John Koewler asked me for more information about EMDR treatment for chronic pain. First an update, then some information.

My heel pain remained at 0-3 on the 11 point pain scale for several weeks. The pain is starting to creep back in, when it shouldn’t. There’s a particular throbbing that I think is generated in the brain, not the tissues of the foot, so I’m going to do a clean-up session to stop the "kindling" in my brain.

What is chronic pain? It can be ecological, or naturally occuring from damaged tissue and stimulated nerves at the place that it feels like it hurts. Or it can start in the brain or start in some body part, shoot a message to the brain, and feel like it’s hurting in some other place. Why would pain start in the brain? Lots of reasons. There are diseases of the brain that telegraph all kinds of wrong information, as if it’s happening in the body. Many medications impact the brain and make it "lie" about what’s happening in the body. Chronic pain in the body, which sends many pain messages to the brain, may start a reaction, like a reflex, in the brain. There is measurable electrical activity in the brain’s representation of amputated limbs, for example, when there is phantom limb pain.

As clinicians, it’s our job to turn off the reaction in the brain. How? Lots of ways. Before I knew EMDR, I used a combination of Hypnosis and Guided Meditation (a different kind of hypnosis). I worked with many AIDS patients, many of whom had neuropathy from the action of the HIV virus or a secondary infection or their meds on the brain. Most of the time I made it go away. Here’s how: In a cadenced, low voice, with a pause after each phrase, I’d use a combination of Stephen Levine’s pain meditations embedded with extra hypnotic suggestions: "Watch what feelings arise as you let your awareness move toward the place of discomfort. Let the pain just be there. Notice if there’s any resistance to the pain. Is there fear there? What feelings arise around the pain? Just notice. Wherever we hurt, we tend to tighten around the pain. It’s a reflex. We even do it in our sleep. Notice if you’ve made a fist around that pain. Gradually let the fingers holding that pain soften, soften, and ease open, finger by finger. That’s right. That’s right, allow that pain to be held softly in your awareness. Notice if it’s sharp or dull or constant or intermittent. Most pain changes, moment to moment. Notice the sensations changing, moment to moment, shifting place, shifting in intensity. That’s right, just notice. (If it’s not ecological pain): Your brain is impacted by HIV/your meds/former pain. Your brain is telling your toes/back/whatever that it’s hurting. In fact, a little spark is popping in your brain that’s lying to you about pain. Tell your brain that you know that it’s lying to you. When you feel that sensation in your toes and fingers it’s just that little spark jumping. Tell your brain, that in this regard, you’re not going to listen to it any more. Got it, brain? Good. Now notice your toes again. Notice what floats into the sea of your awareness as you attend to your toes." (Oftentimes clients said that they felt a tingle, but it was no longer pain, and they learned to disregard the tingle.)

(If it’s "real" pain, from physical damage to the tissue, this pain meditation works, but you don’t tell them that their brain is lying.) "Notice the sensation, now that you’ve allowed the fist around it to soften and open. That’s right. As you breathe in and breathe out allow your self to notice another area of sensation. Notice if it has intensity. Notice how it changes, moment to moment. Is there holding in this area? If so, can you loosen the fist around it, too. "(Then the whole body, then the fear that the sensation has caused to arise, etc. Then have them buy Stephen’s guided tapes, or make them a tape, tailored to their pain and their situation, yourself.)

Since I learned EMDR, and then learned that it worked with pain, I’ve been using it. When I learned about the phantom limb pain protocol, I learned it and then "pointed it" at all the chronic pain in all my clients. I like it so much that I had Sandra Wilson and Bob Tinker, a married couple who have both researched and operationalized EMDR for Phantom Limb Pain, write a chapter for my book, EMDR Solutions. The protocol involves a thorough pain and lifestyle post-amputation and pain intake taking at least two hours. In the third session, you target the worst traumatic aspect of the amputation (or the accident or the onset of the pain, if it’s not an amputation). You clear all the trauma targets with the EMDR standard protocol. That may take weeks. Then you go back to the pain scale and focus on the worst pain and keep going until the pain goes away. You may have to focus on many aspects of the pain. Sometimes, once you start with the pain onset, you can nail it all in one session. Sometimes the pain is gone after you focus on the onset, and there are no other targets. Sometimes you need to go after all the trauma, all the lifestyle losses, and all the ways it works.

Another way I work with pain is also in EMDR Solutions. Jim Cole’s Reenactment Protocol gives another method, that’s not exactly EMDR, but I like it so much I had to publish it. Cole will have people do a fantasy reenactment of the accident or pain-causing incident, using the energy of the pain itself to change how the situation went. I witnessed him working with a therapist who had just been in a car accident. A month later, her hip still hurt. When she imagined that her foot was made out of strong, but flexible rubber, and that right before impact she used it to deflect the other car, both her PTSD and her hip pain disappeared. It took about 5 minutes. The great thing about Cole’s technique, is that it nearly always ends with the client’s delighted giggle.

Mark Grant has published both a manual and guided pain meditation for EMDR with Chronic Pain. Both are excellent. Mark agrees with me that no patient should ever be in agony and that it can be the therapist’s job to advocate for clients to get appropriate medical treatment for pain, before it becomes chronic.

In another post, I’ll tell you about my "miracle client". But I”ve gone on too long in this one.