Healing from the Inside Out: How Your Mind–Body Shapes Pain

Posted: June 9, 2025 | Author: erikpeper | Filed under: attention, behavior, Breathing/respiration, CBT, emotions, healing, health, mindfulness, Pain/discomfort, placebo, self-healing, Uncategorized | Tags: health, meditation, mental-health, mindfulness, Sufism, yoga |2 Comments

Adapted from Peper, E., Booiman, A. C., & Harvey, R. (2025). Pain-There is Hope. Biofeedback, 53(1), 1-9. http://doi.org/10.5298/1081-5937-53.01.16

Pain is more than a physical sensation—it’s shaped by our breath, thoughts, emotions, and beliefs. A striking example: a four-year-old received a vaccination with no pain, revealing the disconnect between what science knows about pain relief and what’s practiced.
The article highlights five key ways to reduce pain:

1. Exhale during the painful moment – This activates the parasympathetic nervous system, calming the body. A yogi famously demonstrated this by pushing skewers through his tongue without bleeding or feeling pain.
2. Create a sense of safety – Feeling secure can lessen pain and speed healing. Sufi mystics have shown this by pushing knives through their chest muscles without long-term damage, often healing rapidly.
3. Distract the mind – Shifting focus can ease discomfort.
4. Reduce anticipation – Fear of pain often amplifies it.
5. Explore the personal meaning of pain – Understanding what pain symbolizes can shift how we experience it.

The blog also explores how the body regulates pain through mechanisms which influence inflammation and pain signals. In the end, hope, trust, and acceptance, along with mindful breathing, healing imagery, and meaningful engagement, emerge as powerful tools not just to reduce pain—but to promote true healing.

Listen to the AI generated podcast created from this article by Google NotebookLM

I took my four-year-old daughter to the pediatrician for a vaccination. As the nurse prepared to administer the shot in her upper arm. I instructed my daughter to exhale while breathing, understanding that this technique could influence her perception of pain. Despite my efforts, my daughter did not follow my instructions. At that point, the nurse interjected and said, “Please sit in front of your daughter.” Then turned to my daughter and said, “Do you see your father’s curly hair? Do you think you could blow the curls to move them back and forth?” My daughter thought this playful game was fun! As she blew at my hair, the curls moved back and forth while the nurse administered the injection. My daughter was unaware that she had received the shot and felt no pain.

My experience as a father and as a biofeedback practitioner was enlightening–it demonstrated the difference between theoretical knowledge of breathing techniques associated with pain perception and practical applications of clinical skills used by a pediatric nurse practitioner while administering an injection with children. An obvious question raised is: What processes are involved in the perception of pain?

There are many factors influencing pain perception, such as physical/physiological, behavioral and psychological/emotional factors related to the injection as described by St Clair-Jones et al., (2020). Physical and physiological considerations include device type such as needle gauge size as well as formulation volume and ingredients (e.g., adjuvants, pH, buffers), fluid viscosity, temperature, as well as possible sensitivity to coincidental exposures associated with an injection (e.g., sensitivity to latex exam gloves or some other irritant in the injection room).

There are overlapping physical and behavioral-related moderators that include weight and body fat composition, proclivity towards movements (e.g., activity level or ‘squirminess’), as well as co-morbid factors such as whether the person has body sensitization due to rheumatoid arthritis and/or fibromyalgia, for example. Other behavioral factors include a clinician selecting the injection site, along with the angle, speed or duration of injection. Psychological influences center around patient expectations including injection-anxiety or needle phobia, pain catastrophizing, as well as any nocebo effects such as white-coat hypertension.

Although the physical, behavioral and psychological categories allow for considering many physical and physiological factors (e.g., product-related factors), behavioral factors (e.g., injection-related behaviors) and psychological factors (e.g., person-related psychological attitudes, beliefs, cognitions and emotions), this article focuses on a figurative recipe for success associated with benefits of simple breathing to reduce pain perceptions.

Of the many categories of consideration related to pain perceptions, following are five key ‘recipe ingredients’ that contributed to a relatively painless experience:

1. Exhaling During Painful Stimuli: Exhaling during a painful stimulus can activate parts of the parasympathetic nervous system leading to promotion of self-healing.
2. Creating a Sense of Safety: Ensuring that the child feels safe and secure is crucial in managing pain. My lack of worry and concern and the nurse’s gentle and engaging approach created a comforting environment for my daughter.
3. Using Distraction: Distraction techniques, such as focusing on the movement of the curls of the hair served to redirect my daughter’s attention away from the anticipated pain.
4. Reducing Anticipation of Pain: My daughter’s previous visits were always enjoyable and as a parent, I was not anxious and was looking forward to the pediatrician visit and their helpful advice.
5. Understanding the Personal Meaning of Pain: The approach taken by the nurse allowed the injection to be perceived as a non-event, thereby minimizing the psychological impact of the pain.

Exhaling During Painful Stimuli

Exhaling during painful stimuli facilitates a reduction in discomfort through several physiological mechanisms. During exhalation the parasympathetic nervous system is activated, which slows the heart rate and promotes relaxation, regeneration, reduces anxiety, and may counteract the effects of pain (Magnon et al., 2021). Breathing moderation of discomfort is observable through heart rate variability associated with slow, resonant breathing patterns, where heart rate increases with inhalation and decreases with exhalation (Lehrer & Gevirtz, 2014; Steffen et al., 2017). Physiological studies show that slow, resonant breathing at approximately six breaths per minute for adults, and a little faster for young children, causes the heart rate to increase during inhalation and decrease during exhalation, as illustrated in Figure 1.

Figure 1. Changes in heart rate as modulated by slower breathing at about six breaths per minute

One can experience how breathing affects discomfort when taking a cold shower under two conditions: As the cold water hits your skin: (1) gasping and holding your breath versus (2) exhaling slowly as the cold water hits you. Most people will report that slowly exhaling feels less uncomfortable, though they may still prefer a warm shower.

An Exercise for Use During Medical Procedures: Paring the procedure with inhalation and exhalation

A simple breathing technique can be used to reduce the experience of pain during a procedure or treatment, or during uncomfortable movement post-injury or post-surgery. Physiologically, inhalation tends to increase heart rate and sympathetic activation while exhalation reduces heart rate and increases parasympathetic activity. Often inhalation increases tension in the body, while during exhalation, one tends to relax and let go. The goal is to have the patient practice longer and slower breathing so that a procedure that might be uncomfortable is initiated during the exhalation phase. Applications of long, slow breathing techniques include having blood drawn, insertion of acupuncture needles in tender points, or movement that causes discomfort or pain. Slowly breathing is helpful in reducing many kinds of discomfort and pain perceptions (Joseph et al., 2022; Jafari et al., 2020).

Implementing the technique of exhaling during painful experiences can be deceptively simple yet challenging. When initially practicing this technique, the participants often try too hard by quickly inhaling and exhaling as the pain stimulus occurs. The effective technique involves allowing the abdomen to expand while inhaling, then allowing exhaled air to flow out while simultaneously relaxing the body and smiling slightly, and initiating the painful procedure only after about 25 percent of the air is exhaled.

Some physiological mechanisms that explain how slow breathing influences on pain perceptions have focused on baroreceptors that are mechanically sensitive to pressure and breathing dynamics. According to Suarez-Roca et al. (2021, p 29): “Several physiological factors moderate the magnitude and the direction of baroreceptor modulation of pain perception, including: (a) resting systolic and diastolic AP, (b) pain modality and dimension, (c) type of activated vagal afferent, and (d) the presence of a chronic pain condition It supports the parasympathetic activity that exert an anti-inflammatory influence, whereas the sympathetic activity is mostly pro-inflammatory. Although there are complex physiological interactions between cardiorespiratory systems, arterial pressure and baroreceptor sensitivity that influence pain perceptions, this report focuses on simpler reminders, such as creating a sense of safety for people as a result of better breathing techniques.

Creating a Sense of Safety

My young daughter did not know what to expect and totally trusted me and I was relaxed because the purpose was to enhance my daughter’s future health by giving her a vaccination to prevent being sick at a future time. Often, a parent’s anxiety is contagious to the child since expectations and emotional states influence the experience of medical procedures and pain (Sullivan et al., 2021). For my daughter, the nurse’s calm and confident demeanor contributed to a safe and reassuring environment. As a result, she was more engaged in a playful distraction, blowing at my hair, rather than focusing on the impending shot. This observation underscores an important psychological principle: when individuals do not anticipate pain and feel safe, they are more likely to experience surprise rather than distress. Conversely, anticipation of pain can amplify the perception of discomfort.

For instance, many people have experienced heightened anxiety at the dentist, where they may feel the pain of the needle before it is inserted. Anticipation evocates a past memory of pain that triggers a defensive reaction, increasing sympathetic arousal and sharpening awareness of potential danger. By providing the experience of feeling of safety, parents, caretakers, and medical professionals can play a crucial role in reducing the perceived pain of medical interventions.

Using Distraction

It is inherently difficult to attend to two tasks simultaneously; thus, focusing one’s attention on one task often diminishes awareness of pain and other stimuli (Rischer et al., 2020). For instance, when the nurse asked my daughter to see if she could blow hard enough to make the curls move back and forth, this task captured her attention in a fun and multisensory way. She was engaged visually by the movement of the curls, audibly by the sound of the rushing air, physically by the act of exhalation, and cognitively by following the instructions. Additionally, her success in moving the curls reinforced the activity as a positive and enjoyable experience.

In contrast, it is challenging to allow oneself to be distracted when anticipating discomfort, as numerous cues can continuously refocus attention on the procedure that may induce pain. This experience is akin to attempting to tickle oneself, which typically fails to elicit laughter due to the predictability and lack of external stimulation. Most of us have experienced how challenging it is to be self-directive and not focus on the sensations during dental procedures as discussed in the overview of music therapy for use in dentistry by Bradt and Teague (2018). The challenges are illustrated by my own experience during a dental cleaning

During a dental cleaning, I often attempt to distract myself by mentally visualizing the sensation of breathing down my legs while repeating an internal mantra or evoking joyful memories. Despite these efforts, I frequently find myself attending to the sound of the ultrasonic probe and the sensations in my mouth. To manage this distraction more effectively, I have found that external interventions such as listening to music or an engaging audio story through earphones is more beneficial.

From this perspective, we wished that the dentist could implement an external intervention by collaborating with a massage therapist to provide a simultaneous foot massage during the teeth cleaning. This dual stimulation would offer enough competing sensations to divert attention from the dental procedure to the comfort of the foot massage.

Reducing Anticipation of Pain

A crucial factor in the experience of pain is the anticipation and expectation of discomfort, which is often shaped by previous experiences (Henderson et al., 2020; Reicherts et al., 2017). When encountering a novel experience, we might interpret the sensations as novel rather than painful. Similar phenomena can be observed in young children when they fall or get hurt on the playground. They may initially react with surprise or shock and may look for their caretaker. Depending the reaction of their caregiver, they may begin to cry or they might cry briefly, stop and resume playing.

Conversely, the anticipation of pain can heighten sensitivity to any stimuli, causing them to be automatically perceived as painful. Anticipatory responses function as a form of mental rehearsal, where the body responds in a manner similar to the actual experience of pain. For example, Peper, et al. (2015) showed that when a pianist imagined playing the piano, her forearm flexor and extensor muscles exhibited slight contractions, even though there was no observable movement in her arm and the pianist was unaware of these contractions (see Figure 2).

Figure 2. The covert SEMG increase in forearm SEMG as the participant imagined playing the piano (reproduced by permission from Peper et al., 2015).

These kind of muscle reactions are also visible in sportsmen. For example, while mentally racing a lap on a motorbike, the arm muscles act like as if the person is racing in the dust of the circuit (Booiman 2018). The blood flow (BVP) and blood vessels are reacting even quicker than muscle tension on thoughts and expected (negative) experiences.

These findings underscore how anticipatory responses can mirror actual physical experiences, providing insights into how anticipation and expectancy can modify pain perception (Henderson et al., 2020). Understanding these mechanisms allows for the development of interventions aimed at managing pain through the modification of expectations and the introduction of distraction techniques.

The Personal Meaning of Pain (adapted from Peper, 2015)

The personal meaning of pain is a complex construct that varies significantly based on context and individual perception. For example, consider the case of a heart attack. Initially, the person might experience chest pain and dismiss it, which can be attributed to societal norms where people are conditioned to ignore pain. However, once the pain is assumed or diagnosed to be a heart attack, the same pain may become terrifying as it may signify the potential for life-threatening consequences. Following bypass surgery, the pain might actually be worse, but it is now reframed positively as a sign of the surgery’s success and a symbol of hope for survival. Thus, the meaning of pain evolves from one of fear to one of reassurance and recovery.

This notion that pain is defined by the context in which it occurs is crucial (Carlino et al., 2014). For instance, childbirth, despite being intensely painful, is understood within the context of a natural and temporary process that leads to the birth of a child. This perception is often reinforced nonverbally by a supportive midwife or doula. It may be helpful if the midwife or doula has given birth herself. Without words she communicates, “This is an experience that you can transcend, just as I did.” Psychologically/emotionally, the pain serves a higher purpose, to deliver a child into the world, which may also make the pain more bearable. There is a reward, namely the child. In addition, women who have had training and information about the process of childbirth have a significant faster delivery (about 2 hours faster).

Piercing the body without reporting pain or bleeding

To further illustrate this concept, Peper et al. (2006) and Kakigi et al. (2005) physiologically monitored the experiences of a Japanese Yogi Master, Mitsumasa Kawakami,who performed voluntary body piercing with unsterilized skewers, as depicted in Figure 3 (Peper, 2015).

Figure 3. Demonstration Japanese Yogi Master, Mitsumasa Kawakami, voluntary piercing the tongue and neck with unsterilized skewers while experiencing no pain, bleeding or infection (reproduced by permission from Peper et al., 2006).

See the video recording of tongue piercing study recorded November 11, 2000, at the annual Biofeedback Society Meeting of California, Monterey, CA, https://youtu.be/f7hafkUuoU4 (Peper & Gunkelman, 2007).

Despite the visual discomfort of seeing this procedure, physiological data from pulse, EEG and breathing patterns revealed that the yogi did not experience pain. During the piercing, his heart rate was elevated, his electrodermal activity was low and unresponsive, and his EEG showed predominant alpha waves, indicating a state of focused meditation rather than pain. This study suggests that conscious self-regulation, rather than dissociation, can be employed to control attention and responsiveness to painful stimuli and possibly benefit individuals with chronic pain (Peper et al., 2005).

A similar phenomenon was observed among a spiritual gathering of Kasnazani Sufi initiates in Amman, Jordan and physiologically monitored during demonstrations as part of a scientific meeting. The Kasnazani order is a branch of Sufism that has gained widespread popularity in Iraq and Iran, particularly among the Kurdish population. What sets the Kasnazani order apart is its inclusive approach—it welcomes both Sunni and Shia Muslims, making no distinction between them. During spiritual gatherings, some followers perform acts that might seem extreme to outsiders: piercing their bodies. These acts are seen as expressions of deep spiritual devotion and are performed in a state believed to be beyond normal physical sensation. With the permission of their Sheikh Mohammed Abdul Kareem Kasnazani, they pierced their face, neck arms, or chest and reported no pain or bleeding and heal quickly, as shown in Figure 4.

Figure 4. Voluntary piercing and with unsterilized skewers by Sufi initiates and subsequent tissue healing after 14 hours.

See the video recording of the actual piercing study organized by Erik Peper and Howard Hall with Thomas Collura recording the QEEG at the 2013 Annual Scientific Meeting of the Association for Applied Psychophysiology and Biofeedback, Portland, OR (Peper & Hall, 2013; Collura et al., 2014), https://www.youtube.com/watch?v=56nLZyG87oc

What Factors Decrease the Experience of Pain and Promote Rapid Healing with the Absence of Bleeding?

In the case of the Kasnazani Sufis, they framed their experience as a normal, spiritual phenomenon that occurs in a setting of religious faith and total trust in their spiritual leader (Hall, 2011). The Sufis reported that they had permission and support from their master, Sheikh Mohammed Abdul Kareem Kasnazani. Thus, they felt totally safe and protected—they had no doubt they could experience the piercing with reasonable composure and that their bodies would totally heal. Even if pain occurred, it was not to be feared but part of the process. The experience may be modulated by the psychological context of the group, the drumming, and the chanting. The phenomenon was not simply a matter of belief; they knew that healing would occur because they had seen it many times in the past. The knowledge that healing would occur rapidly was transmitted as a felt sense in the group that this is possible and following the expected normal pattern.

The most impressive finding was that the physiology markers (heart rate, skin conductance, and breathing) were normal and there was no notable change (Booiman et al., 2015; Peper & Hall, 2013) and the QEEG indicated the inhibition of pain (Collura et al., 2014).

Clinical implications

These observations underscore that the context of pain—whether through personal meaning, spiritual belief, or communal support—can significantly alter its perception and management. This concept is also reflected in clinical settings, where a lack of diagnosis or acknowledgment of pain can exacerbate suffering. An isolated individual, alone at night with the physical sensation of pain, may find the pain tremendously stressful, which tends to intensify the experience. In this situation, there are concerns about the future: “It may get worse, it will not go away, I’m going to die from this, maybe I’ll die alone,” and the worry continues.

If one can let go of these thoughts, breathe through the pain, relax the muscles and experience a feeling of hope, the pain is often reduced. On the other hand, focusing on the pain may intensify it. On the other hand, the meaning of pain implies survival or hope as sometimes is observed in injured soldiers. In context of the hospital setting: “I have survived and I am safe.”
What are the implications of these experiences in clinical settings in which the patient is in constant pain and yet has not received an accurate diagnosis? Or, in cases in which the patient has a diagnosis, such as fibromyalgia, but treatment has not reduced the pain significantly? Experiencing pain or illness that goes undiagnosed, and/or that is not acknowledged, may increase the level of stress and tension, which can contribute to more pain and discomfort. As long as we are resentful/angry/resigned to the pain or especially to the event that we believe has caused the pain, the pain often increases. Another way to phrase this is that chronic sympathetic arousal increases the sensitivity to pain and reduces healing potential (Kyle & McNeil, 2014).

Acknowledgement means having an accurate diagnosis, validating that the pain experience is legitimate and that it is not psychosomatic (imagined), because that simply makes the experience of pain worse. Once the patient has a more accurate diagnosis, treatment may be possible.

When one has constant, chronic, or unrelenting pain, this evokes hopelessness and the patient is more likely to get depressed (Sheng et al., 2017; Meda et al., 2022). The question is, What can be done? The first step for the patients is to acknowledge to themselves that it does not mean that the situation is unsolvable. It is important to focus on other options for diagnosis and treatment and take one’s own lead in the healing/recovery process. We have observed that a creative activity that uses the signals of pain to evoke images and thoughts to promote healing may reduce pain (Peper et al., 2022). Pain awareness may be reduced when the person initiates actions that contribute to improving the well-being of others.

Overall, pain appears to decrease when a person accepts without resignation what has happened or is happening. A useful practice that may change the pain experience is to do an appreciation practice. Namely, appreciate what that part of the body has done for you and how so often in the past you may have abused it. For example, if you experience hip pain, each time you are aware of the pain, thank the hip for all the work it has done for you in the past and how often you may have neglected it. Keep thanking it for how it has supported you.

Pain often increases when the person is resentful or wished that what has happened had not happened (Burns et al., 2011). If the person can accept where they are and focus on the new opportunities and new goals can achieve, pain may still occur; however, the quality is different. Focus on what you can do and not on what you cannot do. See Janine Shepherd’s 2012 empowering TED talk, “A broken body isn’t a broken person.”

Conclusion

The primary lessons from studying the yogi and the Sufis are the concepts that a sense of safety, acceptance, and purpose can transform the experience of pain. Expressing confidence in a patient’s recovery prospects places the focus on their ability to recover. Incorporating these elements into clinical care may offer new avenues for addressing chronic pain and improving patient outcomes (Booiman & Peper, 2021).

We propose the first step is to create an atmosphere of hope, trust and safety and to emphasize the improvements made (even small ones). Then master effortless breathing to increase slow diaphragmatic breathing and teach clients somato-cognitive techniques to refocus their attention during painful stimuli (mindfulness) (Pelletier & Peper, 1977; Peper et al., 2022). Using the slow breathing as the overlearned response would facilitate the recovery and regeneration following the painful situation. To develop mastery and be able to apply it under stressful situations requires training and over-learning. Yoga masters overlearned these skills with many years of meditation. With mastery, patients may learn to abort the escalating cycle of pain, worry, exhaustion, more pain, and hopelessness by shifting their attention and psychophysiological responses. In clinical practice, strategies such as hypnotic induction, multisensory distraction, self-healing visualizations, and mindfulness techniques can be employed to manage pain. A foundational principle is that healing is promoted when the participant feels safe and accepted, experiences suffering without blame, and looks forward to life with meaning and purpose.

Acknowledgement

We thank Mitsumasa Kawakami, Sheikh Mohammed Abdul Kareem Kasnazani, and Safaa Saleh for their generous participation in this research and I thank our research collegues Thomas Collura, Howard Hall and Jay Gunkelman for their support and collaboration.

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