Understanding relaxation therapy for the use in managing Pain

The International Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”.

The use of relaxation therapy in the self-management of pain has extensively been researched over the years and in most cases has been found to be effective as a tool. The reasoning behind this is that pain is a primitive sensation meaning that it is crucial to our survival. When we therefore experience pain, the brain automatically perceive it as a threat, activating our flight or fight response. This stress response has a direct effect on how our muscles react. When you therefore experience pain in the back for example, the muscles naturally will respond to protect, which is normal and expected. However, how we emotionally then respond to the pain can either enhance or decrease some of the “normal” muscle spasm. This is where the awareness of relaxation therapy can be helpful. It is another tool in the box in conjunction with medication, heat or exercises as none alone eliminate the pain completely, however, in combination the tools can help to reduce the symptoms to a more manageable level (well - in most cases).

How you approach relaxation is different for anyone as our emotional resilience is different. Most importantly, is to be aware that relaxation therapy is not just sitting and reading a book or watching television. It is an active involvement with your body. It is also something just like any exercise that you will need to train the brain to do. Many conversations that I have with people reveal that they have over active minds and this impacts on their ability to sleep. Especially, in today’s climate where everything is on demand and we are always “switched on”. Life never really stop – unless you choose to take time out.

The following are relaxation techniques that can be used in order to gradually build on your ability to be “quiet”. The mind does not like being bored and will naturally seek for something to focus on. Hence why pain often can be worse in the middle of the night – no distraction and also why quite often we say being busy is better than bed rest.

So reviewing the above – Relaxation helps

To decrease the flight-fight response
Acts as a distraction, keeping the mind busy but in a more positive way than aimlessly scrolling through facebook and twitter
Decrease the threat – pain is ok, not helpful at the moment, but ok

Breathing exercises

This can be done in sitting or lying and only needs to be done initially for a few minutes

To control your breathing:

Place one hand on your chest and the other over your stomach. You want your stomach to move more than your chest as you breathe. It is what we call diaghragmatic breathing or abdominal breathing. Allowing the air to go down in the biggest part of the lungs.
Take a slow, regular breath in (through your nose if you can). Watch your hands as you breathe in. The hand on your stomach should move and your chest should not
Breathe out slowly through pursed lips
Once you are able to relax the stomach, try to breathe in for 4 counts and out for 6, to help slow your breathing down
Lastly, try to tell the brain to relax, it is ok – you are ok
Repeat this 5-10 times, twice a day and then gradually increase the time.

If the mind starts to wonder and you are thinking of all the things you need to do and all the current worries, then try to incorporate some principles of mindfulness. Keeping the brain distracted by using more senses – listen to what sounds are around you, see what is in the room or in the garden. I mean, really lookas if you see it for the first time. Or, just become more aware of your body, the heaviness, your heart beat, are you happy or sad. It is just being aware – you are not judging yourself or your environment you are just mindful that you are part of everything. Throughout just try to keep your breathing slow and regular.

Progressive or quick muscle relaxation

Some people prefer to do this particular technique as you are more actively involve in the whole process. This exercise will teach you to recognise and reduce muscle tension. You can relieve tension in any part of your body just by tensing and relaxing each muscle in turn.

You can therefore make it as long or as short as you have time for and can start in any body part. This is an example of quick muscle relaxation and can be used at any stage.

Sitting in a comfortable chair:

Close your eyes and concentrate on your breathing. Slowly breath in through your nose and out through your mouth
Make a fist, squeezing your hand tightly
Hold this for a few seconds, noticing the tension
Slowly open your fingers and feel the difference — notice the tension leaving. Your hand is much lighter and relaxed. enjoy this feeling

If a given area is particularly painful, then just skip that area and move on to another.

This technique can gradually move into visualisation, by imagining the energy within the muscles flowing out through the fingertips or toes as you relax or the energy/tension is sinking into the mattress and flowing out of the bedroom door.

Visualisation

This technique involve imagery – focusing completely away from the body and the here and now. And can be difficult to master for the over active mind. We all like to have a sense of control and this technique takes time to learn to let go and for some can be quite scary. It is therefore advisable to start in short bursts – allowing 5 minutes that you gradually increase as the mind gets use to not being “READY” all the time.

Before you start relaxing, make sure your mind, body and surroundings are just right. To prepare yourself:

find a cool and quiet room where you'll not be disturbed
lie down or sit comfortably with your legs uncrossed
put on comfortable clothes and take off your shoes
lightly close your eyes, or focus on a spot in front of you
clear your thoughts and focus on your breath

Create in your mind an ideal spot to relax. It can be:

real or imaginary
somewhere you will find restful, calming, safe and happy
a place you would want to return to whenever you feel the need to relax

Imagine it in as much detail as you can – use your senses to make it as real as possible – and see yourself comfortably enjoying this place.

Now close your eyes and take a slow, regular breath in through your nose. Become aware of your breathing. Focus on your relaxation place in all its detail and breathe out through your mouth.

When you are comfortable with the sense of “letting go” not having to be on full alert you can move on to meditation which enhance the technique. Or some therapist teach what we call pain manipulation. It is a technique that combine visualisation and meditation and takes a lot of work.

Quick relaxation

Once you've mastered some relaxation exercises you can use them whenever, and wherever, you need to throughout the day.

To do this you can use a 'cue' or reminder, something that'll catch your eye and remind you to:

drop your shoulders
check your breathing
relax the muscles in your body

An example of a 'cue' could be a small coloured dot on your watch, or a room in your home or a specific task or sitting at the traffic light, waiting for the children to come out of school, waiting for an appointment – any thing that will or can act as your reminder.

Many therapists and psychologists are trained in teaching the above techniques and often some of these techniques are incorporated into exercise classes. Just remember, relaxation is an exercise just like physical exercises and something that the body needs to get used to.

Most of all – remember to breath and allow time for you!

Relaxation therapy

Jonette Liebenberg

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