True or False: Guided Imagery Can Replace Painkillers
A man asks Belleruth for insight on how guided imagery could reduce dependency on painkillers.
Dear Belleruth,
I would like an explanation of how a technique like guided imagery could take the place of opioids for pain. What are the mechanisms that make it so? I have a sister-in-law who says I can reduce my intake of pain killers for my back. I find it hard to believe, but I want to keep my mind open.  Please explain. Thank you.
Henry J.
Hello, Henry.
Thanks for reaching out. 
I think your sister-in-law is at least partially right. Guided imagery can be a safe, effective alternative to meds for some pain conditions, and at the very least, it can help reduce the dosage for most. It actually produces some natural (endogenous) biochemical changes in the bloodstream that can give opioids some serious competition. 
But let me back up a bit first.
Pain, by definition, is a matter of perception, which means we can use guided imagery to interrupt and distract our awareness of it, which is the same as lowering its intensity.  We can also reframe the experience of pain in a way that gives us a sense of mastery and agency over it. 
My version of this kind of guided meditiation, , Ease Pain, provides imagery for both approaches. And Emmett Miller’s newly released guided hypnosis and imagery audio, Reducing & Relieving Pain, is a wonderfully effective and masterful example of how this works.  It’s been re-recorded, re-mastered and re-mixed, and I’m proud and happy with the result.  Check out the sound samples, and you’ll see what I mean.
There’s also a difference between chronic and acute pain, and the kind of guided imagery or hypnosis that would work best with each.  
Guided imagery that’s designed to turn attention away from pain - provide a vacation from it, so to speak – is often a first choice when we’re dealing with chronic pain. This would be the imagery that takes us to a favorite time or place; or engenders natural feelings of lovingness and gratitude; or recalls some especially sweet, nourishing memories; or imagines mastery and success. 
Needless to say, these types of uplifting, heart-based imaginings also release powerful endogenous opioids – serotonin and its mood-lifting, pain-reducing cousins.  (That’s usually the first observation our vets will share after a guided imagery exercise – that their chronic headache, back ache or knee pain has vanished.)
The other kind of guided imagery is for the acute pain which demands our attention and resists distraction.  In this case, imagery can guide us to deliberately and mindfully place the focus of our attention toward the pain, befriending it and embracing it.  
This can be imagery that encourages us to adopt a warrior stance and dive into our pain - breathe into it and through it, soften around it and accept it.  As I said, the reason this is the preferred option for acute pain, is because it’s not always so amenable to distraction.  It’s what a lot of childbirth exercises are about. 
There are no hard and fast rules about which approach is best.  People have natural preferences that suit them best, regardless of the kind of pain or condition they’re dealing with.  Most people develop their own combination of these two approaches. 
Either way, anything that helps people cease and desist their automatic attempts to hold off pain or resist it, is going to help.  The truth is, fighting with pain, tensing up around it, getting angry at it, or trying to hold it at bay has the paradoxical effect of intensifying it. (That’s also the essence of effective childbirth imagery – it helps you roll with the contractions by embracing them.)
And because guided imagery has long-established its clout for reducing anxiety, and because anxiety increases the perception of pain, we know that the calming, soothing and relaxing properties of guided imagery will further decrease pain.
I hope this answers your question, Henry – at least partially.
All best,