These various techniques may best help long-lasting chronic instances of pain.

Positive outlook
A patient’s emotional or psychological state may affect the course and perception of his pain. The effectiveness of short, intensive programmes of patient education has been evaluated in several studies. In one, individuals with ankylosing spondylitis showed improvement in terms of rates of depression and severity of the disorder at three weeks and this improvement continued until the end of the trial at six months. The researchers noted, however, that motivating the patients to continue their home-exercise programme past the six-month mark remained one of the biggest problems.

Cognitive behaviour
Another study looked at the effect of group treatment on chronic pain and the emotions linked with it—anger, anxiety and depression—on a group that included sufferers of low back pain, tension headache, rheumatoid arthritis and ankylosing spondylitis. A cognitive behavioural programme, which included components of relaxation, cognitive restructuring and the promotion of well-being, was used with great success on all the groups.

Music therapy
Thirty women with rheumatoid arthritis were told to relax, listening to the music of their choice, while researchers studied the effect this had on their perceptions of pain. The results of the study, based on questionnaires completed before, during and after listening to music, showed that this kind of relaxation could be a valid way to help chronic pain.

Hypnotherapy
Hypnotherapy may also be useful. In a controlled study of patients with fibromyalgia, 40 patients were randomized either into hypnotherapy or physical therapy groups for 12 weeks. Follow-up was at 24 weeks. In the hypnotherapy group, the subjective scores of pain, morning fatigue and sleep patterns all showed improvement, though objective assessment of the disease progression showed no change.

Meditation and Visualisation
Meditation is a very effective technique for stilling the mind, taking control and reducing pain. There are many meditation techniques or approaches. There are those that count the breath, or focus on a religious icon, while visualisation is an increasingly popular technique that involves the mind imagining some life-enhancing image such as a sun-drenched beach. Other methods start with a prescribed mantra, or on the “Om” word, or on a koan or illogical saying beloved of the Zen Buddhist tradition.

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