Guiding Internal Body Conversations for Pain Management and Healing
Brief Therapy and Lasting Impressions Conference
Jeanne Hernandez, PhD MSPH
University of North Carolina-Chapel Hill
Department of Anesthesiology
What Is Pain?
Acute Pain Chronic Pain
*pain is a symptom *the wound has already healed
*biologically useful *no biological usefulness
*pathology is recognized *complex physiological and psychological components intertwined
*cure and relief likely *pain is a disease
*has a terminal point *cure and relief may not be possible
*patient gets sympathy *people say it's all in the patient's head
The Challenge of Pain Management
Biologically, one has to over-ride a signal that usually is an alert signal
Psychologically, pain is experienced as emotional suffering; one feels abandoned and depressed
Socially, one begins to feel isolated
Cognitively, pain calls for thinking about its meaning, its cause, remedies and feeling inadequate to meet
the challenge
Spiritually, one feels adrift, and is reminded of mortality
Culturally, one has to fight norms and expectations of a healthy person's role in society
Symptoms of stress that are often concurrent with chronic pain and can exacerbate it
*reduced immunity to disease *diarrhea or constipation
*sleep problem *fatigue
*headaches *poor concentration
*shortness of breath *weight gain or loss
*increased muscle tension *anxiety
*depression
Indicators of good pain management prognosis
motivation to get better
acceptance of the treatment regimen and rationale
Positive coping history
Showing some change within three visits
capacity to be psychologically minded
cognitive flexibility (versus fundamentalist)
Willingness to give up half of the pain
Willingness to be the one who gets the pain to go away -- locus of control
Supportive relationships
Skills in the real world
Help patient lead a productive life and allay opportunity loss
limited income
limited ability to work
re-education less likely
social contacts deteriorate
Keep health from deteriorating
limited exercise -- weight gain, diabetes, poor nutrition
GI side-effects/diseases
limited socialization
lack of toning -- instability
limited time outdoors
Health care drain
chronic pain care -- never get better
new health problems -- can get worse
reimbursement poor
lifetime use of medications
Generalizes to handling other emotions and difficult events
Treating the patient, not the problem
Self-empowering treatments generalize to other life problems
Recentering
What causes Pain?
An impact or insult (listen to the words)
Tension or shock to surrounding tissues leading to
swelling
fluid
stiffening of the muscles
flooding of capillaries
nerve signals to alert the conscious mind of the event
cramping
fear
possible loss of problem solving ability
why is it pain?
Sensations and Connections
Every cell in your body is a part of your self
Nociception is the reception of a stimulus and then the perception of it as suffering or dangerous.
Without the mind’s interpretation, there is no registration of the stimulation as painful.
Feeling -- a private, mental experience of an emotion
*All emotions are played out in the body’s visceral, vestibular and musculoskelatal systems
to create a reaction to an event
anger makes us uncomfortable( and powerful) enough to change a situation;
depression keeps us from doing the same disappointing thing again and again
to prepare the body for something that comes next (fear,fight/flight physiology)
*Felt in the body first
Enteric nervous system -- has its own brain and memory bank separate from the brain, as does the heart.
Physical memory bridges (like affect bridges)
triggered by mechanisms in the base parts of the brain
Metaphors
heart skips a beat
cold feet
gut-wrenching chore
pain in the neck
heart sinking experience
Psychosomatic connections
locked in somatic memories
butterflies in the stomach
low back pain -- lack of social support
gum disease -- stress of financial insecurity
heart attack -- anger
mass fainting
mast cell activation when threatened
Cognitive connections
What you experience emotionally has a body sensation that accompanies it.
Every motion and notion is a product of the unconscious mind, although it may be mediated by the cognitive mind.
Pain is interpreted in the same site where emotions are interpreted.
Goal -- to reinterpret and reprogram the signal
Why gain ability to read your body as part of your unconscious?
Better control over your behavior
Better management of your emotions
Better control over your body
The Ways we do it:
Yoga
centers concentration at the core
with breathing, physical goes where the mental energy goes.
Tai Chi
aligns
starts health-related energy flowing again
Aikido
moves one's energy center while connecting with the other
combined energy field of the two combatants moves
the energy is extended
Solar plexus -- the center of the physical self
houses the connection of many bundles of nerves
hence coordination emanates from there
core self, somatic self, soft center – Trungpa (Training the Mind)
Meditation
Mental Rehearsal
Shamanism Retraining
Forgetting
Self Hypnosis
Hypnosis can help you gain access
Rewrite the physiology that led to that signal
Create a different physiology
Create a new memory
When we get a signal from the body, we don't have to interpret it as a pain.
Have some self-hypnotic internal conversations
Self Psychology with all your parts
Cognitive self -- Last add-on to the survival instincts
memorys
problem-solving, reasoning, planning
secondary process
Community self -- collective awareness, shared values and feeling, desire for connection and socialization
Essential Self – who you essentially
feelings and experiences
Tender soft spot
primary process
inner child
neglected self
'felt sense of self'
Physical Self -- the expressive self, evolutionarily the only important part -- why there are the somatic and
enteric and base brain selves
Negative influences that are not yours -- learned or absorbed from others
Pain signal -- can be misinterpreted
could be an alienating voice
fused with the neglected/somatic self that gets dissociated
diverts from the true distress
appears to be ego-dystonic
Every cell in your body is connected to every other cell
Reconnecting the Supportive self with
Light Trance Hypnosis Inside the Body
The “How to...”
Even with no psychological meaning to the pain, pain is suffering
Patient beliefs
shouldn't have it
the pain has the power
can't get rid of it without help
has to pay attention to it and its voice can't be changed
doesn't have control over it
Opening the connection allows the patient to:
sense the pain as simply a signal
talk to it
calm him/herself
lessen the intensity of the signal
redirect his/her attention
change the physiology that creates, or IS, the pain signal
We can modify:
physiology
psychological interpretation of pain
suffering that takes on physical symptoms
psychological events that take on somatic symptoms
Intense focus into the body is inherently hypnotic
Takes less training for high hypnotics
Takes less training when the patient is in crisis
Takes less training with traumatized patient
Steps
Create comfort to suspend vigilance
Get the felt sense within yourself
Foster split awareness
physical feelings
cognitive self (thoughts and verbal ability)
essential self
neglected self (meaning attributed to the physical feelings)
Listen to the patient, not his/her story
Sponsor patient’s internal conversation
Encourage patient’s train of thought
Keep redirecting inside
Wait for the inroad-- Columbo technique
Advise about the body’s language system
may be physical
may not make sense – like dream content
Talk to the patient, helping him talk to his body
Talk to the patient's right brain -- use hypnotic tones and words from the start
Consider the patient who can't get with your program (is not hypnotic)
Keep talking, looking for the inroad
Keep trustworthy space
Soothe or relax to center him
Use a body-centered trances