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Skills for Managing Chronic Pain

Using mindfulness skills, Kaiser Permanente Northern California members learn to relate to chronic pain in a new way. Pictured above, pain psychologist Les Aria, PhD and pain physical therapist Kristi Sundahl, PT.

In a second-floor classroom at the Kaiser Permanente Folsom Medical Offices, 16 people are gathered to learn how to better manage their chronic pain.

There is a young woman in a neck brace, and an older man using a walker. Everyone is a Kaiser Permanente member who has been in pain for 6 months or longer, suffering from conditions such as lower back pain, neck pain, knee pain, headache, and fibromyalgia.

They are taking a 2 ½ hour pain management workshop that meets weekly for 4 weeks and is led by pain psychologist Les Aria, PhD, and pain physical therapist Kristi Sundahl, PT. Together they teach mindful-based movement and mental skills to help patients calm their nervous systems and relate to their pain in a new way.

“When you have pain for more than 6 months, it puts you on high alert,” explained Dr. Aria. “Your pain is no longer an issue with your back or your knee — it becomes a nervous system problem.”

The workshops are offered through Kaiser Permanente North Valley/Sacramento area’s Comprehensive Pain Management Department, which also offers acupuncture, biofeedback, health coaching, and an opioid safety program. There are similar chronic pain management programs at every Kaiser Permanente Medical Center in Northern California.

Dr. Aria tells the group in Folsom that their thoughts and emotions have a strong influence over how they experience physical pain because thoughts, emotions, and pain are all processed in the same area of the brain. The workshop aims to help patients dial down the thoughts and emotions that influence how they perceive pain, so they can suffer less and improve their quality of life.

Deactivating the Fight or Flight Response

In the mindful movement portion of the workshop, Kristi Sundahl teaches patients practical techniques such as how to engage their core, move with less effort and more ease, and comfortably get out of a chair. She also practices a series of Qigong exercises with the class, which she says will help remind their bodies of “what a calm nervous system feels like.”

Every session also includes practice in mindful meditation, which Dr. Aria describes as “simply focusing on your breath.”

“You feel the physical sensations of your relaxed deep breathing, the rise and fall of your belly, and noticing these things gives your brain focus. Should something take your attention away, notice it, say thank you, and then go back to your breath.”

Research shows that a regular mindful meditation practice deactivates the amygdala (the part of your brain that’s associated with fear, emotion, and the fight or flight response) and it activates the pre-frontal cortex (associated with awareness, concentration, and decision-making).

When patients are in pain, Dr. Aria asks them to breathe calmly and mindfully while focusing on the middle of their pain.

“Once they locate it and do nothing else but breathe in and out gently for 2 to 3 minutes, it’s unbelievable what happens,” he said. “It’s tough work, but for most people there’s a change for the better, and the more they practice the more relief they get.”

‘This Program Saved My Life’

Dr. Aria estimates that about 40 percent of patients who take the series of workshops and 4 aftercare sessions get significant relief. Among them are 53-year old Jaqueline Turos and 65-year-old Ricky Combs.

Combs, who used to own a landscaping business, suffers pain from fibromyalgia, arthritis, disc pain, and neuropathy. He said he’s received so much pain relief from the mindful meditation that he’s working on a book about his experience.

“I tell people that this program saved my life. I wish that everybody who has chronic pain could take it,” he said.

Turos, a business analyst who suffered debilitating chronic neck pain for years, said she’s now almost pain free. She credits the skills and knowledge she gained in the workshop.

“The class is not a pill,” Turos said. “It takes a certain amount of committed discipline. But I am so grateful to have had the chance to learn to help myself. I don’t know what else to say, except thank you.”

Read part 1 of this series, A Mindful Approach to Chronic Pain Management.

Most Kaiser Permanente Medical Centers in Northern California offer either a Mindfulness Based Stress Reduction class or a class on Mind Body Health. Read more about chronic pain and Kaiser Permanente’s pain management classes at the chronic pain page on Relax and listen to any one of several guided imagery podcasts produced to help you reduce stress and promote healing at



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This Post Has 8 Comments

  1. I am 67. I have suffered with chronic pain for much of my like stemming from congenital scoliosis which progressed to the point where walking and standing upright was unbearable. In 2015 I had surgery – fusion T12-L5 (rods and screws) which relieved my pain. Since then, I joined Kaiser and have been an active participant in their chronic pain management program, mindful movement and meditation classes and weight management program. I am so much healthier physically and mentally now and so grateful for the committed professionals at Kaiser who are making a difference in helping educate us.
    Thank you!!!! Carolyn

  2. The importance in the recognition of unaddressed pain is emphasized here:

    “When you have pain for more than 6 months, it puts you on high alert,” explained Dr. Aria. “Your pain is no longer an issue with your back or your knee — it becomes a nervous system problem.”

    And places emphasis on the need to address that pain before it amplifies into something more pervasive. Thanks for the notes.

  3. My father has suffered from chronic pain throughout his life, and I also have chronic pain. My Dad is a firm believer of mind, body, and soul techniques and the connection among them all, and has found relief in practicing both hypnosis and breathing. Thank you for confirming what can help.

  4. This is wonderful! I truly appreciate a mindful approach to every aspect of life. Using mindfulness skills to relate to pain is an excellent tool to teach and possess. Thank you for sharing and offering this.

    1. Yes, well said.

      Mindfulness is a way to just relate differently to our thoughts, emotions, and physical sensations versus using avoidance or other strategies to get rid of painful things. When we accept/a willingness… the struggle is over… and we can direct our energy into more important and meaningful things in our lives.

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