Beyond Pain Management: Effective Techniques for Lasting Relief (Part 1 - Mindset & Psychology)
CONTENTS
Introduction: The Importance of Yellow Flags
Language and Posture: How We Speak About the Body
Understanding Pain: Rewiring the Brain
Pain, Awareness, and Movement Patterns
Pain Education: Learning to Retrain Your Brain
Building Your Toolkit for Pain Recovery
Self-Measurements for Pain Recovery
The Power of Expressive Writing
Introduction: The Importance of Yellow Flags
The first pillar of recovering from pain is mindset. In the introduction to this series, we touched upon the concept of "Yellow Flags" and how they can affect recovery. Evidence suggests that targeting yellow flags, particularly when they are at high levels, is likely to lead to more consistently positive results¹ than either ignoring them or providing interventions regardless of psychological risk factors.What yellow flags reveal is that attitude is critical when it comes to pain recovery especially when they are at high levels. You can’t ignore them and expect to recover well. It isn’t everything, but without a healthy mindset, other interventions are less likely to succeed. The first step in shifting your mindset from defeat to empowerment is education.
Language and Posture: How We Speak About the Body
Have you ever noticed how your emotions and body language are connected? Think about it: when you’re feeling down, your body naturally slumps, and when you’re confident, you stand taller.
Positive expressions such as "walking tall," "head held high," "spring in my step," and "standing proud" symbolise confidence, strength, and resilience. In contrast, negative phrases like "spineless," "no backbone," "weak-kneed," "in a slump," and "bent out of shape" suggest fear, weakness, or emotional distress. These sayings reflect how posture and emotional states are intertwined, indicating that the way we carry ourselves physically can both influence and reflect our mental and emotional states.
It goes both ways—how you hold yourself can shape how you feel inside. This is known as embodied cognition, meaning your thoughts and physical posture influence each other.
Now, take a moment and reflect on your own experiences. Have you ever caught yourself hunched over your desk, shoulders tight, and neck stiff after a long, stressful day at work? Or noticed how that tension lingers even after you clock off, weighing down your body and mind? When you're stuck in that cycle of overwhelm, your body often mirrors it, reinforcing those negative feelings of pressure and burnout.
But here’s the important part: by paying attention to this connection, you can start to shift it.
When you recognise the impact of psychological factors² in your experience of pain, such as how stress impacts your body, you gain a valuable tool for breaking the cycle. We explore this more in section 2 on posture, but for now, know that it’s easy to get trapped in these patterns—both in your thinking and in how you carry yourself.
If you’ve been feeling worn down by stress, don’t be hard on yourself; we’ve all been there. Just remember, each time you pause and release your shoulders or breathe a little deeper, you’re sending a message to your mind that you deserve relief. It’s a powerful step, and it can start to shift your experience.
Understanding Pain: Rewiring the Brain
It’s empowering to know through pain education proven in clinical research³ that we can about recalibrate the brain’s connection to safe, efficient movement, leveraging neuroplasticity—the brain's ability to rewire itself. Fear often traps us in defensive movement patterns, and mindful approaches like the Alexander Technique help retrain these brain-body pathways.
By cultivating awareness of how we hold and move our bodies, we can gradually release tension and shift towards healthier patterns. This reawakening fosters a deep sense of agency, allowing us to feel empowered and pain-free—not just understand it. Through small, mindful adjustments, the brain learns to let go of protective mechanisms, reinforcing a virtuous cycle of healing and ease.
At the heart of the Alexander Technique is “embodied ease” - which we explore more in section 2 - a reminder that our mind and body naturally seek harmony, and by working with this desire, we unlock the body’s ability to heal and move freely once more.
If you’re thinking all of this sounds alien and not relevant at all, remember there’s so much going on in our bodies that we aren’t always aware of. Our muscles, nerves, and emotions are constantly interacting in ways that are hard to appreciate. This can lead us to miss what’s really happening in our bodies, especially when we’re in pain.
Pain, Awareness, and Movement Patterns
Pain and stress have a way of hijacking your attention In their own ways, forcing you to focus solely on the area that hurts. When this happens, you may lose awareness of how you are holding your body—your posture, where you're tense, or even where you’re relaxed.
At the same time, emotions like stress, worry, fear, and anxiety can unconsciously contort your body, creating unhelpful movement patterns that exacerbate pain. If you fear a movement, your brain is already primed to receive a pain signal, causing you to tense up, seize, and create further discomfort.
Pain Education: Learning to Retrain Your Brain
So what does pain education look like? What are the fundamentals of pain science you need to know?
When I work with people, pain education usually starts with changing their understanding of pain. Many are surprised to learn that pain isn’t always caused by tissue damage—it’s often shaped by the brain’s perception of threat.
Modern research⁴ shows that psychological and emotional factors really matter for chronic pain, effectively “teaching” the brain to remain in a state of pain. In some cases, the brain rewires itself, perpetuating the sensation even after the initial injury has healed. For instance, I had a coachee who struggled with persistent lower back pain long after their injury had healed. They were astonished to discover that their brain was still on high alert, misinterpreting normal movement as dangerous.
“Before working with Martin, I had a vague notion that psychological and emotional stress might be connected to physical symptoms, but I didn’t take it that seriously. Martin guided me to a deeper understanding and has fundamentally shifted my attitude to myself.”
Pain education doesn’t have to be complicated.
I keep it simple by offering coachees practical insights they can immediately apply. The focus is on creating safety and calm through mindful movement, reducing stress, and improving posture awareness. The real transformation begins when they learn how to quiet their overactive "fire alarm" system, retraining their brain to move out of its protective mode.
Key pain education facts for pain recovery include:
- Pain protects us and promotes healing: it acts as a warning system, but it doesn’t always signal actual damage.
- Persistent pain overprotects: chronic pain can become overly sensitive, keeping you in a cycle of protection that blocks recovery.
- Many factors influence pain: thoughts, emotions, and external stressors can shape how your brain processes pain.
- Recovery looks different for each person: every individual’s journey is unique and should be tailored to their needs.
- Movement retraining is key: calm, confident, and coordinated movement can help rewire the brain to break free from pain.
- There are people who can help: a pain-informed professional can guide you through the healing process, helping you create a personalised recovery plan and stick to it.
For additional reading, I recommend:
Building Your Toolkit for Pain Recovery
Just like your body, your mind needs training. Managing chronic pain requires addressing both physical symptoms and the mental attitudes that can make pain worse.
Psychological interventions like Cognitive Behavioural Therapy (CBT), Internal Family Systems (IFS), and Acceptance and Commitment Therapy (ACT) help you reframe negative thoughts and shift how you experience pain. These approaches don’t always require months of therapy—simple tools and techniques can lead to meaningful change in a single session.
CBT helps break unhelpful thought patterns, IFS addresses the root of critical attitudes toward pain by exploring your internal dialogue, and ACT encourages accepting pain without judgment while focusing on values-driven action. Techniques like visualisation, mindfulness, and writing further strengthen your ability to calm your nervous system and manage pain.
Building your own toolkit of strategies is key to successfully managing pain day-to-day. This toolkit empowers you to reduce pain and stay in control.
1. Goal-Setting and Habit Formation: Developing effective habits is key to making progress in pain recovery. Start by designing a plan that integrates movement, mindfulness, and self-care, and assess your progress weekly. Set realistic goals that are achievable through micro habits, like a daily 10-minute practice to cultivate healing through movement or mindfulness. For example, aim for 90% adherence to your daily routine and focus on keeping your pain below x/10 for 90% of your work hours.
2. Mind-Body Noticing: Recognise that emotions like fear and anxiety can amplify pain. Techniques such as body scanning, labelling feelings, or journaling help you notice how mental states influence physical sensations. The simple act of noticing these patterns can shift your experience, reducing the intensity of pain.
3. Expanded Awareness: Tap into a broader, more open state of awareness where you create space between yourself and the pain. This spacious awareness allows you to observe the pain without becoming fully identified with it, reducing its emotional and physical grip. By allowing your awareness to be open and expansive, you can hold both the discomfort and the sense of calm together, fostering a deeper sense of ease.
Free Panoramic Awareness Meditation
A free 2 minute meditation to create space between you and pain
4.Reframing: Shift your perspective on your thoughts and emotions. The simplest technique is to ask, “What would a caring friend say to me in this moment?” This helps you distance yourself from negative thoughts and emotions. You can also find the therapeutic approach that fits you best—whether it’s Cognitive Behavioural Therapy (CBT), Internal Family Systems (IFS), or Acceptance and Commitment Therapy (ACT)—to develop a framework for shifting your emotional response to pain.
5. Self-Compassion: Cultivate kindness toward yourself by recognising the difficulties you face without harsh self-judgment. Practices such as self-care routines, meditations, or gentle self-talk help create a more supportive internal environment. This shift reduces the emotional strain of pain and fosters resilience in the healing process.
6. Social Support: Connect with others who share similar experiences of pain to feel understood and less isolated. By normalising your experiences within a supportive community, you gain motivation and empathy, helping you stay aligned with your healing goals and reinforcing your sense of progress.
7. Physiological State Shifting: Use body-based techniques like mindful breathing, Yoga Nidra, or gentle movement (e.g., walking or singing) to calm your nervous system. Shifting your physical state impacts your emotional well-being, creating a sense of safety and reducing the intensity of pain, helping you relax and feel more grounded.
8. Visualisation and Self-Hypnosis: Visualisation techniques help shift your body’s response to pain in a gentle way. Visualising warmth, light, or space around the pain helps diffuse its intensity and creates a sense of calm. This allows your nervous system to relax, making the pain feel more manageable.
9. Behavioural Experiments and Gradual Exposure: Rebuild confidence in stressful situations, including movement, by gradually exposing yourself to challenges. This retrains your nervous system to handle more, teaching it to respond with less fear and tension. Over time, this helps reduce pain and anxiety, allowing you to face stress with greater resilience.
Self-Measurements for Pain Recovery
Most people in pain are tired of tracking with rigid numbers and constant measurement.
This approach shifts the focus to noticing meaningful changes and insights. It’s not about repeating the same functional metrics but recognising how your body and mind feel in the moment. These simple self-measurements help you identify where attention is needed, allowing you to observe small but impactful shifts in your recovery journey. Start by choosing areas where you feel blind spots may exist and track subtle changes to guide your healing.
1. Unusual Experiences in Body or Mind:
What felt unusual in your body or mindset today? Did these experiences move you toward or away from healing and joy in motion? Were there specific stressors or insights related to your pain?
2. Routine (Rest and Breaks):
How well did you pace your day in terms of recognising when to rest and take breaks? Did you maintain a balanced routine of activity and rest?
For example, if you’re on a phased return to work, did you follow a structured schedule such as working 25 hours/week, sitting ≤ 3 hours, standing ≤ 1.5 hours, lying down ≤ 2 hours, and taking frequent breaks?
3. Task Prioritisation:
How well did you prioritise your tasks today? Were you able to focus on routine work and avoid stressful tasks dominating your day?
For example, did you maintain 90% break compliance, limit stressful work to ≤ 10%, and ensure that a stressful day occurred no more than once every two weeks?
4. Movement Time:
How much time did you spend moving today? Did your movement feel aligned with your goals and contribute to your overall well-being?
5. Quality of Movement:
How would you describe the quality of your movement today? Did it feel light, smooth, or easeful? Did your movement reflect what’s important to you?
The Power of Expressive Writing
One of the most powerful tools you can get started by yourself is expressive writing, a type of journaling. It's not just about recording your day-to-day experiences—it’s a space to truly let go and explore your deepest thoughts and emotions. Journaling allows you to connect traumatic or stressful experiences to various aspects of your life, helping you make sense of how these experiences may still be influencing you.
Expressive Writing pioneer James Pennebaker and his team found in many studies that people who practised expressive writing experienced many benefits⁵, including decreased anxiety, blood pressure, depression, muscle tension, pain and stress.
I often recommend journaling for four days, 15-20 minutes each day.
During this time, write freely and without judgment. This is completely confidential—you’re writing for yourself, not for feedback. Let your thoughts flow as you explore your deepest emotions about a significant experience in your life. Reflect on how this connects to your past, present, and future. It could be a trauma, a conflict, or a stressor—whatever has been occupying your mind. The important thing is to allow yourself the freedom to feel and express without restraint.
Journaling like this is more than just a release; it’s a tool for self-discovery and can lead to breakthroughs in both emotional and physical healing. By regularly writing, you begin to notice patterns in your thoughts and behaviours that might be contributing to your pain.
Here are some self-reflection questions to get you started.
Self-Reflection Questions:
Can you recollect the last time you didn’t have any pain at all anywhere? What age were you?
What was happening when this pain started? What were you doing?
What types of things relieve your pain? What worsens it?
What have you stopped doing because of the pain? What would you want to go back to if the pain was gone?
Getting Started on Your Recovery Journey
If all of the above seems too overwhelming We are not motivated or confident enough to take So next steps, that might serve you to get help on your recovery journey. You can see how I can help with a personalised Pain Recovery Plan and ongoing support. You can get in touch with me by email to discuss or book a free 15-minute consultation.
REFERENCES
- Nicholas MK, Linton SJ, Watson PJ, Main CJ; "Decade of the Flags" Working Group. Early identification and management of psychological risk factors ("yellow flags") in patients with low back pain: a reappraisal. Phys Ther. 2011 May;91(5):737-53. doi: 10.2522/ptj.20100224. Epub 2011 Mar 30. PMID: 21451099.
- Steven J. Linton, William S. Shaw, Impact of Psychological Factors in the Experience of Pain, Physical Therapy, Volume 91, Issue 5, 1 May 2011, Pages 700–711, https://doi.org/10.2522/ptj.20100330
- Sharon Reynolds, | 'Retraining the brain to treat chronic pain' | (National Institutes of Health, | 2nd November 2021) | <https://www.nih.gov/news-events/nih-research-matters/retraining-brain-treat-chronic-pain> | accessed: 16th September 2024
- Vadivelu N, Kai AM, Kodumudi G, Babayan K, Fontes M, Burg MM. Pain and Psychology-A Reciprocal Relationship. Ochsner J. 2017 Summer;17(2):173-180. PMID: 28638291; PMCID: PMC5472077.
- 'Write Your Secrets: What James Pennebaker Discovered About Expressive Writing' | (The Change Companies) | <https://blog.changecompanies.net/james-pennebaker-expressive-writing> | accessed: 16th September 2024Vadivelu N, Kai AM, Kodumudi G, Babayan K, Fontes M, Burg MM. Pain and Psychology-A Reciprocal Relationship. Ochsner J. 2017 Summer;17(2):173-180. PMID: 28638291; PMCID: PMC5472077.
