Mark Sauer, Contributor
THEY LAY on their backs, closed their eyes and concentrated on the simple act of breathing.
"Notice your breath as you inhale and exhale, how your belly moves, or how the air tickles your nose," Janet Wolf said, her voice taking on the soothing tone of a hypnotist.
The dozen people on floor mats, men and women from various walks of life, ranged in age from their 30s to retirement. They had one thing in common: chronic, debilitating and often unbearable pain caused by injury or disease.
They had been to specialists, had surgeries, and had tried all kinds of pain medications and relief techniques, such as acupuncture, biofeedback, electrical stimulation, yoga, tai chi, nutrition therapy, aqua therapy, massage and manipulation.
PAIN MANAGEMENT
Some of it had worked, at least to a degree; some not at all.
Now they were trying to manage their pain with their minds.
Wolf, who has taught pain management courses to more than 8,000 people in Southern California over the past 12 years, was showing them how to shift focus to a safe and calming place far from their all-consuming pain.
"With pain, the volume goes up and down; a lot of neuroimaging studies have shown that," said Dr. Robert Bonakdar. "The question is, what can we do to continually turn the volume down? That's what this class is all about."
Bonakdar, director of pain management at Scripps Centre for Integrative Medicine in San Diego, said the idea of Pain Management Essentials, which meets weekly for eight two-hour sessions, is not to suggest that "the pain is all in your head."
"We get patients to link the mind-body aspects of their pain," said Bonakdar. "Does the pain control their lives? Do they see themselves only in terms of their pain? Or can they see themselves beyond the pain?"
This approach, which is increasingly offered at pain centres across the nation, is counter to how medicine is conventionally practised in this country, Bonakdar said.
Integrative medicine blends the conventional with Eastern ideas, like guided imagery and relaxation exercises.
"Western medicine is disease or injury-oriented - you see a broken back, you do surgery and fix it," he said. "When things fall out of that paradigm, the doctor and patient often get frustrated."
An estimated 50 million Americans live with chronic pain, and 80 per cent of us can expect to experience "some type of back pain that will be somewhat disabling," Bonakdar said.
"Patients can't cope, they don't have the tools to deal with this pain. We're trying to expand the tool box and get doctors and patients to use all of them."
PSYCHOLOGICAL PAIN
Sometimes psychological pain - impatience, frustration, anger, self-pity, being a burden to others - can be greater than physical pain, Wolf said. "And that won't show up on any X-ray."
Wolf offers touchstone phrases:
"Pain is inevitable; suffering is optional."
"Be willing to do things differently - major changes in lifestyle can bring relief."
"You don't have to believe this will work, you just can't not believe."
Her challenge with a class that is at once highly-motivated and constantly distracted is to turn such bromides into beliefs, to teach them to calm the screaming pain demon within, freeing themselves to resume life at an acceptable level.
It is the relationship between the psychological and the physical - the critical vortex of pain - that Wolf goes after.
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