Introduction
PAIN IS A POWERFUL WORD that triggers strong feelings—fear, anger, helplessness, panic, and even grief. If you’re one of the millions of people struggling with pain as you read this sentence, you are most certainly not alone. What mystifies patients, loved ones, and treating professionals alike is why pain persists long after an injury has healed, lingering for no apparent reason.
Like many others, you may have shuttled from doctor to doctor, diagnosis to diagnosis, and pain treatment to pain treatment. As your situation has become increasingly complex, you may have given up hope that your pain can shift and improve, and that you can become an authority over your pain, rather than your pain continuing to dominate you.
About two-thirds of the people in pain today have been living with significant pain for more than five years. In fact, the highest percentage of all medical visits is made to seek relief from pain. Yet this relief is often not easily found.
People with persistent and chronic pain struggle to find doctors who can effectively treat them. Untreated or undertreated pain is an ongoing epidemic. One recent study found that one out of four pain patients had changed doctors at least three times, citing the primary reason for change as that they still experienced significant pain. Other reasons given were that their pain was not taken seriously, that doctors were unwilling to treat their pain aggressively, and that doctors were without adequate knowledge to treat their pain effectively.1
A 2011 report issued by the Institute of Medicine (IOM) calls pain a “public health crisis,” emphasizing that more people are suffering from chronic pain than from diabetes, cancer, and heart disease combined. The IOM study calls for better training in pain treatment at medical schools (since only five out of 133 medical schools surveyed currently require courses in pain management) and advocates continuing education training that helps keep professional knowledge current.2
A survey by the American Pain Society in 1999 indicated that more than 40 percent of the general population who suffered moderate to severe pain were unable to find adequate pain relief.3 A report published in 2000 revealed that as many as 60 percent of the respondents believed that pain is just something you have to live with, and 28 percent felt there was no solution to their pain.4
Pain has an enormous impact on quality of life at any age, constricting the ability to work, socialize, exercise, concentrate, perform simple tasks, and sleep. Yet even though there are ever-increasing numbers of new methods being created to resolve and relieve pain, there appears to be an even greater surge of pain conditions with new names, causes, theories, and drugs to treat them.
The cost of unmanaged suffering is huge. Part of the reason for this problem is that pain is so complex—ranging far beyond the intersection of neural transmission and sensory experience. The puzzle of pain involves a complicated labyrinth of emotions, sensations, culture, individual experience, genetics, spiritual meaning, as well as habitual physiological reactions, and some experts believe that chronic pain for many patients has become a disease in itself. 5
Because pain is such a complex puzzle, no single health care perspective or discipline holds the particular puzzle piece that brings a universal solution. Never before has there been such a vast array of therapeutic options for pain, ranging from Western medicine to traditional Chinese medicine approaches such as acupuncture and acupressure; chiropractic, nutritional, and supplemental care; hypnosis, special types of imagery (including guided imagery), and other psychological methods; and bodywork, yoga, and massage, just to name a few.
What does this mean for the pain patient? Frequently, individuals in pain are thrown into increasing confusion in their relentless search for tools that will ultimately bring an end to their suffering. Yet the real power of most pain-treatment methods to bring lasting results lies not within the methods, but in their unique application in alignment with each individual’s needs, beliefs, personality, and experience. While each method is promising in what it can offer, the key puzzle piece remains your contribution—the responses you bring to your own healing process.
There is every reason to believe that the unique qualities of each individual impact and shape painful experience and also provide the platform for resilience and recovery. From our perspective, the one ingredient of individual experience that has not been sufficiently considered in usual attempts to solve the puzzle of pain is the role of unresolved trauma that is held in the body. For example, we know that a high percentage of all chronic pain patients also struggle with some form of traumatic stress. Research has shown that chronic pain may not only be caused by physical injury, but also by stress and emotional issues. In fact, people who suffer from PTSD (posttraumatic stress disorder) are at a much higher risk for developing chronic pain.6
The presence of unreleased traumatic experience changes everything when it comes to the treatment of pain. Both of us have found consistently, in our collective clinical experience spanning more than eighty years, that whenever we have worked with pain that does not respond to usual treatments, the reason inevitably lies in what accumulated stress and trauma contribute to the pain picture. In this program, we distill the best of our thinking and practices to empower you to identify and master the patterns of stress that create and contribute to pain. We will sometimes use examples from our clinical practice to illustrate things that you can do to help resolve your pain. Indeed, we also strongly suggest professional help, when it would be of benefit to you.
We frequently work with people who suffer from neck, back, and shoulder pain related to motor vehicle accidents. Many of them come to us because they are not responding to usual prescriptions of medication, physical therapy, and other treatment approaches. When we explore further, we often find that what blocks their progress is the residue of previous accidents or injuries that seem unrelated to the current one that has triggered their pain. Once we help them to unwind the nervous system responses to accumulated stresses from multiple incidents that may have created traumatic stress, they begin to recover quickly and completely.
We have found it important to address trauma at several different levels:
Working with trauma that may have caused the pain through accident, injury, disease, or other overwhelming events. Usually these are thought of as the precipitating events or triggers. Although it is not necessary to relive overwhelming or painful events that are contributing to your pain, it is important to explore how the event has created or contributed to specific patterns of distress and dysregulation or lack of balance. The good news is that you will be learning simple ways to help you regulate or shift the way your body feels, so that balance and comfort return naturally and reliably.
Discovering how persistent emotional and physical pain become traumatizing. If you weren’t depressed or anxious before your injury or accident or whatever caused your pain condition, the pain itself is a significant stressor that can create those reactions. These traumatic reactions can be strong enough for individuals in pain who have a strong trauma history to receive a diagnosis of PTSD.
Identifying unresolved trauma predating the pain condition that gets stirred up by the current pain problem. For example, traumatizing illness, hospitalizations, and surgeries under the age of five can set the stage for later panic attacks and excess pain related to even a routine dental surgery later in adult life.
Exploring early childhood trauma, such as birth, perinatal, postnatal stress, and attachment trauma, which becomes a barrier to trusting the body and other people to help. We commonly find that people in unrelenting pain did not learn early in life how to regulate uncomfortable or distressing experiences. Frequently, this is because they did not have help and support in doing so when they were too young to regulate themselves. They may have been either neglected or hurt if they expressed distress. If you have difficulty in this area, you may not have had experiences of early comfort that you could learn to internalize and apply as effective soothing and self-regulation skills when your pain developed. You will learn some of these important regulation skills during the Freedom from Pain program.
Although doctors commonly use the word “trauma” in describing some sources of pain, they rarely understand how important treating the effects of trauma can be in resolving pain, nor do they know how to go about this. While an important goal in our practice is to train professionals to identify and treat the interactions of pain and trauma, the message of this particular program is that there are simple practices that anyone in pain can learn and use. These practices can reverse pain and bring lasting relief from endless suffering through the gentle release of trauma reactions that have been held in the body.
Many people ask us, “Why do I still have such intense pain even though my doctors tell me that the physical causes of my pain have healed and I’ve explored all of the treatment methods that any professional has recommended to me? Why do I still hurt?” This program will provide answers to this compelling question, so that your pain is no longer so mysterious to you. We will also teach you simple strategies that you can learn to use effectively in order to recruit your body as your main ally in obtaining lasting freedom from both pain and suffering.
Three essential principles frame what we believe and teach, and form the context of our approach:
1. No one can heal effectively and efficiently from emotional, physical, or spiritual pain and suffering without involving the body at the center of their healing process. This has, of course, been Peter’s life work and the foundation for his Somatic Experiencing® (SE) model. This truth has also been, in a different way, the root of Maggie’s essential beliefs about healing, a thread which she has interwoven through Somatic Experiencing practice into other disciplines, including EMDR (eye movement desensitization and reprocessing), hypnosis, ego-state therapy, and energy psychology approaches.
Somatic Experiencing (www.traumahealing.com) is a naturalistic, body-awareness approach to the healing of trauma being taught throughout the world. It is the result of over forty years of observation, research, and hands-on development by Peter and his students. Based upon the realization that human beings have an innate ability to overcome the effects of stress and trauma, Somatic Experiencing restores self-regulation and returns a sense of aliveness, resilience, and wholeness to traumatized individuals who have had these precious gifts taken away. This work has been applied to combat veterans; rape survivors; Holocaust survivors; auto accident, post-surgical trauma, and chronic pain sufferers; and even to infants who have suffered traumatic births.
The Freedom from Pain program will teach you step-by-step how to reconnect with your body’s resources in ways that will not only comfort and relieve your pain, but also provide an ultimate solution to what has caused and continues to maintain your suffering. Some of the tools we teach may work dramatically for you, and others may have little effect or are not appropriate in terms of timing. We encourage you to take what helps (even a little) and leave what doesn’t. Most importantly, we will teach you how your body can be your most valuable ally in your healing process instead of the painful enemy that relentlessly blocks your forward progress.
2. We acknowledge, due to the inherent complexity of pain, that no one method works for everyone. What works best is a toolbox of methods that you can apply to achieve reliable relief and ultimate freedom from the tyranny of pain in your life. An important predictor of your success is you—your willingness to experiment until you determine what really does help with your pain.
One of the many challenges to holding a flexible focus is the fact that pain is so dynamic, changing unexpectedly in form and location. As your pain shifts and changes in response to the tools you learn, your need to modify those tools will change too. So in addition to persistence and trust, we encourage you to practice openness of mind, heart, and spirit so that you can learn how to befriend the natural resources of your body.
3. The tools you will learn from us are only the beginning. How you learn to use them to achieve creative and successful self-regulation is what will create movement and momentum toward expansion, resilience, and flow, and reverse the vicious cycle of pain, fear, and suffering.
Self-regulation is the cornerstone of our approach in Freedom from Pain. In general, learning to regulate the emotional and physical states that may be linked to your suffering is what will bring you into a collaborative alliance between mind, emotion, and spiritual awareness, through body experience. The moment-to-moment ability to regulate your most painful emotions and body sensations will also create a healthy balance between independence and the ability to find help in your connections with others.
HOW TO USE THIS PROGRAM
In order to help you navigate your journey through this program, we have organized the book as follows:
Chapter 1 is a general overview of how we hurt and why we suffer. We suggest some first steps for body exploration and an exercise to teach you to reinhabit your body.
Chapter 2 shows how people in pain can get stuck in the pain trap and includes two foundational exercises to help you move out of the trap toward freedom.
Chapter 3 explains how we shift from normal, necessary pain to chronic pain. This chapter includes a wide range of tools and exercises for beginning to intervene in chronic pain. Specifically, it offers strategies for dealing effectively with dissociation; anxiety, fear, and panic; helplessness and hopelessness; and anger, rage, and irritability.
Chapter 4 explores the first two stages in the three-stage journey back from pain: stage one, achieving reliable self-regulation; and stage two, ongoing transformation. This chapter includes five exercises.
Chapter 5 provides information on working with specific pain conditions and syndromes. We recommend you read about these, even if you do not suffer from the designated problem, since each discussion offers valuable insight into working with all types of pain.
Chapter 6 concerns preventing and resolving the pain of medical trauma. This chapter includes advice on creating a pain plan for upcoming medical procedures.
Chapter 7 discusses the third stage of the journey back from pain into resilience, continued recovery, and restoration of the deep self. It is designed to help you set your course for further growth and the development of a life that is truly free from pain and infused with vitality and forward direction.
We have also included specific examples from our clients so that you can see how this program has worked with a wide variety of people and pain issues. Please note that although the stories are true, we do not use the patients’ real names in order to protect their privacy.
HOW TO USE THE PRACTICE EXERCISES
The backbone of this program is composed of audio practice exercises. You will find them on the audio that accompanies this book. The audio program offers a different opportunity to interact with the material we have included. We recognize that some people like to work with the written word, some with audio, and many with a combination of the two. We have tried to provide multiple options so you can see what works best for you. The important thing is to feel free to experiment, rather than trying to make any one component of the program exclusive.
We have included fifteen exercises in the audio program. Whenever an exercise has a corresponding audio track, we will note this under the exercise heading so it’s easy for you to find. You will notice that although the audio exercises follow the same outline as the written exercises, they are slightly different. The beauty of the audio format is that it gives us the opportunity to expand the exercises a bit, and therefore offer you yet another way of working with this material.
We recommend that when listening to the audio exercises, you create an environment that will support a productive focus. This might include eliminating background noises by turning off your cell phone, for instance, wearing comfortable clothes, and placing yourself in a position that supports your body fully. Please, never listen to the audio exercises while driving.
We have also included a number of “mini exercises” within the written program. These are opportunities to practice applying some of the principles we present “in the moment” in relation to your body experiences. In order to maximize your success with the audio as well as written practice exercises, we also encourage you to create a pain journal.
HOW TO USE A PAIN JOURNAL
We have had many experiences in helping clients keep and maintain a pain notebook or journal as part of their work with us. You may have been assigned this task at some point, or have chosen on your own to begin journaling as part of moving forward with your growth in some way. Hopefully, you have found this to be helpful in the past, or perhaps you have not persisted long enough or in a way that allowed you to experience success.
Over the years, we have discussed with our clients what has been helpful for them in reaching success with many types of pain. Many of them have mentioned that keeping a pain diary or journal was specifically related to achieving freedom from pain. As an example, Julie, who had struggled with chronic pelvic pain due to endometriosis and scar tissue from several related surgeries, commented at her last session, “I know I resisted keeping a journal. But it wasn’t until you gave me specific assignments for how and when to track my pain that I began to build positive momentum. Before that, I wasn’t really dealing with what was actually happening, but instead with what I wished were true or was afraid was true about my pain.”
Although we suggest that you track your progress with practice exercises throughout our program, we hope that you will expand beyond keeping notes about your practice results. It’s also important to practice rating your pain on a 0–10 pain scale at least once a day (0=no pain and 10=unbearable pain) and to log the types of sensations you are experiencing. If you are not experiencing forward progress with your pain, you may need to “take your pain temperature” three to four times per day so that you get a more complete and accurate picture of your patterns with pain.7
For additional results, you may also find it helpful to chart sudden increases in pain and note any triggers that may have influenced those, as well as noting interventions, activities, and experiences that preceded low pain ratings. It can also be useful to chart the times you take medications and supplements, recording any positive results you are observing as well as negative side effects.
Journaling is an excellent way to keep track of your progress through the Freedom from Pain program and to help you learn to track your pain sensations more effectively. We also include one audio journaling practice exercise (see track 14) to encourage the development of this important skill. Look for this journal icon at the end of each written exercise to remind you to use your pain journal.
We are grateful that you are entrusting us with this opportunity to teach you what we have learned from many people like you about full recovery from the trauma of pain. We hope that what you learn and practice with us will guide you to reclaim your wholeness and bring you the peace that makes life fully worth living.