Distraction and relaxation are regularly recommended as part of a pain management toolkit, with increasing research highlighting the inclusion of music as part of pain management toolkit. However, minimal research has assessed the role of practice effects or familiarity with these techniques when used consistently over time. Passive distraction (participant-selected preferred music) and active distraction (Progressive Muscle Relaxation; PMR) were compared against a no distraction control on the cold-pressor test (CPT). Seventy healthy participants completed the CPT with and without distraction at baseline and 1 week later. Experimental participants practised their distraction strategies daily between trials (7 days), with control participants keeping an activity log. Familiarity with and preference for distractors increased significantly over time, enhancing pain threshold. PMR and music reduced anxiety, enhanced pain tolerance, minimized pain perception and pain ratings. The active distraction of PMR enhanced self-efficacy to a greater extent than music and also regulated heart rate. Repeated exposure to distraction and relaxation approaches enhanced optimal arousal and complexity, maximizing pain management. It is suggested that both PMR, and music, are used together as part of a multidimensional toolkit for pain management.