Books : Effortless Pain Relief : Excerpts

Chapter 1: Pictures of Pain and Healing

To heal from chronic pain, you have an abundance of options. Each specialist who sees you is likely to praise the virtues of his or her approach and may discount the value of other therapies. Chances are that if you are not professionally involved in medicine or alternative therapies, you will have a difficult time trying to figure out what avenue to pursue and why.

You need to find out as soon as possible what is causing your pain. Then you can begin to consider what therapies might be most useful. Stress, in the form of neuromuscular tension, is a leading cause of pain, which results from lifestyle habits that we adopt in the course of handling the pressures of our lives. Consequently, treating pain requires you to change these physical, mental, and emotional lifestyle habits and to reverse their cumulative effect.

The case studies below show how, by reversing certain lifestyle habits, four of my clients reduced their physical pain.

MELISSA

Melissa was forty-eight years old when she first sought my professional assistance. She had been suffering from bouts of chronic pain for eight years. Her symptoms included low back and hip pain, as well as shoulder and neck tension that sometimes escalated into debilitating headaches. Melissa had been told she had fibromyalgia.

The term "fibromyalgia" formally entered the medical lexicon in 1990 as a result of doctors' having been flooded over a number of years with cases of chronic pain that defied medical diagnosis. Research identifying these patients' common traits led to the definition of a fibromyalgia syndrome. Patients are deemed to suffer from fibromyalgia when they feel pain in response to pressure on at least eleven of eighteen "tender points" on the body, points where muscle tendon and ligaments attach to bone. Since 1997, fibromyalgia has become one of the most commonly diagnosed musculoskeletal disorders. There is no known biochemical cause of fibromyalgia, and standard tests, such as X-rays, myelograms, CAT scans and MRIs, fail to isolate specific structural origins of the syndrome. This is not surprising, since the label "fibromyalgia" is actually a blanket term covering a wide variety of pain disorders that have their origin in soft-tissue lesions, adhesions, strains, and imbalances, most of which are not picked up by the usual tests. Once the soft tissue of muscles and connective tissue is damaged, that damage can cause pain in locally affected areas and can also spread throughout the entire body, along the weblike structure of connective tissue that envelops and supports all the body's organs and tissues.

Like many persons diagnosed with fibromyalgia, Melissa had been given medication to manage her pain. She had also been told she would simply have to cope with this problem, for which there was no known cure. Melissa was given no guidance in understanding either how her pain syndrome had developed or how she might reverse some of its effects. Naturally enough, she felt depressed and defeated by the diagnosis. A growing sense of powerlessness about her body cast a pall over her life.

I suspected that Melissa's pain syndrome was not purely structural or biochemical in origin and was interested in finding out more about her in order to get to the bottom of her situation. During our first few sessions, Melissa told me some of the details of her personal life. She had had a difficult childhood under the care of a narcissistic mother, had married and eventually divorced a successful but alcoholic businessman, was the mother of two children, and had herself pursued a hard-driving though erratic career. Her life had had its share of stress, and the combination of her illness and ongoing personal and professional demands continued to put her under daily pressure. I was sure that the origin of Melissa's pain lay in the way she was living in her body, day after day, month after month, and year after year. Something she was doing with her body was causing it to underfunction. If we could change that, she would feel better.

We began our work together by exploring and making changes in some of her deep-seated physical habits. We started by having Melissa focus on one of her most important physical habits: the way she breathed. Her job was simply to become aware of how she breathed under everyday circumstances. I gave her some guidelines for evaluating her breathing patterns, which I'll give you later in this book. When she applied these guidelines, she was surprised to discover that her breathing was relatively uneven, shallow, and somewhat labored. In addition, she frequently held her breath. This pattern of constricted breathing might have been contributing to her physical pain. Constricted breathing deprives the muscles of the vital oxygen that keeps them healthy and also often corresponds to neuromuscular tension in the body. If we could open up Melissa's breathing, we would be reducing her muscle tension and oxygenating her tissues.

Melissa learned some breathing exercises to help her slow down her breathing, deepen it, and make it more regular. I also asked her to become aware of when she held her breath and to try to replace this habit with more even breathing. Melissa worked on becoming conscious of her breathing and applying the new breathing style throughout her daily activities. She noticed that the more she focused on breathing deeply and evenly, the less her back and hip pain bothered her and the less she suffered from headaches.

Now Melissa felt the effectiveness of my approach to reducing pain through changing physical habits. As she continued to work on breath awareness, we also explored other physical habits that will be described later in this book. Like her breathing patterns, these habits were unconscious, and, also like her breathing patterns, they contributed to her discomfort by creating or exacerbating neuromuscular tension. By the time Melissa and I stopped working together, her pain of eight years' duration was 70 percent improved, and she had the information and techniques to continue making progress on her own. Today, her pain has virtually disappeared.

Let's compare Melissa's course of mind-body therapy with traditional treatments for chronic pain to see why Melissa had found no pain relief from the standard medical treatments. When surgery is not an option -- as in Melissa's case -- remedies for chronic pain tend to include the use of medication, physical manipulation, prescribed exercises, or some combination of these. A doctor prescribes medication; a chiropractor, physical therapist, massage therapist, or other body worker applies manual therapy; and a physical therapist, sometimes in collaboration with an orthopedist, prescribes exercises. Patients who receive medication or manual therapy tend to play a passive role in their own treatment. They may not be asked to observe or change lifestyle habits that involve the way they live in their body. Even when professionals treating them recognize such habits as a concern, these professionals may not possess either adequate time to retrain their clients or professional training in sophisticated skills that are required to help patients change deep-seated, largely unconscious habits of physical stress.

Patients who work with exercises to reduce their pain take a more active role. They embark on a course of action to make changes in their own bodies. Yet even these patients do not on the whole address their daily habits of body use or look at their lifestyle habits in anything more than a cursory manner. Such habits inevitably play an important role in the origin and chronic nature of patients' pain, since pain usually involves structural and functional imbalances that have developed over a period of time. If lifestyle habits underlie patients' pain, the benefits of medication and manipulation are likely to be limited. Specific exercises may be useful, but if they fail to address the physical tension that causes pain, they too will have only limited effect. Exercises would be more effective if they were taught in conjunction with a therapy program focused on correcting long-term dysfunctional tension habits involving posture, movement, and chronic stress.

In Melissa's case, medication, manipulation, and exercise had failed to help her in the past and were not likely to work in the future without an additional approach. A key physical habit -- namely, the way Melissa breathed -- played an important role in her pain syndrome, and by changing this physical habit she released deep levels of neuromuscular tension and eased her pain, which was largely due to excess muscular stress.

Melissa noticed that the breathing work not only lessened her physical discomfort, it also reduced her anxiety and improved her mental focus. A simple physical technique -- breath awareness combined with deep, relaxed breathing -- enhanced her physiological, mental, and emotional functioning. Melissa's mental state, her emotional state, and her physical state were all connected; when one improved, the others improved as well.

When you change a way you live in your body, other mental and emotional changes result. Pain is a whole-body phenomenon, the consequence of a subtle interaction of our physiology with our hearts and minds. So too is healing.

MIKE

An elderly gentleman named Mike came to me with chronic low-grade back pain. His pain had begun gradually in middle age, worsening progressively until he found it difficult to stand for any length of time. Mike avoided lines in grocery stores and at bus stops, and when he attended receptions or dinner parties, he sought out a chair so that he could sit rather than stand while chatting with other guests. I asked Mike to walk around the room and then come to a stop. I noticed that when he stopped and stood, he locked his knees. When we lock our knees -- bringing them back as far as they will go rather than bending them slightly and keeping them "soft" -- this causes the pelvis to drop forward, so that it no longer supports the spine above it. As a result, the back becomes swayed. When the back sways, the muscles of the lumbar area have to brace in an effort to stabilize the spine. Over time this bracing reaction overworks and stresses the muscles of the low back, which become increasingly contracted, contributing to discomfort, muscle spasms, and even herniated discs or arthritis.

I showed Mike how to release the pressure on his back by unlocking his knees, and I sent him away with instructions to notice when he locked his knees and to unlock them whenever possible.

A week later, Mike was back in my office, eager to share his observations. He had discovered, to his surprise, that he locked his knees almost constantly. He had never noticed this before. He also noticed that when he paid attention to unlocking his knees, this greatly relieved his back pain. Mike's habit of knee locking created neuromuscular tension. By becoming conscious of and changing that habit -- the way he stood -- he had eliminated excess tension in his low back muscles.

Mike shared some further insights. When he locked his knees, his body seemed to brace, becoming rigid and inflexible. When he unlocked his knees, his body was softer and more pliable, less like a stiff rod and more like a strong young sapling swaying in the wind. Keeping his knees unlocked gave him a better sense of balance, flexibility, and flow. Although this feeling was physical, it also affected his mental and emotional mood. When his knees were locked, he felt psychologically and physically rigid, brittle, and unbending, as if he needed to defend himself. With his knees unlocked, he felt more in control but less controlling. Mike wondered whether he had gotten into the habit of locking his knees as a defensive, self-protective posture. Whether or not this was the case, he noticed that by becoming more conscious of his body and releasing his physical habit of locking, he decreased his physical pain while increasing his sense of mental and emotional well-being. He was more relaxed. Mike realized that his physical, mental, and emotional states were interrelated: physical tension seemed to be tied to mental and emotional tension, and physical ease was connected to mental and emotional ease.

Our mental, emotional, and physical states do not exist separately and apart from each other. Becoming more conscious of how to influence our physical bodies can have a salutary effect on our mental and emotional lives. Similarly, mental and emotional states can affect our physiology. As we shall see, this chain of mutual influences has significant implications for treating and eliminating chronic pain.

When Mike felt the emotional and mental improvements that came from making a physical change in his body stance, he discovered for himself the ancient wisdom that is embedded in the philosophy and practice of Eastern spiritual practices such as chi gung, tai chi, and yoga. These practices have their foundation in body awareness and self-mastery. They recognize that the body's sensations offer important information about our well-being. They focus on improving our total state of well-being by improving our presence to the body. They recognize that the more we focus on developing skills that increase our grace, suppleness, physical ease, and physical self-awareness, the more we feel physically healthy and mentally and emotionally supple and empowered.

The wisdom of these ancient arts and my own personal and professional experience of working with clients in chronic pain serve as a foundation for the approach to chronic pain reduction in this book. My approach emphasizes, first, that habits of body use are the primary cause of physical pain; second, that these bodily habits cause pain because they foster excessive neuromuscular tension; third, that enhancing bodily self-awareness is the critical component for healing the neuromuscular tension that creates chronic pain; and fourth, that the practice of bodily awareness shows us how to reduce physical, mental, and emotional stresses that contribute to our neuromuscular tension and pain.

Mike and Melissa reduced their chronic pain by becoming aware of physical habits that involved unconscious muscular tensions and learning how to release them. Melissa did this by relaxing her whole body through breath awareness. Mike reduced unconscious tensions by improving his body alignment. Mike and Melissa did not improve because a doctor or therapist did something to them. They improved because they changed something in themselves. Their stories demonstrate that exploring how we live in our bodies can be a powerful way to heal from physical pain.

CLARA

In the process of looking at and altering habits of body use, we sometimes make surprising discoveries about ourselves, discoveries that extend beyond simple physical realizations into insights about our personalities and about how our personalities affect our experience of pain. A thirty-five-year-old woman named Clara was referred to me as a result of numbness in her legs that did not respond to conventional treatments. When I examined Clara, I discovered a high level of tension in the pelvic region. Nerves, arteries, and veins pass through the pelvis to the legs. Constriction of any one of these as a consequence of pelvic tension can result in numbness in the legs. Tension in the pelvic muscles can also put excess strain on the muscles of the legs, restricting nerve function and circulation in those areas.

Like Mike's and Melissa's, Clara's problems seemed to be related to excess muscle and pelvic tension. Clara said that she could not herself feel this tension. This was not surprising, as her numbness indicated that she had trouble feeling her body. Lack of feeling is frequently a consequence of excess tension. My challenge was to help Clara approach her body in such a way that she reduced that tension. Clara agreed to follow my recommendations, and over several sessions, during which she lay at ease on a bodywork table, I had her focus on simply feeling and appreciating the sensation of her pelvis. I told her neither to expect particular sensations nor to try to relax her pelvis. Her only goal was to feel whatever her pelvis felt like. Since tension is related to loss of feeling, improving Clara's ability to feel would in turn reduce her physical tension. This is what happened, and along the way, Clara had an illumining realization. She discovered she was uncomfortable with feeling herself. She wanted to interfere with her sensations: to react to, suppress, interpret, do something about, or in some other way control the feelings going on in her body.

Clara's situation is not uncommon. How often have you popped an Advil or an Aleve, rather than feel physical discomfort? We often try to avoid physical sensations that we think are unpleasant. We do the same with sensations that involve our emotions, heading for the freezer in search of ice cream or to the cupboard for a box of cookies when a conversation gets too heated and raises feelings we'd rather not address. How often have you denied you felt anger or grief when you thought you weren't supposed to feel it? In all these situations, we use some tactic to control how we feel physically or emotionally rather than allow ourselves to feel what we feel. When we try to control our feelings -- physical or emotional -- we suppress them. This creates tension, which in turn creates pain.

Clara related to her body as something alien that she needed to control. Unconsciously, she viewed her physical sensations as suspect and problematic. This attitude created tension and confirmed her fears by triggering physical problems. Clara's real problem was her attitude of suspicion and fear toward her own sensations. We have evolved our physical sensations, including sensations of discomfort, as part of feedback that is meant to guide us in surviving and thriving. If we suppress the feedback process, we sabotage nature's intelligence. Clara had become so alienated from her own body that when first asked to explore her physical sensations, she felt she couldn't. She had suppressed her ability to feel behind a wall of tension. As she continued to explore feeling, however, that wall began to dissolve, and then she encountered anxiety and discomfort: feeling itself was uncomfortable. As she learned not to give in to her reactions of anxiety and discomfort, the tension and pain in her body gradually dissipated. She gave up trying to control her body, and her body started feeling better.

Clara came to the realization that her numbness was the consequence of deep-seated tension and her tension resulted from trying to manage and control her feelings and sensations, rather than simply experiencing and accepting them. Her physical numbness and pain had a physical source in neuromuscular tension. Yet that physical tension was also the consequence of mental and emotional attitudes that emphasized her need to control. Clara began to see that letting go might be a better choice than controlling. She improved physically while also discovering healthier emotional and mental options.

Like both Melissa and Mike, Clara reduced her physical pain by exploring and gradually changing a physical habit that was creating tension in her body. All three reduced their physical tension with a self-directed intervention that gave them heightened bodily self-awareness. All three began to observe subtle connections between their physical, mental, and emotional states, connections that indicated that physical pain is often a whole-body expression of interactions between these states. Relaxing into feeling her body helped Clara address and let go of an emotional need to control, which was one cause of her physical discomfort. She became aware of her emotional control issues not through verbal processing but through listening to her body and observing herself more closely. Exploring her ability to feel her body yielded emotional insight that in turn helped her reduce her physical pain.

JEAN

Though we may use physical techniques to alleviate our physical pain, a primary cause of that pain may lie in emotional issues that have an impact on the body. A young woman came to visit me complaining of shoulder pain, from which she had been suffering for three months. Jean was irritated with herself and with her shoulder. As with my other clients, I focused first on helping Jean let go of stress and achieve a deeper state of relaxation through the use of bodily self-awareness techniques that reduced physical tension. I then encouraged her to feel the pain in her shoulder without resistance. Rather than reacting to her pain with upset, annoyance, or anger, she was simply to accept, appreciate, and feel the sensations. As she simply explored and observed her physical sensations, her nonjudgmental, nonreactive stance would help her eliminate tension and identify the underlying causes of that tension.

I asked Jean to consider her sensations of pain not as uninvited intruders but rather as a part of herself that was trying to share important information. At first she felt uncomfortable and skittish about this, but after a period of silence, during which she tried to focus on being present to her sensations of pain without judgment, she began to cry. She reported that she was neither crying from her physical pain, nor was she crying about her physical pain. Her tears were about another pain: the death of her mother a few months before Jean's shoulder injury had occurred. Surprisingly to Jean, as she cried out her grief, her shoulder pain eased. Clearly, her physical tension and pain had been connected to emotional tension and pain. After her cry, Jean told me that the pressure of work and family obligations had been such that she had never allowed herself fully to grieve for her mother's parting. She had bottled up her feelings, which had somehow found their way into her shoulder.

A week later, Jean telephoned to tell me that her pain was completely gone. She had devoted much of the week to communing with her mother's spirit and completing her good-byes. We marveled together at the mystery of life and at the fact that a physical discomfort had been her body's way of telling her that she had unfinished emotional business. Jean recognized that her emotional realizations had come not from talking about her mother but through feeling her body. Her grief had been stored far from her conscious mind, in her body's tissues, and physical self-awareness had unlocked emotional self-awareness.

Jean changed the way in which she was relating to her body. She stopped being irritated or angry with her body and complaining about its limitations. She just let it feel the way it felt. She changed a deep-seated habit of judgmentalism, which had surprising results: it reduced both her physical and emotional pain, which had been locked in her tense, contracted tissues.

RECOMMENDATIONS

In the cases of Melissa, Mike, Clara, and Jean, the ultimate physical source of pain was excess neuromuscular and connective tissue stress and tension. In each case, this tension was related to unconscious bodily habits that were released once the patients became aware of them. In each case, the patient's physiological healing was triggered by his or her own actions. And all of them became aware that changing bodily habits improved their mental and emotional state and that mental and emotional attitudes had contributed to their physical pain.

Letting go of chronic pain involves becoming aware of the way you live in, respond, and react to your body and changing it. Your body is not an alien force; it holds the keys to your health. If you learn how to listen to it, work with it, and understand it, you can heal.

The primary source of neuromuscular tension is stress. The word "stress" is a part of our everyday language, but its actual nature is poorly understood. How does stress work its way through the body? What is physical stress? What is emotional stress? What is mental stress? How are these related to one another and how do they contribute to pain? Chapters 2 and 3 will answer these questions.

Once you understand how stress manifests as neuromuscular tension and creates pain, you can learn body awareness techniques and discover how to use them to eliminate the stress that creates pain. You will also be able use these tools to identify and release whatever unique physical, mental, and emotional stresses may underlie your own history of chronic pain. These methods form the subject of chapters 4 through 15.