Resources to help you manage chronic pain

As you’re beginning to exercise with chronic pain, it’s important to be gentle with your body and not push yourself too hard. You’ll want to gradually increase your activity levels and types of exercise. This will help you improve strength, flexibility and endurance without causing unnecessary stress or pain.

• Exercise frequency – Start with 2-3 times per week and slowly advance to 3-5 times per week.
• Exercise duration – The goal is to exercise for 20-30 minutes at a time. If this is difficult or causes discomfort, start with 3-5 minutes of exercise, 2-3 times per day. Over time, increase to two 10-minute sessions, then one 15-minute session, until you’re able to exercise for 20-30 minutes at a time.
• Exercise types – People tend to get the best relief when they do a combination of aerobic, strength, flexibility and balance exercises. But any and all exercise is beneficial, and the most important thing is that you exercise regularly.

A pain log can be valuable in helping to identify pain triggers, track the effectiveness of treatment and communicate with your care team. It’s best to track changes in your pain throughout the day, especially before and after activities. Your care team may have additional instructions.

• Pain log (PDF)
• Registro del dolor (PDF)

Yoga combines mindfulness practice with gentle physical movement and is very helpful for chronic pain. Research shows that practicing yoga can significantly reduce pain and change brain patterns underlying chronic pain.

Every body is a yoga body. But you may need to find the right practice for you, or utilize modifications, like blocks, blankets or different poses.

• Manage My Pain with Yoga
• Manejando mi Dolor con Yoga (Spanish language videos)

The NeuroWell Individualized Exercise Program focuses on using exercise to improve overall wellness while reducing pain. All new participants will complete a baseline assessment with an exercise physiologist (a specialist who studies how the body responds to physical activity and designs exercise programs to manage health conditions). The assessment is used to set goals and determine your current level of physical fitness. Individualized assessments are sometimes done during group sessions.

For more information, call 651-495-6704 or email neurowell@healthpartners.com.

Aquatic Rehabilitation can be a very effective treatment option for chronic pain. Since the water supports most of your body weight, there’s less weight on your joints, making it easier to perform activities that may be painful on land. At the same time, it gently reduces stress while relaxing your body in warm water. Benefits of aquatic rehabilitation include reduced pain and swelling, increased circulation and improved movement, strength, stability and endurance.

For more information, call 952-993-5900 or email neurowell@healthpartners.com.

Massage therapy can be a valuable part of a pain management program. Insurance doesn’t pay for massage therapy, but FSA/HSA accounts may be used with a provider referral.

For more information, call 651-254-3200 or email neurowell@healthpartners.com.

Acupuncture encourages the body to heal naturally from within while improving function and well-being. Our team provides specialized services to help with chronic pain. Check with your insurance company about coverage.

For more information, call 651-254-3200 or email neurowell@healthpartners.com.

People with chronic pain are more likely to have sleep problems. Unfortunately, lack of sleep makes pain worse. Changing your bedtime routines can go a long way toward a more restful night sleep. These are a few tips for better sleep hygiene that may help.

• Quit drinking caffeine around midday – Try to stop drinking caffeine by around noon. If you work the night shift, try to limit caffeinated beverages to the first half of your shift.
• Avoid nicotine and alcohol before bed – Don’t smoke or use nicotine products within one hour of bed. Also avoid alcohol close to bedtime. While alcohol may make it easy to fall asleep, it can cause sleep disturbances later on in the night.
• Create a wind-down ritual – This helps your body know that it’s getting close to bedtime. And make sure to avoid blue light before bed (this is the light emitted by your phone, television, tablets, laptops and other devices).
• Have a comfortable sleep environment – Your bedroom should be quiet, dark and cool. A comfortable mattress and pillows can also make a big difference.
• Follow a sleep schedule – If you follow a sleep schedule, it can help improve the quality of your sleep. And if you nap during the day, limit it to less than a half hour.
• Don’t try to force sleep – If you can’t sleep, do something relaxing until you’re tired.

Your diet can play a role in managing pain. Some food choices can make you feel better while others can make your symptoms worse.

The Mediterranean diet is often recommended to help manage pain. Try to focus on the following nutrients that can help reduce inflammation, repair cells, and build bones and tissues.

• Water – Dehydration can cause pain, cramps, muscle twitching and weakness. So drink 6-8 glasses of water a day, and make sure to drink after exercise.
• Protein – Protein is involved in the production of neurotransmitters like serotonin and dopamine, which play a role in pain modulation. These neurotransmitters can help improve mood and reduce the perception of pain. Protein also helps build and repair muscles, cartilage and bone, and increases muscle mass and strength.
• Antioxidants – Fruits and vegetables are packed with antioxidants, which can prevent cell and tissue damage and inflammation.
• Omega-3 fatty acids – Fatty fish, nuts, vegetable oils and other foods high in Omega-3 fatty acids can help reduce inflammation.
• Magnesium – Magnesium supports the nervous system and bone health, and can reduce muscle pain and cramps. Foods that contain magnesium include almonds, spinach and pumpkin seeds.
• Calcium – Calcium helps with bone development and health, blood clotting, nerve function and muscle contraction.
• Polyamine-reducing foods – Polyamines are organic compounds that play an important role in biological processes, but high levels can increase pain hypersensitivity. Some foods that can help reduce polyamines include walnuts, green tea, plantains, guava and fruits that are dark blue, purple and red.

You should try to limit or avoid foods and drinks that increase inflammation since they can make pain worse.

• Alcohol – Drinking alcohol can increase inflammation, and chronic alcohol use may cause nerve damage and increase pain sensitivity.
• Sugar – Eating a diet that’s high in sugar can cause inflammation and contribute to chronic pain.
• Saturated fats –“Bad” fats can increase inflammation. Processed foods, fried foods and red meat can be high in saturated fat.

Consider changing how you sit, stand and move (and how often you do it) as it may make a big difference. Try to change your position regularly and stand up every 30-60 minutes to do some gentle stretches. If you aren’t sure where to start, a physical therapist can develop an individualized plan for your body’s specific needs. Here are few things to know about posture and movement.

• Don’t worry about “correct” posture. Despite what you’ve been told throughout your life, you don’t need to sit up straight. Additionally, there aren’t specific “incorrect” postures that should be avoided at all costs.
• Find what’s comfortable for you. Exploring different postures (even ones you have avoided in the past) may help you find symptom relief. While it can be helpful to move and change position, it’s totally okay to sit in one position for 30 minutes or more.
• Posture and movement recommendations should be specific to you. Differences in posture and movement are normal and expected because a person’s body (including the curve of their spine) is unique. Workplace ergonomics and lifting style can make a difference but they should be tailored to your specific needs. Your physical or occupational therapist can help determine what makes sense for you.

If you have a substance use disorder, it can affect all aspects of your life, including relationships, work performance and mental health. People with chronic pain are at a higher risk of developing addiction problems, particularly with substances like opioids.

Opioids are powerful medicines, but they don’t cure a health problem. They relieve pain by changing the way your body feels pain. As these changes take place, you need higher and higher doses of the medicine to relieve your pain – this can lead to addiction or an opioid use disorder . If you’re struggling with an addiction of any kind, talk to your care team. They’ll work with you to help you manage addiction and pain.

A popular type of meditation for pain is mindfulness meditation. This is a practice that involves focusing your attention on the present moment, while calmly acknowledging and accepting your feelings, thoughts and bodily sensations. It’s a form of meditation that helps you become more aware of your thoughts and emotions without getting overwhelmed by them. Regular practice of mindfulness meditation can help reduce stress, improve concentration and enhance emotional well-being.

Try to practice mindfulness meditation twice a day for 5-10 minutes at a time and make sure you record your level of pain or discomfort before and after (this mindfulness practice log (PDF) can help with tracking).

Mindfulness meditation can be especially helpful within the first hour of waking up and within an hour of going to bed. It is not uncommon for people to fall asleep while doing the exercise at night.

1. Find a comfortable position – Sit or lie down in a quiet place.
2. Focus on your breathing – Pay attention to the sensation of your breath as it enters and leaves your body.
3. Observe your thoughts – Notice your thoughts as they come and go. Try not to judge them or get caught up in them. It’s normal for your mind to wander. Be patient and kind to yourself as you practice.
4. Return to your breathing – Whenever you notice your mind wandering, gently bring your focus back to your breathing.

• How to do mindfulness meditation (video)
• NeuroWell events and activities
• Hanh, T. N. (1991). Peace Is Every Step: The Path of Mindfulness in Everyday Life. Blackstone Audio, Inc. ISBN: B00WY7MELU
• Williams, M., & Penman, D. (2011). Mindfulness: An Eight-Week Plan for Finding Peace in a Frantic World. Rodale Books. ISBN: 978-1609618957

Cognitive behavioral therapy (CBT) is a form of talk therapy that helps you identify and develop skills to change negative thoughts and behaviors that affect how you experience pain. CBT helps change your awareness of pain and develop better coping skills, even if the actual level of pain stays the same. Many people work with a therapist or a counselor when using CBT for pain management , but you also can practice CBT skills on your own.

There’s a strong connection between our thoughts, emotions and behaviors. By recognizing this connection, we can begin to understand how to break negative cycles and choose more helpful ways of thinking and acting.

1. Catch the thought – When you notice a strong emotional reaction, pause and ask yourself, "What was I just thinking?" Try to identify the thought that triggered your emotion.
2. Examine the feeling – After identifying the thought, notice the emotions you're experiencing. Labeling emotions (like anger, sadness, and fear) can help create some distance between yourself and the feeling.
3. Observe the behavior – Reflect on how this emotion influences your actions. Are these behaviors helping or harming you?

• Chronic pain: Managing pain with healthy thinking (video)
• Chronic pain: Using healthy thinking
• Zoffness, R. (2019). The Chronic Pain and Illness Workbook for Teens: CBT and Mindfulness-Based Practices to Turn the Volume Down on Pain. Instant Help. ISBN: 978-1684033522
• Zoffness, R. (2020). The Pain Management Workbook: Powerful CBT and Mindfulness Skills to Take Control of Pain and Reclaim Your Life. New Harbinger Publications. ISBN: 978-1684036448.

Binaural beats are a perception of sound created by your brain. If you listen to two tones, each at a different frequency and each in a different ear, your brain creates an additional tone you can hear. This third tone is called a binaural beat. When binaural beats are sustained over a period of time, they can synchronize with your brainwaves and may influence brainwave activity.

Binaural beats that stimulate alpha (8-14 Hz) and theta (4-8 Hz) brainwaves are often used as part of a pain management program since they help with relaxation and may reduce the perception of pain. Other binaural beats can help with focus and motivation (Gamma brainwaves, 30-100 Hz) or help you sleep better (Delta brainwaves, 0.5-4.0 Hz). People respond differently to binaural beats, so experiment with frequencies until you find what works best for you.

• You can listen to binaural beats using apps such as Binaural Beats Generator and BrainWave: 35 Binaural Series. You can also try using a recording of binaural beats from YouTube.
• Aim for 30 minutes of binaural beats a few times a week.
• Use high-quality stereo headphones to ensure you get the full effect of binaural beats.

Emotions like anxiety and stress can make pain worse. Designated worry time journaling is a technique that helps manage strong emotions by setting aside a specific time each day to focus on worries. This structured approach can help prevent them from interfering with your sleep and daily life.

1. Set aside 15-30 minutes each day for your worry time. Make sure it’s the same time every day, preferably not too close to bedtime to avoid affecting your sleep.
2. Be specific about your worries. During this time, write down your worries and concerns in a journal. Be specific about each worry and consider possible solutions or steps you can take to address them.
3. Let go of your worries. After the designated worry time, close the journal and let go of these concerns until the next session.

The emotional freedom technique (EFT) involves tapping your fingertips on specific places on your body. It’s believed that tapping can help turn off the stress signals caused by physical or emotional pain, stress or anxiety.

1. Identify the issue that’s causing emotions. This issue will be the focal point while tapping.
2. Measure the intensity of the emotion. Assign a number to your emotion on a scale of 0 to 10, with 10 being the worst or most difficult.
3. Create a setup phrase. This phrase should describe the issue and be followed by a statement of self-acceptance. It’s commonly structured as, “Even though I have this [fear or problem], I deeply and completely accept myself.”
4. Tap the edge of your palm (the karate chop). Tap repeatedly on the edge of your palm, below your little finger. While you tap, say your setup phrase three times.
5. Tap other points seven times. Tap each of the points below seven times, while using a reminder phrase to focus on the issue. For example, if your setup phrase is, “Even though I’m sad my mother is sick, I deeply and completely accept myself,” your reminder phrase can be, “The sadness I feel that my mother is sick.”
   • Eyebrow
   • Side of the eye
   • Under the eye
   • Under the nose
   • Chin
   • Collarbone
   • Under the arm
   • Top of the head
6. Remeasure how you feel about the issue. Repeat the steps until you assign the issue a lower number or you feel better.

Eye movement desensitization and reprocessing (EMDR) can be very helpful for people who have pain, especially if it’s linked to past trauma. During EMDR, you move your eyes back and forth while working through traumatic memories. The movement of the eyes creates a situation very similar to deep sleep, which is when most memories are normally processed.

Using EMDR helps create a new path in your brain to help you process traumatic memories, so they stop causing stress, anxiety and pain. The more that new path is used, the easier it becomes. A therapist can tell you if EMDR is a good option for you and, if appropriate, refer you to a specialist trained in this technique

• Grant, M. D. (2016). The New Change Your Brain, Change Your Pain: Based on EMDR. Trauma and Pain Management Services. ISBN: 978-1925457247

The relaxation response technique is a series of steps designed to help your body relax and reduce stress. With practice, the response should come with little effort. Practice the technique once or twice daily, but not within two hours after any meal since the digestive processes can affect the relaxation response.

1. Find a quiet place – Sit or lie down in a comfortable position.
2. Close your eyes – This helps to minimize distractions.
3. Relax your muscles – Start from your toes and work your way up, consciously relaxing each muscle group.
4. Breathe through your nose – Take slow, deep breaths. Inhale through your nose, hold for a few seconds, and exhale through your mouth. Choose a calming word or phrase (such as “peace” or “relax”) to repeat each time you exhale.
5. Continue for 10 to 20 minutes – It’s okay to open your eyes to check the time, but do not use an alarm. When you finish, sit quietly for several minutes, at first with your eyes closed and later with your eyes open. Do not stand up for a few minutes.
6. Don’t worry about success – Don’t worry about whether you are successful in achieving a deep level of relaxation. Maintain a passive attitude and permit relaxation to occur at its own pace. When distracting thoughts occur, try to ignore them and repeat your calming word or phrase.

Learning to open up and make room for feelings is a skill that takes practice. And like any skill, the more you practice, the better. Start with all those little moments throughout the day when you’re a bit anxious, sad or irritable. Then, over time, work up to those really intense emotions. The ideal plan would be to practice a “making room” exercise at least once a day.

Understanding your feelings can help you accept them and move beyond them. A useful framework is to “NAME” your feelings.

• N is for “notice and name.” Notice and name what’s happening in your body. Where are the sensations? What are they like? What do you call this feeling?
• A is for “allow.” Give your feelings permission to be there. This emotion is a normal reaction to the current situation.
• M is for “make room.” Open up to this feeling, and let it freely flow through you.
• E is for “expand awareness.” Broaden your focus to include the world around you.

As you NAME your feelings, remind yourself that it’s normal to have feelings and that you can work through them. You can use any phrase that works for you, but here are some that can be helpful:

• This emotion is intense now, but it will pass.
• I have room for this feeling. No matter how big it gets, it can’t get bigger than me.
• This feeling can’t harm me. I don’t need to fight it or run from it.
• I don’t have to let this control me. I can have this feeling and choose to act on my values.

Resonant breathing involves breathing at a specific rate that optimizes heart rate variability (HRV). This type of breathing can help the body’s ability to manage stress and pain.

• Control the rate of your breath – Breathe slowly in and out. It should take 3-4 seconds to fill your lungs and another 3-4 seconds to empty them. This helps to relax the body and reduce the perception of pain.
• Watch your abdomen as you breathe – Pay attention to the rise and fall of your stomach with each breath. This helps engage diaphragmatic breathing (also known as belly breathing), which is more effective for relaxation.

Somatic tracking involves paying close attention to bodily sensations, including pain, without judgment or fear. This practice is grounded in mindfulness and aims to reduce your emotional response to pain.

Changes in pain perception may take time. Approach each session without expectations and be patient with yourself. You’re also likely to get better results if you practice regularly. Aim to practice somatic tracking daily, even if only for a few minutes at a time.

1. Find a quiet space – Begin by finding a comfortable and quiet space where you can sit or lie down without interruptions.
2. Focus on the sensation – Choose a specific pain sensation to focus on. It could be a constant pain or one that comes and goes.
3. Observe without judgment – Pay attention to the sensation with an attitude of curiosity rather than fear or judgment. Notice its qualities. Is it sharp, dull, throbbing, hot or cold?
4. Breathe deeply – Incorporate deep, slow breathing to help maintain a calm and focused state. Deep breathing can also help reduce tension, which can affect pain levels.
5. Notice changes – As you focus on the sensation, observe any changes in the pain. Does it get better or worse, or stay the same? Does your perception of the pain change as you observe it?
6. Reflect on the experience – After practicing somatic tracking, take a moment to reflect on the experience. Did your attitude toward the pain change? Did you notice anything new about the sensation?

• Demonstration of somatic tracking and pain reprocessing therapy (YouTube video)
• Gordon, A., & Ziv, A. (2021). The Way Out: A Revolutionary, Scientifically Proven Approach to Healing Chronic Pain. Avery. ISBN: 978-0593086834

HealthPartners offers a Lifestyle Renewal Program to help you increase function and participation in everyday activities while decreasing limitations from pain. The program is staffed by highly trained occupational therapists who use a variety of treatment techniques, tools and therapeutic strategies to help you restore and calm your body.

For more information call 952-993-5900.

Chronic pain can affect your brain’s executive functions, which include skills like planning, decision-making and problem-solving. Pain can also affect your ability to focus on tasks, switch between ideas, and manage thoughts, emotions and actions.

It can help to be very deliberate about when and how you approach activities. And using organizational tools, detailed instructions, visual aids and lifestyle modifications can make it easier for you to complete everyday tasks.

• Plan breaks – After focusing on a task for a while, take a short break. It’s good to take breaks, even if you don’t think you need them.
• Choose the right time for challenging tasks – Think about when you have the most energy and focus. These times will be the best for challenging tasks. Also plan for recovery time afterwards.
• Break large activities into smaller chunks – Pace activities by breaking tasks down. For example, doing laundry can be lumped into tasks such as bringing the clothes to the laundry room and loading the washing machine. Goblin.tools is a great resource to help break down activities into simple steps.
• Use alarms – Set alarms for every 30-60 minutes to check in with your body to see if you need a break. Pomofocus is a great online timer that allows you to schedule work time and break time.
• Know what helps – Create a list of activities that can provide calm, energy or lift your spirit. Check in with your body throughout the day to see if one of these activities could help.
• Try bullet journaling – The Bullet Journal Method can be a very effective way of organizing your thoughts and focusing on what matters.