by Celine Tien

There is no one-size-fits-all for chronic pain management. As the Principal Investigator on clinical trials for pain management and the head of a team developing pain management tools, I’ve learned how unique each pain experience is.

However, after spending years researching and working with patients, my team and I have discovered some established techniques that can become effective tools in each person’s toolbox. 

One of the best techniques for managing pain we recommend is getting into flow state. 

What is flow state?

Flow state, or flow, is when you are simultaneously relaxed and focused. It is a mental and physical state many describe as “in the zone.” In flow, you are completely engaged with the activity at hand and the activity is rewarding in of itself. It feels timeless. 

Flow state was first named by psychologist Mihaly Csikszentmihalyi in 1975, although the concept of flow state has existed under various names throughout history. Csikszentmihalyi first began his research into flow state when he worked to characterize a mental and physical state he had observed in artists who would become so immersed in their work they often disregarded their need for food, water, and sleep.

In these artists, Csikszentmihalyi began to hypothesize that, for the most part, people are able to decide what they want to focus their attention on. However, when an individual is in flow state, they are completely engrossed with the task at hand and can lose awareness of external things, such as people, time, distractions, and potentially even things like pain and anxiety. 

We have now come to study the cognitive science of flow state under the rubric of “effortless attention” since Csikszentmihalyi’s pioneering research in the 1980s. 

What defines flow state? 

Csikszentmihalyi, along with researchers Jeanne Nakamura and Kendra Cherry, identified eight key factors that encompass a flow state experience.

1. Clarity of goals and immediate feedback. For example, a tennis player knows exactly what is required in order to win a game. They have an understanding of the rules and the points needed to win. When they hit a ball, there is immediate feedback on whether or not their hit was a good or bad shot. In this way, a tennis player can experience flow because part of their experience includes understanding their goal and being able to perceive feedback in the moment. 

2. A high level of concentration on a limited field. This means that an individual’s consciousness is fully immersed into one activity at hand. An example could be an artist completely focused on their canvas and the painting they are working on at the moment. (U.S. Pain offers a specialized support group called the Writing Room where you can learn how to use writing as a tool to help manage pain—click here to register.)

3. Balance between skill and challenge. The difficulty of the activity at hand has to provide the right degree of challenge to the individual’s ability. If the activity is too difficult, it may leave the individual frustrated. But if the activity is too easy, it may leave the individual bored. Therefore, flow occurs between “too challenging” and “too easy.”

4. Feeling of control. A major experience of flow is feeling heightened control over one’s actions. The word “control” can evoke associations with dominance or nervous attention, when in fact, control during flow is quite different. Control in flow is a state of security and relaxation. 

5. Effortlessness. This doesn’t mean the activity doesn’t have a level of difficulty, but there is a sense of harmony and ease. Decisions during flow do not arise from strained thinking, but rather, from spontaneous action.

6. An altered perception of time. When you are experiencing flow state, your perception of time is often put on hold, or completely altered. Two hours can feel like two minutes, and while you’re engaged in the activity at hand, it feels timeless. 

7. Coming together of action and consciousness. During flow, your consciousness is overtaken by the action and state you’re in. Worry, fear, or self-conscious thinking do not enter the picture. Your action and consciousness meld together in the present moment, expanding to the activity, the moment, and possibly to your surroundings or others you’re working with. 

8. Return on investment. This means the activity at hand feels in and of itself rewarding and fulfilling. 

While there seems to be a lot of factors that make up a flow state experience, Csikszentmihalyi boils it down to flow being the “optimal experience” because an individual in flow state experiences immense gratification, relaxation, and focus. 

Who can benefit from flow state? 

Anyone can benefit from flow state, but for individuals who experience pain, anxiety, and stress, flow state can be particularly powerful. Flow state can alter an individual’s perception and management of physical and mental pain. However, to get into flow state, an individual has to learn to transition their body from a state of “fight-or-flight” mode to “rest-and-recovery” mode. 

In our next article, we explore how flow state and the nervous system are related and its potential to help with pain relief and relaxation. 

U.S. Pain does not endorse or recommend the use of any particular product, medication, procedure or therapy.  Information is provided for educational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding your medical condition and appropriate treatment.


About the Author

Celine Tien is the founder of Flowly: relaxation training, a mobile platform that combines virtual reality and biofeedback training to help individuals transition from pain state to flow state. Tien is also Principal Investigator on National Institute on Drug Abuse-backed clinical trials at the University of Pittsburgh Medical Center and USC.