Pain management: Our expert columnist shares his tips

Exploring the connection between anxiety, sleep, and chronic pain, to uncover effective tools to help tackle the troubling loop

Anxiety, sleep, and chronic pain are experiences that are closely intertwined. When pain persists, it often creates worry: why is this happening? Will it get worse? Will I cope? That anxiety increases stress hormones and muscle tension, which can heighten the perception of pain. At night, an overactive mind and tense body can make restful sleep difficult, in turn, lowering pain thresholds, and reducing emotional resilience the next day. The result is a self-perpetuating cycle – but hope is not lost.

Solution-focused hypnotherapy offers a practical and empowering way to manage this, by helping you understand how the brain responds to stress, and shifting attention away from problem-focused thinking towards solutions and resources. Rather than analysing the origins of pain, it focuses on how you want to feel, and what small, realistic steps can help you in moving forward.

This can be explored using the ‘miracle question’. Clients are invited to imagine that while you’re asleep a small miracle happens, and the problem becomes easier to manage. When you awake, what would be the first signs that things were improving? Perhaps you would notice moving a little more comfortably, feeling calmer about symptoms, or sleeping more deeply. Identifying these small changes helps the brain begin to focus on progress and possibility, rather than constantly scanning for problems.

A key part of the process is understanding how the brain’s threat system works; when you experience ongoing stress or pain, the brain’s ‘fight-or-flight’ response can become overactive. The mind scans for danger and reacts quickly, often before rational thinking can step in. In chronic pain conditions, this system can remain switched on for long periods, keeping the nervous system in a heightened state of alert.

Understanding why this is happening can be reassuring, allowing people to realise that their experience is not a personal weakness, but a nervous system that has become stuck in protection mode. As anxiety begins to settle, the body naturally reduces tension, the stress response calms, and pain can become easier to manage.

As a state of focused relaxation, this is where hypnosis comes in, allowing the mind to become more receptive to positive suggestions and helpful imagery. For pain management, this might involve visualising turning down a ‘pain dial’, imagining warmth and comfort flowing through the affected area, or mentally rehearsing moving more freely and confidently. These images are not about pretending pain is absent. Instead, they help the brain reinterpret signals in a calmer, and less threatening, way.

Research supports the idea that hypnosis can influence how the brain processes pain, with a 2017 study, published in Scientific Reports, finding that hypnotic analgesia reduced activity in brain regions, such as the anterior insula and amygdala, which are involved in how the brain evaluates and responds emotionally to pain. This suggests that hypnosis may help to change the way that pain signals are interpreted, reducing the distress attached to them, rather than simply blocking sensation.

Improving sleep is another important part of the process. When the mind is calmer, the body finds it easier to move into deeper, restorative sleep. During hypnosis, suggestions often focus on letting go of racing thoughts, slowing the breath, and creating a sense of safety and comfort. Many clients use a relaxation recording at bedtime, which helps condition the brain to associate night with rest, rather than rumination.

As the nervous system settles, and the body enters restorative sleep, the brain’s threat system becomes less active. This calming effect can reduce the intensity with which pain signals are processed by the brain, helping discomfort feel more manageable.

What’s important to note is that these techniques are tailored to the individual. Language and imagery are adapted to match personal goals, strengths, and experiences. With repetition, new neural pathways begin to form, helping calmer responses become more automatic.

The good news is that, alongside hypnosis, there are simple tools people can use straight away:

Controlled breathing: Breathing in for four seconds and out for six helps to activate the body’s relaxation response, and reduce physical tension.

Future visualisation: Spending a few minutes imagining tomorrow going slightly better than today helps the brain focus on progress instead of problems.

Scaling questions: Rating pain or anxiety from zero to 10, and asking what might move it down by one point, encourages achievable steps.

Self-hypnosis cue words: Repeating a word such as ‘calm’ or ‘ease’, while breathing slowly, can help the brain associate the word with relaxation.

Sleep rehearsal: Mentally practising drifting off easily before bedtime can help the brain recreate that experience more naturally.

Of course, there’s no one-size-fits-all route for pain management, and solution-focused hypnotherapy does not claim to cure chronic pain. Instead, it focuses on reducing the anxiety and sleep disruption that often amplify suffering. By calming the nervous system, improving sleep, and strengthening solution-focused thinking, it can create a healthier feedback loop, allowing confidence and quality of life to begin to return.

The goal is not perfection, but progress – helping people regain a sense of control, and recognise that while pain may be part of their story, it does not have to define them.