Using Graded Exposure to Manage Chronic Pain

Posted on: Sat, 01/26/2013 - 8:46pm By: Alice

Graded exposure can be a useful technique for persons living with chronic pain. Graded exposure is a method of finding movement that is pain-free and building on that. The idea is to break the brain's association between a particular movement and pain.

Say, for instance, that when you bend from the hips you begin to experience pain at about a 45° angle. To use graded exposure, you would start by finding a very easy range of movement. Perhaps you would start at only 5° of movement. Stand upright, bring your attention into your body, make sure that you feel relaxed, and slowly bend at the hips to about 5°. Then return to your starting position. Notice how you feel, notice that you can do this successfully. Repeat 20 - 30 times. Outside of this, avoid bending from the hips as much as you can for awhile. That may be inconvenient but you are trying to get rid of a chronic problem and it may take some short term sacrifice for longer term gain. If you do, in your daily life, bend over and feel pain, don't panic. Try to relax, let it pass, remind yourself that you are okay. If you have a few seconds, repeat your easy movement to remind your nervous system that it's okay, it can move in that direction. 

On the next day, repeat the exercise but this time bend just a little further, maybe to 10°. Again, make sure you are relaxed and that the movement is pain-free and done with awareness. Repeat 20 - 30 times.

Each day, bend just a little further. If you reach a point where you begin to feel tension or pain, back up to where you can still move without pain or tension for a day or two. The idea is to find successful movement and keep building on it. On one hand, you are trying to break the brain's association between a particular movement and pain. On another, you may find ways of moving that are slightly different than your usual manner of movement that may be more successful for you. 

Graded exposure can be adapted to almost any movement. You can design it to fit your own specific needs. In extreme cases where even slight movement is painful, just a hint of movement or mentally visualizing successful movement can be a start. 

I was first introduced to the idea many years ago in a Feldenkrais class and later used it to overcome an impasse in my own physical therapy for a knee problem. More recently, the book Explain Pain by Butler and Moseley describes graded exposure and elaborates ways in which to use it. I recommend this book highly to anyone with chronic pain and anyone who works with people in pain.  To check it out, click on the image below:

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For more information about how pain works, watch an entertaining video by Lorimer Moseley here.