Many children with pain, especially chronic pain, have lost the ability to feel relaxed because they have spent so much time hurting and tensing against the pain. They often need to re-learn how to completely and fully relax. Health-care providers will recommend specific exercises or play times to help children more naturally become relaxed by resuming their normal sports and social activities. They may also teach children specific relaxation techniques to lessen tense muscles throughout the body.
These techniques are commonly used with guided imagery because the concrete imagery makes it easier for children to learn how to relax tense muscles. With practice, children and young people can get very good at becoming deeply relaxed very quickly. This gives the child or young person another tool to use so that they feel more in control of their life.
There are many effective relaxation techniques that children can use to reduce pain. Indeed, relaxation makes up some part of most of the psychological coping methods. The point of relaxation is exactly that: to relax and let stress go. The goal is not necessarily to fall asleep — though if your child wants to fall asleep and relaxation techniques help them do so, that is also fine.
Progressive muscle relaxation
This technique consists of systematically tensing and relaxing specific muscle group twice before moving on to the next muscle group. The clickable script uses 14 muscle groups, though the number of muscle groups is not set. You may wish to do more or less depending on time. In some cases, a muscle group should not be used because of injury. After some practice, a script may no longer be necessary; however, many people find that listening to the recorded script with headphones helps eliminate other noisy distractions. If you choose to use a script, it may be recorded by parents or other caregivers or by the child themselves. The length of time each muscle is tensed then relaxed is up to you, but whatever time chosen should be comfortable and not cause pain.
You may do this relaxation technique in any comfortable, well-supported position, sitting or lying down. To get the most out of relaxation, prepare yourself and your surroundings by reducing potential distractions, such as from the telephone and television.
After some time using progressive muscle relaxation, you may wish to re-record the script more to the child's liking. Once your child has gained skill in using this technique, if time is limited, using a portion of the script can still be beneficial. This technique can also become part of daily life. To prevent tension from building up, at different times throughout the day your child can clench their fists, note the tension, and then relax, noting the feelings of relaxation. Relaxation of one part of the body may spread throughout the body.
Here is a sample script to help get you started. This script was adapted from: McCaffery M, Beebe A. Pain: Clinical Manual for Nursing Practice. St. Louis: Mosby; 1989.
Autogenic relaxation
This is a form of muscle relaxation that relies on imagination rather than tensing and relaxing muscles. Children are often very good at this and don’t need the formal structure of progressive muscle relaxation.
Ask your child to pick an image that feels relaxing to them. This might be imagining they are a cat lying on a sunny windowsill or a candle slowly softening or melting in the sun. They could imagine they are swinging gently in a hammock or any other situation that makes sense to them. As they do this, suggest other sensations such as sound, smell, taste, and touch that go with the situation. It will often help to suggest that specific muscle groups (as in the progressive muscle relaxation script above) are relaxing, but it isn’t necessary to tense the muscles first. You might suggest that as they breathe steadily in and out, they are blowing away the tension in their muscles.
It is worthwhile noting that, while adults tend to pick inactive images to relax, children often imagine vigorous activities such as dancing, playing hockey, riding a bike, etc., and these work well for them.
Hypnosis
Hypnosis is a technique that should be learned from a professional. Part deep relaxation, part intensive guided imagery, hypnosis can be a highly effective way of controlling pain. It is a method of achieving very focussed attention, resulting in an altered state of consciousness known as “trance.”
A “trance state” is something most people experience to a minor extent several times a day. An example of a light trance would be a daydream. We are thinking about something so intently that we are less aware of our surroundings and may be able to “see” or “hear” things that are part of what we are imagining. Children are usually very good at this and their free sense of imagination makes it easier for them to enter a hypnotic trance. Once in a trance, people are more open to suggestions and can be encouraged to reduce or control pain.
When in a trance, a person cannot be made to do something they do not want to do when they are fully alert. But, if you are inexperienced, it is possible to give confusing suggestions that are not helpful. This is why it is important that a professional is the one to train your child in the use of hypnosis to control their pain.
Although your child might have to be three or four years old to be old enough to be hypnotised, children tend to be better at it than adults. Children between the ages of eight and twelve are particularly good candidates for hypnosis. Hypnosis can be used for procedural pain and post-operative pain. Even once the techniques of hypnosis are learned, it is usually not as effective without the aid of a qualified therapist.
Turning down the pain switch
Hypnosis works by making your child’s mind open to suggestion by focussing and narrowing their attention. While your child is in a hypnotic state or trance, the therapist will gently suggest a positive re-framing of their pain experience. One common strategy is the pain switch technique.
Your child is told how the brain receives and interprets pain messages through the nerves and then told that there are switches within the brain that can control or even stop pain messages from getting through. Your child will then be asked to concentrate and visualize these switches. They will then be asked to start turning the switches down. Using this technique, many children experience a decrease in their pain level. The goal is reduction of pain. Once your child has established a lower level of pain, they will be brought out of the hypnotic trance. Using post-hypnotic suggestion, they will be encouraged to maintain the lower level of pain even though they are completely conscious.
The pain switch is just one hypnotic technique of many. The therapist will adapt the therapy and the imagery used to your child’s age and interests.
Hypnosis is also highly effective at reducing stress and the physiological changes that accompany stress. It should be noted that unlike in the movies, people under hypnosis cannot be made to do things that they do not wish to do.