The Influence of Gratitude Practices on Physical Pain

May 24, 2024

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Often perceived as a simple feeling of thankfulness, gratitude can be a free, powerful tool for pain management, as well as for boosting Joy and improving your overall well-being
Robert Emmons, one of the leading scientific experts on gratitude, notes that people who keep gratitude journals are less bothered by everyday aches and pains
Research shows that gratitude practices help with the perception of pain by directing your focus toward positive emotions as well as through neuroendocrine mechanisms
In addition to appreciating the simple things around you, there are numerous other ways to practice gratitude. Additional suggestions from various experts are included

Chronic pain affects about 51.6 million American adults, or about 21% of the U.S. population, according to data from the U.S. Centers for Disease Control and Prevention.¹ If you’re one of those experiencing pain, it’s wise to seek natural options before resorting to medications like nonsteroidal anti-inflammatory drugs (NSAIDs), which come with a host of side effects.²

One often overlooked aspect of pain management is the role of the mind-body connection. How you perceive and respond to pain can significantly influence your physical experience, and this is where the practice of gratitude comes into play.

Often perceived as a simple feeling of thankfulness, gratitude can be a free, powerful tool for pain management. It’s also a profound way to boost Joy in your life and improve your overall well-being, as discussed in the featured video above by Robert Emmons, one of the leading scientific experts on gratitude.

The Virtues of Being Grateful

Gratitude encompasses emotions, virtues and behaviors. It has two components, according to Emmons. "First, it’s an affirmation of goodness. We affirm that there are good things in the world, gifts and benefits we’ve received," he writes in an essay published in the Greater Good Magazine.³ "The second part of gratitude is figuring out where that goodness comes from."

Emmons recognizes the importance of gratitude as a relationship-strengthening emotion, as it "requires us to see how we’ve been supported and affirmed by other people."⁴ In the featured video, he presents findings from their 11-year placebo-controlled study⁵ involving thousands of participants between ages 8 and 80. Their research shows that gratitude practices, like keeping a gratitude journal, led to three categories of benefits — psychological, physical and social.

These findings are echoed by Dr. Sonal Shah, a general practitioner from the National Health Service in the U.K. In the book "A Prescription for Healthy Living," she underscores the potential role of gratitude in clinical medicine:⁶

"The practice of gratitude was traditionally associated with religious activities, but it has recently gained significant interest from the medical community. The field of positive psychology has been developing over the past three decades and has found that the practice of gratitude has benefits in five key areas: emotional, social, personality, career and health.

There is evidence that those who are naturally more ‘grateful’ are happier, healthier, have better overall wellbeing, are more satisfied with life and sleep better … The potential health benefits of gratitude lead to the possibility that it could be used as an intervention in healthcare or as adjunct to support traditional medical management in a variety of clinical settings."

Gratitude and Pain Perception

Several studies have delved into the connection between gratitude and pain perception. Emmons noted in the video, "In the domain of bodily functioning, we find that people who are keeping gratitude journals feel better about their health. They’re bothered less by everyday aches and pains."

This aligns with findings from a study⁷ published in The Australian Journal of Rehabilitation Counselling, which explored the impact of integrating character strengths and gratitude interventions to help alleviate chronic back pain. The study revealed that focusing on positive emotions like gratitude can enhance daily happiness and significantly reduce feelings of anger, thereby improving patients’ quality of life and their ability to cope with pain.

Further supporting this, a study⁸ published in Current Pain and Headache Reports explains the effect of "seeing the glass half-full" on the experience of pain — a concept that is akin to gratefulness, as they both prompt you to appreciate what you have rather than dwelling on what you lack. The researchers suggest that "optimism could indirectly influence the experience of pain through hopefulness and pain acceptance."

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The Biological Mechanisms Behind Gratitude’s Influence on Pain

Beyond psychological benefits, gratitude impacts pain perception through physiological mechanisms. According to a study⁹ published in the journal Frontiers in Psychology, "Gratitude can inhibit the hypothalamic-pituitary-adrenal (HPA) axis and lower cortisol levels. Cortisol, considered a crucial mediator of mental states and health-related outcomes, is the hormonal end-product of the HPA axis and can modulate neuroendocrine stress responses."

Lowering cortisol levels is essential because chronically elevated cortisol can lead to widespread inflammation and exacerbate pain.¹⁰ Research also reveals that gratitude practices may help mediate the production of pro-inflammatory cytokines associated with pain.^11,¹²

Furthermore, individuals who engage in gratitude practices have been shown to have higher levels of the CD38 gene, which plays a role in promoting the release of oxytocin. A study¹³ published in Mens Sana Monographs explains the inverse relationship between oxytocin and pain:

"During prolonged periods of fear, anxiety and depression, pain thresholds are lowered and cortisol levels and blood pressure can be chronically and deleteriously elevated. In contrast, during periods of sustained oxytocin release, cortisol levels and blood pressure are reduced, pain thresholds are increased and a calm nonanxious state results."

Through these mechanisms involving the neuroendocrine systems, gratitude can play a pivotal role in managing pain, improving not only your physical symptoms but also your emotional well-being.

Other Ways Gratitude Practices Can Benefit Your Health

In addition to its role in pain management, Emmons highlighted the physical, psychological and social benefits of gratitude journaling:

"In terms of sleep, we find a 10% increase in sleep duration. When people are keeping gratitude journals, they actually sleep 10% longer, and they wake up and they feel more refreshed … restorative active sleep is more efficient in people when they're keeping gratitude journals …

They’re [also] more sensitive to situations, which they themselves can become helpful, outgoing, altruistic, prosocial, generous, compassionate and so on. Less lonely, less isolated. So more positive behaviors, fewer destructive social behaviors …

In the domain of childhood and educational settings … we found that classes [that] were assigned to a gratitude journaling condition actually showed benefits … they became more satisfied with their educational environment, their teachers … the grade-point average increased over the course of an academic year."

Emmons also pointed out the cardiovascular benefits of gratitude, an area backed by substantial research. For instance, a study¹⁴ published in The Journal of Positive Psychology found that gratitude positively influences biomarkers such as endothelial function, as well as prognostic inflammatory markers. It also promotes adherence to positive health behaviors. Gratitude practices have also been linked to:

Better management of blood sugar levels¹⁵	Improved productivity¹⁶
Reduced materialism and increased generosity¹⁷	Increased happiness and life satisfaction¹⁸
Better interpersonal relationships¹⁹	Decreased risk of mental health problems²⁰

Gratitude Cultivates Joy

The notion that you can shape your perception of pain by choosing to focus on what’s good and right with your life resonates deeply with the principles in my upcoming book, "The Power of Choice." Up until now, all my books, nearly all of which have become best-sellers, have focused purely on diet and lifestyle strategies for physical health and longevity.

"The Power of Choice" is also, ultimately, about health, but approaches it from a different perspective — that of connection to your consciousness. It emphasizes the importance of prioritizing Joy in your decision-making process, as it will empower you to make healthy choices and align with your authentic Self.

I capitalize "Self" and "Joy" here to underscore their deeper, transcendent nature. Self represents unlimited, immortal consciousness, while Joy denotes a profound state of contentment that emanates from within yourself.

Practicing gratitude is an act of embracing the power of choice, helping you redirect your attention away from discomfort and toward the Joy that exists even in difficult moments. It nurtures your connection to your Spirit, which unlocks the door to a world where Joy is not just a fleeting emotion but a guiding force on the journey toward optimal health.

10 Ways to Build and Strengthen Your Gratitude

In addition to keeping a daily gratitude journal and appreciating the simple things around you, there are numerous other ways to practice gratitude. I've compiled 10 additional suggestions from various experts below. The key is consistency — incorporate your chosen method into your routine, ideally daily, and stay committed to it.

Write thank-you notes — When thanking someone, be specific and acknowledge their effort or cost. Make it a habit to write thank-you notes or letters for each gift or kind act, or simply to show appreciation for someone being in your life. Try practicing mindful thank you’s for seven days straight to get started.

Say grace at each meal — Saying grace before meals is an effective way to strengthen your gratitude and deepen your connection to your food. This moment of thankfulness doesn't have to be religious. You could simply say, "I am grateful for this food and appreciate all the effort involved in its production, transportation and preparation."

Master the skill of letting go — Stress is an unavoidable part of life, so the key is managing it effectively. Rather than dwelling on stressful events, learn to let go of negativity by acknowledging that the way you feel has little to do with the event itself, and everything to do with your perception of it. As the saying goes, "You can't control what happens to you, but you can control how you react to it."

Be mindful of your nonverbal actions — Smiling and hugging are powerful ways to express gratitude, encouragement, excitement, empathy and support. These physical actions also help enhance your inner experience of positive emotions.

Give praise — Research²¹ suggests that when you express gratitude by praising others rather than focusing on yourself, it tends to have a stronger impact. For instance, showing gratitude to someone with a phrase like "thank you for making the effort to do this," carries more weight than a compliment focused solely on your own happiness, such as "it makes me happy when you do that."

The first approach tends to evoke greater feelings of happiness in the person you're praising and makes them feel more positive toward you. Also, be mindful of your delivery — say it like you mean it. Establishing eye contact is another tactic that helps you show your sincerity.

Pray and practice mindfulness meditation — Expressing thanks during prayer or meditation is another way to cultivate gratitude. Practicing "mindfulness" means that you're actively paying attention to the moment you're currently in. A mantra is sometimes used to help maintain focus, but you can also focus on something that you're grateful for, such as a pleasant smell, a cool breeze or a lovely memory.

Create a nightly gratitude ritual — One suggestion is to have a gratitude jar,²² where every family member can contribute notes of gratitude each day. Any jar will do. It's a simple practice; just jot down a brief note on a slip of paper and place it in the jar. Make an annual, biannual or monthly event of going through the jar and reading each slip out loud.

For families with young children, Dr. Alison Chen in a Huffington Post article²³ suggests creating a bedtime routine that involves stating what you're grateful for out loud.

Prioritize experiences instead of materialistic goals — Research²⁴ shows that spending money on activities rather than material things generates more gratitude and generosity.

Embrace the idea of having "enough" — Practice being grateful for the things you already have, and release yourself from the iron grip of advertising, which tells you there's a lack in your life.

Many who have adopted the minimalist lifestyle claim they've been able to reduce the amount of time they have to work to pay their bills, freeing up time for volunteer work, creative pursuits and taking care of their personal health, thereby dramatically raising their happiness and life satisfaction.

The key here is deciding what "enough" is. Consumption itself is not the problem; unchecked and unnecessary shopping is.

Try the Emotional Freedom Techniques (EFT) — EFT is a form of psychological acupressure based on the energy meridians used in acupuncture that can quickly restore inner balance and healing, and helps rid your mind of negative thoughts and emotions, including the lack of gratitude. In the video below, EFT practitioner Julie Schiffman demonstrates how to tap for gratitude.

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