Chapter 1: Pictures of Pain and Healing

To heal from chronic pain, you have an abundance of options. Each specialist who sees you is likely to praise the virtues of his or her approach and may discount the value of other therapies. Chances are that if you are not professionally involved in medicine or alternative therapies, you will have a difficult time trying to figure out what avenue to pursue and why.

You need to find out as soon as possible what is causing your pain. Then you can begin to consider what therapies might be most useful. Stress, in the form of neuromuscular tension, is a leading cause of pain, which results from lifestyle habits that we adopt in the course of handling the pressures of our lives. Consequently, treating pain requires you to change these physical, mental, and emotional lifestyle habits and to reverse their cumulative effect.

The case studies below show how, by reversing certain lifestyle habits, four of my clients reduced their physical pain.

MELISSA

Melissa was forty-eight years old when she first sought my professional assistance. She had been suffering from bouts of chronic pain for eight years. Her symptoms included low back and hip pain, as well as shoulder and neck tension that sometimes escalated into debilitating headaches. Melissa had been told she had fibromyalgia.

The term "fibromyalgia" formally entered the medical lexicon in 1990 as a result of doctors' having been flooded over a number of years with cases of chronic pain that defied medical diagnosis. Research identifying these patients' common traits led to the definition of a fibromyalgia syndrome. Patients are deemed to suffer from fibromyalgia when they feel pain in response to pressure on at least eleven of eighteen "tender points" on the body, points where muscle tendon and ligaments attach to bone. Since 1997, fibromyalgia has become one of the most commonly diagnosed musculoskeletal disorders. There is no known biochemical cause of fibromyalgia, and standard tests, such as X-rays, myelograms, CAT scans and MRIs, fail to isolate specific structural origins of the syndrome. This is not surprising, since the label "fibromyalgia" is actually a blanket term covering a wide variety of pain disorders that have their origin in soft-tissue lesions, adhesions, strains, and imbalances, most of which are not picked up by the usual tests. Once the soft tissue of muscles and connective tissue is damaged, that damage can cause pain in locally affected areas and can also spread throughout the entire body, along the weblike structure of connective tissue that envelops and supports all the body's organs and tissues.

Like many persons diagnosed with fibromyalgia, Melissa had been given medication to manage her pain. She had also been told she would simply have to cope with this problem, for which there was no known cure. Melissa was given no guidance in understanding either how her pain syndrome had developed or how she might reverse some of its effects. Naturally enough, she felt depressed and defeated by the diagnosis. A growing sense of powerlessness about her body cast a pall over her life.

I suspected that Melissa's pain syndrome was not purely structural or biochemical in origin and was interested in finding out more about her in order to get to the bottom of her situation. During our first few sessions, Melissa told me some of the details of her personal life. She had had a difficult childhood under the care of a narcissistic mother, had married and eventually divorced a successful but alcoholic businessman, was the mother of two children, and had herself pursued a hard-driving though erratic career. Her life had had its share of stress, and the combination of her illness and ongoing personal and professional demands continued to put her under daily pressure. I was sure that the origin of Melissa's pain lay in the way she was living in her body, day after day, month after month, and year after year. Something she was doing with her body was causing it to underfunction. If we could change that, she would feel better.

We began our work together by exploring and making changes in some of her deep-seated physical habits. We started by having Melissa focus on one of her most important physical habits: the way she breathed. Her job was simply to become aware of how she breathed under everyday circumstances. I gave her some guidelines for evaluating her breathing patterns, which I'll give you later in this book. When she applied these guidelines, she was surprised to discover that her breathing was relatively uneven, shallow, and somewhat labored. In addition, she frequently held her breath. This pattern of constricted breathing might have been contributing to her physical pain. Constricted breathing deprives the muscles of the vital oxygen that keeps them healthy and also often corresponds to neuromuscular tension in the body. If we could open up Melissa's breathing, we would be reducing her muscle tension and oxygenating her tissues.

Melissa learned some breathing exercises to help her slow down her breathing, deepen it, and make it more regular. I also asked her to become aware of when she held her breath and to try to replace this habit with more even breathing. Melissa worked on becoming conscious of her breathing and applying the new breathing style throughout her daily activities. She noticed that the more she focused on breathing deeply and evenly, the less her back and hip pain bothered her and the less she suffered from headaches.

Now Melissa felt the effectiveness of my approach to reducing pain through changing physical habits. As she continued to work on breath awareness, we also explored other physical habits that will be described later in this book. Like her breathing patterns, these habits were unconscious, and, also like her breathing patterns, they contributed to her discomfort by creating or exacerbating neuromuscular tension. By the time Melissa and I stopped working together, her pain of eight years' duration was 70 percent improved, and she had the information and techniques to continue making progress on her own. Today, her pain has virtually disappeared.

Let's compare Melissa's course of mind-body therapy with traditional treatments for chronic pain to see why Melissa had found no pain relief from the standard medical treatments. When surgery is not an option -- as in Melissa's case -- remedies for chronic pain tend to include the use of medication, physical manipulation, prescribed exercises, or some combination of these. A doctor prescribes medication; a chiropractor, physical therapist, massage therapist, or other body worker applies manual therapy; and a physical therapist, sometimes in collaboration with an orthopedist, prescribes exercises. Patients who receive medication or manual therapy tend to play a passive role in their own treatment. They may not be asked to observe or change lifestyle habits that involve the way they live in their body. Even when professionals treating them recognize such habits as a concern, these professionals may not possess either adequate time to retrain their clients or professional training in sophisticated skills that are required to help patients change deep-seated, largely unconscious habits of physical stress.

Patients who work with exercises to reduce their pain take a more active role. They embark on a course of action to make changes in their own bodies. Yet even these patients do not on the whole address their daily habits of body use or look at their lifestyle habits in anything more than a cursory manner. Such habits inevitably play an important role in the origin and chronic nature of patients' pain, since pain usually involves structural and functional imbalances that have developed over a period of time. If lifestyle habits underlie patients' pain, the benefits of medication and manipulation are likely to be limited. Specific exercises may be useful, but if they fail to address the physical tension that causes pain, they too will have only limited effect. Exercises would be more effective if they were taught in conjunction with a therapy program focused on correcting long-term dysfunctional tension habits involving posture, movement, and chronic stress.

In Melissa's case, medication, manipulation, and exercise had failed to help her in the past and were not likely to work in the future without an additional approach. A key physical habit -- namely, the way Melissa breathed -- played an important role in her pain syndrome, and by changing this physical habit she released deep levels of neuromuscular tension and eased her pain, which was largely due to excess muscular stress.

Melissa noticed that the breathing work not only lessened her physical discomfort, it also reduced her anxiety and improved her mental focus. A simple physical technique -- breath awareness combined with deep, relaxed breathing -- enhanced her physiological, mental, and emotional functioning. Melissa's mental state, her emotional state, and her physical state were all connected; when one improved, the others improved as well.

When you change a way you live in your body, other mental and emotional changes result. Pain is a whole-body phenomenon, the consequence of a subtle interaction of our physiology with our hearts and minds. So too is healing.

MIKE

An elderly gentleman named Mike came to me with chronic low-grade back pain. His pain had begun gradually in middle age, worsening progressively until he found it difficult to stand for any length of time. Mike avoided lines in grocery stores and at bus stops, and when he attended receptions or dinner parties, he sought out a chair so that he could sit rather than stand while chatting with other guests. I asked Mike to walk around the room and then come to a stop. I noticed that when he stopped and stood, he locked his knees. When we lock our knees -- bringing them back as far as they will go rather than bending them slightly and keeping them "soft" -- this causes the pelvis to drop forward, so that it no longer supports the spine above it. As a result, the back becomes swayed. When the back sways, the muscles of the lumbar area have to brace in an effort to stabilize the spine. Over time this bracing reaction overworks and stresses the muscles of the low back, which become increasingly contracted, contributing to discomfort, muscle spasms, and even herniated discs or arthritis.

I showed Mike how to release the pressure on his back by unlocking his knees, and I sent him away with instructions to notice when he locked his knees and to unlock them whenever possible.

A week later, Mike was back in my office, eager to share his observations. He had discovered, to his surprise, that he locked his knees almost constantly. He had never noticed this before. He also noticed that when he paid attention to unlocking his knees, this greatly relieved his back pain. Mike's habit of knee locking created neuromuscular tension. By becoming conscious of and changing that habit -- the way he stood -- he had eliminated excess tension in his low back muscles.

arMike shared some further insights. When he locked his knees, his body seemed to brace, becoming rigid and inflexible. When he unlocked his knees, his body was softer and more pliable, less like a stiff rod and more like a strong young sapling swaying in the wind. Keeping his knees unlocked gave him a better sense of balance, flexibility, and flow. Although this feeling was physical, it also affected his mental and emotional mood. When his knees were locked, he felt psychologically and physically rigid, brittle, and unbending, as if he needed to defend himself. With his knees unlocked, he felt more in control but less controlling. Mike wondered whether he had gotten into the habit of locking his knees as a defensive, self-protective posture. Whether or not this was the case, he noticed that by becoming more conscious of his body and releasing his physical habit of locking, he decreased his physical pain while increasing his sense of mental and emotional well-being. He was more relaxed. Mike realized that his physical, mental, and emotional states were interrelated: physical tension seemed to be tied to mental and emotional tension, and physical ease was connected to mental and emotional ease.

Our mental, emotional, and physical states do not exist separately and apart from each other. Becoming more conscious of how to influence our physical bodies can have a salutary effect on our mental and emotional lives. Similarly, mental and emotional states can affect our physiology. As we shall see, this chain of mutual influences has significant implications for treating and eliminating chronic pain.

When Mike felt the emotional and mental improvements that came from making a physical change in his body stance, he discovered for himself the ancient wisdom that is embedded in the philosophy and practice of Eastern spiritual practices such as chi gung, tai chi, and yoga. These practices have their foundation in body awareness and self-mastery. They recognize that the body's sensations offer important information about our well-being. They focus on improving our total state of well-being by improving our presence to the body. They recognize that the more we focus on developing skills that increase our grace, suppleness, physical ease, and physical self-awareness, the more we feel physically healthy and mentally and emotionally supple and empowered.

The wisdom of these ancient arts and my own personal and professional experience of working with clients in chronic pain serve as a foundation for the approach to chronic pain reduction in this book. My approach emphasizes, first, that habits of body use are the primary cause of physical pain; second, that these bodily habits cause pain because they foster excessive neuromuscular tension; third, that enhancing bodily self-awareness is the critical component for healing the neuromuscular tension that creates chronic pain; and fourth, that the practice of bodily awareness shows us how to reduce physical, mental, and emotional stresses that contribute to our neuromuscular tension and pain.

Mike and Melissa reduced their chronic pain by becoming aware of physical habits that involved unconscious muscular tensions and learning how to release them. Melissa did this by relaxing her whole body through breath awareness. Mike reduced unconscious tensions by improving his body alignment. Mike and Melissa did not improve because a doctor or therapist did something to them. They improved because they changed something in themselves. Their stories demonstrate that exploring how we live in our bodies can be a powerful way to heal from physical pain.

CLARA

In the process of looking at and altering habits of body use, we sometimes make surprising discoveries about ourselves, discoveries that extend beyond simple physical realizations into insights about our personalities and about how our personalities affect our experience of pain. A thirty-five-year-old woman named Clara was referred to me as a result of numbness in her legs that did not respond to conventional treatments. When I examined Clara, I discovered a high level of tension in the pelvic region. Nerves, arteries, and veins pass through the pelvis to the legs. Constriction of any one of these as a consequence of pelvic tension can result in numbness in the legs. Tension in the pelvic muscles can also put excess strain on the muscles of the legs, restricting nerve function and circulation in those areas.

Like Mike's and Melissa's, Clara's problems seemed to be related to excess muscle and pelvic tension. Clara said that she could not herself feel this tension. This was not surprising, as her numbness indicated that she had trouble feeling her body. Lack of feeling is frequently a consequence of excess tension. My challenge was to help Clara approach her body in such a way that she reduced that tension. Clara agreed to follow my recommendations, and over several sessions, during which she lay at ease on a bodywork table, I had her focus on simply feeling and appreciating the sensation of her pelvis. I told her neither to expect particular sensations nor to try to relax her pelvis. Her only goal was to feel whatever her pelvis felt like. Since tension is related to loss of feeling, improving Clara's ability to feel would in turn reduce her physical tension. This is what happened, and along the way, Clara had an illumining realization. She discovered she was uncomfortable with feeling herself. She wanted to interfere with her sensations: to react to, suppress, interpret, do something about, or in some other way control the feelings going on in her body.

Clara's situation is not uncommon. How often have you popped an Advil or an Aleve, rather than feel physical discomfort? We often try to avoid physical sensations that we think are unpleasant. We do the same with sensations that involve our emotions, heading for the freezer in search of ice cream or to the cupboard for a box of cookies when a conversation gets too heated and raises feelings we'd rather not address. How often have you denied you felt anger or grief when you thought you weren't supposed to feel it? In all these situations, we use some tactic to control how we feel physically or emotionally rather than allow ourselves to feel what we feel. When we try to control our feelings -- physical or emotional -- we suppress them. This creates tension, which in turn creates pain.

Clara related to her body as something alien that she needed to control. Unconsciously, she viewed her physical sensations as suspect and problematic. This attitude created tension and confirmed her fears by triggering physical problems. Clara's real problem was her attitude of suspicion and fear toward her own sensations. We have evolved our physical sensations, including sensations of discomfort, as part of feedback that is meant to guide us in surviving and thriving. If we suppress the feedback process, we sabotage nature's intelligence. Clara had become so alienated from her own body that when first asked to explore her physical sensations, she felt she couldn't. She had suppressed her ability to feel behind a wall of tension. As she continued to explore feeling, however, that wall began to dissolve, and then she encountered anxiety and discomfort: feeling itself was uncomfortable. As she learned not to give in to her reactions of anxiety and discomfort, the tension and pain in her body gradually dissipated. She gave up trying to control her body, and her body started feeling better.

Clara came to the realization that her numbness was the consequence of deep-seated tension and her tension resulted from trying to manage and control her feelings and sensations, rather than simply experiencing and accepting them. Her physical numbness and pain had a physical source in neuromuscular tension. Yet that physical tension was also the consequence of mental and emotional attitudes that emphasized her need to control. Clara began to see that letting go might be a better choice than controlling. She improved physically while also discovering healthier emotional and mental options.

Like both Melissa and Mike, Clara reduced her physical pain by exploring and gradually changing a physical habit that was creating tension in her body. All three reduced their physical tension with a self-directed intervention that gave them heightened bodily self-awareness. All three began to observe subtle connections between their physical, mental, and emotional states, connections that indicated that physical pain is often a whole-body expression of interactions between these states. Relaxing into feeling her body helped Clara address and let go of an emotional need to control, which was one cause of her physical discomfort. She became aware of her emotional control issues not through verbal processing but through listening to her body and observing herself more closely. Exploring her ability to feel her body yielded emotional insight that in turn helped her reduce her physical pain.

JEAN

Though we may use physical techniques to alleviate our physical pain, a primary cause of that pain may lie in emotional issues that have an impact on the body. A young woman came to visit me complaining of shoulder pain, from which she had been suffering for three months. Jean was irritated with herself and with her shoulder. As with my other clients, I focused first on helping Jean let go of stress and achieve a deeper state of relaxation through the use of bodily self-awareness techniques that reduced physical tension. I then encouraged her to feel the pain in her shoulder without resistance. Rather than reacting to her pain with upset, annoyance, or anger, she was simply to accept, appreciate, and feel the sensations. As she simply explored and observed her physical sensations, her nonjudgmental, nonreactive stance would help her eliminate tension and identify the underlying causes of that tension.

I asked Jean to consider her sensations of pain not as uninvited intruders but rather as a part of herself that was trying to share important information. At first she felt uncomfortable and skittish about this, but after a period of silence, during which she tried to focus on being present to her sensations of pain without judgment, she began to cry. She reported that she was neither crying from her physical pain, nor was she crying about her physical pain. Her tears were about another pain: the death of her mother a few months before Jean's shoulder injury had occurred. Surprisingly to Jean, as she cried out her grief, her shoulder pain eased. Clearly, her physical tension and pain had been connected to emotional tension and pain. After her cry, Jean told me that the pressure of work and family obligations had been such that she had never allowed herself fully to grieve for her mother's parting. She had bottled up her feelings, which had somehow found their way into her shoulder.

A week later, Jean telephoned to tell me that her pain was completely gone. She had devoted much of the week to communing with her mother's spirit and completing her good-byes. We marveled together at the mystery of life and at the fact that a physical discomfort had been her body's way of telling her that she had unfinished emotional business. Jean recognized that her emotional realizations had come not from talking about her mother but through feeling her body. Her grief had been stored far from her conscious mind, in her body's tissues, and physical self-awareness had unlocked emotional self-awareness.

Jean changed the way in which she was relating to her body. She stopped being irritated or angry with her body and complaining about its limitations. She just let it feel the way it felt. She changed a deep-seated habit of judgmentalism, which had surprising results: it reduced both her physical and emotional pain, which had been locked in her tense, contracted tissues.

RECOMMENDATIONS

In the cases of Melissa, Mike, Clara, and Jean, the ultimate physical source of pain was excess neuromuscular and connective tissue stress and tension. In each case, this tension was related to unconscious bodily habits that were released once the patients became aware of them. In each case, the patient's physiological healing was triggered by his or her own actions. And all of them became aware that changing bodily habits improved their mental and emotional state and that mental and emotional attitudes had contributed to their physical pain.

Letting go of chronic pain involves becoming aware of the way you live in, respond, and react to your body and changing it. Your body is not an alien force; it holds the keys to your health. If you learn how to listen to it, work with it, and understand it, you can heal.

The primary source of neuromuscular tension is stress. The word "stress" is a part of our everyday language, but its actual nature is poorly understood. How does stress work its way through the body? What is physical stress? What is emotional stress? What is mental stress? How are these related to one another and how do they contribute to pain? Chapters 2 and 3 will answer these questions.

Once you understand how stress manifests as neuromuscular tension and creates pain, you can learn body awareness techniques and discover how to use them to eliminate the stress that creates pain. You will also be able use these tools to identify and release whatever unique physical, mental, and emotional stresses may underlie your own history of chronic pain. These methods form the subject of chapters 4 through 15.

Copyright © 2005 by Ingrid Bacci, Ph.D.

Introduction

If you suffer from chronic pain, you are not alone. Chronic pain is a social and personal problem of epidemic proportions in our society. In the course of their lifetime, 80 percent of Americans will suffer from chronic pain related to dysfunction of the muscles, bones, and joints. In 2004, at least 50 million Americans were living in chronic pain. Back pain is the leading cause of visits to doctors, hospitalization, surgery, and work disability. The Centers for Disease Control and Prevention (CDC) estimated in 2002 that one-third of all Americans had some form of joint disease, most commonly osteoarthritis. And a new musculoskeletal pain syndrome, identified in 1990 as fibromyalgia, has become the second most commonly diagnosed chronic pain disorder after osteoarthritis. By 2004, an estimated 8 million people were said to be suffering from fibromyalgia, 85 percent of them women.

If you suffer from chronic pain related to the bones, joints, or muscles, have not yet found adequate relief, and feel frustrated at the limited assistance available to you, this book is for you. It offers you a thorough -- and unusually simple -- understanding of the causes of chronic neuromuscular, joint, and skeletal pain, along with a clear, step-by-step process for reducing and possibly even eliminating pain. Unfortunately, traditional health care has proven to be woefully inadequate for people suffering from chronic pain. Of all physical illnesses and nonacute problems, chronic pain is recognized as the one least susceptible to treatment with traditional health care techniques, and according to The Journal of the American Medical Association, pain is the number-one reason people turn to alternative medicine.

Traditional health care has been unable to meet the demand for effective therapy and unable to stem the growth of chronic pain. The cost to our society is increasingly burdensome. When we look at standard medical treatments for neuromuscular, skeletal, and joint dysfunctions, we see why. There are two predominant modes of therapy: surgery and medication. Each of them has significant drawbacks. Surgery is beneficial in some cases but is not always a viable option. Moreover, even where surgery is a possible form of treatment, its benefits are far more limited than the public generally believes. A survey conducted in 2003 by the American Academy of Physical Medicine and Rehabilitation concluded that a full 48 percent of the population believes that surgery is the only real cure for at least half of all low-back-pain cases. But, the academy continued, surgery is actually effective in less than 5 percent of cases! In a similar vein, a report published in 2003 in The New England Journal of Medicine said that doctors are far too aggressive in using operations to treat pain. Finally, according to a Norwegian study of 126 disk-surgery patients, four years after surgery those who had been operated on had equivalent levels of pain to those who had not. The implications are that the advantages of surgery are more limited than we tend to think and that anyone with chronic pain should seriously consider other options before going under the knife.

The second standard form of medical treatment for chronic pain is medication. Its goal is usually either to reduce inflammation or to suppress symptoms. It is most useful as a short-term therapy. Over the long term, however, it can result in toxic side effects, sometimes even including severe intestinal bleeding and heart disease. Patients on regular medication can also expect, as the months and years go by, to need increasing doses of such drugs, which may harm their health and which treat only the symptoms and not the source of their discomfort. They are likely to experience a gradual increase of pain and disability; anxiety over a physical condition that seems beyond their control; a sense of powerlessness; and the depressing feeling that they must live with a problem that is incurable.

While medication tends to represent the road most taken, research indicates that it can sometimes be less effective than other less expensive but more intensive and empowering therapies. For example, the U.S. Headache Consortium, led by the American Academy of Neurology, recommends relaxation training -- including meditation and progressive muscle relaxation -- over drug therapy as the therapy of choice in dealing with migraines.

Obviously, something is missing from the standard diagnosis of the causes of pain. That diagnosis usually seeks the origin of pain in a structural or biochemical imbalance. Yet the underlying cause of pain is in most cases neither structural nor biochemical. Once you understand the true causes of chronic pain, you will be able to find effective solutions that you yourself can apply to reducing your own pain, empowering yourself, and finding a better lifestyle.

When you suffer from chronic pain, you must look "outside the box" to find innovative, accurate, objective, and -- once understood -- obvious answers. The solutions offered in this book show you how you can become your own best doctor. Along the way, you will also free yourself from excessive reliance on medical and insurance options that become increasingly expensive and drain your pocketbook even as they provide mixed results.

The highlights of Effortless Pain Relief include these revelations about the fundamental causes of and solutions for chronic pain.

1. The most common cause of chronic pain is neither structural nor biochemical imbalances, but rather lifestyle habits. What causes chronic pain? In a few cases, genetic predisposition or physical trauma endured through accidents plays a role. However -- more important by far -- in a full 80 percent of cases, the single most critical factor in the development of chronic pain is lifestyle habits. In fact, even if your pain started with an accident or has a genetic basis, it is often the lifestyle habits that you have developed to accommodate to the pain that bear primary responsibility for your pain.

"Lifestyle habits," as the term is used here, are the unconscious habits that involve the way you live in your body: the way you breathe, stand, and move; and the way you store physical and emotional stress in your tissues. Over months and years, these unconscious habits foster increasing physical stress, eventually wearing down muscles, joints, and bones, thus causing escalating discomfort. You can be your own worst enemy, and your own lifestyle habits can be the cause of your dis-ease. But knowing this also has very positive implications. Just as developing unconscious habits of body and mind can result in pain, so too becoming conscious of these habits and altering them can alleviate and even eliminate pain. Rather than having to rely on outside sources to help you, you will discover that you are your best resource for reducing and even eliminating chronic pain. This simple fact makes Effortless Pain Relief the first and only complete guide to the self-empowering process of healing from chronic pain. It shows you exactly how and why the way you live in your body may have created the pain from which you suffer. It also shows you how and why changing the way you live in your body frees you from pain. Finally, it offers you a complete tool kit for implementing that process.

2. Lifestyle habits that create pain are both the expression and the cause of stress. In the course of a lifetime, we experience many forms of stress. Stress can be physical (for example, an injury or repetitive stress syndrome), mental (for example, excessive work demands), or emotional (for example, ongoing anxiety). No matter what the origin of stress, however, it is always reflected in the body. Like physical stress, mental and emotional stresses are acted out through changes at all levels of the body: biochemical, neurological, and physiological. All chronic stresses also reflect themselves in certain physical habits, or ways of experiencing and responding with your body. These habits involve unnecessary physical tensions. The tensions of lifestyle habits contribute to pain, pain creates further stress, stress creates further tension, which contributes to further pain, and so on. By understanding the many aspects of stress, how it is reflected in lifestyle habits, and how these habits create tension and discomfort in the body, you will also begin to understand how to reverse the stress and lifestyle habits that underlie your problem and reduce your pain.

3. Body awareness is the primary vehicle for changing the lifestyle habits that express and create stress and pain. Just as pain is a physical experience in your body, so too the stresses and lifestyle habits that create physical pain are experiences of your body. You can reduce your pain by becoming conscious of bodily patterns and experiences that are unconscious and by changing those bodily patterns and experiences. For example, you can reduce your pain by changing the way you breathe under stress, the way you sit at the computer, the way you walk down the street, the way you react with tension when someone challenges you, or the way you feel anxiety on a visceral level when you are under internal or external pressure.

You can reduce your pain by changing your body. This does not mean that your pain will improve as a result of your doing physical exercise. Physical exercise can be a very useful adjunct to the process of healing from chronic pain, but there are already many books available on that subject and exercise is not the best method of healing chronic pain. The best way you can heal is by becoming aware of the way you live in your body and changing it: the way you respond to situations, the way you move, the way you react to pressures around you. Healing results from heightened body awareness, and this book shows you how to develop that awareness. As you develop body awareness, you will automatically know how to release unconscious tensions that foster pain.

4. Your body teaches you how to heal from chronic pain. As you work with this book, you will explore and experience your body more fully. By enhancing your awareness of your body -- of how it feels moment by moment, how it functions, how it reacts to situations, and how it stores your personal history -- you will naturally and organically begin to learn things about your body and about yourself that you did not know. In this process, you will shift the way you live in your body, adopting patterns that reduce discomfort and increase ease, while enlarging your overall sense of well-being.

The body is a teacher. If you listen to it, you can learn from it. You will learn to listen to your body's signals. Just as emotional pain in a personal relationship can be an indication of poor communication between partners, so too, when you are in physical pain, your body may be signaling to you that you are doing something that is causing a problem. If you fail to pick up on the meaning of that signal, your discomfort may become habitual. In the chapters that follow, you will discover what it means to pick up on and respond effectively to your body's signals.

Some of the body's signals are purely physical. For example, you may lean your head too far forward when you sit for hours at the computer. This will eventually give you a headache, neck pain, or temporomandibular joint (TMJ) problems, or shoulder trouble. In this case, a physical habit of poor posture is creating pain. Yet a great many signals you receive from your body are not solely physical. They have a mental or emotional component as well because the body holds our mental and emotional stresses. These stresses -- some of which are conscious but many of which are unconscious -- are recorded as subtle body shifts and tensions, which, if held over a long period of time, cause physical distress.

We experience and express our emotions in and through our bodies. We are aware of this every time we feel our stomach flutter when we face a challenging situation: we experience a tightening of the chest or jaw in anger; or we feel our neck or shoulders tense in anticipation of a deadline. Long-term mental and emotional stresses leave their mark in the body's physiology and can contribute to your pain. As you become more aware of your body, you will also become more aware of the mental and emotional stresses that register themselves in your body and contribute to chronic pain.

5. Healing chronic physical pain can involve both your mind and your heart. All forms of stress, whether mental, emotional, or physical in origin, express themselves through unconscious habits of physical tension in the body. As you learn to release physical tension habits through heightened body awareness, you will simultaneously reap emotional and mental benefits: You will reduce mental and emotional stress. You may also become aware of mental and emotional attitudes that contribute to your pain. You may decide to let go of some of these attitudes. All aspects of our lives intersect in our bodies, and healing the body can create deep ripples of change in the type of person you want to be and how you choose to interface with the world.

6. Stress is associated with feelings of disempowerment, and disempowerment is often an ingredient in the development of chronic pain. When stressed, we feel controlled by something outside ourselves. An accident, a sudden illness, getting fired, or losing money in a stock market slide are obviously stressful, yet life also presents us with many subtler stresses: a temperamental family member who always has to be right; a rigid work environment or difficult colleagues; long commutes; a hypervigilant superego that criticizes us constantly. Much of life can feel beyond our control. When it does, we feel disempowered to some degree. Stress and feelings of disempowerment tend to go together.

The most obvious emotions that stem from a sense of disempowerment are chronic anger or frustration and chronic anxiety or fear. Effortless Pain Relief shows you how these feelings manifest as physical reactions of stress and how these stress reactions create pain. It also shows you how to use your body awareness to let go of negative emotions of fear and anger to reduce stress, become more empowered, and eliminate chronic pain. Once you see the intimate relationship among chronic pain, stress, and feelings of disempowerment, you will have a road map for healing your physical pain. In the process, you will develop greater control over your own life.

MY JOURNEY OUT OF PAIN

This book offers a unique pathway to healing from chronic pain, a pathway that takes you into a deeper experience and appreciation of your body, its messages, tools, and response patterns. I know this approach works because it is how I overcame my own crippling pain and because I have taught it to others so that they could do the same.

I have worked for years to understand and resolve the problem of chronic pain, both for myself and for my patients. Today I work as an alternative health care practitioner specializing in movement therapy and in a manual approach to bodywork called craniosacral therapy. In addition to my private practice, I teach pain reduction seminars at hospitals and HMOs, teach craniosacral therapy nationally, run retreats, write books and articles, and create audio programs and videos on reducing stress and pain. At the age of fifty-nine, I am graced with radiant health. I run, bike, swim, hike, practice yoga almost daily, and enjoy intensive circuit training workouts. But I wasn't always so healthy. Nor has my professional work always been in alternative health care. I entered that field after leaving a career as a college professor and in the process of working through fifteen years of disabling pain. My journey into personal healing, combined with training in several approaches to bodywork, and my twenty years in private practice helping others heal from chronic pain have led me to the approach described in this book. It is an approach that works.

I was born in New York City, the daughter of well-established, first-generation European immigrants. My father was an internationally renowned mathematician, who was frequently invited to teach abroad. My mother was a literary editor, homemaker, and wonderful mom. By the time my twin sister and I were nine, we had lived in Europe for several years and, in addition to English, spoke French and Italian fluently. Then we moved back to New York City and my parents got divorced.

I was privileged to receive the very best that education can offer, at the Brearley School, a private girls' school with an outstanding reputation. On completing high school, I attended Radcliffe College, the sister of Harvard University, which merged with Harvard in 1977. I graduated in 1967 first in my class and with highest honors, then went to England to study on a fellowship at Cambridge University. On my return to the United States, I completed a doctorate in philosophy at Columbia University, then became an assistant professor of Philosophy at the State University of New York. My life seemed to be running smoothly and successfully.

But within five years, everything had changed. Over a period of a few months, my strength disappeared and my body inexplicably collapsed. I developed excruciating low back pain and began to have burning sensations throughout my body. When bed rest didn't solve the problem, I began to seek medical advice. I was hospitalized twice in New York City's finest hospitals, subjected to endless tests, and given numerous anti-inflammatories, painkillers, and mood elevators. I visited every doctor I could imagine: neurologists, orthopedists, internists, and rheumatologists. I also tried chiropractors, massage therapists, physical therapists, and nutritionists. I was given no conclusive diagnosis, other than that I seemed to be suffering from a collagen disease. Today, I would have been told I had a severe case of fibromyalgia and of chronic fatigue syndrome. None of the remedies did much more than offer symptomatic relief. After fruitless and time-consuming forays in a number of directions, I was finally told that I would just have to live with my condition.

I went on extensive sick leave from university teaching. I had no other choice. I spent three years in and out of bed, but mostly in bed. On a good day I could take a short walk around the block of my New York City apartment, always with a family member or friend to guide and support me. On a bad day I was confined to my room, an inmate in prison, my indeterminate sentence stretching out darkly before me. I suffered from extreme loneliness, severe anxiety, and deep depression. Life seemed hopeless. The best experts had been unable to help me, and I was unable to help myself.

After three years of growing hopelessness and despair, one day I came across an article about a woman named Elsa Gindler, who had lived in the early part of the twentieth century. As a young woman she had been confined in a sanatorium with severe tuberculosis. She had been told that there was little hope for her recovery. Gindler cured herself, however, through a process of becoming more and more deeply aware of her breathing. Her growing awareness enabled her to change her breathing patterns in a way that helped her body heal. Elsa Gindler later became famous for establishing a form of self-awareness training and self-healing called Sensory Awareness. That approach achieved popularity in the United States primarily through the work of Gindler's student and associate Charlotte Selver.

Reading about Elsa Gindler offered me my first ray of hope in years. Here was something to inspire me and lift me out of my gloom. Like me, Gindler had been told there was little chance of her healing, yet she had healed herself by following an approach that had never occurred to me: observing and experimenting with her own bodily sensations, gradually learning how to gain control over them and to change them in a way that cured her disease.

Since no one had been able to help me, I decided to try to help myself. I began to work with my breathing. I observed it, noticed when it felt more or less restricted, and slowly, painstakingly, found my way to deepening and relaxing it.

As I worked with changing my breathing patterns, it became quite clear that the way I breathed affected my level of pain. When I breathed more deeply, easily, and calmly, my pain would gradually diminish.

Through this form of bodily self-awareness, I learned a great deal about myself. Most especially I recognized that the stresses of my life always translated into my breathing patterns and that, if I could shift my breathing, I could decrease my stress, which seemed in turn to reduce my pain. In addition, I began to sense that I could become aware of how I used my arms, my legs, my torso, my muscles in general, this process might also lead to a reduction in pain. But I didn't know how to proceed.

A friend opened the door for me when she recommended Alexander Technique training, a form of movement therapy that uses your own senses to relax the body, reduce chronic pain and tension, and improve the body's alignment. (Some of the core principles of the Alexander Technique are described in chapters 6 and 7). My first lesson in the Alexander Technique, a mere thirty minutes, gave me such a feeling of well-being that I decided on the spot to study it. Three years later, I was a certified teacher and I was also feeling a lot better, having learned to let go of many of the unconscious habits of tension and effort that had contributed to my pain.

I resigned from my academic career and opened a private practice in the Alexander Technique. Although I was feeling much better and had begun to teach, I still suffered bouts of pain and was constantly stiff and frequently sore. Since enhanced body awareness had helped me a great deal, I wanted to continue exploring that pathway and resolved to study other systems, including Feldenkrais Awareness Through Movement, Somatics, and Aston Patterning. All these disciplines invite you into the body, increasing your presence to yourself as well as your ability to perceive, respond to, and master the way your body deals with life's events. The essence of these teachings (described primarily in chapters 8 and 9) is simple: reduce the effort you expend by paying very close attention to how you move and what muscles you use in movement, and you will enhance the fluidity, grace, and ease of your body.

Slowing down and observing my body helped me see more clearly into my body, its problems, and how to conquer those problems. I spent hours on the floor exploring tiny movements, learning how to make them slowly, softly, and gently. I was gradually undoing the knots created by years of stressful living piled on top of a genetically inherited physical structure that suffered from scoliosis and other misalignments. I learned that one of the fastest routes to letting go of chronic pain is to focus on learning how to reduce effort, to make a discipline of exploring effortlessness.

The more I studied how to decrease effort in my life, the more my pain receded. The more I taught this art, the more my clients' pain diminished. By now most of my clients were people who, like me, had explored traditional therapies and found them limited. They needed help, and they were willing to look in out-of-the-way places. I was glad to assist them.

The next step in my own healing process came with the discovery that the more present I became to my physical body and the more I was able to reduce my physical tensions, the more present I also became to emotions that were unconsciously contributing to my pain. Part of this discovery happened as a natural result of my increasing awareness of my own body. Part of it happened as a result of exploring craniosacral therapy, a powerful hands-on treatment that helps release deep adhesions and tissue tensions from the body and that in the process often evokes emotions and memories that have contributed to the creation of those tensions. (The story of how emotions translate into pain, and how to release emotions that create pain, forms the subject of chapters 10 through 15.)

I also trained and became certified in craniosacral therapy, which I now integrate into the movement work I do with my clients. I also teach it nationally to doctors, physical therapists, chiropractors, massage therapists, and occupational therapists through the Upledger Institute, one of the world's leading centers for craniosacral therapy.

I discovered that the combination of body and movement awareness work, along with gentle hands-on therapies such as craniosacral therapy, creates a synergy that motivates the deepest layers of healing, whether the origins of that healing lie in physical or in emotional pain.

Out of necessity, I became a pioneer in my own healing. Fifteen years after I started my journey, I was not only older and wiser but also completely free of pain and able to engage in any sport or activity I desired. In my early thirties, I had felt like a ninety-year-old inmate of a nursing home. In my fifties, I feel and -- according to others -- look like a thirty-year-old athlete. The odds were against this. Yet I believe that my path has not been unusual and that my life has blessed me with a learning that I am meant to share with others who suffer from chronic pain, so that they too can let go of what doesn't serve them through becoming more aware of how to live gracefully, easily, and powerfully in their bodies.

Today, I am a pioneer in helping others heal. I have helped thousands of people who have come to work with me, many of whom knocked on my door out of desperation that nothing else had helped. The lectures, seminars, books, articles, videos, and audio programs I have created all have one purpose: to introduce you to a process of self-healing that is simple and obvious in its core, yet that most of us overlook. Though I have put my own words to that process, the fundamental ideas I express in this book are not new. Like any ideas that work, they have been discovered and rediscovered again and again. In the pages that follow, I invite you to take the time first to understand the origins of your pain and then to follow the step-by-step process of reducing your pain. You are going to find this process very pleasurable. Enjoy it!

Copyright © 2005 by Ingrid Bacci, Ph.D.