Pain May Be in the Brain, But It's Still Real

One place that does is the Sensorimotor Psychotherapy Institute in Boulder, Colo., founded by Dr. Pat Ogden in 2000. Fisher trained there after 18 years as a clinical psychologist.

"What made me interested was the failure of talking therapies to resolve the effects of psychological trauma," she said.

Sensorimotor psychotherapy attempts to make the connection between physical, emotional and cognitive experience, examining whether there may be an emotional cause for a person's physical pain, and then addressing both issues. In some cases, emotions are used as the key to ease a physical problem; in others the process works the other way.

Hypervigilance and Pain

In one case, Fisher said, a woman came to her who suffered severe chronic back pain and had a history of physical and sexual abuse as a child. Fisher said she worked with the woman's pain as a symptom of her childhood trauma, the way flashbacks or nightmares might be.

"I suggested that her back might be holding hypervigilant, suggested that her back was standing guard for her," she said. "We talked about her back standing guard for her, and as we talked about it, her back started to relax."

Six months after that one session, the only problem the woman has had is occasional achiness, Fisher said, and that when her back starts to get a little tense, she is able to work through it.

"Most situations don't resolve that dramatically," Fisher said.

In another case, a woman came to her who said she had not slept through the night in 25 years since she was sexually assaulted in her home. Even though the rapist was found, arrested, convicted and was still in jail, the woman still felt so scared every night, she could not sleep in the same room with her husband, because the sounds of him rolling over would terrify her.

"Every night she was reliving the experience of being woken up, being terrified and having to be hypervigilant," Fisher said.

Activating the Fight Response

They worked together over a period of several months, and when the anniversary of the assault came, they made an appointment for a session.

At that meeting Fisher worked with the woman to reactivate the fight response to what she experienced 25 years before, and to have her feel it in her muscles.

"She pushed against my outstretched arms, very slowly, very slowly because we want people to feel the power of that musculature," Fisher said. "We spent about 20 minutes engaging all the muscles from her feet planted on the ground, through her legs, up through her back and her arms."

Afterwards, the woman felt tired, but did not feel terrified, she said.

"She went home, was able to sleep for a few hours, and was able to feel triumphant over her memory, if not over her assailant," Fisher said.

The approaches to pain treatment being developed by study of the link between emotions and pain offer the hope that drugs will not be the only recourse doctors have when faced with patients who suffer from chronic pain.

"It changes the paradigm, definitely, and opens up new arenas for study," Zautra said. "Pain is a signal, part of the response of the brain and the mind. It is part of a broader class of responses that a person needs to address, and they can use a variety of methods to address it."

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