Targeted Treatment for Pain, Without the Meds

Contributor

Jeff A. Draisin, M.D.

California Pacific Medical Center

Sutter Pacific Medical Foundation

Illness, physical dysfunction and pain have a profound impact on the way we think of ourselves. They alienate us from our bodies because we see them as evidence that our bodies have failed. Once they are enemies, separate and feared, we reach for weapons to snuff them out. Our weapons of choice tend to come from an ever expanding array of medications, many of which can make a contribution to pain relief, often with a price: complicated side effects, escalating cost, diminishing effectiveness, addiction.

Can you improve or heal while locked in battle with your own body? No. Your body is the most important resource you have in dealing with illness, physical dysfunction and pain. It serves you, even when it hurts. Rather than distancing yourself from pain, consider taking a closer look and enhancing awareness of your body as a way to eliminate pain.

In my experience, there are three components to an effective plan to address pain. This is a simple plan, but it takes discipline, dedication and practice. (It also helps to have support from a practitioner invested in the approach.) The three elements of this Personal Plan for Pain Management are: Self Observation; Interaction and Experimentation; and Development of Enhanced Relaxation and Concentration.

These techniques won’t necessarily eliminate pain entirely, but they make a profound contribution to a total pain management program. They allow you to answer the most important question: What do you know about your pain or approach to pain that you didn’t already know?

The answers to this question become the basis of the next steps in your care. They help determine the additional skills you may want to acquire or improve. They reveal what you need to improve in your overall health and healing potential, what spheres of your life require attention, what role medication should play and which new treatments to try.

In essence, this approach yields targeted treatment, personalized for the body that is going to do the heavy lifting of healing. And there is a gift for those who do the work: As you develop the capacity to feel the sensations of your body, you aren’t just better able to handle your pain. You also grow your capacity to appreciate your pleasure.

Self Observation

The first step in a personalized approach to pain management is Self Observation and this is how it works:

Find a journal that divides the day into specific blocks of time. Make sure there is room for detailed observations. Make your own if that works best for you.
Track and describe your pain as fully as possible. What does it feel like? What sensations do you experience? Where are they? How long do they last?
Track and describe the changes in the quality of the pain, the location, and the intensity. Are they different at different times of the day or week? Are there predictable triggers: physical exertion, inadequate sleep or dietary changes?
Include observation of how your states of mind affect your pain. How does the rest of you feel when part of you is in pain? How are people at work or at home involved with you pain? Who helps you? Who doesn’t?

This might feel like a demanding exercise. That’s because it is. But the insight to be gained from this work is tremendous.

Interaction and Experimentation

At this point, you may be feeling some journal fatigue. At the same time, by recording the depth of details I’ve suggested, you might already be revealing some unexpected information about your pain and the complex role it has in your life.

Interaction and Experimentation involves more record keeping. More!? I know. This is a challenging approach. Pain is not something most of us are drawn to observe and explore so intensely. This new aspect of the observation has you actively experiment with what you can do to influence the pain. It is a tool that deepens your connection to your body and awareness of your sensations.

Use a journal, observation log or “intervention chart” to record these activities and observations.

Does altering activity or position or using props to support your body make a difference in the pain?
How does applying direct pressure, heat or ice affect the pain?
Is movement or rest better?
Does dietary experimentation teach you something new?
Do different thoughts make a difference?
How can you call upon the people in your life to help? Who helps? Who hinders?

Developing Enhanced Relaxation and Concentration

In the last step of the personalized pain management program, you will use your collection of observations — a personal goldmine of insight — to develop skills to respond to your pain and choose treatment options that make sense for you.

Your journals become the foundation of your personalized pain management plan. While they won’t necessarily eliminate your pain entirely, the information they hold allows you to answer the million-dollar question: What do you know about your pain or approach to pain that you didn’t know before?

The answers lead to the next steps of your care. They help you understand the additional skills you need to improve your health, your healing potential and the spheres of your life that need attention (work, relationships, recreation). They tell you what role medication will play in your pain management and what treatments to try.

For instance, your journal data might show that when you tense your body in anticipation of pain or as a response to it, that tension amplifies your pain. It might also show that a tense mind also increases body tension and pain. To act on this knowledge, you can build skills that allow you to more deeply relax, decrease voluntary muscle tension and calm your mind. These new skills might also allow you to focus your attention without being engaged with bodily sensations or mental activity.

Techniques to acquire these skills include breath training, progressive muscle relaxation, mindfulness meditation and autogenic self-hypnosis. You can learn them through one-on-one training sessions with practitioners or in classes. Written materials and audio tapes are also tools for developing these skills.

Some patients might identify in their journals the need to understand their pain in a different way — a way that is less centered on the physical body and more intuitive or metaphorical. They need skills to help answer questions like: What is this pain really about? Why is it happening now? What is my body telling me? In this case, guided imagery or expressive arts might allow for the dialogue with the pain to uncover its personal meaning.

Illness and pain are complex phenomena that have myriad effects on your experience of life. They require a comprehensive holistic response that addresses the full range of our sensations and the healing capacities we each possess. They also require us to be present to the experience of our body — painful though it may be. Illness and pain bring us opportunities to become more aware, and as we develop our ability to feel the sensations of our body, we are better able to handle our pain — and appreciate our pleasures.