What is the impact of stress and mental states, such as pain catastrophizing, on pain thresholds, and can non-pharmacological interventions, including relaxation techniques like meditation or prayer, be effective in managing pain?

From the Guidelines

Stress and mental states have a significant impact on pain thresholds, and addressing these factors can be a crucial aspect of non-pharmaceutical pain management. Pain catastrophizing, which involves magnifying the threat value of pain and feeling helpless about it, is a key target for intervention. Cognitive-behavioral therapy (CBT) and mindfulness-based stress reduction (MBSR) programs have been shown to be effective in reducing pain intensity and improving function, as noted in studies such as 1. MBSR, in particular, helps patients observe pain sensations without judgment, reducing emotional reactivity. Regarding relaxation methods, both brief phone app-guided relaxation and prayer can be effective, though their efficacy depends largely on the individual's belief system and engagement level, as suggested by the principles outlined in 1 and 1. The neurobiological mechanism involves activation of descending pain inhibitory pathways from the brain to the spinal cord, releasing endorphins and enkephalins that modulate pain signals. Some key points to consider in non-pharmaceutical pain management include:

• Consistency in practice is crucial for optimal results
• Finding a method that resonates personally with the individual is more important than the specific technique used
• Integrating the chosen method into a comprehensive pain management approach that may include physical therapy, appropriate medication, and lifestyle modifications is essential
• Techniques such as tai chi, yoga, and mindfulness-based stress reduction have shown promise in managing chronic low back pain, as indicated by studies like 1. Ultimately, the most effective approach will be one that is tailored to the individual's needs and preferences, and that addresses the complex interplay between physical, emotional, and psychological factors that contribute to pain perception.

From the Research

Influence of Stress and Mental States on Pain Thresholds

• Stress and other mental states, such as anxiety and depression, can significantly influence an individual's pain thresholds 2
• Pain catastrophizing, a negative mental state, can amplify the perception of pain and is a potential target for non-pharmacological pain treatment 3, 4
• Mind-body therapies, including meditation, mindfulness, and cognitive-behavioral therapy, can help reduce stress and improve pain management 5, 2, 6

Non-Pharmacological Pain Treatment

• Non-pharmacological interventions, such as cognitive-behavioral therapy, mindfulness-based stress reduction, and physical therapies, can be effective in reducing chronic pain 5, 3, 4
• Digital therapeutics, including phone apps, can provide accessible and convenient platforms for relaxation and pain management 3
• The efficacy of non-pharmacological interventions can be enhanced by placebo and expectation effects, highlighting the importance of patient engagement and education 3, 4

Comparison of Relaxation Techniques

• The choice of relaxation technique, such as phone apps or prayer, may not be as important as the individual's engagement and commitment to the practice 2
• What matters most is the ability of the technique to reduce stress, promote relaxation, and improve mental well-being, which can in turn help manage pain 5, 6
• Further research is needed to fully understand the relative effectiveness of different relaxation techniques in pain management 3, 4