Notes

Introduction

1. “Chronic Pain in America: Roadblocks to Relief,” a study conducted by Roper Starch Worldwide for American Academy of Pain Medicine, American Pain Society and Janssen Pharmaceutica, (1999).

2. Institute of Medicine, “Relieving Pain in America: A Blueprint for Transforming, Prevention, Care, Education, and Research,” The National Academies Press (2011), healthland.time.com/2011/06/29/report-chronic-undertreated-pain-affects-116-million-americans/ print/.

3. “Chronic Pain in America.”

4. Gallup Organization, “Pain in America: A Research Report,” survey conducted for Merck (2000).

5. Institute of Medicine report, “Relieving Pain in America.”

6. R. S. Roth, M. E. Geisser, and R. Bates, “The Relation of Post-Traumatic Stress Symptoms to Depression and Pain in Patients with Accident-Related Chronic Pain,” Journal of 'Pain 9 (2008): 588-96.

7. For a free, downloadable pain journal and a pain tracking device, please visit reversingchronicpain.com/journal.html and reversingchronicpain.com/tracker.html.

Chapter 1: Why We Hurt and How We Suffer

1. Eugene Gendlin, Focusing (New York: Bantam Books, 1982). This is a classic book that can teach you a great deal about how to focus on your body experience.

2. If massage seems beyond your budget, consider contacting local massage schools in your area. Most massage schools offer low-cost referrals to their student practitioners, who are supervised by instructors and are usually well-trained and eager to please.

3. For additional examples of the language of sensation and tips on how to use it, please visit http://larisakoehn.com/sensations-list/.

Chapter 2: The Pain Trap

1. Ronald Melzack and Patrick Wall, The Challenge of Pain (New York: Penguin, 1996).

2. For more information on circle breathing, see Maggie Phillips, Reversing Chronic Pain: A 10-Point All-Natural Plan for Lasting Relief (Berkeley, CA: North Atlantic Books, 2007), 22, and her online program at reversingchronicpain.com.

Chapter 3: Neutralizing the Factors That Cause Chronic Pain

1. Body scans were made popular by Dr. Jon Kabat-Zinn, one of the pioneers in the mindfulness movement. The purpose is to train your focus systematically on various parts of the body while remaining mindful and accepting of any sensations encountered. For more information, please see “Body Scan” in the resources section.

2. This technique is modified from that presented by Neil Fiore, author of Awaken Your Strongest Self (New York: McGraw-Hill, 2010).

3. Procedural or implicit memory is a form of long-term memory. Every day, we rely on procedural memory, which allows us to perform simple tasks like tying our shoes or brushing our teeth without consciously thinking about these activities. For more information about how trauma is related to implicit memory and how Somatic Experiencing can work with procedural or “body” memories, see http://traumahealing.com/somatic-experiencing/techniques-to-work-through-and-treat-trauma-memory.html.

4. Cortisol is a steroid hormone, or glucocorticoid, produced by the adrenal gland. It is released in response to stress. Most people with PTSD show a low secretion of Cortisol and high secretion of catecholamines in their urine in contrast with individuals who demonstrate normal fight and flight responses, when both catecholamine and Cortisol levels are elevated. See N. Bohnen, N. Nicolson, J. Sulon, K. Jolles, “Coping Style, Trait Anxiety and Cortisol Reactivity during Mental Stress,” Journal of Psychosomatic Research, 35(2-3) (1991): 141-47.

5. This study was conducted by Ulrich Sachesse, Susanne von der Heyde, and Gerald Huether, “Stress Regulation and Self-Mutilation,” American Journal of Psychiatry 159 (April 2002): 672.

6. Dr. Martin Seligman pioneered work in this area and first developed the theory of learned helplessness to help explain situations where humans and other animals have learned to behave helplessly, even when the opportunity is restored to avoid an unpleasant or harmful circumstance to which it has been subjected. “Learned helplessness theory is the view that clinical depression and related mental illnesses may result from a perceived absence of control over the outcome of a situation.” (en.wikipedia.org/wiki/Learned_helplessness). See also Martin Seligman, Helplessness: On Depression, Development, and Death (San Francisco: W. H. Freeman, 1975). Dr. Seligman has developed the Positive Psychology Center at the University of Pennsylvania, and his work on learned optimism and positive psychology is also of interest in repairing helplessness (see http://ppc.sas.upenn.edu/publications.htm for selected articles and video on this topic).

7. Robert Scaer, The Trauma Spectrum: Hidden Wounds and Hidden Resiliency (New York: W. W. Norton, 2005).

8. Conflict-free imagery has been used to contain or work with conflict-free experience or energy. To learn more about this technique, see Maggie Phillips, Finding the Energy to Heal: How EMDR, Hypnosis, TFT, Imagery, and Body-Focused Therapy Help Restore Mindbody Health (New York: W. W. Norton, 2000).

9. The over-energy correction (Cook's Hookup) is very helpful as a stress reduction technique and is also useful in reducing symptoms of anxiety, sleep disturbance, insomnia, and panic. Please see “Energy Approaches” in the resources section for more information and a diagram.

Chapter 4: The Journey Back from Unmanageable Pain

1. The gate theory of pain was introduced by Drs. Ron Melzack and Patrick Hall in 1965 with the finding that special nerve cells (nociceptors) carry nerve signals from the site of injury to the dorsal horn in the back of the spinal cord. Past experience, current experience, and certain psychological factors can shut the gate, inhibiting transmission to the brain, or open the gate to send pain signals directly to the brain. For more information on the gate theory, see Ron Melzack and Patrick Hall, The Challenge of Pain (New York: Penguin, 1996), and Maggie Phillips, Reversing Chronic Pain.

2. There has been an explosion of pain technology and methodology in recent years. Specific examples of these are described in more detail in the resources section.

3. Increasing concern about addiction to pain drugs makes it harder for professionals to prescribe and harder for people in pain to consider taking certain medications, especially opiates. Research shows that 3—16 percent of people who suffer from chronic pain and are treated with long-term opiate narcotics have a risk of developing addiction to these drugs. There is a much higher percentage (more than 80 percent of this group), however, that does not develop addiction and really benefits from the use of opiates. Consider consulting a doctor who specializes in pain medicine rather than a general practitioner or a psychiatrist if this is an issue for you. See medicinenet.com/script/ main/art.asp?articlekey=50318 for more information.

4. Levine, In an Unspoken Voice, 271.

5. Other types of tapping used with pain include energy tapping and bilateral tapping. Energy tapping refers in general to tapping on acupoints in a prescribed sequence to treat many common issues, including anxiety, phobias, pain, and PTSD. The most popular of these is Emotional Freedom Technique (EFT), developed by Gary Craig (visit eftuniverse.com for more information). Tapping has also been used in EMDR (eye movement desensitization and reprocessing) to activate bilateral stimulation. One popular method is the self-help approach developed by Laurel Parnell, Tapping In: A Step-by-Step Guide to Activating Your Healing Resources through Bilateral Stimulation (Boulder, CO: Sounds True, 2008).

6. To learn more about inner conflict, see Maggie Phillips and Claire Frederick, Healing the Divided Self: Clinical and Ericksonian Hypnotherapy for Dissociative Conditions (New York: W. W. Norton, 1995).

7. Resonance circuits are beyond the scope of this book. Daniel Siegel explores them in The Mindful Brain: Reflection and Attunement in the Cultivation of Well-Being (New York: W. W. Norton, 2007).

8. For more information on Brother David and his ministry, see David Steindl-Rast, Gratefulness, the Heart of Prayer: An Approach to Life in Fullness (Ramsey, NJ: Paulist Press, 1984), and gratefulness.org.

9. The Institute of HeartMath has published an excellent free e-book on its scientific research called Science of the Heart: Exploring the Role of the Heart in Human Performance. This can be downloaded at heartmath.org/research/science-of-the-heart/introduction.html. Another helpful reference is Doc Childre and Howard Martin, The HeartMath Solution: The Institute of HeartMath's Revolutionary Program for Engaging the Power of the Heart's Intelligence (New York: HarperCollins, 1999), which can be ordered at store.heartmath.org/books/heartmath-solution.

10. This practice is designed to develop Quick Coherence*, which can be downloaded as a narrative and as an MP3 audio at heartmath.org/free-services/tools-for-well-being/quick-coherence-adult.html.

11. This meditation is based on one developed by Christopher Germer, The Mindful Path to Self-Compassion: Freeing Yourself from Destructive Thoughts and Emotions (New York: Guilford Press, 2009). You can find free downloads and other information at mindfulselfcompassion.org. Another good source is Sharon Salzberg, Lovingkindness: The Revolutionary Art of Happiness (New York: Shambhala, 2002).

12. Brain plasticity, also called neuroplasticity, is a term used to describe the brain’s ability to change at any age due to new experience. This new science replaces the previous theory that DNA and genetics predetermined an individual's developmental history, including health, personality, and other attributes. For more information, also consult Norman Doidge, The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science (New York: Penguin, 2007).

Chapter 5: Working with Specific Pain Conditions

1. An excellent and comprehensive resource for further reading is Wendy L. Cohan, RN, The Better Bladder Book: A Holistic Approach to Healing Interstitial Cystitis and Chronic Pelvic Pain (New York: Hunter House, 2010).

2. “Treating Interstitial Cystitis,” Harvard Medical School Family Health Guide, health.harvard.edu/fhg/updates/update0104d.shtml.

3. I. Castro et al., “Prevalence of Abuse in Fibromyalgia and Other Rheumatic Disorders at a Specialized Clinic in Rheumatic Diseases in Guatemala City,” Journal of Clinical Rheumatology 11, No. 3 (June 2005): 140–45.

4. These two photos are from Peter Levine, Healing Trauma: A Pioneering Program for Restoring The Wisdom of Your Body (Boulder, CO: Sounds True, Pap/Com edition, 2008), 60.

5. The ventral vagal system is the social engagement, bonding, and relational function of the polyvagal system described by Dr. Stephen Porges, The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation (New York: W. W. Norton, 2011).

6. See the audio program by Tara Brach, Radical Self Acceptance: A Buddhist Guide to Freeing Yourself from Shame (Boulder, CO: Sounds True, 2005). To order and hear a preview, go to www.soundstrue.com/shop/SelectProd.do?prodId=330.

7. This is one of the main protocols for clearing energy reversals. For more information and a diagram, see Maggie Phillips, Reversing Chronic Pain, 111—113.

8. For more information about the science of affirmations, please visit affirmativethinking.wordpress.com/science-of-affirmations-proof and hubpages.com/hub/self-affirmations.

9. To learn more about how to create new neuronal pathways, which is an application of neuroplasticity, visit whatisneuroplasticity.com/pathways.php.

Chapter 6: Preventing and Resolving the Pain of Medical Trauma

1. You might also want to explore a very useful CD by Belleruth Naparstek called Successful Surgery, which we recommend highly. Other possibilities include audios recorded in consultation with a professional that are made especially for you.

2. Discussing the use of medications before, during, and after a medical procedure is highly important. For guidelines, please see mayoclinic.com/health/pain-medications/PN00060.

3. The Pain Patient Bill of Rights, created by the National Pain Foundation, can be found in its entirety at nationalpainfoundation.org/articles/295/patient-bill-of-rights.

4. For additional resources for effective ways of communicating with your doctor, including making decisions about who will perform your surgery and whether or not you need surgery, visit http://muschealth.com/safety/documents/choosingdr.pdf and http://poultry-line.com/2010/03/how-to-decide-whether-to-have-surgery-or-not.html.

5. Please see http://healthpages.org/health-a-z/how-to-make-and-use-an-ice-bag for information on how to make and use ice packs.

Chapter 7: Resilience, Continued Recovery, and Restoring the Deep Self

1. A more complete description of this process can be found in Levine, In an Unspoken Voice, 73—95.

2. There is some evidence that Dr. Kabat-Zinn's Mindfulness-Based Stress Reduction (MBSR) Program may increase left frontal lobe activity resulting in greater ability to cope with stress. Please see Richard J. Davidson, PhD, Jon Kabat-Zinn, PhD et al., “Alterations in Brain and Immune Function Produced by Mindfulness Meditation,” Psychosomatic Medicine 65 (2003): 564—70. You may also want to read Dr. Kabat-Zinn's book Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness (New York: Delta, 1990) for a complete description of this program.

3. Intentions are very similar to affirmations. Although the distinction is murky, most people accept the difference that intentions are global statements that encompass an overall attitude toward life (for example, “I want to be a more compassionate person” or “I want to learn how to support myself during the job interview process“). Affirmations are stated as if they are already happening (for example, “I am creating a happy relationship“ or “I am living a happier life”). Typically, these terms are used interchangeably; we believe that it's important to use both. For more information on the effects of affirmations, please refer to Sheila Bender and Mary Sise, The Energy of Belief: Psychology's Power Tools to Focus Intention and Release Blocking Beliefs (Fulton, CA: Energy Psychology Press, 2007). Also see Belleruth Naparstek’s excellent CD program, Guided Imagery for the Three Stages of Healing Trauma: Nine Meditations for Posttraumatic Stress (Akron, OH: Health Journeys, 2005), which can be ordered at health) http://healthjourneys.com/Product_Detail.aspx?id=250.

4. For more information about the conflict-free deep self, see Maggie Phillips and Claire Frederick, Empowering the Self Through Ego-State Therapy, 2010, an ebook that can be ordered through reversingchronicpain.com

5. Peter Levine, Healing Trauma.