Pain and Positive Thinking

Pain and Positive Thinking

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Can positive thinking affect pain? Absolutely. Pain is a very subjective experience. Expectations, stress, social support and underlying beliefs can influence the degree of pain one feels.

Can positive thinking affect pain? Absolutely. Pain is a very subjective experience. Expectations, stress, social support and underlying beliefs can influence the degree of pain one feels. It’s long been recognized that optimism can influence the experience of pain. What is new is the increasing number of studies that illustrate the physiological changes positive thinking can create in regards to pain.

As, Dr. Michael Selzer, a professor of neurology at the University of Pennsylvania School of medicine says “There have always been people who have said that we could make ourselves better by positive thinking. After pooh-poohing this for years, here are studies that show our thought may actually interact with the brain in a physical way.”(Carroll, Linda 2006)

New research is illustrating how thought affects the biochemistry of the brain, the firing of impulses in the brain and other physiological contributors to pain such as muscle tension, blood pressure and breathing.

Brain scans show that the experience of pain occurs in emotional as well as sensory areas of the brain, and that we have much more control over these areas than most of us would ever guess at.

Recent studies show that one’s belief and expectation about drugs and medications are, in a large part, responsible for their effectiveness. Drugs and medications work to relieve pain by blocking or reducing brain impulses and signals or by increasing the release of the body’s natural pain-killers. Research also shows that we can use a variety of mind-body techniques to do the very same thing.

Placebo research, in particular, is finding that expectation and optimism are determining factors in pain relief.

The placebo effect (the use of fake treatment) has long been documented in terms of pain relief.

  • Dr. Henry Beecher used sugar pills in WWII to alleviate the pain of wounded soldiers.
  • Fake chest surgery worked just as well as the real deal to relieve angina pain in the 1950’s and 60’s.
  • If patients are not told they are receiving morphine for pain, it takes 12% more of the drug for relief to begin.
  • Similarly, the painkiller CCK agonist had no effect on pain if volunteers weren’t told that’s what they were getting.
  • Fake acupuncture treatments reduce lower back pain.

Recent research is tracing the physiological effects of positive thinking and pain.

  • Wake University researchers first conditioned participants to expect low, moderate or high levels of pain (with differing levels of applied heat) according to specific signals.

When researchers mixed up the signals and the levels of heat, the participants reported pain levels according to the signal that they registered, not the level of heat that was applied.

Using functional Magnetic Resonance Imaging (fMRI), the researchers found that a decreased expectation of pain corresponded with decreased activity in specific sensory and emotional areas of the brain.

Expectation reduced the experience of pain by 28%, the same as a shot of morphine.

Researcher Dr. Robert Coghill says that this is important evidence of the importance of cognitive therapy. “Pain is not solely the result of signals coming from an injured body region,” he said, “Pain needs to be treated with more than just pills. The brain can powerfully shape pain, and we need to exploit its power.” (Jones, Michelle D. 2005)

  • A Duke University study looked at patients with osteoarthritic knees. They found that higher levels of self-efficacy reduced physical disability due to pain. Self-efficacy is the belief that one has the ability to take measures that will improve outcomes. When patients believed that they could influence their condition by what they did…they did.
  • Catastrophizing is an exaggerated and fearful way or thinking about pain.       Catastrophizing exacerbates headaches in young adults, researchers at John Hopkins University found. Teaching participants cognitive behavioral therapy techniques to reduce their distress over pain reduced the frequency and intensity of their headaches.
  • A Stony Brook University study found that chronic pain patients who had coping resources such as optimism and high self-esteem experienced less severe pain, less life interference from pain and less depression than patients who were not optimistic or who had low levels of self-esteem.

A recent survey found that about 50% of doctors prescribe some degree of placebo because they believe in the beneficial effects. Mind-body techniques and cognitive behavioral therapy are regularly used at pain clinics, cancer treatment centers and the like to help patients manage pain.

“Things like pain don’t just happen to you;” Colombia University’s Dr. Wager explains, “your brain has to interpret the meaning and value to you. Those circuits are partly under our control. The placebo is a way to [control] it beyond what we can [normally] do voluntarily.”(Singer, Emily 2005)

Positiv Tenkning som SmertebehandlingPain Management Techniques

How does positive thinking affect pain? Awareness is the key.

We are often unaware of how our expectations, our emotions and our mental chatter affect our lives and experiences. Mind-body therapies increase awareness of these dynamics, making the unconscious conscious. With increasing awareness comes increasing control and choice becomes a deciding factor in our perception of pain.

The following are some common pain management techniques that increase awareness, engender change in thought and control, bust stress and decrease pain.


Resistance greatly influences how we perceive pain. Remember the adage “The only thing we have to fear is fear itself?” Like trying to stem the flow of a river, resisting pain is a losing battle that builds up its force.

When you allow the experience of pain, let go of anticipation, fear and tension, pain can flow through you as a current, not as a raging torrent. Some people refer to this as “going into the pain.”

Why can surgeons operate on infants without anesthesia? Infants haven’t yet learned to fear pain; to them it is simply another sensation.



Biofeedback is a great tool to help us become more aware of the things we usually don’t have conscious control over: heart rate, blood pressure, temperature, muscle tension and brain waves.

Using the EEG, EMG and EDR, subjects learn how these physical responses influence pain and note how their thoughts and emotions can affect these responses.


Emotional Management

Emotions have very powerful effects on pain and they are caused by our thoughts, thoughts that are often so habitual we are unaware of them. A variety of techniques, from anger and stress management to Emotional Freedom Technique (EFT) and Neuro-linguistic Programming (NLP) can help to make us aware of our inner chatter and the anxiety, fear and depression that heighten pain.

Cognitive Behavioral Therapy (CBT) has proven to be one of the most effective therapies for pain. CBT helps to uncover core beliefs and negative thinking that trigger our emotions and behaviors. It gives us the power to change our thinking.


Visualization or creative imagery is another powerful tool for pain, health and life changes.

Cancer patients have used creative imagery to shrink tumors; visualization is now a core part of Olympic training programs; remembering a traumatic event can trigger all of the physiological symptoms that occurred then; picturing a loved one causes endorphins to be released.

Some common uses of imagery with pain are those that involve patients imagining themselves “breathing out the pain” or imagining themselves moving freely and easily without pain.

Laughter therapy

It’s not just Patch Adams and Norman Cousins using humor to fight disease and disorder. More and more, studies support the healing power of laughter. It’s been found to reduce pain, decrease stress and boost the immune system. Laughing releases endorphins, increases oxygen uptake, lowers blood pressure. It’s difficult to not have a positive outlook when you’re laughing

Progressive relaxation

Tightening and releasing muscles in a progressive and systematic way increases body awareness and heightens relaxation.


Meditation isn’t just the stereotypical lotus-position-palms-upward-thumb-and-pointer-finger-in-a-reverse-OK-symbol.

Meditation involves a slowing and centering of your consciousness, a way of becoming present in your body and the moment fully.

All forms of meditation clear the mind and ease body tension that can heighten pain. They also allow you to become aware of the unconscious chatter that goes on in your head and enable you to disengage from or change that thinking.

  • Conceptual meditation
    • Conceptual meditation is the contemplation of deep concepts such as the meaning of pain or suffering, compassion, love, forgiveness, life and death.
  • Deep breathing
    • Breathing deep lowers blood pressure and releases tension. Focusing on your breathing brings you into the present and increases your awareness of the connection between the body and the mind.
  • Mantra meditation
    • Do you have a favorite mantra? A word, phrase, quote or sound that is affirming? Concentration on something like this can help you to disengage from mental stress and chatter. The “ohmmmm” sound that’s been the butt of so many jokes has a physiological basis: the sound works to release nitric oxide which enlarges blood vessels. This lowers blood pressure and eases muscle tension. “Yummm” and “Zoommmm” work just as well.
  • Mindful meditation
    • Mindful meditation involves widening your awareness instead of narrowing your thoughts. Try and expand your awareness and perception of everything going on around you: traffic noises, crickets, birdsong, chatter…It’s a different way of becoming present that allows you to choose and detach from specific sensory input.
  • Moving meditations
    • If you’re one of those people with a “monkey mind,” if you find it difficult to be still, try a moving meditation. Tai chi requires such concentration that it empties your mind. Athletes speak of practicing until “they enter the zone.” Creative expression can work in the same way…sculpting, gardening…activity that busies your mind and body can help you to become wholly absorbed in the moment
  • Prayer
    • Prayer involves concentration and meditation that calms the mind and eases the spirit. Use prayer to spread and increase positive thoughts and intentions within yourself and for others.
  • Self-hypnosis
    • Self-hypnosis can involve visualization, affirmations or other positive messages you work to embed in yourself. The concentration involved helps to reduce pain and relax the body and mind.



Most changes involve self-monitoring. Keeping a chronicle or journal can help you identify negative thoughts and beliefs, recognize physical and emotional triggers for pain, and notice other patterns that contribute to your awareness and control of pain.

Gratitude journals, listing the positives of every day, go a long way as far as helping to change negative thinking to optimism.



Beecher, Henry (1952): “The Powerful Placebo”. Journal of the American Medical Association.

Bendetti, Fabrizio (2009) Placebo Effects: Understanding the Mechanisms in Health and Disease: Oxford University Press.

Buenaver, LF, Edwards, RR, Smith, MT, Gramling, SE, Haythornwaite, JA (2008): “Catastrophizing and pain-coping in young adults: associations with depressive symptoms and headache pain”. The Clinical Journal of Pain.

Cannella, DT, Lobel, M, Glass, P, Lokshina, I, Graham, JE (2007): “Factors associated with depressed mood in chronic pain patients: the role of intrapersonal coping resources”. The Clinical Journal of Pain.

Carroll, Linda (2006) “Scientists tap into fake pill’s effects to help real pains” MSNBC

Chopra, Deepak (2007) “The Future of the Body”: blogs

Cobb, L, Thomas, G, Dillard,D, Merendino, K, Bruce, R (1959) “An Evaluation of  Internal—Mammary—Artery—Ligation by a Double—Blind Technic”: New England Journal of Medicine.

Jones, Michelle D. (2006): “Expectations of Pain: I Think, Therefore I Am”. National Institutes of Health Press Release.

Koyama, Tetsuo, McHaffie, John G, Laurienti, Paul J, Coghill, Robert, C (2005) “The subjective experience of  pain: Where expectations become reality”. Proceedings of the National Academy of Sciences.

Nauert, Rick (2006): “Psychotherapy Reduces Chronic Pain” PsychCentral.

Shelby, RA, Somers, TJ, Keefe, FJ, Pells, JJ, Dixon, KE, Blumenthal, JA (2008) “Domain specific self-efficacy mediates the impact of pain catastrophizing on pain and disability in overweight and obese osteoarthritis patients”. The Clinical Journal of Pain.

Singer, Emily(2005): “Placebo Power”. Los Angeles Times.

Sullivan, Michael J.L., Thorn, Beverly, Haythornwaite, Jennifer A, Keefe, Francis, Martin, Michelle, Bradley, Laurence A, Lefebvre, John C. (2001): “Theoretical Perspectives on the Relation Between Catastrophizing and Pain”. The Clinical Journal of Pain.

Talbot, Michael (1992): The Holographic Universe. Harper Collins.

Tilburt, Jon C, Emanuel, Ezekiel J, Kaptchuk, Ted J, Curlin, Farr A, Miller, Franklin G (2008) “Prescribing “placebo treatments”: results of national survey of US internists and rheumatologists.”BMJ.

Wager, Tor D., Scott, David J., Zubieta, Jon-Kar (2009): “Placebo effects on human-opioid activity during pain.”  Columbia University

Zubieta, Jon-Kar, Bueller, Joshua A., Jackson, Lisa R., Scott, David J., Xu, Yanjun, Koeppe, Robert A, Nichols, Thomas E., Stohler, Christian S. (2005) “Placebo Effects Mediated by Endogenous Opioid Activity on µ-Opioid Receptors”: The Clincial Journal of Neuroscience


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