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Podcast – Hope As A Therapeutic Intervention For Chronic Pain With Dillon Caswell, PT, DPT, SCS

The following podcast continues to explore how meaningful activity and hope plays an important role in chronic pain management

Welcome back to the Healing Pain Podcast with Dillon Caswell, PT, DPT, SCS

The more we study pain and pain management, the more we realize how much power the person experiencing the pain has over their own experience and healing. This is why our job as practitioners is not to be the solution for our patients, but to help them find the solution for themselves. This powerful perspective is brought to us by Dillon Caswell, PT, DPT, SCS, a groundbreaking expert on using hope as a therapeutic intervention for chronic pain. In this episode, we learn how hope can easily be one of the most effective salves to pain that we have access to. This is not the passive yearning that we often associate with the word “hope”. This is something much more powerful, and it may be the thing that makes a difference in your practice or in your life. Tune in to learn more!

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TRANSCRIPT – Hope As A Therapeutic Intervention For Chronic Pain With Dillon Caswell, PT, DPT, SCS

In this episode, we’re discussing hope, widely considered as an important therapeutic factor in health, and the usefulness of hope as a therapeutic intervention, not only for chronic pain but also for many other chronic health conditions. We’re joined by Dr. Dillon Caswell. Dillon is a sought-after doctoral-trained physical therapist with over a decade of experience in practice as well as higher education as an adjunct professor at SUNY Upstate Medical University.

Dillon is on a mission to cut through the misleading narratives that surround the human experience of healing while unearthing the science that supports this process. Dillon is host of one of the world’s leading health podcasts called the Prehab Podcast as well as the author of a new book called, Hope Not Nope: Using Hope For Healing and Reclaiming Identity as a Lifelong Athlete in a Sick Healthcare System.

In this episode, we dive headfirst into the depressing challenges society faces when it comes to pain and the process of healing. We’ll also explore the heart-wrenching question of why people give up on meaningful activities and how we can infuse hope into a healthcare system that sometimes feels like it’s drowning in despair. Dillon’s work also begins to unravel the incredible power of the human brain and how a shift in our mindset can be the key to unlocking relief for those suffering from chronic pain.

Thank you for joining us as we embark on this transformative journey of discovering the role that hope plays in chronic pain recovery. Don’t forget to hit that subscribe button and make sure to share this episode with your friends and family. Without further ado, let’s begin and let’s meet Dr. Dillon Caswell.

Dillon, welcome. It’s great to have you on.

Joe, thanks for having me on. I’m excited to dive into this conversation.

Me too. We dance around this topic a lot, but we don’t ever talk directly to it or raise awareness around it the way you’re doing with some of the work you’re leading. I think we’re going to talk about some of the work you do as a licensed physical therapist and a practitioner and then raise awareness around this topic. Why is the topic of hope something that we should be talking about in chronic pain and chronic illness in healthcare in general?

It’s a great way to start it off and dive into it. There are a lot of misconceptions about the term hope. A lot of people will think that hope means that it’s something passive. You’re sitting there and hoping that something gets better. You’re hoping that you get out of chronic pain and get back to these activities. When we look at hope, there’s a famous researcher out of Kansas University named C.R. Schneider. He was a hope researcher and found that for hope to exist, it’s an interplay of the following three statements of self-agency, goal-directed behavior, and a framework.

When we look at that, we start to understand why hope is so important to be integrated into our healing process. Much of what we’re getting from our current healthcare system speaking to the United States is, “Nope, you go in, you’re in pain, and you’re uncertain.” You don’t know what’s going on. You want to know, “Am I going to be okay? Am I going to be able to work? Am I going to be able to provide for my family? Am I going to be able to play this sport? Am I going to be able to go for the morning run?”

All these things that make you the person that you are, you’re starting to wonder, “Am I going to be able to do these things because I’m uncertain? My movement system seems pretty chaotic right now. I’m having this pain response and may not know what’s creating it. I then go into an office. Instead of getting a solution, I’m being told or given more evidence that I’m frail and fragile.” It could be through imaging or by not being heard. There’s research showing that a person is interrupted every eleven seconds in an office when they’re trying to tell their story.

I go back and think of growing up, having an Italian family, and how frustrating it is to attempt to tell a story and then continuously get interrupted. You get to the point where you’re like, “I’m not going to tell the story anymore. I’m checked out of this because I want to move on to the next thing.” Many people are having this experience when they’re looking for some certainty, answers, or a solution. They’re getting further rejected. They then start to give up things that are meaningful because they’re afraid to live the life that they’re meant to live.

I commonly say that we have so many people in this world, but not a lot of people are alive. A lot of people are getting up and putting their effort into getting through that day. Granted, we all have those days you’re struggling to get through. Overall, we need more people who are alive, enthusiastic, and happy to be doing the things that they were meant to do. To me, that’s where hope comes in. We need self-agency. We need to recognize that we can take ownership of our actions. There’s this common thought that we have this lizard brain that controls us. This lizard brain makes us do certain things.

We have so many people in this world but not a lot of them are alive. We need more people who are alive, who are enthusiastic, who are happy to be doing the things they were meant to do. That’s where hope comes in.CLICK TO TWEETLearning from Dr. Lisa Feldman Barrett, one of the top neuroscientists in the world, we learned that we have the ability to respond versus react to situations. We can create self-generated actions to start to take control of whatever experience we’re going through. A lot of people will sit back and be delivered the note and go, “Whatever. That’s what was supposed to happen. I’m not supposed to move forward with this.” There’s a whole other side to this story that we’re hoping to give through this message of hope not nope.

We talk a lot about active ways to cope with pain and other conditions. There are passive ways to cope. It sounds like what you’re saying is that hope is an active means of coping with whatever condition, situation, and poor health that someone is facing. Initially, when people think of hope, it’s almost like you hear the expression, “Tonight, I’m going to hope and pray on this.” Some people view that as taking a more passive or backseat approach to what they’re dealing with.” However, you’re trying to say, “Hope is a positive psychological way to cope with whatever it is that you’re facing.”

It’s using these self-generated actions, goal-directed behavior, and a framework to achieve it. One of my favorite sayings is that hope is learned and earned, meaning we learn to become hopeful when we face adversity and suffering. If you’re living, you’re going to face adversity and suffering as part of the human experience. One of the things that we can guarantee in this life is that there are suffering and obstacles that you’re going to face.

As you go through those and adapt and become more resilient, you start to learn that you can remain hopeful in these situations. It didn’t happen by you passively letting these things happen to you. They happen because you decided to lean into it and that there was going to be a different outcome that was going to happen from that obstacle. People think of hope as being this passive, “I’m going to hope that it gets better.” Hope is learned and then it’s earned. How is it earned? It’s earned from putting the work in and by taking actionable steps to get closer to that outcome.

Of course, this is all wrapped up in the thought of, “How do we help people heal?” I say, “How do we help people?” What you’re saying is that, in some way, our job as a practitioner, or maybe your job as a friend or a colleague, is to empower someone to heal. What are some of the challenges you see with regard to the way we approach, on this show, chronic pain, but in general, the healing of chronic illness and disease in our Western society and medicine?

It’s partly why I wrote the book Hope Not Nope to hopefully become part of the solution. I spent so much time becoming angry and complaining about the healthcare system. I said earlier that we all will face suffering, but my belief is that our suffering has been conditioned to be longer than it was meant to be because of the narrative surrounding these chronic illnesses and the lack of control.

HPP 318 | Hope
Hope Not Nope: Using Hope for Healing and Reclaiming Identity as a Lifelong Athlete in a Sick Healthcare System

When we look at the number of chronic diseases, it’s pretty scary. The rates of type 2 diabetes are increasing. Seeing this number increase, but people are not getting the message, “There are a lot of lifestyle habits that you can use that this thing can be preventable.” Type 1 diabetes is a completely different story, but in type 2, we have a good chance to get rid of that when we look at the current treatments that are offered for chronic pain.

Joe, I know you’ve done a lot of work in this area, but at least in the United States, people are often offered opioids as a first-line defense to taking care of their chronic pain. We know that that’s not the solution. In Upstate New York, we’ve gotten a ton of pollen. There hasn’t been a lot of rainfall, so there’s been all this pollen all over the place. I have a studio, and in front of the studio, there was this layer of pollen coating the driveway.

I spent about three weeks sweeping out the garage because of all the pollen that was in there. I kept sweeping it out to the driveway. The next day, I’d go in, pop the door open, and the pollen would come back in. I kept doing this over and over again until I had the realization that I needed to take the next step. The next step is to sweep the pollen out of the studio. Now, I need to get it out of the driveway, or else it’s going to keep blowing back in again.

When we look at chronic disease, that’s what the model is right now. It’s taking the pollen and sweeping it back into the driveway, but it’s not taking care of what’s causing that underlying condition. We offer these short-term fixes. What ends up happening is that the person then gets in the cycle that it keeps coming back because what has likely created it hasn’t been dealt with front on. It’s just been distracted.

To me, the challenge is how we get our system to start taking that second step. How do we get people to start going, “I’m going to go ahead and decline that opioid because I want a different approach that’s going to take the pollen and get it out of the driveway?” Once that’s out of the driveway, and back to that analogy, now I’m not spending my morning sweeping for an hour. I’m not spending my evening sweeping for an hour. I’ve gifted myself two hours in the day to partake in meaningful activity because sweeping is not meaningful to me. It’s a task that I do to keep my clients happy, but it’s not something I enjoy doing.

Now, I don’t have to sweep as much. That means I have two more hours to read, research, or hop into conversations. By doing that and taking that extra step, I’ve now gifted my time to be able to do things that are more fulfilling. By doing that, as that time adds up over time, my body is going to start to heal itself because of the fulfillment that it’s feeling. Instead of doing these tasks, it’s going to be, “I’m excited to do these things.”

It’s essentially because you see people with pain as well. When we talk to people with pain in their history somewhere, at one point, they had a ritual active life, and then this pain or this condition developed, or whatever happened to someone. There is this tipping point where you can see the meaningful activities at that point started to become less important, or for some reason, got pushed to the wayside or got put on the back burner.

It’s interesting to see or start to think about, “Why do people give up their meaningful activities?” If they are meaningful and bring you a sense of joy and fulfillment and you see a lot of value in what’s being done, what does lead to that straw breaking the camel’s back of, “Now, I’m not going to focus on my meaningful activities? I’m going to focus on my pain.”

The short answer to that is fear. It’s fear of, if they were to continue that activity, what potentially could happen. It starts with the conversation of what pain is because pain is this experience that most of us are going to have. I used to say all of us will have it, but there is a condition and congenital insensitivity in which a person doesn’t have that output of pain. What’s interesting is that when people have that, their lifespan is shorter. Pain gives us a constraint. It lets us know our thresholds. That can be an emotional or a physical threshold. Taking a step back, we need to change our perspective on pain.

Pain is not a bad thing. Pain is a constraint. Pain is asking us to change something about our life or being. It may be our sleep habits, relationships, work, or an activity that we’re doing. Pain is a request to change something about your being. With that being said, I was researching and reading this story about Albert Einstein, which I included in the book because it got me thinking. I start by saying it was from Albert Einstein because if you hear this story, you’d be like, “That sounds witty. That was Albert Einstein. That makes sense.”

Pain is not a bad thing. Pain is asking us to change something about our life or something about our being.

The story goes that Albert Einstein was a freshman in his college class, and his professor stated the question, “If God exists and God created everything, then did God create evil?” The class was pretty silent. Einstein raises his hand, and he goes, “I have a question for you. Does cold exist?” The professor goes, “Of course, cold exists.” Einstein goes, “No. We have heat and mega heat. We have all these different levels of heat. We have absolute zero. We can continue to measure heat as it gets hotter, but we have no measurement for cold. Cold doesn’t exist. Cold is just the absence of heat.” The professor goes, “Okay.”

Einstein keeps going, “Does darkness exist?” The professor goes, “Of course, darkness exists.” Einstein says, “No. We can measure the speed of light. We have all these different variables for light, but we are continuously looking for dark matter and can’t find it. Darkness is the absence of light.” He keeps on going on. In the story, what stuck out to me and what I started reflecting on in our work is, “Does pain exist, or is it an absence of something?” We’ve seen the definition of pain evolve. We’ve seen international societies developing more pain definitions. Basically, what it comes down to is that it’s an individualized experience that’s specific to that person and the parameters around it.

We could have the same shoulder injury, but our response to that can be completely different depending on your previous beliefs, mindset, environment, and solutions that you’ve been offered. We can have the same injury but have a completely different pain response to it. It got me thinking, “Does pain really exist?” It’s a deep-thought question. I know it’s one that when people are tuning in, they’re probably like, “What do you mean? Yeah, pain exists.” The question that I pose is, “Does it exist, or is it an absence of meaningful activity?”

HPP 318 | Hope
Does pain exist, or is it just the absence of meaningful activity?


The reason that I pose that is because people I’ve worked with who are in chronic pain have that tipping point in which they’ve given up their meaningful activity. I gave an example in the book about this. I’ve worked with this one lady and she was in chronic pain for years. We tried a bunch of different things, and it seemed like nothing was working. I got to the end of it where I was like, “I don’t think I have much more that I can offer.” I’m not giving up on this, but I don’t want to be wasting her time. I want to make sure that she’s seeing the right provider and getting the right things.

She mentioned to me that her lifelong childhood dream was horseback riding. She was going on a trip to Puerto Rico, and she was wondering, “Do you think it would be a bad idea to ride the horse?” We got into the conversation and worked through it together. I was like, “It’s been your lifelong dream to ride this horse. You have the opportunity to do it. What’s keeping you?” She’s like, “The back pain that I feel.” “If you ride the horse or you don’t ride the horse, you’re still going to have back pain. Why not try it? Go for it. If it’s bothering you, then at least you tried it. You’re then not living with this what-if. You don’t have that regret anymore.”

She came back, and she had the biggest smile on her face. The entire time that she rode the horse, she had no back pain. It was the first time that she had no back pain for a part of the day in a long time. She came back and had one more appointment with me. She kept the appointment because she wanted to tell me about the experience. That’s what the appointment was for. I’m like, “You can just call.” She’s like, “No, I want to come in.” I’m like, “Okay.” I’m glad she did because I got to see that smile and the glow that she had back. It was amazing. She had no back pain while riding the horse.

When you learn about spine mechanics and all the things that you think you would need for horseback riding, you would think that this is going to “destroy her spine.” It didn’t. It led to her having a better well-being. I got into this of like, “People do well in chronic pain when we start to replace the pain they’re experiencing with meaningful activity.”

There are lots of different methods out there. When you look at a lot of methods that center around chronic pain, things like behavioral activation, activities of daily living, values-based activities, and meaningful activities, they all point in that area. You’re telling that story, which I think is a great story to tell because all of us, as physical therapists, probably have a similar story, where a patient was in pain and unsure whether they should do something. We basically encouraged or gave them permission to do that one thing. It worked out well for them. They felt good, and they didn’t have any pain from it, or at least maybe the pain didn’t get any worse.

As you’re telling the story, I’m tracking that story with you. There are three distinct parts I see there. The first is the relational piece that’s happening between you and the patient or the person you’re caring for. I see hope instilled there because you’re probably the first person who instilled hope in her that she could do something that she probably never thought she’d be able to do. I think she probably thought about it, contemplated it for a while, and hope started to build up inside of herself.

She then gets on the horse. Maybe a little nervous. She’s like, “I’m not sure I should be doing this. I’m thinking about my spine. The therapist said it was okay,” and then you do this activity. You’re in the Caribbean, it’s sunny, you’re riding a horse, it’s fun, and I’m sure there are friends and family around, etc., more hope builds. It makes me wonder as we start to look for things that alleviate pain. What you’re saying in some way is that hope is one of the great anesthetizes that we have access to.

I think it is and it’s part of the mission. From my experiences in researching this, hope can be the greatest healing agent that we have available to us. The difficulty with that is to get to the hope, you have to unpack a lot of the no that people have been given. A lot of the misinformation or lies or environment, as you were alluding to, of she was in the Caribbean, didn’t have environmental stresses, was with family, and didn’t have all these pressures on her. That environment then allowed her to have more hope and ability to have that thought process of, “I can do this. Not just I can do this, but I’m going to do this”.

Hope is super powerful. I remember doing an episode on a podcast with Chris Norton. His story, as I share it, people will probably start to remember it. He was a college football player. He wanted to make a tackle on a kickoff. He had a C-spine injury and was airlifted to the hospital. He was given a 3% chance to ever move again. Not a 3% chance to walk again, but a 3% chance to ever move again. In the process, what he said is, “That’s not 0%. I’m going to take advantage of that 3%.” With hope, he started pursuing that. In the process, he was in the hospital and started firing the providers telling him that he was making things up because he started to get some shoulder movement.

He started shrugging his shoulder, and they’re like, “No, that’s not happening.” He started to say, “I’m feeling something in my foot.” They came in and said, “That’s phantom limb pain. You’re paralyzed from the neck down. You’re not feeling these things.” He started to get movement in his toe back. Again, they came in and said, “You’re not moving it. It’s a thing that’s made up in your head.” He progressed to his college graduation and walked across the stage to receive his diploma. He gets engaged and walks down the aisle to marry his wife.

Was it the way that we would think of walking? No, he had assisted devices. He had people surrounding him, but this was a guy who was given a 3% chance to ever move again. He’s now standing and moving his limbs under his own power with support around him to do this. One of the things that he shared with me, and his documentary and book, was he had support from the community. His family started a Facebook group and people were pouring in messages of inspiration of what he was doing was impacting their lives and the difference he was making. He had his football team that was helping him to still pursue his college education. He had all the support in the world, but he was still being dealt this plate of nope.

There was one nurse who came to him at nighttime. He was at a low. He was crying and thinking, “I should start listening to this. This is what I’m stuck with. I’m not going to move again.” That nurse was the first one to get down on his level, look him in the eyes, and say, “Chris, this is possible. You can do this.” That little extra time, that look in the eye, getting to someone’s level, and giving them that message of encouragement fueled him to now get to that next level of that outcome.

As providers, that’s on us. When we’re building these relationships with people, we want to give them hope. The tricky part is that we don’t want to be unrealistic with the hope that we’re providing. We do still want to go through a thorough assessment. We want to understand their past, goals, and medical history. In doing that, we can start to provide appropriate hope. Back to the beginning, what do we need for hope? We need a framework. Getting those details allows us to develop that framework.

I’m wondering if, in some way, you think that the most giant nope people might experience is the healthcare provider who doesn’t know how to instill hope in someone’s recovery process. That most certainly exists in our Western medicine world.

It absolutely does. I’m going to take it a step further and say that it’s anyone who is a respected figure who is instilling nope into someone or rejecting someone. It can go down to the level. A lot of my work is with lifelong athletes. A lot of times, it’s from a coach they had when they were seven years old.

It could be a teacher.

A teacher like, “You stink. Go sit on the bench. Don’t get slivers in your butt.”

It could be the person who is authorizing the insurance coverage because that’s a person of respect who says, “Our data shows that people like you don’t walk again.” It could be a respected friend or even a spouse. There’s some research around a spouse or others’ influence on someone’s recovery.

I’ve worked with people a lot. They’re starting to have some knee discomfort and they don’t want to have surgery. They know a total knee replacement is available, but they don’t want that. They want an alternative way to go about it. Sometimes, the hardest part is getting their significant other on board with it. The typical conversation that I’ve run into, and maybe Joe, you’ve had a similar thing, is that the significant other goes, “They’re good when they see you, but you don’t have to hear them complaining about their pain later on. I’m dealing with the complaints, so I want this pain to be gone as soon as possible.” The way to do that is the surgery.

As a provider or bring it out to the bigger picture, as a respected figure, you have to get the team on board. You have to put in that extra time and take that next step to make sure everybody is rowing the boat in the same way. If one is rowing this way and another one is rowing that way, you’re doing a circle the whole time. I used to get myself in those circle situations all the time, and I’d be headbutting the desk of, “Why is this plan not working? What am I missing?” It was like, “I didn’t coach the whole team.”

The person that we’re working with has a support system with them that we should learn about as providers. Maybe you’re not sitting down and getting dinner with their second cousin. That’s fine. You don’t need to do that much work. At least saying, “The closest people to you, what do they think about the situation? What’s the information that you’re getting from them?”

Give us 1 or 2 practical, simple ways that someone can start to move toward this direction. There are people tuning in that are like, “I get this 100%. I’m on board with this, but I want to know how do I start to shift myself or my mindset.” A lot of this revolves around someone’s mindset. How do I start to shift my mindset toward a mindset of hope and healing?

That’s key because there’s a readiness that has to be available for this to be successful. I love the quote from Hippocrates, “When a person is saying that they’re ready to heal, ask them, are they ready to give up the things that made them ill?” I think that’s so powerful. That question of, there’s been a lot of things that have happened in your life that have led to this one point. It wasn’t just this one experience.

“When a person is saying that they’re ready to heal ask them, ‘Are they ready to give up the things that made them ill?’” – HippocratesCLICK TO TWEETI will say this, and I don’t have research to back this. This is from my clinical observation, but I’ve never worked with an athlete who got injured when they were at their best. When they were feeling their best, their families were all doing great. They had social support, sleep, and nutrition. They have never had that experience. Every athlete that I’ve worked with has gotten injured on the field. If you look a week or two weeks prior, there was a significant event that happened. The loss of a loved one, not having enough community, or not getting enough sleep. There’s something that preceded that injury happening.

With the shift in mindset to get someone on this path of healing, we have to look at the whole story. The first step is to be willing to share that story with people who are on your team to get you to that next step. After sharing, you have to have an openness to learn and make sure that you’re learning from credible information to allow that to start to shift your mindset and perspective. The worst thing that happens is when people, for example, come on a podcast and say something, and then the person goes, “I’m going to go do that because Dillon said to go do that.” No. Go put some research in and see if that is the right thing for you.

Our job is we’re here to guide people toward a solution. We’re not here to be that solution for them. When people say, “Go see Dillon, Dillon fixed me.” I go, “No, I did not fix you. I guided you to the ability to fix yourself by putting the right resources in front of you. It was you that did that.” If you’re that person who has struggled with no and has faced this rejection, you don’t want that anymore. You want to get back to hope. It starts with finding that person that you can work with, sharing their story, being open-minded, and putting the work in that you’re not receiving the information, but you’re an active part of it. As the perspective starts to shift and your body wants to start moving, that’s when we have to start to let it move.

I feel like constantly, we’re giving people permission to move. We’re creating safety. It’s interesting because when we look at research in the business world, what makes a business organization successful? Amy Edmondson has done a ton of research on this. What makes a business successful? The number one factor that has emerged is psychological safety. When people feel safe, they’re then more willing to take a potential risk because they know that they’re going to be supported.

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When people feel safe, they’re more willing to take a potential risk because they know that they’re going to be supported.


I jokingly say, but seriously say that when a toddler is learning how to walk, they tend to fall about seventeen times per hour. Each time they fall, the parent doesn’t go, “You call that walking? That was terrible. Learn how to walk, kid.” They pick the kid up, nurture them, and say, “It’s okay. You hit the floor, but you’re going to get it. Go ahead and try it.” Even from that young age, that psychological safety that is presented allows us to then take the risk and move towards healing and experiencing hope.

Dillon, I want to make sure that we point everyone to your latest book. It’s called Hope Not Nope. Everyone can find that online. Amazon or your other favorite online book retailer. It’s a great book that Dillon wrote on this concept that we spoke about in this episode. Dillon, thanks for joining me here. Let people know how they can learn more about you and follow your work.

Thanks for having me on, Joe. It’s always great to connect with you and have these conversations. My website is Instagram is @HopeNotNope. Feel free to DM us and chat with us there. As Joe said, the book is online. It’s on Amazon and Barnes & Noble. There’s an Audiobook, physical copy, and Kindle available. Whatever one you like to read, it’s available for you there.

Everyone, hop on over to to check out the book. If you are on Instagram, you can reach out to me or Dillon. You can find us on Instagram. We do lots of activities there. I want to thank everyone for joining us to talk about the importance of hope, healing, and overcoming chronic pain. Make sure to share this episode with your friends and family on Facebook, LinkedIn, Twitter, and Instagram, wherever anyone is talking about chronic pain and the hope to overcome it. See you next episode.

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About Dillon Caswell

HPP 318 | HopeDr. Dillon Caswell is a sought-out enthusiastic clinical Doctor of Physical Therapy with expertise and a Board Speciality Certification in Sports. He has spent more than 10 years in higher-level education both as a student and adjunct professor at SUNY Upstate Medical University.

He desires to empower and educate the next generation by cutting through the biased lies surrounding the human experience by constantly seeking and delivering the truth in science and healing. This mission has fueled him to author Hope Not Nope: Reclaiming Identity as a Lifelong Athlete in a Sick Healthcare System and to host one of the top alternative health podcasts in the world: The Prehab Podcast.

Dr. Caswell embodies servant-based leadership, bringing people that have been shamed with “nope” to the truth of hope, in a practice he founded and owns: Action Potential Performance Physical Therapy (AP3T), PLLC in Syracuse, NY.

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Podcast – Living and Dying with Dignity

The title of the podcast “living and dying with dignity” is a challenging one, especially for our community living with chronic pain and who are often left feeling there is no hope for a better life.

Dr. Chochinov has worked primarily in palliative care research, but sees a parallel in his work for people living with chronic pain. He explains what Patient Centred care really is and believes all medical professionals should strive for The Platinum Rule which he explains during the podcast.

How decisions are made and patients cared for are often guided by the Golden Rule, which would have us treat patients as we would want to be treated in similar circumstances. But when patients’ lived experiences and outlooks deviate substantively from our own, we stop being a reliable barometer of their needs, values, and goals. Inaccurate perceptions of their suffering and our personal biases may lead to distorted compassion, marked by an attitude of pity and therapeutic nihilism. In those instances, The Platinum Rule, which would have us consider doing unto patients as they would want done unto themselves, may be a more appropriate standard for achieving optimal person-centered care. This means knowing who patients are as persons, hence guiding treatment decisions and shaping a tone of care based on compassion and respect.

This podcast was published by Deana Tsiapalis of Pain 2 Possibilities


Dr. Harvey Max Chochinov is a distinguished professor of psychiatry at the University of Manitoba and Senior Scientist, CancerCare Manitoba Research Institute.

He is well known for many accomplishments including leading the research team that pioneered the Dignity Model and Dignity Therapy. He won the Prose award for his 2011 book – Dignity Therapy: Final Words for Final Days and he’s just published his new book: Dignity in Care – The Human Side of Medicine. He’s also the co-founder of the Canadian Virtual Hospice, the world’s largest repository of web-based information and support for dying patients, their families and healthcare providers.

  • The Platinum Rule
  • Seeing Ellen and the Platinum Rule
  • Strategies and approaches to dignity conserving care in practice
  • The ABCDs of Dignity in Care
  • Intensive Caring: Reminding Patients They Matter
  • Depression is a Liar


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Self Compassion and Self Expression in the Arts

With our October Dance Festival awareness event just around the corner, this podcast exploring how artists living with chronic pain, organise their performances around their limitations is very relevant.

Is self-compassion a trait or a state of being? This edition is inspired by findings that suggest stronger self-compassion is associated with reduced impact of chronic pain.

Self-compassion, in this sense, is the ability to respond to pain and difficulties with kindness and openness rather than criticism. In this episode we ask our artistic contributors, and ourselves, how to step towards achieving self-compassion and the importance of movement in looking after our bodies.

This edition of Airing Pain was made possible by the invaluable contributions of our participating artists who showcased their works at the Edinburgh Fringe Festival, and those in the academic field. We learn the motives behind using dance as a way of supporting those in pain, but also expressing and communicating pain to audiences.

Listen to Podcast

Dr Sarah Hopfinger, Artist and Researcher (Edinburgh Fringe: “Pain and I”)
Victoria Abbott-Fleming MBE, Founder of the Burning Nights CRPS
Dr Emma Meehan, Associate Professor, Centre for Dance Research, Coventry University
Tali Foxworthy Bowers, Choreographer and Movement Director (Edinburgh Fringe: “Monoslogue”)
Jenna Gillett, PhD Student, Department of Psychology University of Warwick

The music used at the beginning of this edition was an original composition for Pain & I by Alicia Jane Turner.
Images provided by Sarah Hopfinger.

Read transcript

Time Stamps:
1:35 – Miriam Introduces Sarah Hopfinger’s “Pain and I” performance during Edinburgh’s Festival Fringe, and asks what techniques from the world of dance offer those living with pain?
3:41 – Pacing as a technique. Also see 13:25 for Sarah Hopfinger on pacing.
6:34 – Emma Meehan, at the British Pain Society, on how dancers living with pain approach pain.
8:34 – Introducing Tali Foxworthy-Bowers
15:54 – A huge thank you, and invitation, for filling in our survey
16:20 – Emma Meehan and research into what somatic practices in movement can offer those living with pain.
18:20 – The importance of sharing and telling stories about pain experiences as an act of self-compassion for performers, and mutual connection. See also 25:53 for a continuation of this sentiment from Tali Foxworthy Bowers.
21:25 – Pain catastrophising, how we frame pain, and techniques for being kinder to ourselves with self-love and compassion.
27:54 – Suggestions of how to support those close to you who are living with pain.
31:34 – Emma Meehan discussing agency with pain, as showcased at the British Pain Society ASM 2023.
35:10 – The role of charities in patient support, and what else can charities be doing?
37:27 – Chronic pain is chronic strength: acceptance of pain as part of the bodies we love and care for.

Additional Resources:
Burning nights
NHS Resources
Somatic Practice
Dr Meehan’s Book: Performing Process

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Regional Care And Chronic Pain

Australia is a vast and beautiful country, but for those who need Regional care coping with chronic pain, accessing appropriate medical care poses huge challenges.  The following article covers the subject in depth.

Rural patients deserve better health care. We just need to be brave and implement change.

By Jack Archer – Posted 

If you live in rural and remote Australia, your access to health care remains well below the standard that citizens of one of the richest nations on Earth should expect.

Rural and remote areas experience serious health workforce shortages, despite having a greater need for medical services.

Lower rates of cancer screening and higher rates of potentially preventable hospital stays are just some of the issues people in the regions face.

The outcome is lower life expectancy and higher rates of illness and disease.

It is a key issue that drives people to move away from rural and remote areas, undermining progress for these economies and communities.

For those of us who don’t live the reality, this stream of facts and stories can be tiring. It can seem like just another unfortunate thing in the world that can’t be changed.

But if you look a little harder, you can see this isn’t really true. In fact, many of the answers are right in front of us.

A masked nurse adjusts their blue plastic glove in an operation room.

More could be done to utilise nurses’ skills.(Rawpixel: Chanikarn Thongsupa)

How tech creates opportunities

New technologies are opening up exciting opportunities for better access to quality care each day.

Artificial intelligence is assisting isolated healthcare workers to collect information for a rapid diagnosis without specialist training.

There are also new initiatives identifying ways to resolve chronic workforce shortages across the sector.

The small town of Glen Innes in rural New South Wales, which suffers from serious health workforce shortages, recently secured two new local general practitioners, a pharmacist, an exercise physiologist, a diabetes educator, a nurse practitioner and a speech pathologist in just six months.

They did this by embracing the emerging Attract Connect Stay initiative that helps communities lead the way in finding, welcoming and retaining new health workers.

Despite the workforce shortages, there is already the same or a stronger presence of nurses per person in rural and remote areas.

Generic shot of a nurse testing unidentified patient's blood sugar.

Specialist nurses in regional areas could ease the burden on the healthcare system.(ABC: Emma Wynne)

The opportunities to enable these nurses to do more and to make their practice more rewarding and impactful are significant.

For example, overseas evidence shows that nurse practitioners are able to provide 67-93 per cent of all primary care services if given the scope of practice and access to funding similar to Medicare.

At present, these skilled specialist nurses who can diagnose and prescribe for many illnesses, and work closely with specialist doctors to provide complex care, are thin on the ground.

By investing in more nurse practitioner positions in rural and remote areas and expanding their scope of care we could make a big, big impact on rural health problems.

Telehealth improves access to care.

Last, but certainly not least, is the role that telehealth now plays in rural and remote health care.

The pandemic finally gave government the push to make telehealth more widely available, with enduring benefits for people in rural and remote areas in terms of access to care.

These are all great examples of the change that is possible.

Man sits at desk looking at laptop screen, woman is displayed on screen

Telehealth is now a vital tool to deliver health care in regional Australia. (Supplied)

There are many others, and they should all give us real hope for the future.

But the reality is that, aside from the telehealth rollout, these are fragile green shoots, good options or just one-off pilots that prove change is possible, but don’t make it so.

Real change needs a long-term investment combined with a system-wide commitment to innovation and change.

The foundation for making this happen is moving to equitable Medicare spending for rural and remote communities.

A rapid analysis of the latest data* on national health spending reveals that the Medicare Benefits Scheme (MBS) spent about $290 less per person in small rural towns and remote areas than in major cities over the previous financial year.


2021 population

Medicare benefits July 2021–December 2022

Benefits per person


16.5 million

$11.3 billion


Regional centres

2.1 million

$1.3 billion


Large rural towns

1.5 million

$944 million


Medium rural towns


$571 million


Small rural towns

1.7 million

$989 million


Remote communities


$109 million


Very remote communities


$55.5 million


*Source: Department of Health and Aged Care, Medicare quarterly statistics

In total, this equates to more than $600 million each year that is not being spent on Medicare benefits for rural and remote Australians, mostly because they can’t access the services they need.

This gap is not new.

In 2014–15, the National Rural Health Alliance found that the underspend through the MBS was $374 less for remote residents compared with people in metropolitan areas.

The recurring underspend should be invested in an ongoing innovation fund, with the states, private sector and philanthropists challenged to match the commitment.

Over a 10-year period, this equity-based approach to funding could generate billions of dollars to invest in trialling new ways of delivering health services at scale and then rapidly rolling out the innovations that work.

It would be a game changer for rural and remote health.

The government is looking at widespread changes to Medicare right now.

If the reforms include a commitment to the equality of spending for rural and remote Australians, we could have things up and running and be investing in real change within 12 months.

Let’s not wait for another pandemic to make major positive changes in rural and remote health.

Time to be brave and make it happen.

Jack Archer is an advisor on regional development issues and former chief executive of the Regional Australia Institute.

Another article covering the subject


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Mindfulness meditation use in chronic pain treatment in rural Australia: Pitfalls and potential – A case report

Meditation and mindfulness has been shown to not only help with mental health , but also the management of chronic pain.

The Federal Government funded mindfulness App Smiling Minds is a highly regarded free online tool, to help mental wellness and mindfulness techniques and programs

Smiling mind app

We believe our community can benefit from online programs facilitating self management tools.

Below is a research article exploring mindfulness meditation techniques.

 2023 Jul-Sep; 14(3): 516–521.
Published online 2023 Aug 16. Prepublished online 2023 Feb 10. doi: 10.25259/JNRP-2022-4-7
PMCID: PMC10483197

Mindfulness meditation use in chronic pain treatment in rural Australia: Pitfalls and potential – A case report


Mindfulness is a state of awareness characterized by open and non-judgmental recognition of thoughts and sensations and an ability to resist the usual wandering of an individual’s attention. Usually achieved by meditation, mindfulness is recognized as a treatment for chronic pain. Evidence, thus far, has been characterized by poor quality trials and mixed results, but a growing body of research is further investigating its effectiveness. Despite inconclusive evidence, the inherent difficulties of mindfulness research, and problems of accessibility in rural settings, mindfulness meditation is an emerging treatment strategy for many chronic pain patients. This report presents the case of a patient admitted to a rural hospital in New South Wales, whose quality of life was severely impacted by chronic pain.

Keywords: Aging, Behavioral neurology, Pain,


Chronic pain is highly prevalent in rural Australia with a lack of holistic pain management services.[] Chronic pain is complex in its etiology and lasts longer than 3–6 months, or beyond the duration required for normal tissue healing after an acutely painful event.[] Acute pain is mostly biological in nature, whereas chronic pain results from a combination of biological, psychological, and social factors and often requires a multifactorial approach to evaluation and management.[,] In Australia, one in every five people lives with persistent pain (i.e., 3.24 million Australians in total), and nearly 70% are of working age.[] However, referrals to pain specialists occur in <15% of GP consultations, whereas medications are used in nearly 70%.[] Access to holistic pain management services is especially poor in regional and rural Australia, with most multidisciplinary-care clinics located in major cities.1,2 Allied health professionals, who are expected to play a significant role in the non-pharmacological treatment of chronic pain, are underrepresented in rural areas.[] Further, those who are able to access pain services often wait months to be seen, with a median wait time of 85 days in provincial (non-capital city) clinics.[] Given these challenges, chronic pain patients are often difficult to treat in rural and remote settings.

Mindfulness is a state of awareness characterized by open and non-judgmental recognition of thoughts and sensations and an ability to resist the usual wandering of an individual’s attention.[] Usually achieved by meditation, mindfulness is recognized as an effective treatment for chronic pain.[] Evidence, thus far, has been characterized by poor quality trials and mixed results, but a growing body of research is further investigating its effectiveness.[] Meditation uses a distinct brain pathway – change in the cortical thickness in the brain – to deal with chronic pain. Studies reported that mindfulness meditation promotes cognitive disengagement and also induces a person’s body opioid system to reduce the feeling of pain.[,] Despite inconclusive evidence, the inherent difficulties of mindfulness research, and problems of accessibility in rural settings, mindfulness meditation is an emerging treatment strategy for many chronic pain patients.

This report presents a patient case admitted to a rural hospital in New South Wales, whose quality of life was severely impacted by chronic pain. As an adjunct to medication, mindfulness meditation became an important part of his treatment plan. This report highlights the effectiveness of mindfulness meditation and ends with a discussion of the difficulty accessing these services in rural Australia, and the role technology can play in improving access.


A Clinical Case in Rural Australia
Barry Davidson (pseudonym) was an inpatient at a rural hospital in New South Wales, Australia from July to September 2021. A 52-year-old T4 paraplegic, Barry had been admitted under the general surgeons for management of NPUAP stage 4[] pressure injuries from prolonged immobilization. The cause of these pressure injuries was Barry’s chronic abdominal and back pain, worsening dramatically over the previous few months to the point where any movement was painful. Living alone in rural New South Wales, it had become very difficult for Barry to continue managing his own care. While admitted, the surgical team investigated his abdominal and back pain. Blood tests and abdominal imaging found no pathology and a spinal MRI found old compression fractures of T4-5, now partially fused, but no acute pathology. He was further investigated for medical causes of his pain. Gastroscopy and colonoscopy were unremarkable, as were his kidney and liver function tests and full blood count. Ultimately, no cause of the chronic pain was identified. The network-wide chronic pain service was consulted, but they were only able to see Barry 3 weeks later, despite him remaining an inpatient. Due to the unfeasible waiting time for non-pharmacological services for chronic pain, he was commenced on oral paracetamol and 5–10 mg oxycodone by the Acute Pain Service, which worsened constipation and made him nauseous. He was then swapped to clonidine and rectal indomethacin. To encourage weaning of his dependence on opioids, he was also commenced on gabapentin and tapentadol. This regimen, however, led to a number of side effects including sedation and fatigue, so these were ceased in favor of duloxetine. Ultimately, he remained on regular oxycodone CR and PRN oxycodone and oxazepam. Barry was not fit to return to living alone; however, rural rehabilitation hospitals nearby thought that he was too complex to manage.
Barry was transferred to a smaller, rural rehabilitation hospital after 8 weeks as an inpatient, once his pressure injuries had healed. Despite this, the management of his chronic pain was still suboptimal. He recovered some function gradually with the help of nursing and allied health staff, while remaining on duloxetine, clonidine, indomethacin, oxycodone and oxazepam. Yet, his ongoing dependence on care prevented him from returning to his own home, and thus he was discharged to a residential aged care facility.

Management of Barry’s chronic pain

The management of Barry’s chronic pain within the inpatient setting and rural rehabilitation hospital was suboptimal. The chronic pain management in Australia is guided by the National Institute of Health and Care Excellence (NICE) guidelines.[] The first step is to treat any identifiable source of pain medically or surgically. Then, engage any of the non pharmacological therapies: Exercise, physical therapy, sleep hygiene techniques, behavioural and psychological therapies, healthy lifestyle interventions, or acupuncture. If there is an ongoing pain that interferes with normal functioning, pharmacological treatments may be added. For nociceptive pain, first line is NSAIDs; for neuropathic pain, there are a few options including antidepressants and antiepileptic drugs. If there is still insufficient response, opioids may be used, but only after consideration of severity of pain, and weighing the benefits and risks. A Cochrane review of opioids for long-term treatment of non-cancer pain found that continuation of long-term opioids led to clinically significant pain relief.[] However, the quality of the evidence in this review is weak; 25 out of 26 trials were case studies without controls, and the only randomized and controlled trial (RCT) compared two opioids. Evidence for other treatments, including physical activity[] and psychological therapy,[] is also weak, but these strategies are still advocated for.[]

The management of chronic pain in Barry’s case followed the above step-wedge approach, but limited access to non pharmacological services in the inpatient setting led to some divergence. The introduction of opioid analgesia came after excluding medical or surgical causes and high-dose oral paracetamol. Introducing the mindfulness meditation earlier may have reduced the need for opioid analgesia, but these strategies were difficult to implement in the busy inpatient environment and pharmacological options were preferred by Barry. While a resident in rural aged care facility, Barry began to engage in the meditation classes provided by a local meditation guide that visited the facility.

Effectiveness of mindfulness meditation in Barry’s case

Meditation became the most important part of his pain management in aged care facility. Barry attended weekly meditation sessions delivered to a group in an in-person setting. Over subsequent weeks, his participation steadily increased and his pain began to improve. Barry continued to attend the weekly meditation sessions over the following months and despite reporting that his pain was not completely resolved. In brief but noticeable moments of mindfulness, Barry has been able to focus on his pain, recognize it as an appearance in consciousness, and simply come to terms with it. On days that Barry meditates, he describes a lasting feeling that he is able to connect with feelings of pleasure and relief, even when at other times his pain is overwhelming. Barry was fortunate to have access to a meditation guide, as access to in-person meditation sessions is often rare in rural areas. Furthermore, Barry was unwilling to engage in online and app-based guided meditation, due to concerns of difficulty maintaining interest and enthusiasm. This may be a concern shared by many potential meditators and the regularity and commitment of an in-person program may improve engagement. However, a more flexible and individualized approach (such as through app-based courses) may still be preferable to many people.


The case that we have presented was initially an inpatient with chronic pain, who were referred to a rural residential aged care facility because of his ongoing dependency on care for pain. The strength of this case is the illustration of a step-wedge way of managing chronic pain in a monitored setting following the NICE guideline. However, the limitations were: (i) mindfulness meditation and low access to non pharmacological services, like mindfulness meditation in the inpatient setting; (ii) lack of individualized approach in therapy; and (iii) unwillingness to engage in online and app-based guided meditation. An understanding of and engagement with mediation as well as adequate access to such therapy in rural health-care settings would enhance the chance of managing chronic pain in a successful way.

In Western cultures, meditation is typically associated with yogis, hippies, and “self-help gurus,” has struggled to break from its Buddhist roots, and become established in an increasingly secular society. Dan Harris, an American news anchor, wrote a book about meditation after stumbling on the practice whilst working as a “religion correspondent.”[] This author asserts that the problem with meditation is that “its most prominent proponents talk as if they have a perpetual pan flute accompaniment,” but, “If you can get past the cultural baggage…you’ll find that meditation is simply an exercise for your brain.”[] Commonly, meditation sessions involve focused awareness on an appearance in consciousness, such as the sensation of breathing or the feeling of one’s body while sitting in a chair. Humans are constantly distracted by thought and meditation is the practice of recognizing these thoughts merely as appearances in our consciousness, just like sensations, and then re-orientating oneself to the practice. Each time one notices, they are lost in thought, the act of bringing attention back to the breath or sensations acts to train the mind. Mindfulness has been found to regulate the sensation of acute[] and chronic[] pain, improve cognition,[] and treat anxiety[] and depression.[]

Mindfulness-based stress reduction (MBSR) is a therapy developed by Jon Kabat-Zinn at the University of Massachusetts.[,] It typically involves a standardized course of 8 weeks of mindfulness meditation sessions, performed once-weekly for 1.5–2.5 h [Figure 1].[,] There has been important research in the last decade investigating the role of MBSR in the treatment of chronic pain,[,] with inconsistent results. A number of studies show reduced pain intensity in groups treated with MBSR,[,] but these improvements may be short lived.[] The mechanism by which pain is reduced in these patients has been postulated to be through the effects of medication on psychological factors. Indeed, a number of studies find that the benefits of meditation are most prominent in reducing symptoms of depression and anxiety and improving psychological functioning.[,,] One important trial, conducted on older patients in in whom pharmacological analgesia is often complicated by adverse effects, found that MBSR led to improvements in chronic pain.[] The MBSR approach is fairly common in the literature and has the largest evidence base supporting it; however, there is considerable heterogeneity in the format used depending on billing structure, type of session (guided vs. silent), and other factors. The approach taken by Barry involved ongoing weekly sessions 30 min in length, as facilitated by the meditation guide.

An external file that holds a picture, illustration, etc. Object name is JNRP-14-516-g001.jpg

Approach to the treatment of chronic pain, highlighting the role of mindfulness-based stress reduction.

Mindfulness is often associated with cognitive behavioral therapy (CBT), as there are many similarities between the two practices. Both are psychological therapies that encourage the practitioner to examine their thoughts, emotions, sensations, and behaviors. The techniques used in these practices, including deep breathing and self-reflection, are also common to both therapies. CBT has been studied since the 1980s but recent reviews suggest only a small to moderate effect on pain,[] with some patients receiving no benefit.[,] Further, a number of studies have compared MBSR and CBT. A systematic review in 2011 found that MBSR was no better than CBT in the treatment of chronic pain, but it may be a good alternative.[] Despite the low quality evidence, the authors recommended therapies that combined both mindfulness and behavioral therapy. In a larger, randomized, and interviewer-blind trial, MBSR and CBT were both found to improve chronic low back pain compared to usual care, with no differences identified between MBSR and CBT.[] In one RCT of patients with rheumatoid arthritis (RA), CBT conferred the largest improvement in pain, but meditation was more beneficial in RA patients with psychological manifestations of their pain.[] The poor quality of many of the studies, however, makes it difficult to conclude the effectiveness of MBSR in treating chronic pain, as noted by a systematic review in 2012.[] A more recent RCT of 109 patients found no significant differences in pain measures between MBSR and a wait list control.[] Access to psychological therapies such as CBT is often difficult in rural areas. Improvements in technology, such as telehealth conferencing, may improve access to CBT, but the individualized therapy prohibits the scalability offered by online and app-based guided meditation services. Although technology may allow those in rural areas to access CBT services provided in metropolitan areas more easily, the format of one-on-one therapy may limit engagement due to wait times for appointments and out-of-pocket costs.

There are inherent difficulties in performing high quality trials of mindfulness in medical research. Measuring mindfulness is difficult and there is little consensus as to the components of the mindfulness experience.[] Much of the research involves self-reporting of results, which exposes trials to significant response bias.[] Further, problems emerge when designing control interventions, as many trials involve wait-list controls, where the control group is given no intervention for the study period, then offered the intervention at a later date.[] Another factor that compounds inconsistency of intervention is the modification of MBSR,[] leading to variability in the intervention given and reduced generalizability. There are also significant difficulties in elucidating the dose-response relationship of mindfulness,[] as measuring both the dose of meditation and the response to it is abstract and challenging. Some practitioners achieve benefit almost immediately and some require years of practice.

Further research should prioritize quality and comparison using quantitative measures, where possible. Structured measurements of mindfulness may be used, including scales such as the Mindfulness and Attention Awareness Scale[] and the Frieburg Mindfulness Inventory.[] A pain assessment in patients before and after the mindfulness session, using the appropriate scale such as Numerical Rating Pain Scale, Wong-Baker Faces Pain Scale, FLACC Scale, CRIES Scale, COMFORT Scale, or McGill Pain Scale would be a better scientific approach to such case study. These measures may allow for quantitative analysis of the effects of meditation and allow for correlation with pain scores. Empirical evidence of the extent of mindfulness may also reveal the most effective meditation techniques, including in specific subpopulations such as those with chronic pain. In addition, the future studies should incorporate active control groups and standardized mindfulness interventions,[] to promote comparison between different treatment modalities and to encourage adoption of mindfulness on a larger scale. High-quality RCTs using quantitative measurement of mindfulness and active control groups in chronic pain patients are needed.

There remains the problem of access to meditation services, especially in regional and rural areas. Access to guided meditation can be difficult and expensive. Classes and retreats are often fully booked with existing clients and those taking new clients are expensive. The Meditation Association of Australia suggests fees of up to $400/h for sessions delivered to community groups and $1000/h for businesses.[]

Practical steps in mindfulness meditation prescribing in rural areas

Technology has improved access to many health-care services for patients in rural areas. These services include pain management and research has suggested that delivery of meditation sessions through teleconferencing may be effective.[] Furthermore, access to mindfulness meditation services in rural areas has been transformed by the development of online and app-based resources. Many of these resources involve pre-recorded, guided meditation sessions, and delivered at a time of the practitioner’s convenience. In the era of COVID-19, when most group therapy sessions have been cancelled, these resources are especially relevant and may be preferable for many people. There are a variety of programs available online and to download. Some, such as Smiling Mind, Insight Timer, UCLA Mindful and Healthy Minds offer free access to meditation sessions. Some other apps, such as Headspace, Calm, Waking Up, and Stop Breathe Think, require a paid subscription, but often include extra content such as podcasts. Evidence for app-based delivery of mindfulness meditation in the treatment of chronic pain is lacking, but it represents a low cost, safe, and accessible option for patients in rural areas with less access to traditional services. Rural health practitioners may consider these emerging technologies when dealing with a multi-pronged approach to chronic pain.

The search for effective chronic pain treatments is ongoing, but there may be further benefit gained from existing strategies, such as mindfulness meditation and CBT. Our case clarifies the effectiveness of mindfulness, but lack of access to services was evident. It is a reasonable choice for clinicians to advocate for, due to its negligible harms, additional psychological benefits, and increasing accessibility through technology. Access to meditation services in rural and regional Australia may be challenging, but online and app-based programs may provide a new avenue for the treatment of chronic pain.


The search for effective chronic pain treatments is ongoing, but there may be further benefit gained from existing strategies, such as mindfulness meditation and CBT. Our case clarifies the effectiveness of mindfulness, but lack of access to services was evident. It is a reasonable choice for clinicians to advocate for, due to its negligible harms, additional psychological benefits, and increasing accessibility through technology. Access to meditation services in rural and regional Australia may be challenging, but online and app-based programs may provide a new avenue for the treatment of chronic pain.

Funding Statement

Financial support and sponsorship



How to cite this article: Bishop ME, Hamiduzzaman M, Veltre AS. Mindfulness meditation use in chronic pain treatment in rural Australia: Pitfalls and potential – A case report. J Neurosci Rural Pract 2023;14:516-21

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Conflicts of interest

There are no conflicts of interest.


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22. Cramer H, Haller H, Lauche R, Dobos G. Mindfulness-based stress reduction for low back pain. A systematic review. BMC Complement Altern Med. 2012;12:162. doi: 10.1186/1472-6882-12-162. [PMC free article] [PubMed] [CrossRef[]
23. La Cour P, Petersen M. Effects of mindfulness meditation on chronic pain: A randomized controlled trial. Pain Med. 2015;16:641–52. doi: 10.1111/pme.12605. [PubMed] [CrossRef[]
24. Morone NE, Greco CM, Moore CG, Rollman BL, Lane B, Morrow LA, et al. A mind-body program for older adults with chronic low back pain: A randomized clinical trial. JAMA Intern Med. 2016;176:329–37. doi: 10.1001/jamainternmed.2015.8033. [PMC free article] [PubMed] [CrossRef[]
25. Cherkin DC, Sherman KJ, Balderson BH, Cook AJ, Anderson ML, Hawkes RJ, et al. Effect of mindfulness-based stress reduction vs cognitive behavioral therapy or usual care on back pain and functional limitations in adults with chronic low back pain: A randomized clinical trial. JAMA. 2016;315:1240–9. doi: 10.1001/jama.2016.2323. [PMC free article] [PubMed] [CrossRef[]
26. Reiner K, Tibi L, Lipsitz JD. Do mindfulness-based interventions reduce pain intensity? A critical review of the literature. Pain Med. 2013;14:230–42. doi: 10.1111/pme.12006. [PubMed] [CrossRef[]
27. Mars TS, Abbey H. Mindfulness meditation practise as a healthcare intervention: A systematic review. Int J Osteopath Med. 2010;13:56–66. doi: 10.1016/j.ijosm.2009.07.005. [CrossRef[]
28. Veehof MM, Oskam MJ, Schreurs KM, Bohlmeijer ET. Acceptance-based interventions for the treatment of chronic pain: A systematic review and meta-analysis. Pain. 2011;152:533–42. doi: 10.1016/j.pain.2010.11.002. [PubMed] [CrossRef[]
29. Ball EF, Sharizan EN, Franklin G, Rogozińska E. Does mindfulness meditation improve chronic pain? A systematic review. Curr Opin Obstet Gynecol. 2017;29:359–66. doi: 10.1097/GCO.0000000000000417. [PubMed] [CrossRef[]
30. Turk DC. The potential of treatment matching for subgroups of patients with chronic pain: Lumping versus splitting. Clin J Pain. 2005;21:44–55. doi: 10.1097/00002508-200501000-00006. discussion 69-72. [PubMed] [CrossRef[]
31. Vlaeyen JW, Morley S. Cognitive-behavioral treatments for chronic pain: What works for whom? Clin J Pain. 2005;21:1–8. doi: 10.1097/00002508-200501000-00001. [PubMed] [CrossRef[]
32. Zautra AJ, Davis MC, Reich JW, Nicassario P, Tennen H, Finan P, et al. Comparison of cognitive behavioral and mindfulness meditation interventions on adaptation to rheumatoid arthritis for patients with and without history of recurrent depression. J Consult Clin Psychol. 2008;76:408–21. doi: 10.1037/0022-006X.76.3.408. [PubMed] [CrossRef[]
33. Brown KW, Ryan RM. The benefits of being present: Mindfulness and its role in psychological well-being. J Pers Soc Psychol. 2003;84:822–48. doi: 10.1037/0022-3514.84.4.822. [PubMed] [CrossRef[]
34. Walach H, Buchheld N, Buttenmüller V, Kleinknecht N, Schmidt S. Measuring mindfulness-the Freiburg mindfulness inventory (FMI) Pers Individ Dif. 2006;40:1543–55. doi: 10.1016/j.paid.2005.11.025. [CrossRef[]
35. Meditation Association of Australia . Australia: Meditation Association of Australia; 2021. Suggested Fees: How Much Should Meditation Teachers Charge for Their Services? Available from: [Last accessed on 2021 Oct 12] []
36. Gardner-Nix J, Backman S, Barbati J, Grummitt J. Evaluating distance education of a mindfulness-based meditation programme for chronic pain management. J Telemed Telecare. 2008;14:88–92. doi: 10.1258/jtt.2007.070811. [PubMed] [CrossRef[]

Articles from Journal of Neurosciences in Rural Practice are provided here courtesy of Scientific Scholar
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TNAA Collaboration with Q Magnets in a Pain Management Trial

Our Association has been in consultation with James Hermans, the Managing Director of Q Magnets to offer an exciting opportunity for our members. “TNAA Collaboration with Q Magnets in a pain management trial”.

Although there has been research covering the effectiveness of magnets to help reduce pain, it is extremely difficult to set up clinical trials and set a generalised standard for people who live with chronic pain.  Every person who lives with chronic pain is unique in the pain they experience.

We believe that utilisation of Q Magnets should be applied in an individual treatment program, but to provide parameters we need anecdotal feedback and data that can be analysed.

In order to provide a protocol that could be applied, the Association has purchased 5 sets of Q Magnets, utilising donations this year, and will be loaning the sets of magnets to our members who are willing to undergo a 6-week trial, complete data collection surveys each day the magnets are used, and, provide feedback on their experience.  If an improvement to pain levels is experienced by the member trialling the product, Q Magnets have offered a 20% discount if they would like to purchase their own set.

The Association is hoping our members embrace this opportunity.  Members who agree to satisfy the conditions of the trial, (see below for conditions) can register their initial interest by completing our Q Magnet Trial Participant Request Form

Please complete participation interest form below.

Q Magnets Pain Management Trial Participation form
Q Magnet Pain Management Trial

Q Magnet Pain Management Trial

First Name
Last Name
Are you a current member?
Can you attend a face-to-face support group meeting?

In order for our Association to offer the loan of Q Magnet sets, it will be a requirement for the participants to agree to the following:-

  1. Each trial participant is a current financial member.
  2. The Product Loan will be facilitated at a face to face support group meeting.
  3. A refundable deposit of $50 is paid via the Associations website or cash.
  4. Participate in a 6-week trial.
  5. Completion of Loan Agreement.
  6. Completion of data recording each day the Product is used via the Associations website.

Note – data collection must be completed online to ensure protocols are adhered to.

Please complete the Daily Data Collection Form every day the Q Magnets are used – this should take no longer than 5 minutes.

Daily Data Collection Form
Q Magnet Pain Management Trial - Data Collection

Q Magnet Pain Management Trial - Data Collection

What is your level of pain today? (check one)
Where is your pain? (check all that apply)
Which Q Magnets were used today (check all that apply)
Do you have bi-lateral pain (check one)
Which side of the face has pain? (Check one)
Q Magnet used and placement. (check all that apply)
Q Magnet used and placement (check all that apply)
Q Magnet used and placement (check all that apply)
Q Magnet used and placement (check all that apply)
Time Q Magnets were applied (click all that apply)
Approx length Q Magnets were applied (check one)
End of Day Observations - Pain Intensity(check one)
End of Day Observations - Pain Duration (check one)
End of Day Observations - Pain Frequency (check one)

Details of the Q Magnets to be included in the trial.

Q Bonus Package – General Use

Total retail cost of the product is $387

Members who trial them, will have all three types of magnets to choose from which will also help in gathering feedback to further support the research.

The update to the protocol from the information booklet is below.

  1. Use the HF20-3 over the trigeminal ganglion, just in front of the tragus
  2. For the central component of the nervous system, apply a magnet over the TCC (trigeminocervical complex), which covers C1, C2 and C3. So instead of placing the QF28-3 magnet over the occiput, place it just under the occiput. So that it basically finishes at the top of the hairline. Which still makes it tricky to apply, but a bit easier than over the occiput.

Loan Agreement and Terms for Q Magnets used for Pain Management Trial

Parties: This Loan Agreement (“Agreement”) is entered into between Trigeminal Neuralgia Association Australia, a registered Charity “Charity” with its principal office at 8 Wadsley Crescent, Connells Point, NSW 2221, , and the member, referred to as “Borrower,” with the contact information recorded on the Agreement

Product Description: The Charity agrees to loan the Borrower Q Magnets for a Pain Management Trial (” Product “) for a fixed term of two months from the date of this Agreement.

Terms and Conditions:

  1. Loan Term: The Borrower agrees to borrow the Product for a period of two months, commencing from the date of this Agreement and lodge a deposit of $50 via the Charity’s designated website platform at Home – Trigeminal Neuralgia Association Australia ( or by cash.
  2. Return of Product: The Borrower shall return the Product to the Charity’s Support Group Meeting no later than the end of the two-month loan term. The Borrower is responsible for any shipping or transportation costs associated with returning the Product.
  3. Usage and Reporting:
    • The Borrower agrees to use the Product as directed and for its intended purpose.
    • The Borrower further agrees to diligently track and record their pain management progress and results while using the Product.
    • These progress reports shall be submitted via the Charity’s designated website platform at Home – Trigeminal Neuralgia Association Australia ( or by utilising the manual data collection forms, throughout the loan term.
  4. Cost of Non-Return:
    • In the event that the Borrower fails to return the Product within the specified two-month loan term, the Borrower shall be held liable for the full cost of the Product, which is valued at $400.
    • The Borrower hereby authorizes the Charity to charge the Borrower’s provided payment method for the full cost of the Product in case of non-return.
    • On return of the Product the deposit value of $50 will be refunded to the Borrower.

Indemnification and Liability:

The Borrower agrees to use the Product responsibly and acknowledges that any misuse or damage caused to the Product during the loan term shall be the responsibility of the Borrower. The Borrower agrees to indemnify and hold the Charity harmless against any loss, damage, or liability arising from the Borrower’s use or possession of the Product.

Governing Law:

This Agreement shall be governed by and construed in accordance with the laws of Australia, without regard to its conflict of law principles.

Entire Agreement:

This Agreement constitutes the entire understanding between the parties with respect to the subject matter hereof and supersedes all prior agreements, understandings, and representations.


By completing the Agreement Form below, the parties acknowledge their acceptance and agreement to the terms and conditions set forth in this Loan Agreement.

Please complete the Loan Agreement form – a copy will be emailed to the participant.

Q Magnets Pain Management Trial Loan Agreement
You do not have permission to view this form.

Manual Loan Agreement below can be downloaded as an alternative to the online process

TNAA Q Magnets Pain Management Trial - Loan Agreement



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Pain Australia Resources

Pain Australia posts great resources on their website.  The resources include fact sheets that they produce and from other organisations.

These fact sheets are not only useful to our community but can also act as a training tool for family members or work colleague, who often have never heard the words trigeminal neuralgia. Often they have no understanding of the impact that a diagnosis of TN can have on a person either.

We aim to raise our voices when we can, and the best way to do that is by using educational resources which are well written, factual and provide support.

Chronic Pain Management

Pain Australia Fact Sheet 1- The Nature and Science of Pain

Pain Australia Fact Sheet 2 - Prevalence and the Human and Social Cost of Pain

Pain Australia Fact Sheet 3 - Clinical Assessment of Pain

Pain Australia Fact Sheet 4 - Multidisciplinary Pain Management

Pain Australia Fact Sheet 5 - Spinal Cord Stimulation

Pain Australia Fact Sheet 9 - Neuropathic (Nerve) Pain

Pain Australia Fact Sheet 10 - Self Managing Chronic Pain

Pain Australia - Chronic pain – a major issue in rural Australia

Beyond Blue - Chronic physical illness, anxiety and depression

Pain Toolkit - Resource Pack

Chronic Pain Management Strategies

Pain and Physical Activity

These resources can also be used as discussion point documents at support group meetings.  Let us open conversations about the challenges our community deal with every day.


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Motivation and Chronic Pain

Dealing with motivation and chronic pain can feel absolutely overwhelming.  It is easy to start believing that you are at fault, that you are lazy or not worthy, especially when those thoughts of “why bother” are constantly in your head.

The good news though is, that there is science behind what you are feeling, and importantly it is not your fault, and reassuring, there are ways to gain some control.

May you make the best use of what is in your power and take the rest as it happens.

How Chronic Illness Ruins Your Motivation (and what to do about it)

Study reveals brain mechanism behind chronic pain’s sapping of motivation

Mice suffering chronic pain undergo a change in brain circuitry that makes them less willing to work for a reward, even though they still want it.

July 31, 2014 – By Bruce Goldman

Robert Malenka and his colleagues found that chronic pain changed the brain circuitry in mice, making them less willing to work for rewards. Steve Fisch

Chronic pain is among the most abundant of all medical afflictions in the developed world. It differs from a short-term episode of pain not only in its duration, but also in triggering in its sufferers a psychic exhaustion best described by the question, “Why bother?”

A new study in mice, conducted by investigators at the Stanford University School of Medicine, has identified a set of changes in key parts of the brain that may explain chronic pain’s capacity to stifle motivation. The discovery could lead to entirely new classes of treatment for this damaging psychological consequence of chronic pain.

Many tens of millions of people in the United States suffer persistent pain due to diverse problems including migraines, arthritis, lower back pain, sports injuries, irritable bowel syndrome and shingles. For many of these conditions, there are no good treatments, and a crippling loss of mojo can result.

“With chronic pain, your whole life changes in a way that doesn’t happen with acute pain,” said Robert Malenka, MD, PhD, the Nancy Friend Pritzker Professor in Psychiatry and Behavioral Sciences and the study’s senior author. “Yet this absence of motivation caused by chronic pain, which can continue even when the pain is transiently relieved, has been largely ignored by medical science.”

A series of experiments in mice by Malenka and his colleagues, described in a study published Aug. 1 in Science, showed that persistent pain causes changes in a set of nerve cells in a deep-brain structure known to be important in reward-seeking behavior: the pursuit of goals likely to yield pleasurable results. Malenka’s lab has been studying this brain structure, the nucleus accumbens, for two decades.

“We showed that those brain changes don’t go away when you transiently relieve the mice’s pain,” Malenka said. The experiments also indicated that the mice’s diminished motivation to perform reward-generating tasks didn’t stem from their pain’s rendering them incapable of experiencing pleasure or from any accompanying physical impairment, he said.

How pain and reward interact

“This study is important — to my knowledge, the first to explain how pain and reward interact. It begins to get to an understanding of why it’s such a struggle for people undergoing chronic pain to get through the day,” said Howard Fields, MD, PhD, a professor of neurology at the University of California-San Francisco and founder of that school’s pain management center.

Fields, who did not participate in the Malenka group’s study but wrote an accompanying perspective piece published simultaneously in Science, described the psychological effect of chronic pain as “the clouding of the future. There’s no escape from it. You want it to end, but it doesn’t.” As a result, people become pessimistic and irritable, he said. “People come to expect the next day is going to wind up being painful. It just takes the edge off of life’s little pleasures — and big pleasures, for that matter.”

The experiments were spearheaded by the study’s first author, Neil Schwartz, PhD, a postdoctoral scholar in Malenka’s lab. “You can’t just ask a hungry mouse how motivated it is to pursue its heart’s desire,” Malenka said. “But there are ways of asking that mouse, ‘How hard are you willing to work for food?’”

Schwartz, Malenka and their associates looked at lab mice enduring chronic paw pain due either to persistent inflammation or to nerve damage. The mice also happened to be hungry. The scientists trained the mice to poke their noses into a hole to get a food pellet. At first, a single nose poke earned a pellet. But over time, the number of nose pokes required for a reward was increased. In essence, the researchers were asking these mice: How hard are you willing to work for food? Will you poke your nose into that hole once to satisfy your hunger? Ten times? Even 150 times?

Fading motivation

Within a week after the onset of chronic pain, the animals grew increasingly less likely to work hard for food than pain-free control animals were. The researchers next explored three possible explanations: Were the mice unable to work because their pain was too severe? Did something about being in pain cause them to not value the food reward as much? Or was their failure to seek food due simply to a lack of motivation? Additional tests showed that the mice had no movement problems. “Like other research groups, we found that they can scamper around just fine,” said Malenka. Also, when the mice were given free access to food, they ate just as much as the animals who weren’t in pain — so they still valued the food. But they were less willing to put in an effort to obtain food than mice who’d suffered no pain.

Moreover, the difference didn’t disappear even when the scientists relieved the mice’s pain with analgesics. “They were in demonstrably less pain, but they were still less willing to work,” Malenka said.

The Stanford scientists then focused on the nucleus accumbens, a brain structure known to be involved in computing the behavioral strategies that prompt us to seek or avoid things that can affect our survival. They found that chronic pain permanently changed certain connections to the nucleus accumbens, causing an enduring downshift in the excitation transmitted by them. Importantly, Malenka’s group showed that a particular brain chemical called galanin plays a critical role in this enduring suppression of nucleus accumbens excitability.

Galanin is a short signaling-protein snippet secreted by certain cells in various places in the brain. While its presence in the brain has been known for a good 60 years or so, galanin’s role is not well-defined and probably differs widely in different brain structures. There have been hints, though, that galanin activity might play a role in pain. For example, it’s been previously shown in animal models that galanin levels in the brain increase with the persistence of pain.

Possible therapies?

Schwartz, Malenka and their peers identified receptors for galanin on a set of nerve cells in the nucleus accumbens and demonstrated that disabling galanin’s signaling via this receptor prevented the long-term suppression of motivation seen in mice — and people — with chronic pain. This suggests that therapeutic compounds with similar effects could someday be developed, although they would have to be carefully targeted so as to not disrupt galanin signaling in other important brain circuits.

“There’s no reason to think this finding won’t generalize to people,” said Fields of UCSF. “Our brains have galanin, and a nucleus accumbens, just as mouse brains do. However, before jumping from mice to humans it would be wise to test other animal species. If the same things happen in a non-rodent species that happen in mice, then it’s probable they happen in humans, too.”

The study was funded by a Banting postdoctoral fellowship and the National Institutes of Health (grant DA008227). Additional co-authors were postdoctoral scholars Paul Temkin, PhD, and Jai Polepalli, PhD; former postdoctoral scholars Sandra Jurado, PhD (now at the University of Maryland), and Byung Kook Lim, PhD (now at UC-San Diego); and anesthesiology instructor Boris Heifets, MD, PhD.

Information about Stanford’s Department of Psychiatry and Behavioral Sciences, which also supported this work, is available at

Bruce Goldman is a science writer for the medical school’s Office of Communication & Public Affairs.Bruce Goldman

Original Article

The following article was published on

Having the motivation to get up every day and face each new challenge can be incredibly difficult.

If you’ve found that you’ve been losing some motivation lately, or you’ve been struggling for quite a long time, read on to find out how you can continue to move forward one day at a time

Plan for the future

A lack of motivation can stem from feelings of helplessness, of uncertainty about the future, and a feeling that future rewards are not worth the current effort.

This can be a crippling feedback loop that can chip away at your mental health. If you are committed to motivating yourself and continuing to do positive actions for yourself, it’s important to be in touch with your feelings and recognise when you have great days, okay days, bad days, and particularly bad days.

In the latter times, your mind will be more prone to telling you that you’re not able to do this. Accept that like everyone, you will have good and bad days, and try to remain aware that the bad days will pass.

Allow yourself to reimagine a future of your own design. What does that look like? Map out what makes you happy. How can you find happiness in small ways every day?

looking forward to the future. It doesn’t have to be planning an international trip, it can be as simple as getting a bottle of wine at the weekend, meeting up with friends for an online call, or getting a good takeaway.

Factor in the difficult times

We might as well just say it as it is: on some days, having a chronic illness can make life unbearable. The concept of radical acceptance proposes that we make a step back from trying to fix or fight our problems and fully accept our experiences.

By coming to terms with the knowledge and understanding that you have a long term condition, we are better placed to tackle our issues head on.

This does not mean that we can’t advocate for ourselves or continue to search for ways to live meaningful lives. It simply means that we do not waste energy trying to change reality to suit our vision of what life ‘should’ be.

It’s also important to note that this would not necessarily apply to situations where pain management is a challenge. If you are suffering, you shouldn’t accept it simply because your care provider hasn’t been able to support you.

Factoring in the bad days along with the good will help you to get through the rollercoaster.

Plan, schedule, organise

When the pandemic hit, it was the first time for many people to find themselves stuck at home with limited opportunities to leave their home.

Many disability rights groups highlighted how many non-disabled people were experiencing this for the first time, but it was something that people with disabilities had been experiencing on a long-term basis without much recognition.

There were plenty of how-to articles and guides on how to cope with major changes to routines or advice for people who had suddenly been made redundant.

One of the key themes across these articles was to make plans and to keep to a daily schedule. This advice is really important for mental health and resilience skills.

Experts agree that finding ways to put purpose in your day is key to building good mental health. This could be as simple as preparing a healthy breakfast, making time to check in with friends or family, getting some form of exercise, or spending time being creative.

If you’re able to develop a bathing and grooming routine that works well for you, it can pay dividends for your overall motivation.

Making plans is an important way to keep looking forward to the future. It doesn’t have to be planning an international trip, it can be as simple as getting a bottle of wine at the weekend, meeting up with friends for an online call, or getting a good takeaway.

Be patient with yourself

Do you ever find yourself getting frustrated with yourself? Are you overly self-critical? Do you get impatient with yourself for not doing enough or not meeting your goals?

This is normal behaviour, but if left unchecked, it can be very detrimental to your mental health. Don’t allow yourself to slide down into feelings of consistent self-criticism because it can be very hard to stop yourself from getting stuck in these patterns of thought.

Imagine that you were speaking to a friend who is telling you some of the problems you were having. How would you react? Show yourself the kindness and compassion you would show to others and allow yourself the time that you need.

If you plan your day and you hope to get X, Y, and Z completed, but by the end you only get half of X done – give yourself a break. There’s no rulebook on how anyone should live their lives.

With the additional needs placed on people with CRPS it’s common to feel like you’re a burden on family, friends, or caregivers. Danielle (not her real name) told us how she felt that “CRPS just chips away at you.”

Practice gratitude

Studies show that people who actively practice gratitude and thankfulness in their daily lives have higher levels of motivation and wellbeing.

Being able to acknowledge the positives during adversity is important because it helps to put life in perspective.

Perhaps you are struggling with your chronic pain, but you are able to maintain a high level of independent mobility. Maybe you are finding managing your mental health difficult, but your pain levels are under control today.

Everything is relative in that you neither have the easiest nor the most difficult life. In order to build resilience and maintain high levels of motivation, practice gratitude by writing down lists of things you’re happy about.

As well as being thankful for what you have, give something back if you can. Why not volunteer  and help others in a similar situation?

Rely on your community

Never forget to reach out to people who care about you and those who know first-hand what it’s really like to suffer from a chronic illness.

Although it may feel like you’re on your own, reach out to access a wide network of people who can empathise, rant, rejoice, and share in your experiences.

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Can Reiki Help Your Chronic Pain

Can Reiki Help Your Chronic Pain?  We are constantly looking for therapies which can help our community living with trigeminal neuralgia manage pain.

Reiki is a Japanese form of energy healing, a type of alternative medicine. Reiki practitioners use a technique called palm healing or hands-on healing through which a “universal energy” is said to be transferred through the palms of the practitioner to the patient in order to encourage emotional or physical healing

This ‘energy transfer technique’ may help to ease chronic pain when used as a complementary therapy.

Medically Reviewed

Chronic pain not only limits a person’s ability to work and enjoy leisure time, it’s also linked with anxiety, depression, and other health problems. Experts estimate that as many as one in five people live with chronic pain, which is defined as pain on most days lasting six months or longer, according to the Centers for Disease Control and Prevention (CDC).

More and more people are choosing complementary health approaches such as acupuncture, massage, and Reiki to help manage pain. Complementary medicine usually refers to treatments that fall outside traditional Western medical care and are used alongside more conventional medical treatments.

A typical Reiki session is intended to guide energy throughout the body to encourage self-healing, and begins at the head or feet with light touch or even no touch, with the practitioner’s hands a few inches above the client’s body, according to the International Association of Reiki Professionals.

“Nobody knows exactly why it works, but it can be beneficial to people,” says Martay. “How effective it is is up to the patient. In my opinion, the patient is the healer; as practitioners, we can only offer treatment and see what comes out of it,” he says. While the clinical research evidence on efficacy is variable, Reiki is considered safe and has not been found to have adverse effects, according to the University of Minnesota’s Earl E. Bakken Center for Spirituality and Healing in Minneapolis.

How Can Reiki Address Chronic Pain?

Reiki can be used as a complementary therapy to treat different kinds of pain, including chronic pain, says Martha Lacy, MD, a hematologist at Mayo Clinic in Rochester, Minnesota, and a Reiki master. “I wouldn’t recommend Reiki instead of Western medicine, but I think it could be used as an adjunct or a complement to those therapies,” says Dr. Lacy.

“Chronic pain is a complicated issue. There is the anatomical physical aspect and then there is the emotional one,” says Martay. Of the five pain centers located in the brain, two of them are located in the limbic system of the brain, he says. “The limbic system is where emotions are processed, and that makes a tight connection between pain and emotions,” says Martay. Reiki can potentially address that aspect of chronic pain for some people, he says.

Reiki can’t be used to change what is basically an anatomical problem, says Martay. “For example, if somebody has chronic back pain and we look at the MRI and see that there is an eroded disc — there’s an anatomical problem; you can’t improve or change that aspect with Reiki. Reiki works more on the emotional level by calming people down,” he says.

Studying Reiki Proves Challenging for Researchers

Although there isn’t an abundance of studies to show Reiki’s impact on chronic pain, that doesn’t necessarily mean that it isn’t effective; the dearth of evidence could also be due, at least in part, to the difficulty in recruiting people and executing studies for the therapy.

To prove the benefits of Reiki in a randomized controlled clinical trial, researchers need to include an arm where “sham” Reiki is performed. Sham Reiki is typically performed by an actor or a person who isn’t trained in Reiki and doesn’t believe in the concept of biofield energy, that there is a field of vibrational energy surrounding and affecting the body.

Recruiting enough participants for these trials can be challenging, according to the authors of a Reiki meta-analysis published in December 2014 in Pain Management Nursing. It took some studies up to two years to gather just 24 subjects because participants refused to be in the trial unless they could be placed in the Reiki group rather than the sham group.

The meta-analysis did find that although the number of studies is limited, there is evidence to suggest that Reiki may be effective for pain and anxiety. The authors believed that there might have been improved findings if trials had lasted longer — some studies lasted less than a week.

Is There Evidence for Using Reiki in Treating Chronic Pain?

Authors of a review published in October 2017 in the Journal of Evidence-Based Complementary and Alternative Medicine see below speculate that Reiki may trigger the vagus nerve to activate the parasympathetic nervous system, which controls mood, digestion, heart rate, and even the perception of pain.

The authors of that review analyzed two studies that looked at Reiki as an adjunct treatment to help with acute or chronic conditions and concluded that there was “strong evidence for Reiki being more effective than placebo, suggesting that Reiki attunement leads to a quantifiable increase in healing ability.”

In Martay’s experience, there are times when Reiki can be effective, not necessarily in the ways the patient was seeking, but rather where the patient’s body felt that it was needed. “We had a woman come in with severe arthritis in her knees. The patient was in physical rehabilitation and came to Reiki sessions, but her knees didn’t improve. However, she had suffered from constipation for many years and that disappeared. The patient attributed that improvement, at least in part, to Reiki,” says Martay. In Reiki, the body may take the energy to another part of itself other than where you intended it to go, he adds.

Can Reiki Help With Neuropathy Pain?

Research is limited on Reiki’s benefits for neuropathy, the nerve damage that can result from diabetes among other causes. A study published in Diabetes Care compared Reiki, sham Reiki, and usual care for people with painful diabetic neuropathy. Investigators found that after 12 weeks of treatments there was no difference in the perception of pain or improvements in walking distance between the groups that received real Reiki and sham Reiki.

Reiki can sometimes provide pain relief in neuropathy, though how long that relief lasts may vary from person to person, says Martay. “Often when people try a therapy like Reiki they have usually gone through a plethora of orthodox medicine, and this may be their last hope,” he says. “I’ve seen people who this has helped, and they were happy with the incremental benefits,” he says.

How to Prepare for a Reiki Session

If you decide to try Reiki, wear loose-fitting and comfortable clothes to your first session; you’ll remain fully clothed throughout the process. In most cases, you will be semi- or fully reclined on a massage table.

Martay suggests that the best preparation for your first Reiki session is none at all. “Come completely unprepared, because then you have no expectations,” he says. “The first session is often the most successful one for the patient for this very reason; whatever happens, happens. Sometimes it’s best to have no preconceived ideas, then there are no barriers in the way.”Reiki

 2017 Oct; 22(4): 1051–1057.
Published online 2017 Sep 5. doi: 10.1177/2156587217728644
PMCID: PMC5871310
PMID: 28874060

Reiki Is Better Than Placebo and Has Broad Potential as a Complementary Health Therapy


This study reviews the available clinical studies of Reiki to determine whether there is evidence for Reiki providing more than just a placebo effect. The available English-language literature of Reiki was reviewed, specifically for peer-reviewed clinical studies with more than 20 participants in the Reiki treatment arm, controlling for a placebo effect. Of the 13 suitable studies, 8 demonstrated Reiki being more effective than placebo, 4 found no difference but had questionable statistical resolving power, and only one provided clear evidence for not providing benefit. Viewed collectively, these studies provide reasonably strong support for Reiki being more effective than placebo. From the information currently available, Reiki is a safe and gentle “complementary” therapy that activates the parasympathetic nervous system to heal body and mind. It has potential for broader use in management of chronic health conditions, and possibly in postoperative recovery. Research is needed to optimize the delivery of Reiki.

Keywords: Reiki, clinical studies, placebo effect, parasympathetic nervous system, complementary health therapy, chronic health conditions, postoperative recovery

Reiki is one of the more popular complementary modalities used by Australians to manage their health conditions, There is little data available on how widely Reiki is used in Australia, but information gleaned from public sources indicates that it is being employed with good effect in some hospitals, cancer support centers, drug and alcohol rehabilitation centers, and in palliative care. At the Oncology-Haematology Unit at Bega Valley Health Services, Reiki sessions are provided by Jennifer Ahrens, who reported,

Patients and carer responses noticeably referred to their fear and anxiety during a time of diagnosis of cancer and follow-up treatments. Most patients are grateful that the hospital provides this service, which they report as bringing diverse benefits, particularly on an emotional level and one that is personally supportive as they negotiate a stressful and traumatic period with less fear, anxiety or depression.(p19)

Reiki is not an alternative to allopathic medicine—it is a “complementary” therapy that can be implemented alongside all other medical and therapeutic techniques. It is a gentle technique that is suitable for even very fragile patients, so it is accepted widely in hospitals and hospices around the world. The profound relaxation produced by Reiki has been anecdotally reported to alleviate anxiety and stress, the perception of pain, and to promote a feeling of psycho-spiritual well-being.

Reiki was developed by Mikao Usui in Japan in the 1920s. It is a relaxing form of healing therapy that is applied through noninvasive, non-manipulative gentle touch. Reiki involves lightly laying of hands just above or on the clothed body, working over the front and back in a slow progression of hand positions. Reiki has no religious doctrine and is accepted by people from all backgrounds and belief systems.

One of the key defining features of Reiki is that the ability to practice is conferred through an “attunement” process and is not dependent on any innate personal healing capability. Attunement is done by a Reiki master, through a series of rituals that are said to open the energy channels of the body. Attunement to first-degree Reiki (Reiki I) confers the ability to treat oneself and others by touch. Attunement to second-degree Reiki (Reiki II) confers the ability to use specific symbols to access Reiki mentally for distant healing. Attunement to third-degree Reiki (Reiki III), or master level, confers the ability to attune others into Reiki. At each level, the ability to effectively heal with Reiki develops progressively through committed practice.

Understandably, the ability to confer special healing abilities through an attunement ritual is regarded with skepticism by many people. It could be argued that any health benefits of Reiki are nothing more than a placebo effect and that the same benefits could be achieved without attunement.

Reviews of Reiki clinical trials have been published by Lee et al, vanderVaart et al, and by Baldwin et al. In summary, these reviewers found that Reiki had some promise in the areas of pain, relaxation, and anxiety management, but there was a need for further experiments with greater numbers of subjects to allow statistically meaningful interpretation.

In recent years, there have been many new publications on Reiki trials, but these have not been subject to review. The present study was undertaken to review the available clinical studies of Reiki to determine whether there is evidence for Reiki providing more than just a placebo effect.


Four selection criteria were applied to Reiki studies for inclusion in this review. First, only studies of hands-on Reiki were considered. While distance healing is considered to be a valid Reiki technique, there are currently too few published studies to draw statistical conclusions.

Second, only quantitative studies including a “sham Reiki” placebo control were considered. Sham Reiki involves an actor mimicking the hand positions and other procedures used by the attuned Reiki practitioner. It is intended to serve as a placebo control, in which the only significant experimental variable is whether or not the practitioner has received a Reiki attunement.

Third, this review only includes reports published in peer-reviewed journals, thereby excluding master’s and PhD theses. The rationale for this is that the methods and results in published articles have survived screening and evaluation by peer review, whereas master’s and PhD theses have not.

Fourth, this review only includes studies involving 20 or more participants in the Reiki treatment arm. A criticism raised in previous reviews is that many studies were flawed by the use of too few experimental subjects, making them incapable of reaching statistically significant conclusions. The inclusion of studies with 20 or more participants helps ensure that the conclusions are statistically robust.

The exception to this criterion is the inclusion of 2 studies that used laboratory rats as experimental recipients of Reiki., These were rigorously conducted studies that collected “hard” evidence through microscopic tissue examination and implanted telemetric transmitters, with care taken to ensure statistically significant outcomes. These are regarded as highly significant studies because they prelude the possibility of a psychological placebo effect. Even so, a sham Reiki placebo control was used in each study.

Identification of English-language Reiki studies was done by undertaking a Google Scholar search using a variety of key words, repeated over a period of more than 3 months. In addition, the reference lists of identified articles were also scrutinized, to help identify any additional references. Full copies of all identified publications were obtained, to ensure that experimental details were correctly understood. Only the publications meeting all of the selection criteria were included in this review.


There were 13 peer-reviewed studies published between 1998 and 2016 that met all of the selection criteria. There were 4 randomized single-blind studies and 7 randomized double-blind studies with human participants, and 2 studies using rats. The studies included both pilot studies and clinical trials, looking at both short-term and long-term application of Reiki.

To assist in the interpretation of these data, the selected studies can be grouped into 4 categories:

  1. Physiological responses to Reiki
  2. Use of Reiki as a complementary therapy for a chronic condition
  3. Use of Reiki as a treatment for a chronic condition
  4. Use of Reiki as a complementary therapy for an acute condition

Physiological Responses to Reiki

Witte and Dundes conducted a randomized, placebo-controlled pilot study using university student volunteers to measure objectively the effect of Reiki on physical and mental relaxation. Reiki was provided by a Reiki I practitioner over a period of 20 minutes, involving 4 hand positions on head, neck, and upper torso of a seated participant. Four treatment arms were used, each with 25 participants: Reiki, sham Reiki placebo, a control group relaxing and listening to a meditation tape, and a control group listening to calming music. It was found that Reiki was more effective than placebo, music, or meditation for inducing physical relaxation, but there was no difference between groups for mental relaxation.

Baldwin and Schwartz investigated whether application of Reiki could reduce the deleterious effects of noise-induced stress in rats. Loud noise can cause damage to the tiny blood vessels in the mesentery of rats, so the extent of microvascular damage can provide a quantitative measure of the level of stress experienced by the animals. The experiments involved 3 treatment arms: (1) noise + Reiki (n = 4), (2) noise + sham Reiki (n = 4), and (3) noise-only control (n = 4). Reiki or sham Reiki were provided to the caged rats for 15 minutes per day over 21 days. The experiment was replicated 3 times, and then again using different Reiki practitioners. It was found that the extent of stress-associated microvascular damage for noise + Reiki was significantly less than that for noise + sham Reiki or the noise-only control.

Baldwin et al extended their earlier study to investigate whether Reiki can reduce the heart rate and blood pressure of noise-stressed rats. The rats were fitted with implantable telemetric transmitters to provide accurate physiological data. The same procedure was used as before, with 3 rats in each treatment arm and Reiki or sham Reiki provided for 15 minutes per day over 5 days. It was found that Reiki, but not sham Reiki, significantly reduced both the average resting heart rate and the rise in heart rate produced by exposure of rats to loud noise. However, neither Reiki nor sham Reiki significantly affected mean arterial pressure.

Díaz-Rodríguez et al employed a randomized, single-blind, placebo controlled, crossover design pilot study to investigate the physiological effects of Reiki in health care professionals with burnout syndrome. The study involved 21 participants receiving either Reiki or sham Reiki placebo, with heart rate variability, body temperature, salivary flow rate, and salivary cortisol levels measured both pre- and posttreatment. Reiki was provided by a practitioner with 15 years of experience, involving a 30-minute session covering the head, eyes, ears, and chest. It was found that a single session of Reiki increased heart rate variability and body temperature but not salivary cortisol levels, indicating that Reiki shifts the autonomic balance toward parasympathetic dominance.

Salles et al investigated the effect of Reiki on abnormal blood pressure using a randomized, cross-sectional, descriptive, and double-blind clinical trial. Hypertensive patients were randomized to 1 of 3 treatment arms: (1) Reiki (n = 22), (2) sham Reiki placebo (n = 22), or (3) rest control (n = 22). Reiki was provided as a single 20-minute session (no details provided). It was observed that blood pressure decreased in each of the 3 groups, with statistically significant differences between each group. The Reiki group had the greatest reduction in blood pressure, followed by the placebo and the control group.

All 5 of these studies provide evidence that Reiki is better than placebo for inducing a physically relaxed state. This appears to be an objective fact, given that it has been replicated in both humans and rats. Physiological measurements indicate that Reiki is more effective than placebo in reducing resting heart rate, increasing heart rate variability, and reducing blood pressure. These results indicate that Reiki is more effective than placebo in activating the parasympathetic nervous system.

Reiki as a Complementary Therapy for Chronic Conditions

Dressen and Singg investigated the potential benefits of Reiki for patients with a variety of chronic illnesses. This randomized, single-blind, placebo controlled pilot study involved 4 treatment arms: (1) Reiki (n = 30), (2) sham Reiki placebo (n = 30), (3) progressive muscle relaxation (n = 30), and (4) rest control (n = 30). Reiki was provided by 4 Reiki masters as 30-minute sessions covering the full body of a recumbent participant, given 2 times per week for 5 weeks. It was found that Reiki was more effective than the other treatments for reducing pain, depression, and state anxiety in chronically ill patients. Reiki was also found to cause desirable changes in personality, including reduced trait anxiety, enhancement of self-esteem, a shift toward internal locus of control, and toward a realistic sense of personal control.

Catlin and Taylor-Ford investigated whether provision of Reiki therapy during outpatient chemotherapy is associated with increased comfort and well-being. This was a double-blind, randomized clinical controlled trial with 3 treatment arms: (1) Reiki (n = 63), (2) sham Reiki placebo (n = 63), and (3) standard care (n = 63). A Reiki master nurse provided a single Reiki session of 20 minutes duration (no details provided). It was found that participants in both the Reiki and sham Reiki placebo groups showed improvement in pre- and postcomfort and well-being outcomes, while those in the standard care groups showed no differences in well-being or comfort. The researchers concluded that Reiki was no better than sham Reiki and that the attentive presence of a designated nurse at the bedside was more important for patient well-being and comfort than the delivery of Reiki.

Erdogan and Cinar evaluated the effect of Reiki on depression in elderly persons living in nursing homes using a randomized, single-blinded pilot study with 3 treatment arms: (1) Reiki (n = 30), (2) sham Reiki placebo (n = 30), and (3) control (n = 30). Reiki was applied to the experimental group by a Reiki master for 8 weeks, once a week for 45 to 60 minutes. Sham Reiki was applied by 4 nurses who did not have Reiki training but thought that they were practicing Reiki. The control group had no intervention. The researchers observed a statistically significant decrease in depression levels for the Reiki group on the 4th, 8th, and 12th weeks. No significant decrease in depression scores were found for the sham Reiki or control groups. There was no significant difference in the depression scores between the sham reiki and control groups. This study indicated that Reiki might be effective for reducing depression in elderly persons living in nursing homes.

Alarcão and Fonseca employed a randomized, double-blinded, placebo-controlled study with a cross-sectional design to investigate the effects of Reiki on the quality of life of blood cancer patients. The study involved 2 treatment groups: (1) Reiki (n = 58) and (2) sham Reiki placebo (n = 42). Reiki (by Reiki masters) or sham Reiki treatment was provided in 60-minute sessions, twice a week for 4 weeks. Patient responses were assessed using the WHOQoL-Bref, an abbreviated generic Quality of Life Scale. It was found that the Reiki group showed significantly more improvements in the general, physical, environmental, and social dimensions of the WHOQoL-Bref. They generally felt better about themselves, their physical condition, and their relationships with their environment and other people.

Each of these studies investigated a particular aspect of how Reiki may be employed as a complementary therapy in the management of chronic conditions. In 3 of these 4 studies, Reiki was applied repeatedly over an extended period, with 1 or 2 sessions per week over a period of up to 8 weeks. In these 3 studies, Reiki was found to be more effective than placebo, resulting in reduced anxiety and depression, and improved self-esteem and quality of life.

Only one of the studies did not find a significant difference between Reiki and placebo. Interestingly, this was the only study that utilized Reiki as a one-off, short-duration intervention, to improve patient comfort and well-being during chemotherapy. Interpretation of this study outcome is difficult because the trial did not include a “usual treatment” control, which would have provided insight into the sensitivity of the instruments used to measure “comfort” and “well-being.”

Reiki as an Adjunctive Treatment for Chronic Conditions

Gillespie et al investigated the efficacy of Reiki for alleviating pain and for improving mobility and quality of life in patients with type 2 diabetes and painful diabetic neuropathy. This was a randomized, semidouble-blind, placebo-controlled, 12-week clinical trial involving 3 treatment arms: (1) Reiki (n = 93), (2) sham Reiki placebo (n = 88), and (3) usual care control (n = 26). Reiki was provided by 2 experienced practitioners who provided 2 sessions in the first week, followed by weekly sessions over 12 weeks. Patients were recumbent during each 25-minute session. The researchers found that global pain scores and walking distance improved in both the Reiki and placebo groups. However, there were no significant differences between groups at the final visit. The researchers noted that the pain scores were relatively low in all groups, with high variability, which reduced the power to detect a statistically significant difference between treatments.

Assefi et al conducted a clinical trial to determine whether Reiki can be beneficial as an adjunctive treatment for fibromyalgia. The trial was factorial designed, randomized, double-blinded, and sham-controlled, with 2 treatment arms: (1) Reiki (n = 25) and (2) sham Reiki placebo (n = 25). Reiki was provided by 3 experienced Reiki masters using two 30-minute sessions weekly for 8 weeks to recumbent participants. The trial results showed that neither of the treatments improved the pain, fatigue, well-being, or physical and mental functioning of patients with fibromyalgia. These researchers concluded that adults with fibromyalgia are unlikely to benefit from Reiki.

Both of these studies evaluated the potential of Reiki to relieve the pain of painful diabetic neuropathy and fibromyalgia, which are difficult conditions to manage with allopathic medicine. In the trial by Gillespie et al, both Reiki and placebo showed some promise for relieving the pain of painful diabetic neuropathy, but the experiment did not have sufficient statistical power to detect a significant difference between treatments. In the trial by Assefi et al, neither Reiki nor placebo was able to relieve the pain of fibromyalgia or the resulting fatigue and reduced well-being, indicating that Reiki is not a potential cure for this recalcitrant and difficult condition.

Reiki as a Complementary Therapy in Acute Settings

Bourque et al undertook a randomized, double-blinded pilot study to determine whether the use of Reiki decreases the amount of analgesics administered to patients undergoing screening colonoscopy. The trial included 3 treatment arms: (1) Reiki (n = 25), (2) sham Reiki placebo (n = 5), and (3) retrospective chart review of prior patients as the control (n = 30). A Reiki master provided a 10-minute Reiki treatment simultaneously with intravenous administration of midazolam (a sedative), prior to the colonoscopic procedure. During colonoscopy, meperidine (an analgesic) was administered to the conscious patient, depending on the level of pain experienced. The trial results indicated no statistically significant difference in meperidine administration between the patients in the control and Reiki groups. The researchers noted that the study would have been enhanced by having a pain scale to determine the amount of meperidine to be administered to the patients. It was observed that patients displayed a calmer demeanor after screening colonoscopy with Reiki.

Kundu et al investigated the potential benefits of Reiki as an adjuvant to opioid therapy for postoperative oral pain control in pediatric patients. In this double-blind, randomized clinical trial, children aged 9 months to 4 years who were scheduled for elective dental work or for palatoplasty surgery were randomly assigned to 1 of 2 groups: (1) preoperative Reiki (n = 20) or (2) preoperative sham Reiki control (n = 18). Reiki was provided by a Reiki master for 20 to 30 minutes (details not provided). It was reported that there was no evidence of benefit from a single session of preoperative Reiki in terms of reducing pain intensity, analgesic requirements, incidence of side effects, or perioperative family satisfaction.

In both of these trials, Reiki was not found to be more effective than placebo for reducing acute pain during medical procedures. In both cases, however, it is unclear whether the design of the experiments provided sufficient statistical power to reach a firm conclusion. Bourque et al stated that the experiment could have been improved by using a pain scale to help calibrate the amount of analgesic administered. Kundu et al used the Face, Legs, Activity, Cry, Consolability (FLACC) pain scale, which is appropriate for determining the dosage of postsurgery analgesic for young children, but its statistical resolving power is not well defined.


This review identified 13 placebo-controlled studies of Reiki that included at least 20 participants in the Reiki treatment arm, of which 8 found that Reiki was more effective than placebo.,, There were 4 studies that found no difference between Reiki and placebo, but this could be attributed to a lack of statistical resolving power of the experiments.,,, In one study in which Reiki was not better than placebo, involving patients with fibromyalgia, neither Reiki nor the placebo had any beneficial effect.

Viewed collectively, these studies provide reasonably strong support for Reiki being more effective than placebo. Two of the studies were conducted with rats and produced clear, objective evidence of a benefit of Reiki over placebo. This suggests that there is some merit to the claim that Reiki “attunement” imparts an extra healing capacity to the recipient. Although there is currently no scientific explanation for this, the clinical trial evidence is compelling. Further research is warranted to better understand this phenomenon.

Reiki has been shown to be better than placebo for inducing a state of relaxation., Physiologically, this means that Reiki is effective in activating the parasympathetic nervous system, quantitatively measured as reduced heart rate, reduced blood pressure, and increased heart rate variability. The parasympathetic nervous system is one branch of the autonomic nervous system, the other branch being the sympathetic nervous system. In a healthy individual, the activity of the 2 branches can be rapidly modulated in response to changing environmental demands, but overall are maintained in a state of dynamic balance, or homeostasis. This regulatory process is primarily mediated by the parasympathetic nervous system via the vagus nerve.

It is known that the vagus nerve plays a vital role in mediating the mutual interactions between the brain and the body. According to the neurovisceral integration model, the vagus nerve plays a key role in processes that regulate the health of the body, including inflammatory responses, glucose regulation, and hypothalamic-pituitary-adrenal function. In each of these processes, the regulatory role of the vagus nerve is thought to be associated with its function as part of the “inflammatory reflex.”

According to the polyvagal theory, the autonomic nervous system is the neurophysiological substrate for emotional expression and contingent social behavior. The perception of pain, like other emotions, is an affective state that is governed by the autonomic nervous system. Chronic pain is associated with dysregulation of the autonomic nervous system and reduced heart rate variability. Increased heart rate variability indicates a greater capacity of the autonomic nervous system for affect regulation and reduced pain sensitivity.,

A compromised autonomic nervous system, as characterized by reduced heart rate variability, is associated with cognitive and affective dysregulation, and psychological inflexibility, which are major psychological risk factors for psychopathologies such as chronic anxiety and depression. Conversely, increased heart rate variability is associated with better regulation of emotional responses, better coping strategies, more positive emotions, and increased social connectedness, supporting an “upward spiral” in social and psychological well-being.,

Thus, the vagus nerve plays a vital role in mediating both physical and mental health. Artificial stimulation of the parasympathetic nervous system via the vagus nerve has been shown to reduce the perception of pain, reduce depression, and improve mood and quality of life.

For patients with chronic health conditions, Reiki has been found to be more effective than placebo for reducing pain and anxiety, depression, and for improving self-esteem and quality of life. It seems likely that these effects are the result of Reiki’s ability to activate the parasympathetic nervous system and increase heart rate variability, which can be understood in terms of the neurovisceral integration model and the polyvagal theory.

As a safe and gentle way to activate the parasympathetic nervous system via deep relaxation, Reiki has the potential to provide valuable support for a broad range of chronic health conditions. Research to date does not suggest that Reiki can cure any health condition, so it is not appropriate to regard Reiki as an alternative to allopathic medicine. Instead, Reiki should be regarded as a useful complement to conventional practices, especially for chronic illnesses where the use of drugs offers little benefit.

Previous research has provided evidence to suggest that Reiki may be a useful complementary therapy in acute settings. For example, the effectiveness of Reiki as an aid to recovery after major surgical procedures has been tested in an Indian hospital. Reiki was provided for 7 days after surgical procedures such as laparotomy, gastrectomy, hysterectomy, cholecystectomy, mastectomy, and general abdominal surgeries. Reiki was found to improve the vital signs (temperature, pulse, respiration, blood pressure, and pain), hence the prospects for better recovery and to reduce anxiety and depression. Also, Reiki has been found to significantly reduce pain and the need for analgesics following total knee arthroscopy and delivery by Caesarean section., Such results are potentially significant, because it has been shown that high preoperative anxiety and depression and its persistence during the postoperative period leads to a higher morbidity and mortality rate. Reiki could potentially play a complementary role in acute surgical procedures, to reduce the risk and cost of postoperative complications.

However, in the 2 placebo-controlled trials considered in this review,, Reiki was not found to be more effective than placebo for reducing acute pain during medical procedures. A possible reason for this is that, in these 2 trials, Reiki was provided for a short period (10-30 minutes) prior to the procedure. In contrast, in the trials that reported success, Reiki was provided for a number of days post procedure, that is, for 2,, 3, or 7 consecutive days.

No research has been conducted to evaluate the optimum duration of a Reiki session, or the optimum number of sessions that should be provided. Typically, a Reiki practitioner would recommend the use of 3 sessions as a starting point, regarding more Reiki as being better than less. The optimum amount is likely to be different for each condition, and possibly each person, so this could be a significant source of experimental variation that has not yet been taken into account. Since Reiki has been shown to have a significant effect on measurable physiological variables such as heart rate variability, it is recommended that research be undertaken to investigate whether the effect of Reiki on heart rate variability has only a transient or lasting benefit, and whether multiple Reiki sessions over an extended period of time have a cumulative effect.


Reiki is a safe, gentle, and profoundly relaxing healing modality that can be practiced by anyone who has received an “attunement” from a Reiki master. This review has found reasonably strong evidence for Reiki being more effective than placebo, suggesting that Reiki attunement leads to a quantifiable increase in healing ability.

Reiki is better than placebo in activating the parasympathetic nervous system, as measured by reduced heart rate, reduced blood pressure, and increased heart rate variability. For patients with chronic health conditions, Reiki has been found to be more effective than placebo for reducing pain, anxiety, and depression, and for improving self-esteem and quality of life. According to the neuro visceral integration model and the polyvagal theory, these effects are due to higher parasympathetic nervous system activity, mediated via the vagus nerve.

This understanding suggests that Reiki has the potential to provide valuable support for a broad range of chronic health conditions. However, there is no justification to regard Reiki as a cure for any health condition. Instead, Reiki should be regarded as a complementary therapy that can be implemented alongside all other medical and therapeutic techniques.

Further research is recommended to help optimize the application of Reiki for specific health conditions and to examine the benefits arising from provision of multiple Reiki sessions over an extended period of time.


The author wishes to acknowledge the guidance and wisdom of his Reiki masters, Elizabeth and Robert Thuan, who are dedicated to professionalizing the practice of Reiki. The author is grateful for the support of fellow members of the committee of management of the Australasian Usui Reiki Association, who are dedicated to letting the love of Reiki shine in the world.


Declaration of Conflicting Interests: The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author received no financial support for the research, authorship, and/or publication of this article.

ORCID iD: David E. McManus, PhD

Ethical Approval: Ethical approval was not needed for the research published in this review article.


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Articles from Journal of Evidence-based Complementary & Alternative Medicine are provided here courtesy of SAGE Publication 
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Should You Stop Talking About Your Pain?

Should You Stop Talking About Your Pain?

Getting pain under control starts by talking about it differently—and less.

Posted April 9, 2021 Reviewed by Devon Frye


  • The language we use in both words and thoughts plays a key role in how the brain processes information and produces pain.
  • We often mistake symptoms that occur when the brain senses a threat—including pain—for a disease or disorder.
  • Healthcare providers unknowingly can increase a person’s concern about their health and well-being by using alarmist or hopeless language.
  • Reducing the sense of threat in the brain—and thus the pain itself—can start by simply changing how people talk about pain.

We love to share our struggles with others, get support, and feel understood. That is a good thing, right?

It depends. Talking about pain keeps pain at the center of our attention, which in turn keeps our brain in threat mode. When the brain senses a threat, increased pain may be the result. Luckily, this downward cycle toward pain can easily be stopped.

Why Pain Education Matters

A central part of pain rehabilitation is providing education to pain patients and their families. Chronic pain not only impacts the individual who is hurting, but it also impacts family, friends, and coworkers as well.

Most people share common misunderstandings about chronic pain—they picture that an injury, mechanical problem, or disorder has taken over a person’s life and is producing unmanageable pain. This misconception leads to a great deal of “pain talk.”

Chronic pain sufferers often talk about their pain levels, latest injections, doctor visits, and surgeries. Friends and family ask about sleep problems, medications, treatments, and therapies. Everyone feels bad that so little can be done to manage pain and worries about the wellbeing of the pain sufferer. This is understandable but not helpful.

What “Pain Talk” Does to the Brain

Pain neuroscience education begins by helping people understand the role of language in how the brain processes information and produces pain. As our brain monitors our peripheral nervous system, it is collecting evidence for danger and evidence of safety. The brain weighs available evidence to determine if there is truly a threat that requires it to produce a protective response.

The brain’s protective response might be pain, but it could be any number of rsponses. Common ways the brain says, “Something is wrong,” might be a tremor, non-epileptic seizure, stomachache, headache, dizziness, hives, nausea, blurred vision, muscle tightness, heart palpitation, chest pain, or a muscle twitch.

We often mistake symptoms that occur when the brain senses a threat for a disease or disorder. Chronic pain is often the result of an overactive nervous system that is constantly sensing a threat and producing pain even though pain would provide no help or protection. Chronic pain is thus not necessarily a disease or disorder that can be treated directly with medical intervention.

Healthcare providers unknowingly can increase a person’s concern about their health and well-being by the language that they use when talking with patients. Here are some common medical statements our brain would use as evidence for danger:

  • Your MRI is abnormal.
  • This is the worst case I have ever seen.
  • I am surprised you can still walk.
  • Strong medication hardly seems to touch your pain.
  • You have degenerative disc disease.
  • Your mother had the same problem. It runs in your family.
  • You are going to eventually need more surgery.
  • You need to start using a cane or walker to get around.

These statements are viewed by the brain as evidence for danger. When people have chronic pain, their brain lacks a good collection of credible evidence for safety. They have few reasons to believe that they should not be in pain, few reasons to believe that movement doesn’t cause harm, and few reasons to believe they can learn to manage their pain effectively.

How to Change the Conversation Around Pain

Reducing the sense of threat in the brain can start by simply changing how people talk about pain. The goal of changing how we talk about pain is to get our attention off pain and on to the direction we want to be moving with our life despite pain.

James Hudson, M.D., a chronic pain specialist, provides new chronic pain patients with two simple instructions written out on his prescription pad. He wants pain patients to change how they talk and how they think about pain.

The first prescription is simple: “Stop talking about pain.” People ask pain sufferers about pain all the time, but the pain patient needs to learn to redirect questions to focus on other aspects of life. They might say, “Thanks for asking. I’d rather not talk about pain anymore. I’d be happy to tell you what I have planned for this week.”

The second prescription is similar: “Stop exaggerating about your pain to others or even when talking to yourself.” We often use extreme language when referring to pain, such as, “This pain is killing me,” or “My pain is at a level 12 out of 10 right now.” This type of language only reinforces the idea that there is an extreme threat; when the brain senses there is a threat, it will often protect you by producing more pain.

When patients bring these two instructions home, it takes a while to retrain friends, family, and coworkers. Friends and family are often anxious and worried, which is why they ask about pain. But if the topic of conversation changes, the results are often dramatic. After years of starting conversations focused on their pain, pain patients begin to talk about things that are meaningful, hopeful, and enjoyable. They focus on what they can do, not what they can’t do.

As minor as these changes may seem, the language we use every day affects how the brain views and produces pain. You can start today by telling your friends and family that you appreciate their concern, but it’s time to start a new conversation, one that is focused on growth, hope, and a better future.

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