Three Relaxation Techniques to Ease Chronic Pain

Orthopaedic & Spine Center
Dr. Martin

Andrew L. Martin, PsyD

I vividly remember my first relaxation exercise. I was a psychology intern, co-facilitating a fibromyalgia psychotherapy group at the Navy hospital in San Diego. My supervisor led the group in a breathing exercise, and I got caught up in the exercise with the group members. A few minutes later, I was floating out of the room, raving to my supervisor about his skill as a facilitator!

Twenty years later, I’ve had the privilege of sharing relaxation techniques with hundreds of people and seeing similar reactions. Indeed, the research evidence continues to grow, showing simple relaxation techniques can significantly impact stress, chronic pain and mood, both in the short term, and when used regularly, in the long term1.

For people struggling with chronic pain, I usually use the three scripted relaxation techniques from Jennifer Murphy’s protocol for the cognitive behavioral treatment of chronic pain1 – diaphragmatic breathing (or deep, belly breathing), progressive muscle relaxation, and guided imagery.

Diaphragmatic breathing means breathing like you breathe when you are asleep or deeply relaxed. The belly pushes outward during a breath in, pulling air deep into the lungs, then the belly is released, allowing air to leave the lungs effortlessly. The shoulders and chest move very little. This is also a basic mindfulness exercise, meaning you focus without judgment on one pleasant experience, such as the motion of your belly during relaxed breathing. Some find it helpful to focus on the temperature difference as air enters and leaves the nose or mouth. Examples of this technique in other settings include Lamaze breathing during labor, or a free-throw shooter or pitcher taking a deep breath to relax and focus before the big play.  

Progressive muscle relaxation involves tensing and relaxing each of the major muscle groups. You generally start with the lower legs by pulling the feet upward toward the body, holding that tension for five seconds, the relaxing for ten seconds before moving on to the next muscle group. There are a couple of points to the exercise. The first is to get rid of any tension you may be storing in your muscles. The second is to learn to notice tension in your body. As researchers try to understand why this technique is so helpful, they are zeroing in on this noticing of tension as the most effective piece2.

Finally, guided imagery is a mindfulness technique offering powerful distraction from pain, stress, and worry. It works by bringing to bear all your senses at once, in your imagination.  Have you heard of “go to your happy place?” Guided imagery involves going to your happy place, then thinking about all of that place’s sights, sounds, smells, textures, air temperature, etc. This floods the brain with distracting and pleasant sensations, leaving little room for other thoughts or sensations.

How do you know if these exercises are working? I usually recommend people check that in two ways: 1) On a 1-10 scale, rate your stress level immediately before and after doing an exercise; and 2) At the end of a week, after practicing each day, see if you’ve noticed overall changes in your mood, pain, and stress levels. For many, daily practice works like a medicine that slowly builds up in the body, becoming more effective over time.

Why do these techniques work so well for so many people? Pain is in the nervous system. So is our brain. And the rest of our body is connected to the nervous system. These techniques use those connections to relax the nervous system. A relaxed nervous system is less likely to notice pain or communicate pain signals to the brain. Our brain also associates physical relaxation with peace and comfort. So just like the cat when it hears the can opener (gets excited because the can opener means food), we can cause a desired response (relaxation), by applying a stimulus (deep breathing, relaxed muscles, and a mind focused only on a pleasant sensation).

In addition to helping with chronic pain, relaxation techniques have been shown to help with mood, energy level, concentration, sleep (especially falling asleep), anxiety, and blood pressure1. Maybe that’s why these techniques have been around for thousands of years.

1Murphy, J.L., McKellar, J.D., Raffa, S.D., Clark, M.E., Kerns, R.D., & Karlin, B.E. Cognitive behavioral therapy for chronic pain among veterans: Therapist manual. Washington, DC: U.S. Department of Veterans

2Neblett R. Surface Electromyographic (SEMG) Biofeedback for Chronic Low Back Pain. Healthcare. 2016; 4 (2). doi:10.3390/healthcare4020027