Alternative and Complementary
Guided Imagery and Pain Relief
Guided imagery teaches you to use your imagination to reduce stress, relieve pain, and stimulate healing responses in your body. It can be a powerful tool in helping persons in pain lessen their pain and stress, take a more active role in their treatment, and regain a feeling of control. Research has shown that stress and tension can increase pain levels — learning to relax the body and mind can help you manage your pain and use the mind-body connection to improve your health.
A graduate of the University of Michigan Medical School in 1969, Martin L. Rossman, MD, is the director and founder of the Collaborative Medicine Center in Greenbrae, Calif., and co-director of the Academy for Guided Imagery in Malibu, Calif. He has taught clinical guided imagery to more than 10,000 health professionals since 1982 and has created dozens of guided imagery audios and home study courses for both patients and professionals. Dr. Rossman has provided a free 12-minute audio download "stress buster" that guides you through your inner peaceful place and helps you relax. Click here to download the stress buster audio.
How did you become interested in mind-body medicine?
Dr. Rossman: I've always been interested in how the mind and body interrelate, and my interest grew during medical school. Early in my career I became interested in working with people with chronic illnesses like diabetes, heart disease, hypertension, arthritis and chronic pain problems. These illnesses are chronic because, unfortunately, we cannot cure them so they take place over a long period of time.
If you have a chronic illness, the way you think, the way that you handle stressors – whether you create stress that you don't need or whether you have the ability to relax your body or self-regulate your physiology – can be a very important factor in how well you live with your chronic disease.
I became very interested in the difference between people who naturally had the ability to relax or who were willing to learn some techniques and tools that involved their mind-body connection. I saw that when people learned to physiologically and mentally relax and when they learned to manage their stress and their emotions better, they were not only happier and living better lives, they also experienced a positive effect on their physical well-being, including their pain.
Even though relaxation techniques didn't always take pain away completely, I saw that there was a big difference between people who were using their minds to regulate stress and people who weren't, so I began studying motivational psychology and mind-body medicine.
Is mind-body medicine more accepted now than when you began studying it?
Dr. Rossman: Mind-body medicine has really started to come into its own as we've learned more and as we've been able to watch physiologically what happens in the body as people learn some simple relaxation, guided imagery, self-hypnosis, meditation, and biofeedback skills.
Functional MRI studies allow us to watch the parts of the brain that become active when someone has chronic pain. Some of the really recent studies in chronic pain have shown us that when pain gets chronic, it sets up base in a different part of the brain than the acute pain response from the original injury.
This lends a lot of excitement to those of us in the mind-body field because we have seen that when people learn relaxation and guided imagery, they very frequently are able to help themselves live more comfortably. What this functional MRI research suggests is that some people are able to use one part of the brain to soothe or quiet down another part of the brain that is generating pain signals.
At Stanford, they've even starting using the fMRI as a type of biofeedback technique to show chronic pain patients when they are quieting the parts of the brain that are connected to the pain. Those people are getting pain relief. That's something that hopefully will blossom and really extend an even greater effectiveness to these mind-body techniques.
What is guided imagery and how does it help pain conditions?
Dr. Rossman: Imagery is basically thinking with your senses. It's thoughts that you imagine seeing, hearing smelling and feeling in your mind. It's the stuff that daydreams are made out of.
In a way, guided imagery is a kind of directed use of daydreaming. We frequently start guided imagery by teaching people a very simple way to mentally and physically relax. What we usually do, after inviting them to get their breathing a little bit deeper, is to have them go through and relax each part of the body.
Then we invite people to go to a place that's very beautiful and soothing – a place that they love to be in their mind. It might be a place they've been or it may be a place they've made up. The idea is that it's beautiful, it's peaceful, it's safe, and it's comfortable. It may even be a healing place.
Then we ask people to go through and notice what they see, hear and smell, and what the temperature is like and what time of day it is. We're asking them to pay attention to all these different sensory queues. As they do that, the brain sends messages down the nervous system that they're actually in such a place. These messages help the nervous system quiet down. Using guided imagery allows a person to generate a relaxation response.
People have been using guided imagery for a long time, but now – with the functional MRI – we can see that when people imagine that they see trees, flowers and a beautiful blue sky, they actually activate the visual part of their brains. When they imagine hearing sounds, they activate the hearing part of the brain. As they go through the different senses, they turn on the different parts of the brain that normally process those senses.
The thinking cap part of the brain – called the cortex – sends the messages down to the instinctual autonomic parts of the brain that generate either stress responses or relaxation responses. The cortex tells those lower parts of the brain, "This looks like a beautiful, peaceful place, it feels like it, it sounds like, and it smells like it." This causes the body to go into a relaxation physiology rather than a stress physiology.
Why is it important to create this relaxation response?
Dr. Rossman: For people with chronic pain, what's important about creating a relaxation response is that we know that stress physiology amplifies signals of pain. Fear, stress and emotional upset don't cause pain, but they can greatly amplify it.
When you are stressed or you're afraid that your pain is going to get out of control, the pain signals are amplified which makes pain worse and more difficult to control. When you worry about the future or something that hasn't happened yet – which you need to do to some extent – you can scare yourself and generate a great deal of stress. That's a form of imagery as well.
So we're during guided imagery, we use the same pathways to calm the nervous system and shift into a more physiologically relaxed state. Calming the nervous system will often reduce or eliminate the amplification effects of the stress.
After achieving a relaxed state, we can use specific suggestions that are soothing or calming, such as suggestions of anesthesia, numbness or comfort or images of secreting endorphins and other pain relieving brain chemicals into the blood stream. The suggestions and images that are specifically for pain reduction seem to add another quantity of pain relief on top of the relaxation effect. Some people are very susceptible to this and get surprisingly good relief, especially if they practice regularly. Almost everybody gets some pain relief and it's welcome when they do.
What's the difference between self-hypnosis and guided imagery?
Dr. Rossman: They're very, very similar. A lot of people are afraid of hypnosis and they associate it with the idea that someone's going to take over their mind. It's a misunderstanding – there's a lot of baggage that the term "hypnosis" causes.
There are some technical differences – you don't have to go into hypnosis to use guided imagery. But when you go into imagery, it tends to produce what looks like a hypnotic state.
A hypnotic state is simply a state where the person is relatively relaxed but their mind is very focused. That's all a hypnotic state is – it's nothing mystical or weird. When you're in a hypnotic state, what you focus on will have a bigger effect on you. If you're choosing ideas, images, and suggestions that suggest relaxation and comfort, that your body has healing abilities and that your body can turn down things that are painful, there's an effect that will often happen – whether you call it self-hypnosis or not, I think they're pretty much the same thing.
Do you have to go to a health professional to use guided imagery?
Dr. Rossman: We can teach people a lot of really effective tools through CDs or audio downloads like the kind we provide at The Healing Mind. CDs, books and audio downloads are "over the counter" strength guided imagery and are an inexpensive way to learn on your own.
For most people, I would encourage them to start with the self-help approach. Experiment for a few weeks and see how it goes. If you find that it is particularly difficult or you are getting into difficult emotional or psychological issues, then you should look for a professional trained in these methods.
How do you find someone qualified in teaching this technique? What sort of credentials or experience should you look for?
Dr. Rossman: For people with chronic pain, I would look for somebody who is a licensed health professional that has both training and experience working with people with pain and working with interactive guided imagery or hypnosis.
You can go to the Academy for Guided Imagery web site at http://www.academyforguidedimagery.com, which has a "find the practitioner" function that will give you health professionals that are certified in interactive guided imagery. To become certified, health professionals go through a 150-hour certification training. Of the 150 hours, 56 hours are directly observed by clinical faculty. When we give people a certification, it means that they've demonstrated that they're competent, ethical and capable of safely and effectively using this approach. It's an in-depth kind of approach – you can use guided imagery on a lot of levels, from simply relaxing or using imagery-based suggestions to get pain relief to digging in and exploring yourself on a very deep level and finding resources that may help you live a better life.
You also can search for a certified professional by state and specialty on the American Society for Clinical Hypnosis web site at http://asch.net/.
What suggestions do you have for people to get the most out of these techniques?
Dr. Rossman: First, give them a fair chance. Realize that it's something you learn to do. Give yourself a little time to experiment and learn. A lot of people will feel more relaxed right away. There's a good feeling that tends to come with practicing guided imagery. Once people give themselves permission to try it, they generally like it and look forward to it. It helps people feel more energized and it often helps people sleep.
I like to see people who are dealing with a difficult chronic pain issue to take enough time to give it a chance to work. Think about all the other things we do to treat chronic pain and how long we try them – all the different medications, exercises, or procedures. For people who have a serious chronic pain problem, I ask them to take two times a day for about 20 minutes at a time, if possible, and practice one of these relaxation, guided imagery techniques. Give it about three weeks and then see where you are. Don't judge it by one time.
Most people will notice a beneficial effect long before the end of the three-week period, but some people really need to dig in and do it with repetition. When you think about it, we're trying to set up new brain patterns. We're interrupting those deeply grooved pain pathways. We're establishing new pathways. Repetition helps change the brain structure so that you've got new pathways to go down that will take you to a more comfortable place.
If you feel like there's potential in these techniques for you, but you're having difficulty with the self-help approach, seek out a professional who has some expertise with it.
Are there other integrative modalities that help with pain?
Dr. Rossman: Absolutely. Mind-body techniques, acupuncture and nutrition are the three major legs of the stool that we've used to help people with chronic pain in my practice.
Along with being a physician for almost 40 years, I've been an acupuncturist for most of that time. I use acupuncture on a daily basis with my chronic pain patients. Again, some people get very good results. Some get partial results and for some people, it's not helpful. About 30 years ago, when I was in Michigan, I saw some patients with very difficult intractable pain who had multiple neurosurgeries, nerve blocks, heavy medications and nothing worked. It was the type of patient population where if you could have helped any one person, you could have written it up as a journal article. That's where I saw that acupuncture was a real thing and that it was providing real pain relief for these most difficult pain conditions. They were helping about 40% of those people with intractable pain. That's what really got me started on learning acupuncture and incorporating it into my practice. Acupuncture is an extremely helpful modality.
We also teach people to eat an anti-inflammatory diet and use anti-inflammatory nutraceuticals, such as fish oils. A lot of people – through their diet and chronic stress – tend to tip their bodies toward an inflammatory state. Inflammation is not a problem in all people with chronic pain, but it is a significant problem in some people with chronic pain.
Dr. Rossman will be discussing the benefits of acupuncture and an anti-inflammatory diet in helping chronic pain in two upcoming interviews. Visit The Healing Mind for information on guided imagery CDs that address stress, pain, and sleep.
Disclaimer: The National Pain Foundation does not endorse or recommend any specific treatment, procedure, or product. Information on this page and in the National Pain Foundation web site is provided to help explain what pain is and what resources are available to manage pain. Patient-related inquiries about pain should be directed to your health care provider.
A graduate of the University of Michigan Medical School in 1969, Martin L. Rossman, MD, is the director and founder of the Collaborative Medicine Center in Greenbrae, Calif., and co-director of the Academy for Guided Imagery in Malibu, Calif. He has taught clinical guided imagery to more than 10,000 health professionals since 1982 and has created dozens of guided imagery audios and home study courses for both patients and professionals. Dr. Rossman has provided a free 12-minute audio download "stress buster" that guides you through your inner peaceful place and helps you relax. Click here to download the stress buster audio.
How did you become interested in mind-body medicine?
Dr. Rossman: I've always been interested in how the mind and body interrelate, and my interest grew during medical school. Early in my career I became interested in working with people with chronic illnesses like diabetes, heart disease, hypertension, arthritis and chronic pain problems. These illnesses are chronic because, unfortunately, we cannot cure them so they take place over a long period of time.
If you have a chronic illness, the way you think, the way that you handle stressors – whether you create stress that you don't need or whether you have the ability to relax your body or self-regulate your physiology – can be a very important factor in how well you live with your chronic disease.
I became very interested in the difference between people who naturally had the ability to relax or who were willing to learn some techniques and tools that involved their mind-body connection. I saw that when people learned to physiologically and mentally relax and when they learned to manage their stress and their emotions better, they were not only happier and living better lives, they also experienced a positive effect on their physical well-being, including their pain.
Even though relaxation techniques didn't always take pain away completely, I saw that there was a big difference between people who were using their minds to regulate stress and people who weren't, so I began studying motivational psychology and mind-body medicine.
Is mind-body medicine more accepted now than when you began studying it?
Dr. Rossman: Mind-body medicine has really started to come into its own as we've learned more and as we've been able to watch physiologically what happens in the body as people learn some simple relaxation, guided imagery, self-hypnosis, meditation, and biofeedback skills.
Functional MRI studies allow us to watch the parts of the brain that become active when someone has chronic pain. Some of the really recent studies in chronic pain have shown us that when pain gets chronic, it sets up base in a different part of the brain than the acute pain response from the original injury.
This lends a lot of excitement to those of us in the mind-body field because we have seen that when people learn relaxation and guided imagery, they very frequently are able to help themselves live more comfortably. What this functional MRI research suggests is that some people are able to use one part of the brain to soothe or quiet down another part of the brain that is generating pain signals.
At Stanford, they've even starting using the fMRI as a type of biofeedback technique to show chronic pain patients when they are quieting the parts of the brain that are connected to the pain. Those people are getting pain relief. That's something that hopefully will blossom and really extend an even greater effectiveness to these mind-body techniques.
What is guided imagery and how does it help pain conditions?
Dr. Rossman: Imagery is basically thinking with your senses. It's thoughts that you imagine seeing, hearing smelling and feeling in your mind. It's the stuff that daydreams are made out of.
In a way, guided imagery is a kind of directed use of daydreaming. We frequently start guided imagery by teaching people a very simple way to mentally and physically relax. What we usually do, after inviting them to get their breathing a little bit deeper, is to have them go through and relax each part of the body.
Then we invite people to go to a place that's very beautiful and soothing – a place that they love to be in their mind. It might be a place they've been or it may be a place they've made up. The idea is that it's beautiful, it's peaceful, it's safe, and it's comfortable. It may even be a healing place.
Then we ask people to go through and notice what they see, hear and smell, and what the temperature is like and what time of day it is. We're asking them to pay attention to all these different sensory queues. As they do that, the brain sends messages down the nervous system that they're actually in such a place. These messages help the nervous system quiet down. Using guided imagery allows a person to generate a relaxation response.
People have been using guided imagery for a long time, but now – with the functional MRI – we can see that when people imagine that they see trees, flowers and a beautiful blue sky, they actually activate the visual part of their brains. When they imagine hearing sounds, they activate the hearing part of the brain. As they go through the different senses, they turn on the different parts of the brain that normally process those senses.
The thinking cap part of the brain – called the cortex – sends the messages down to the instinctual autonomic parts of the brain that generate either stress responses or relaxation responses. The cortex tells those lower parts of the brain, "This looks like a beautiful, peaceful place, it feels like it, it sounds like, and it smells like it." This causes the body to go into a relaxation physiology rather than a stress physiology.
Why is it important to create this relaxation response?
Dr. Rossman: For people with chronic pain, what's important about creating a relaxation response is that we know that stress physiology amplifies signals of pain. Fear, stress and emotional upset don't cause pain, but they can greatly amplify it.
When you are stressed or you're afraid that your pain is going to get out of control, the pain signals are amplified which makes pain worse and more difficult to control. When you worry about the future or something that hasn't happened yet – which you need to do to some extent – you can scare yourself and generate a great deal of stress. That's a form of imagery as well.
So we're during guided imagery, we use the same pathways to calm the nervous system and shift into a more physiologically relaxed state. Calming the nervous system will often reduce or eliminate the amplification effects of the stress.
After achieving a relaxed state, we can use specific suggestions that are soothing or calming, such as suggestions of anesthesia, numbness or comfort or images of secreting endorphins and other pain relieving brain chemicals into the blood stream. The suggestions and images that are specifically for pain reduction seem to add another quantity of pain relief on top of the relaxation effect. Some people are very susceptible to this and get surprisingly good relief, especially if they practice regularly. Almost everybody gets some pain relief and it's welcome when they do.
What's the difference between self-hypnosis and guided imagery?
Dr. Rossman: They're very, very similar. A lot of people are afraid of hypnosis and they associate it with the idea that someone's going to take over their mind. It's a misunderstanding – there's a lot of baggage that the term "hypnosis" causes.
There are some technical differences – you don't have to go into hypnosis to use guided imagery. But when you go into imagery, it tends to produce what looks like a hypnotic state.
A hypnotic state is simply a state where the person is relatively relaxed but their mind is very focused. That's all a hypnotic state is – it's nothing mystical or weird. When you're in a hypnotic state, what you focus on will have a bigger effect on you. If you're choosing ideas, images, and suggestions that suggest relaxation and comfort, that your body has healing abilities and that your body can turn down things that are painful, there's an effect that will often happen – whether you call it self-hypnosis or not, I think they're pretty much the same thing.
Do you have to go to a health professional to use guided imagery?
Dr. Rossman: We can teach people a lot of really effective tools through CDs or audio downloads like the kind we provide at The Healing Mind. CDs, books and audio downloads are "over the counter" strength guided imagery and are an inexpensive way to learn on your own.
For most people, I would encourage them to start with the self-help approach. Experiment for a few weeks and see how it goes. If you find that it is particularly difficult or you are getting into difficult emotional or psychological issues, then you should look for a professional trained in these methods.
How do you find someone qualified in teaching this technique? What sort of credentials or experience should you look for?
Dr. Rossman: For people with chronic pain, I would look for somebody who is a licensed health professional that has both training and experience working with people with pain and working with interactive guided imagery or hypnosis.
You can go to the Academy for Guided Imagery web site at http://www.academyforguidedimagery.com, which has a "find the practitioner" function that will give you health professionals that are certified in interactive guided imagery. To become certified, health professionals go through a 150-hour certification training. Of the 150 hours, 56 hours are directly observed by clinical faculty. When we give people a certification, it means that they've demonstrated that they're competent, ethical and capable of safely and effectively using this approach. It's an in-depth kind of approach – you can use guided imagery on a lot of levels, from simply relaxing or using imagery-based suggestions to get pain relief to digging in and exploring yourself on a very deep level and finding resources that may help you live a better life.
You also can search for a certified professional by state and specialty on the American Society for Clinical Hypnosis web site at http://asch.net/.
What suggestions do you have for people to get the most out of these techniques?
Dr. Rossman: First, give them a fair chance. Realize that it's something you learn to do. Give yourself a little time to experiment and learn. A lot of people will feel more relaxed right away. There's a good feeling that tends to come with practicing guided imagery. Once people give themselves permission to try it, they generally like it and look forward to it. It helps people feel more energized and it often helps people sleep.
I like to see people who are dealing with a difficult chronic pain issue to take enough time to give it a chance to work. Think about all the other things we do to treat chronic pain and how long we try them – all the different medications, exercises, or procedures. For people who have a serious chronic pain problem, I ask them to take two times a day for about 20 minutes at a time, if possible, and practice one of these relaxation, guided imagery techniques. Give it about three weeks and then see where you are. Don't judge it by one time.
Most people will notice a beneficial effect long before the end of the three-week period, but some people really need to dig in and do it with repetition. When you think about it, we're trying to set up new brain patterns. We're interrupting those deeply grooved pain pathways. We're establishing new pathways. Repetition helps change the brain structure so that you've got new pathways to go down that will take you to a more comfortable place.
If you feel like there's potential in these techniques for you, but you're having difficulty with the self-help approach, seek out a professional who has some expertise with it.
Are there other integrative modalities that help with pain?
Dr. Rossman: Absolutely. Mind-body techniques, acupuncture and nutrition are the three major legs of the stool that we've used to help people with chronic pain in my practice.
Along with being a physician for almost 40 years, I've been an acupuncturist for most of that time. I use acupuncture on a daily basis with my chronic pain patients. Again, some people get very good results. Some get partial results and for some people, it's not helpful. About 30 years ago, when I was in Michigan, I saw some patients with very difficult intractable pain who had multiple neurosurgeries, nerve blocks, heavy medications and nothing worked. It was the type of patient population where if you could have helped any one person, you could have written it up as a journal article. That's where I saw that acupuncture was a real thing and that it was providing real pain relief for these most difficult pain conditions. They were helping about 40% of those people with intractable pain. That's what really got me started on learning acupuncture and incorporating it into my practice. Acupuncture is an extremely helpful modality.
We also teach people to eat an anti-inflammatory diet and use anti-inflammatory nutraceuticals, such as fish oils. A lot of people – through their diet and chronic stress – tend to tip their bodies toward an inflammatory state. Inflammation is not a problem in all people with chronic pain, but it is a significant problem in some people with chronic pain.
Dr. Rossman will be discussing the benefits of acupuncture and an anti-inflammatory diet in helping chronic pain in two upcoming interviews. Visit The Healing Mind for information on guided imagery CDs that address stress, pain, and sleep.
Disclaimer: The National Pain Foundation does not endorse or recommend any specific treatment, procedure, or product. Information on this page and in the National Pain Foundation web site is provided to help explain what pain is and what resources are available to manage pain. Patient-related inquiries about pain should be directed to your health care provider.