DISCLOSURE: I AM NOT A MEDICAL DOCTOR AND DO NOT PRESCRIBE DRUGS OF ANY KIND. ALWAYS GET YOUR DOCTOR’S ADVICE AND APPROVAL BEFORE ATTEMPTING ANY INTERVENTION.
That said, I am a licensed psychotherapist in Tennessee and certified in EMDR therapy, an evidenced-based treatment that has been demonstrated to be effective in the treatment of psychological trauma, anxiety, depression, eating disorders, substance use disorders, and chronic pain.
Over the past several years, chronic pain and its treatment have taken the forefront of the news. Tennessee has been no exception to the news covering overdose deaths and near deaths. As a volunteer firefighter I have responded to overdose calls in McNairy County. Naloxone has become almost as common as cold medicine as nearly every family has been touched by opioid addiction. The Tennessee Department of Health (Tennessee Department of Health, 2017) reported that in 2017 there were 47,600 deaths involving opioid overdoses. Tennessee accounted for 1818 of those deaths. This death rate outpaced deaths from motor vehicle accidents, homicide, or suicide. Tennessee ranks in the top 10 per capita nationally for opioid prescription use in the U.S. This same report notes that almost 116 million US adults, more than the number affected by heart disease, cancer, and diabetes combined, suffer from chronic pain! We in the US are truly in a crisis of not only opioid addiction, but chronic pain as well. Much of the chronic pain experienced often relates back to the opioid pain medication intended to ameliorate that same pain.
A Little About Pain
While I am not a medical doctor and this article is not intended to be a comprehensive discussion of the source and sensation of pain, in general terms, pain is a sensation that is generated in the brain, not in skin and organ tissue. When we wake up in the middle of the night and stump our toe on the side of the night stand, sensory nerves sense the noxious stimulus of hitting out toe. The nerve impulses travel up through neurons to our spinal cord where they cross to the opposite side of the body, and into our brain. This explanation is general and crude, but offers the general idea. Once the signal reaches the brain, it is processed and evaluated by the brain. The brain then sends the signal to areas of the brain that interpret this signal as pain. This is the important part. The signal has to be “interpreted” by the brain as noxious or potentially dangerous. This signal is then interpreted by the brain, which allows us to feel the pain that we interpret as coming from our toe (or whatever the part of the body affected). While we interpret the pain as coming from out toe, the pain sensation is coming from our brain.
How Pain chronic persists
Our brains are designed to learn. When we chronically experience pain, our brains learn to have pain and do it well. This is why your doctor will prescribe pain medication when you have a medical procedure, including surgeries, dental procedures, or even injuries. The goal is to reduce the pain so your brain does not learn to have the pain long-term. This is also why your doctor will often refuse to allow you to have repeated refills of pain medication, especially opioids. When we use opioid medication for an extended period of time, our body can actually learn to depend on the medication and develop dependence, and tolerance of the medications. Tolerance means that your body learns to deal with the medication in a way as to eliminate it, resulting in a higher requirement to get the same effect. If you’ve ever been on any kind of medication for very long, this is why your doctor will need to prescribe higher and higher doses, and eventually need to replace the medication with a different med your body hasn’t become accustomed to. This also helps to explain how people often become addicted and need to increase amounts of drugs used or to even resort to illegal drugs or drugs not prescribed by their doctors.
How To Reduce Pain Without Medication – A Step By Step Approach
Before outlining a specific step by step approach, it is worth noting that there is no single best way to reduce chronic pain. There are many methods that can be extremely helpful. I will describe only one, and even this is only one component to a comprehensive treatment for chronic pain. The method I will describe is one I’ve developed by using parts of models people much smarter than me have developed. Please get your doctor’s advice before attempting any exercise. Here we go!
STEP 1 – Find a quiet place where you can relax. This can be either sitting or lying down, where you have no springs in your back or any pinch points causing discomfort. You should be as comfortable as you can be considering the pain. Begin by taking slow, deep breaths, breathing fully in and slowly exhaling. Take at least 4 or 5 breaths like this, each time focusing your attention on the sensation of the inhale and exhale. Focus all of your attention on your breath. This may be difficult but do the best you can.
STEP 2 – Now notice the pain. Scale your pain from 0 to 10, where “0” is no pain at all and “10” is the worst you can imagine. Where do you feel the pain? What would you compare the pain to? Is it sharp? Dull? Achy? Hot? Cold? Stabbing? What does it feel like? These questions engage the right brain hemisphere.
STEP 3 – Now develop a mental image of what the sensation of pain might look like. Ask, If it had a shape, what might it be? If it had a texture, what would it be? If it had a color, what color would it be? If it had a size, what size might it be? If it had temperature, would it be hot? Cold? Warm? Or just room temperature? Now you have engaged the left hemisphere of your brain using language to develop a mental image of the sensation.
STEP 4 – Now identify a part of your body that has a neutral sensation or that just feels good. Notice that part.
STEP 5 – This is the part that doesn’t come natural to us but is needed. Notice the sensations you feel and the intensity, BUT WITHOUT JUDGING THEM. Just notice what you feel like you are an archeologist looking at a fossil. The idea is to notice it without judging it as good or bad; just notice what you notice. Now notice the image of the sensations you created in your mind. Just notice the image as you hold it in your hand and turn it around to see all sides. Try not to judge it. Just notice it. Do this for a couple of minutes focusing all of your attention on what you notice.
STEP 6 – Now shift your focus to the part of your body that is neutral or may even feel good. Notice that part. Focus all of your attention on that part, and only on that part. Notice if there is any sensation at all. Maybe it’s warm. Perhaps it just feels good. If it’s a joint, it may just feel flexible and warm. Notice what you notice and do this for a couple of minutes.
STEP 7 – Now shift your focus back to the part with the negative sensation. Repeat step 5, except this time, notice if anything has changed. Notice if perhaps the image has gotten smaller. Maybe the texture has changed. Sometimes the color may change. The temperature may cool or warm. Now, notice the intensity. Notice if the sensation of pain has reduced. Notice how you feel in that area of your body. Notice your breath. Notice if you are beginning to relax a little. Just notice what you notice. Notice this for a couple of minutes. You shouldn’t have to force anything. If you have been focusing your attention, the image and sensation will likely change.
Continue this “back and forth” focusing, each time noticing the negative sensation and noticing any changes that might occur. Within 10 minutes people often report that the sensation of pain has been significantly reduced. Parts of this intervention were from EMDR, Peter Levine’s “pendulation” and John Kabat Zinn’s Mindfulness-based Stress Reduction.
If you are experiencing chronic pain, ask your doctor about potentially exploring psychotherapeutic approaches to help manage your symptoms. If I can be of any help, please feel free to visit our website at https://www.hoperenewedemdr.com/ or by email at james@hoperenewedemdr.com .
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