Imagery Training for Pain Relief
Humans are visual creatures and so it makes sense that some people living with chronic pain experience pain imagery. This is the spontaneous intrusion of distressing mental pictures. Examples are hot pokers, weights pulling, an angry animal or jolts of electricity. These mental pictures shape the person’s perception of their pain as threatening and beyond their control and are linked with increased anxiety and depression.
People don’t know for sure but it is theorised that pain imagery does two things.
It distorts pain evaluation and decision making pathways in the brain.
It also changes the body matrix - this is the representation our brain has for our body.
What can be done to help reduce your pain if you are someone who experiences pain imagery? I use a collaborative imagery training process centred around ten components. They are;
Breathe
The exercise starts with five slow breaths as a way to encourage relaxation and bring you into your parasympathetic mode. Slow breathing has been used as a pain management technique for centuries.
Describe
I ask you to describe your pain to help you change any errors in your body representation. For example macrosomatognosia is the prception that your painful area is larger than it actually is. Some people with CRPS report that their affected limb feels as if it no longer belongs to them. This exercise clarifies the exact location and size of your pain. It is also an opportunity to notice pain with curiosity instead of fear.
Change Your Pain
I then ask you to change your pain, change its size, colour, temperature and texture. A minifying lens has been shown to reduce phantom limb pain, mirror therapy, motor imagery and virtual reality are all modalities that modify a person’s perception of their body and their pain to reduce pain. Visualising the pain shrinking or changing colour is an implicit version of these exercises.
Change Your Image of Your Pain
Modifying the powerful and distressing images that you have of your pain, has been shown to reduce pain levels, change the meaning of the pain and reduce the perceived permanence of the pain. On top of this many index pain images are linked to the theme of losing control. Modifying your image is giving you back control.
Distance
Creating distance, such as watching the objectified pain float away from the body, makes the pain changeable. It offers a moment of reprieve where something never ending actually leaves the body.
Optimism
To bring focus to a future point when pain is successfully managed is the opposite of catastrophising which is a correlate of pain, pain-related disability, and chronification. A future focus also stops pain from being the primary focus and bring awareness to functional goals instead. A focus on future goals is a reminder of the quality of life changes that the you are working towards. People give up hobbies, interests and social interaction due to their chronic pain. A reminder that these activities can be engaged in on your terms is important for your psychological wellbeing.
Explicit Motor Imagery
Explicit motor Imagery is a fancy way of saying mental rehearsal of a movement. A person with knee pain might visualise themselves picking something up from the floor, smoothly and with ease. This mental practice of pain free movement helps retrain the brain to create a sense of safety around this action.
Safety
In the words of Mosely and Butler: “we won’t have pain when our credible evidence of safety is greater than our credible evidence of danger.” A focus on messages of safety dampens your protective responses.
Self Efficacy and High Internal Locus of Control
When you focus on the skills and resources that you have to manage your pain you increase your locus of control and pain-related self-efficacy. These factors are predictors of physical and mental health one month following treatment.
Positive Affect
Asking you to provide reassuring sentences about your current situation aims to create positive affect which is related to the mood states of comfort, happiness and well being. This has been found to buffer negative mental and emotional responses to pain and enhance the self-management of chronic pain.
After we talk through these elements I create a ten minute recording with a quiet background of calming music. The recording incorporates each of the above components and I ask you to listen to the recording at least five times a week for a month. At the one month mark we check in and see if we have measurable progress such as a reduction in pain flares; achievement in movement and life goals; and even a reduction in pain scores. Then I ask you to persevere for another month. Why? because changing neural circuits takes time. As the marvellous story of Pain scientist Dr Moskowitz shows. He recovered from his chronic pain using visualisation exercises. Each time he felt his pain he visualised the problem areas in his body and his brain shrinking. At three weeks he noticed a very small reduction in pain. At six weeks the pain between his shoulders disappeared. At four months he experienced pain-free periods in his neck. Within a year he was almost pain-free. Inspiring stuff hey?