help to shift your relationship with it.

10. Gratitude journaling – focusing the mind on what’s still good or meaningful. Spending some time really being back in the moment you are grateful for can help to counterbalance our brain’s innate negativity bias. Taking a few minutes jotting down what you were grateful for that day can make a big difference, even if it seems hard or hokey at first. If you get into the habit, you'll find that you start to notice those moments more as they happen, too.

11. Visualization – mentally imagining what’s happening in your body also can help to change your relationship with the pain; understanding the anatomy and physiology of what’s going on can create some distance from the pain and reduce some of the emotional component.

12. Emotional vocabulary - In her book, How Emotions are Made, Lisa Feldman Barrett argues that increasing your emotional vocabulary can help you to regulate your emotions more efficiently. There are apps that can help with this (e.g., by prompting you to identify specific emotions you are feeling in the moment), or you can do it yourself by setting an alarm and trying to identify what emotion you are feeling when it goes off (you can consult an emotion wheel for ideas). Another way to start to think in a more nuanced way about emotions is by journaling about a meaningful event that occurred recently and working to really identify the emotion(s) you experienced, how it felt in the body, what thoughts or urges accompanied it, and what came before and after. While this isn’t directly related to pain, being able to efficiently regulate your emotions certainly can’t hurt.

    
    

Emotional Support & Social Connection

1. Talk with a trusted friend – even a short conversation can reduce emotional pain and engage the calming and restorative #parasympathetic nervous system. A hug is even better. Fight the urge to isolate. Pain will make your nervous system feel like the world is out to get you, try to recognize that your brain is on threat-detection mode and therefore may not be the most objective at assessing social dynamics.

2. Support groups – find communities of people with similar conditions. Facebook is often a good place to find online groups, but they also can be a mixed blessing. If it seems to just be people sharing war stories rather than offering support and encouragement, it’s probably not useful. You can sometimes find online or even in person support groups on MeetUp.com, through non-profits and advocacy organization websites, and through hospital websites.

3. Writing – #journaling about emotions and experiences related to the pain. Even if you’re not up for talking with someone else, writing in a journal can be helpful.

4. Letter writing – writing letters to people (not to be sent) to process emotional pain. Pain is processed in the same networks of the brain, regardless of whether it’s emotional or physical - so working through emotional pain can help to lighten the overall load. (We’ll work on this in sessions, too!)

Restorative & Comforting Practices

1. Sleep - this is number one for many, many reasons. Sleep impacts pain perception, emotional reactivity, and executive functioning, among many other core mental processes. It’s much harder to inhibit reactivity when energy is low, and regardless of whether you are dealing with physical or emotional pain, being able to choose your response when you really have to is important, and sleep seems to really help those inhibitory neurons do their thing. There’s a vicious cycle it’s easy to fall into where pain (either physical or emotional) disrupts sleep which reduces ability to handle pain - so prioritizing sleep when you can is important. (If sleep is elusive, NSDR or yoga nidra seem to have similar benefits for many.) Remember to give yourself permission to rest. Remember you deserve the care and concern you give to others. Remember that very little gets solved at 3am, so you might as well sleep anyway. Research suggests sticking to a fairly set sleep schedule (independent of duration) and getting sun pretty soon after waking are both also quite good to do, if you can.

2. Comfort positioning – finding and using optimal body positions to reduce strain. Even brief moments of greater comfort make a difference, so find an extra pillow, squeeze that squishmallow, or buy that support brace (and don’t be ashamed to use it!). Check the ergonomics of your work set-up while you’re at it, too - it can have a surprisingly large impact. 

3. Ice and heat – heat is soothing and helps to reduce stress and increase blood flow - it can help reduce muscle tension and relax cramps. Ice can also help, especially acute injuries and swelling, but it also can provide distraction from other types of pain. Lotions and patches that activate the temperature-sensing receptors on nerves can also be helpful - biofreeze, icyhot, etc..

4. Breathing exercises – box breathing will help restore balance to your nervous system, 4-7-8 breathing will help increase calm by activating the parasympathetic nervous system. If those don’t do the trick for you, there are others to try. I have a handout on breathing and non-breathing ways to activate the parasympathetic nervous system and increase calm.

5. Connect to nature - the science keeps backing this up - getting out into nature or connecting with it in some way is good for your health. Go for a walk, take care of a plant, even just looking out your window is helpful. Focusing your eyes on a point far away on the horizon helps to reduce sympathetic nervous system activation (weird, but true!), while staring at the clouds, the sky, and the stars, can trigger awe, which helps to counterbalance all the danger input your brain is getting in the form of pain signals. A walk in nature (ideally alone with no phone) also can boost “directed attention”, which in chronic pain world translates to increased resources to block out pain noise so you can focus on accomplishing what you want to do.

6. Body scans – mentally moving attention through the body to notice sensations helps to shift the focus from the emotional component of pain to the sensory experience. There are many guided audio versions of this available (e.g., on YouTube, Spotify, iTunes, etc.).

7. Progressive muscle relaxation – sequentially tensing and releasing muscles (can be done lying down) is helpful for similar reasons and can also reduce muscle tension. I can give you a script or guided audio, or you can find a million versions online.

8. Aromatherapy – using calming scents like lavender or chamomile. Our nervous system reacts most strongly to smell, so if there is a scent you find soothing - make use of it.

9. Reducing sensory noise - doing what you can to reduce the number of things that might irritate your nervous system can help free up resources to better tolerate your pain - that can mean turning down lighting, switching to calming music, or wearing soothing fabrics. It might also mean cleaning up your living space so the clutter doesn’t further stress you out.

10. Play with a pet - Playing with a pet helps to calm the nervous system and get the parasympathetic nervous system and the social engagement system back online. Even just looking at pictures of a beloved pet can do wonders for a jacked up nervous system.

11. Move - even when it’s the last thing you want to do. Moving in any way you can tolerate almost always helps to shift something. Even a short walk might help in the moment. Longer term - the hype is true- exercise is good for you. But you have to balance that with the physical toll it may take and the energy it uses. Trying to find something that helps more than it hurts is typically a good investment of your time.

12. Cry - chronic pain sucks and there’s much to grieve. Sometimes crying is the best option. It will not last forever, and it can help the emotions to move through you.

Spiritual & Reflective Practices

1. Prayer or spiritual reading – Even if you’re not a prayer person, philosophy and poetry can often be soothing when health is poor. Finding something that helps you to make sense of your experience or to find meaning can help when things are otherwise pretty bleak. Poetry can be more manageable when pain is wreaking havoc on your attention span.

2. Setting daily intentions – writing hopes, wishes, or goals for the day can help motivate you to live in line with your values and keep you looking out for the good things, rather than constantly scanning for threats, as the pain brain is so apt to do.

3. Affirmations - I have a complicated relationship with affirmations. On the one hand, they feel a bit like advice to "just think positive" which is really not helpful (and often infuriating and dismissive). On the other hand, I have seen affirmations really help. Research suggests that when they are individually tailored, values-based, and realistic, affirmations can reduce stress and provide a boost to well-being. If you're interested, we can work together to construct some affirmations that resonate with you.

4. Gratitude - I already mentioned gratitude journaling under Cognitive Strategies, but it’s worth mentioning again since the research keeps piling up (e.g., here, here, here, here, and here.). Reflecting on what’s good and what you’re grateful for is a simple way to improve your health and mental outlook. 

Distraction Techniques

1. Audiobooks/podcasts – Immersive distractions are great when you’re riding out the pain. Listening to something comforting before bed can be both soothing and distract from needless mind monkeys. 

2. Watching comfort shows or movies – lighthearted or familiar tv shows and movies. Laughter is wonderful for all kinds of reasons if you can muster it.

3. Learning something new – if serious study is too difficult right now, language apps, trivia, or memory games can provide brief bursts of distraction.

4. Mental games – such as crossword puzzles or Sudoku. Even the mindless ones can be helpful at times.

5. Coloring or drawing – even abstract doodles can help shift focus and coloring can be meditative; you can use apps to do both if pen and paper is too much effort.

6. Knitting or handcrafts – if hand movement is manageable, creativity can be restorative.

I have many lists of additional ideas - if you are struggling to find something, we can scour them.

Body Budgeting

1. Creating a routine – routine can be just as important as nutrition and exercise for well-being; predictability helps ease anxiety. It also helps you to figure out how to budget your energy and resources to minimize how much your pain interferes.

2. Setting small goals – breaking goals down into manageable tasks helps provide a sense of purpose and increase motivation, plus checking off those items can be oh-so-satisfying.

3. Pacing – balancing activity and rest to avoid flare-ups. Chronic pain is a marathon. It is super tempting to go all out when you’re feeling okay, but pacing is critical. 

4. Tracking symptoms –Tracking what hurts and helps allows you to have greater control over your well-being. When you can predict how activities will impact you, you can allocate your spoons more effectively. Relying on pain brain to make the best decision in the moment is also fraught, so having past data can be really useful for improving choices. We can build a tracker if we have not already.

5. Nutrition - Sometimes just being able to eat anything at all is a victory, I know. But when you can, try to put good, whole, nutritious foods into your body. It helps with energy levels, among many other things. Some people swear by anti-inflammatory diets, others by anti-histamine or low FODMAP. Do what’s best for you. We can find a dietician if you need help - insurance often covers them these days.

6. Supplements - Many people with chronic illness have a Vitamin D deficiency at the very least, so if you haven’t recently, it might be time to get some bloodwork. Correcting deficiencies with supplementation or diet often can provide an energy boost. Magnesium is another big one when it comes to chronic pain - talk to your doctor about whether you ought to be boosting it or anything else. Examine.com seems to be a good resource when checking if supplements have any scientific support.

*Please use your own judgment when it comes to apps and websites, I'm mentioning these as examples but I have not thoroughly vetted them.