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Pain

Introduction

Acute chronic and recurrent pain is a significant problem worldwide for children and adults and one of the leading reasons that people seek medical (conventional or complementary) treatment. Negative emotional states such as anxiety and fear go hand in hand with pain experiences and are often as important as the pain stimulus itself in the patient’s experience of distress. In addition, patient perceptions of control or lack thereof over their pain, can contribute to poor coping with pain. Excess sympathetic nervous system arousal may contribute to or mediate pain intensity in certain conditions. Therefore, the emWave PC/Mac Stress Relief System and its techniques that promote stress reduction, reframing of emotional states and offer active control, are very helpful.


Pain Case Study I: Chronic Lower Back Pain

Here is a case from a pain specialist at a hospital in California that gives a good sense of how the emWave PC/Mac Stress Relief System can be used in a chronic pain situation:

Author’s Commentary: Patients come into our inpatient chronic pain management program having tried unsuccessfully with surgery, medication, single outpatient treatment modalities and talk therapy to deal with their chronic pain condition. With repeated failure they frequently report feeling utterly helpless to modify their pain or function in a meaningful way. Their attempt to cope is often maladaptive such as muscular bracing and guarding, lying down or sitting throughout most of the day, and social isolation, which itself becomes part of the problem of chronic pain.

Tom had worked in construction for many years prior to his back injury and subsequent 2 back surgeries. He had been a very active person and someone who loved organizing social events with co-workers. He described himself as the person others sought out when they had problems or needed advice or support. Now he was unable to work, had limited tolerance for activity as he experienced increased pain with exertion and rarely got together with anyone other than family. He had turned increasingly to narcotic medication to cope with his unremitting back pain and now experienced negative side effects from the medication, and still had debilitating pain. Tom came into the chronic pain program to slowly wean off his narcotic medication while simultaneously increasing his strength and endurance, learning proper body mechanics and pacing during activities and developing coping skills from our interdisciplinary team.

He said he used to be “high on life” and his biggest goal was to somehow “get back to being the person he used to be”. He reacted negatively to his pain as if the pain sensations were triggers reminding him of what he feared he had lost forever. At first he was angry to hear he would be learning to manage his pain, not get rid of it.

As a biofeedback specialist I may use a number of modalities, depending on the problem. I began with EMG biofeedback training to bring Tom’s awareness to the excessive muscle tension in his neck and shoulder area (his “solution” to keep pressure off his back) and a likely source of his aching shoulders and frequent headaches. I also trained him in Autogenic Relaxation and gave him my relaxation tape to use in learning what relaxation is and developing “intentional” self-quieting skills. After he learned to breathe deeply without fear that his back would spasm, I introduced the Quick Coherence technique and the emWave PC/Mac Stress Relief System. I knew he needed to change his relationship to his pain and asked him if he would react angrily to his child if he were injured. Of course he said he would give him his love, support, and do everything he could to comfort him. I suggested that he consider offering his injured back the same love and concern as he would his child; that his pain merely signified injured tissue. As he practiced with the emWave PC/Mac Stress Relief System and began to open his heart, he changed his perception and shifted away from his emotional battle with his pain. Frequently he reported his pain sensation decreased following training. A wonderful moment came after a session when he exclaimed that he experienced for the first time in years the “high on life” feelings he had longed to feel again. With training he said that even when he had a pain flare, he was able to maintain peace in his heart and use that feeling “as a shield from the pain over his pure self”.

During the 4-week program, Tom had tapered off all his narcotic medications and switched to non-opioid medication and as happens so often, his pain was often decreased. He stopped talking about pain, his sense of humor returned, he rarely used his cane, and he had several plans for fun activities after returning home. Tom “got his life back”, which is what most patients really want out of the program. HeartMath tools have become an indispensable treatment component for me to use with chronic pain patients to promote emotional wellness and perception change about themselves and their pain.


Pain Case Study II: Teenager with Abdominal Migraine

Author’s Commentary: This case is an example of how the emWave PC/Mac Stress Relief System can help kids and teens with migraine and migraine variants. Studies clearly support the efficacy of a variety of relaxation/self­regulation techniques in the treatment of headache. This was extrapolated to an application with abdominal migraine with great success.

Elaine is a 13 year old female who had a history of periumbilical recurrent abdominal pain since a young age (several years) and who had completed extensive evaluations with specialists in neurology and gastroenterology with no specific findings. Evaluation at the integrative medicine clinic found her history to be consistent with a diagnosis of abdominal migraine. Results of laboratory and radiologic tests were all within normal limits and previous therapeutic interventions which included a food elimination diet and use a smooth muscle relaxant medication proved to be unhelpful. At the time of her visit, she reported (her parents concurred) having severe abdominal pain episodes several times per month, screaming and writhing in pain, necessitating several trips to the local emergency room which resulted in no definitive findings.

Occasionally Elaine described experiencing a headache before, during or after the abdominal pain but this symptom is not consistent. In addition to the abdominal pain, she will occasionally experience concurrent symptoms of nausea and vomiting.

Elaine had been missing school several days per year on average because of this ongoing pain and this had increased recently. In addition, her family felt that her pain was beginning to affect the entire family’s function. Pain episodes could last anywhere from a few hours to a few days at this point and nothing was providing Elaine with any consistent relief. Mental health screening was within normal limits. Past medical history was otherwise noncontributory except to note a strong paternal family history for migraine.

Initial recommendations were made for a multimodality treatment approach that included low-dose SSRI coverage which was not started initially, self-regulation skills training to facilitate a lowered state of sympathetic nervous system arousal and some basic nutritional supplementation

At her first follow up visit one week later, Elaine had reported 2 severe abdominal pain episodes during the prior week. In fact, one had occurred while the family was out of town and they all ended up coming home early because of Elaine’s pain symptoms. At this session, Elaine was taught to discriminate differences in relaxed versus aroused states of mind/body, and she was coached through basic progressive muscle relaxation and diaphragmatic breathing exercises and a practice plan was made.

At her second visit one week later, things were about the same. She was instructed in the relevance of peripheral temperature as a marker for stress and then the basics of mental imagery were reviewed.

At her third follow-up she noted the frequency and severity of events had slightly decreased. At that visit she was introduced to the emWave PC/Mac Stress Relief System and the Quick Coherence technique. The use of skills that she had previously been practicing and mastering was discussed, showing how those skill helped with getting into the “zone”. We reviewed home and school practice strategies.

By her fourth follow up things were continuing to improve and Elaine had only one severe episode in the previous 3 weeks. She was attending school every day which was a great improvement and was receiving A and B grades. She reported only one minor episode of pain in 4 weeks. Elaine described practicing 1-2 times each day for 5-10 minutes. We then worked on the idea of taking shorter more frequent “mini-breaks” for 1-2 minutes a time, several times each using the Quick Coherence technique.

At the fifth and sixth follow-ups each about 4 weeks apart she continued to do extremely well with minimal abdominal migraine episodes, regular school attendance and with her family also commenting about improvements noted in her mood. Elaine reports using the various self-regulation techniques on a regular basis and feeling quite confident in using them in both preventative and abortive modes. 


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