Chronic pain is defined as any pain lasting more than 12 weeks and is linked to anxiety, depression, dependency on opioids, restrictions in daily activities, and reduced quality of life (Dahlhamer et al., 2018). This condition impacts 50 million U.S. adults with the highest incidence among women, older adults, and among those with public health insurance. Direct and indirect expenses are estimated at $560 billion (Dahlhamer et al.). In addition to the associated cost burden, a national opioid epidemic has placed an emphasis on seeking effective nonaddictive approaches to mitigate pain. Physical therapists (PTs) possess a skill set inclusive of valuable nonpharmacologic intervention strategies aimed at reducing fatigue, diminishing emotional stress, improving self-efficacy, and promoting optimal sleep patterns (Schaffer & Yucha, 2004). Although exercise is one method employed in the management of chronic pain, rehabilitation professionals have additional skills aimed at preventing, screening, and educating individuals on pain management strategies. Mind-body therapies are one such complimentary pain management technique that can be easily integrated into therapy care plans.

Mind-body therapies encompass meditation, Yoga, Tai Chi, Qigong, deep breathing exercises, guided imagery, and progressive muscle relaxation (Bertisch et al., 2009). Although three of these techniques will be further described in this article, each technique allows an individual to manage pain using a parasympathetic dominant response that corresponds with a decrease in heart rate, blood pressure, muscle tension, and improved mood (Schaffer & Yucha, 2004).

Tai Chi is a mind-body application that encompasses sequential slow movement patterns inclusive of weight shifting, stability, and balance. Deep breathing, physical postures, and meditation are core principles of this self-paced technique that incorporates gentle stretching and physical exercise with constant motion. Tai Chi has evidence to support its positive effects on chronic pain especially with duration dosing of 6 to 10 weeks (Kong et al., 2016). Additionally, comprehensive benefits have been reported for conditions such as osteoarthritis, lower back pain, fibromyalgia, and osteoporosis among others (Kong et al.).

Deep breathing exercises are another intervention that can impact pain perception via modulation of the cardiovascular system. A study by Bernardi et al. (2001) found that a slower respiratory rate reduced the chemoreflex response and increased baroreflex sensitivity. The baroreceptor system has a central nervous branch that connects with higher cerebral portions of the brain, thereby impacting emotion and cognition (Jafari et al., 2017). Deep breathing exercises incorporate complementary psychomotor activities including: sitting quietly in a comfortable position, closing the eyes, sequentially relaxing all muscles beginning at the head and moving down to the feet, and breathing through the nose (Schaffer & Yucha, 2004). Slowing the respiratory rate to approximately five to seven breaths per minute with exhalations taking twice as long as inhalation is recommended for optimal benefit (Schaffer & Yucha).

Another technique that has proven effective in pain management is progressive muscle relaxation. It is designed with the premise that mental calmness will naturally follow physical relaxation. This method of pain relief improves pain tolerance by enhancing the brain's responsiveness to endorphins, enhancing mood related to pain, reducing inflammation, and reducing hypervigilance (Hassed, 2013). It is noteworthy that this intervention is commonly used concurrently with other pain management interventions such as pain medication (Hassed). The technique uses contraction of varied muscle groups during inhalation which is followed by relaxation of the same muscle groups during exhalation (Healthwise Staff, 2018). Individuals are instructed to tighten a muscle group vigorously, hold for approximately 5 seconds, and then allow the muscle to relax. Therapists should observe for overstraining, holding breath, and/or performing Valsalva as these are undesirable compensations.

Mind-body interventions reduce pain-related stress and are effective in the management of anxiety and depression (Bertisch et al., 2009). Specifically, Tai Chi has been shown to reduce stress, depression, and social withdraw with patients suffering from chronic pain (Kong et al., 2016). Progressive muscle relaxation technique is a common intervention for the treatment of anxiety and depression (Bertisch et al.) and deep breathing improves distress, pain, and anxiety-related symptoms (Jafari et al., 2017). Each technique can be useful in a PTs' practice to reduce the psychological strain of chronic pain and its associated sequela.

Building an individual's capacity to manage chronic pain using mind-body interventions techniques may be beneficial in reducing the need for opioid medications, improving functional performance, and increasing quality of life (Jafari et al., 2017). Tai Chi, deep breathing, and progressive muscle relaxation are three interventions that have demonstrated effectiveness in managing pain and its related stress and anxiety. The skill of a rehabilitation provider is useful in choosing the optimal mind-body therapy and then tailoring the education to the individual's home environment, level of functional independence, need for caregiver assistance, learning preferences, and resources available to carry out the techniques.

REFERENCES