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Chronic pain is a serious concern for millions of people. The Centers for Disease Control and Prevention estimates that it affects roughly 20% of American adults, and daily discomfort is a top reason why people seek medical care. Chronic pain is a hallmark symptom for many physical ailments — including fibromyalgia, arthritis, migraine, and irritable bowel syndrome.

Chronic pain can be managed and treated in several ways, but a common approach is prescription opioids. Those are a class of effective-but-highly-addictive medicines used to treat moderate-to-severe pain. According to a U.S. Department of Health and Human Services report, over 22% percent of adults with chronic pain use a prescription opioid.

But opioids aren’t always effective. And they often carry side effects such as anxiety, pain sensitivity, and serious dependency issues. Many people who experience chronic pain have legitimate concerns about taking them.

And you don't have to. Scientific researchers are discovering that the mind-body connection, which is the link between a person's thoughts, behaviors, and their physical health, can help ease chronic pain too. If you struggle with this problem, this is useful information to know.

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How the Body and Mind Connect on Chronic Pain

Physical discomfort and emotions are more closely related than you think. "Pain and mood are processed in similar places in the brain," says Lauren Abshire, PsyD. She is a clinical psychologist with the Cleveland Clinic who specializes in treating chronic pain. "We tend to see that strong emotions rise and fall in correlation with pain." In other words, a tense argument or stressful drive in rush hour traffic can make your pain worse.

Both pain and negative emotions are processed and stored in your brain's nervous system, Dr. Abshire says. Both of those things trigger a release of stress hormones. This initiates your "fight-or-flight" stress response. That is a series of changes that are designed to help your body handle a perceived threat. Your blood pressure rises, muscles tense, and breathing becomes fast and shallow, Abshire says.

If you experience chronic pain, your nervous system can get stuck in fight-or-flight mode. These constant stress signals amplify pain, which increases stress, creating a vicious cycle. By learning how to calm your mind, you can help ease pain - and vice-versa. Experts recommend the mind-body strategies below to help you feel better.

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Cognitive Behavioral Therapy

Cognitive behavioral therapy, also known as CBT, is one of the most common and widely researched mind-body approaches to chronic pain. It’s a form of talk therapy that tackles “how pain influences your emotions, thoughts, and behaviors, and how those things influence our perception of pain,” Abshire says.

A mental health professional helps you swap out your unhelpful thoughts and beliefs about pain with more realistic alternatives. For example, many patients with chronic pain don't think they're ever going to feel better. These types of negative thoughts can lead to feeling stressed and hopeless, which often worsens pain, Abshire notes. Plus, it takes away any motivation to find a solution.

So how effective is it? Its success may depend on the severity of your pain. Research in the Cochrane Database of Systematic Reviews found evidence from nearly 60 studies that CBT has a small effect on reducing chronic pain. People with milder symptoms may do well with CBT alone, but those with more severe or lasting pain may need to supplement CBT with medication or other mind-body approaches, Abshire notes.

Movement and Exercise

Even if you think moving around will make your aches worse, it usually doesn't. Gentle movements like those found in yoga and tai chi can be helpful for chronic pain. “A lot of physical therapists say things like, ‘motion is lotion,’” Abshire says. Moving your body loosens tight, tense muscles, which can lower any associated pain. Plus, exercise is one of the best ways to boost mood, per a review in Brain Plasticity. And a better mood often means less pain.

The key is to find exercises that don't cause pain flare-ups. Those are periods of pain that are more severe than usual, Abshire says. You can talk to your doctor about experimenting on your own or get guidance about what exercises to try from a physical therapist.

If you're afraid to exercise, tell your therapist if you're trying CBT. "Often, I utilize CBT to empower people to move past their fear of engaging in activities that will bring them pain and allow them to experience those activities more freely," says Peter Safirides, M.D.. He is a board-certified psychiatrist in Columbus, Ohio and founding member of the Psychophysiologic Disorders Association, a group focused on mind-body approaches to chronic pain.

Deep Breathing

Abshire considers this the gateway to pain relief. If you’re stressed or in pain, deep breathing prompts your nervous system to reverse course. It slows heart rate, lowers blood pressure, relaxes muscles, and calms your mind. Researchers at the University of Michigan found that mindful deep breathing can help lessen pain sensitivity.

Deep breathing also releases feel-good hormones like oxytocin, which are like natural painkillers, Abshire says. She teaches her patients to shift their breathing to their abdomen and breathe gently in through their nose and out through their mouth when they feel stressed.

Press play to try mindful deep breathing:

Journaling

Getting your thoughts out of your head and onto paper is a powerful exercise for managing stress and chronic pain. A study from Penn State University found that patients with anxiety and other health conditions who kept a journal saw greater improvements in well-being than those who didn't jot things down.

"I'm a huge fan of journaling and recommend it to all of my patients," says Dr. Zafirides. "The simple act of writing down your feelings and laying them out away from you on a sheet of paper can be very empowering."

Zafirides also has his patients practice free-association writing. Simply sit down and write for five minutes non-stop. "Don't worry if the thoughts aren't connected, just keep writing," Zafirides says. The more you give voice to what you're experiencing, the easier it will be to manage it.

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See our sources:
Prevalence of chronic pain: Centers for Disease Control and Prevention
Prescription opioids and chronic pain: S. Department of Health and Human Services
Cognitive behavioral therapy for pain management: Cochrane Database of Systematic Reviews
Exercise and mood: Brain Plasticity
Mindful breathing and pain management: The University of Michigan
Journaling and pain management: JMIR Mental Health

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