Footstep 9

Relaxation and mindfulness

Relaxation is an important strategy in managing pain, stress and sleep problems. As well as participating in enjoyable and well-paced activities, patients can learn some key relaxation skills based around breathing, mindfulness and shifting the focus of their attention.

Relaxation is a skill, an active process, not just something that happens by default when we sit down with a cup of tea. Learning this skill takes a bit of time and your patient will need to work out which activities are most beneficial. Your role is to offer options for them to explore.

Here are some ideas that you could suggest they explore:

  • Relaxing activities
  • Guided relaxation
  • Mindfulness or meditation

Action to take

Some ideas for you to offer your patient

Relaxing activities

These are activities that can be absorbing and distracting. Examples include:

  • Gardening
  • Listening to favourite music
  • Fishing
  • Colouring/puzzles/crafting
  • Mind-body exercise: Yoga, Tai-Chi, Pilates

All of these can also be done ‘mindfully’ to maximise benefits.

Guided relaxation

This includes things such as:

  • Progressive muscle relaxation
  • Breathing exercises
  • On the spot arousal reduction (OTSAR) - see link below
  • Distracting the mind to imagine being in a pleasurable environment e.g. walk on the beach

Mindfulness or meditation

Mindfulness is about training the brain to be in the moment and creating a pause between thoughts and feelings enabling a choice in how to respond rather than a reaction.

Mindfulness practices have been shown to be beneficial in the management of persistent pain.

There are many free resources available at libraries and online (see links below).

Learn about mindfulness

Mindfulness is now a fairly mainstream technique used to manage many mental health problems, chronic health conditions and even to manage mental well-being. It can be used effectively by chronic pain patients to help them to live better with their condition.

“Mindfulness is a translation of a word that simply means awareness. It’s direct, intuitive knowing of what you are doing while you are doing it. It’s knowing what’s going on inside your mind and body, and what’s going on in the outside world as well. Most of the time our attention is not where we intend it to be. Our attention is hijacked by our thoughts and emotions, by our concerns and desires, by our hopes or worries for the future, and our memories and regrets from the past. Mindful awareness is about learning to pay attention, in the present moment, and without judgement. It’s like training a muscle – training attention to be where you want it to be.” (Oxford Mindfulness Centre, 2020).

Mindfulness is a skill and has to be learned and practiced regularly and has four components, as illustrated in this diagram:

The patient may have access to mindfulness groups through IAPT or local charities such as MIND. There are also numerous self-help resources available and some of these are listed below.

What is the evidence base?

A recent systematic review and meta-analysis of 38 RCT studies investigating outcomes of mindfulness interventions for chronic pain patients, (Ann Behav Med. 2017; 51 (2)) noted the limitations of much of the research in this area. Many studies, for example, are small scale and heterogeneous, including patients with different types of persistant pain. Nevertheless, accepting these limitations, the authors found a statistically and clinically significant reduction in depressive symptoms and an improvement in quality of life. A small reduction in pain was also reported but this was statistically insignificant.

Resources for your patient


Breathworks

Breathworks is a phenomenally rich collection of resources and courses for all people with pain and their clinicians.


Oxford Mindfulness Centre

Course, resources, audio recordings and short videos


Books

Living Well with Pain and Illness: The Mindful Way to Free Yourself from Suffering

by Vidyamala Burch, Piatkus Books 2008

Also available as an audiobook, with downloadable meditations

Mindfulness for Health: A practical guide to relieving pain, reducing stress and restoring wellbeing

by Vidyamala Burch and Dr Danny Penman, Piatkus Books 2013

In both print and audiobook formats

The Mindful Way through Depression: Freeing Yourself from Chronic Unhappiness

by Mark Williams, John Teasdale, Zindel Segal and Jon Kabat-Zinn, Guilford Publications

Relaxation and mindfulness

Summary of key points

  • Relaxation and mindfulness are skills that patients learn and practice at regular intervals, like learning a language
  • These activities are safe and evidenced to benefit mood and quality of life
  • You can encourage patients to choose relaxation methods that most appeal to them – there are many options
  • By participating in a mindfulness course, patients can become skilled in directing their attention to where they want it to be

Quick links