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Case Studies - Page 9

Case Commetary

By Ronald Siegel

Maggie Phillips lucidly illustrates the successful treatment of a remarkably common problem—getting stuck in chronic pain as a result of trying to get relief through drugs, surgery, and rest. Pain, which may have begun with an injury or illness, becomes exacerbated and entrenched by emotional trauma, stemming, in part, from failed medical interventions. Phillips's 10-point program flexibly combines relaxation, turning attention to somatic experience, exploring the unconscious connections between emotional trauma and physical pain, and developing avenues of emotional support and encouragement. Together these approaches help relieve the fear, tension, anger, and aversion that create pain signals (often by increasing muscle tension) and amplify those signals (through hypervigilance and fear). The program worked well for Amy, and I trust that it would be effective for many others.

Sometimes, however, the very quest to become free from pain—what brings a client into our office—is at the heart of his or her problem. In these cases, well-meaning interventions designed to reduce pain actually multiply clients' miseries by keeping their attention focused on their pain level. Every behavior, treatment, and other life choice is judged by whether it seems to increase or decrease the sensations of pain.

For these clients, an effective alternative is to help them give up the quest to become free of pain and focus attention on becoming free of disability instead. This entails practicing mindful acceptance of the coming and going of pain sensations while embracing the goal of behaving like a normal, healthy person—free of pain-related limitations. For most clients, this means learning to treat pain like the weather: destined to change, but not ultimately under our control.

To accomplish this, clients learn to use mindfulness practices to let go of the aversion responses to the pain (such as wincing, grimacing, and wishing for relief) and to approach pain sensations with interest and curiosity, rather than as problems to be solved. Clients are invited to view concerns about whether their pain is increasing or decreasing as passing thoughts, not calls to action. At the same time, they're encouraged to pursue a sensible, incremental program of increased exercise and activity, with the goal of functioning like a healthy person of their age, build, and level of physical fitness.

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