Guest Editorial
by David E. Bresler, PhD, LAc, Dipl Ac, QME
 Patients living with
chronic pain develop a long-term relationship with their pain, whether they choose to do
so or not. In terms of interpersonal dynamics, this relationship is usually negative,
characterized by feelings of fear, resentment, hostility and mistrust.
Most therapists and counselors agree that developing and maintaining healthy, positive
relationships is one of the most challenging of all human endeavors. Two questions I like
to ask that give a good sense of the health of any relationship are: 1. "How do you
feel when you're with ___?" and 2. "How does ___ make you feel about
yourself?"
We generally feel good when we're with someone we love – they usually make us feel
good about ourselves. How do our patients feel when they're with pain, and how does pain
make them feel about themselves? Not so good, which is why many of them start the
relationship looking for a "pain killer." How healthy is a relationship when one
party attempts to "kill" the other?
As an alternative, I think it's better to first find out what pain may be trying to
communicate before attempting to kill it. Using Interactive Guided Imagerysm techniques, I
frequently invite my patients to close their eyes, allow an image of their pain to appear
and begin a dialogue with it. During this dialogue, I suggest they ask their pain why it's
here, what it wants, what it needs, where it's going and under what conditions it would be
willing to leave.
After listening to thousands of these "inner conversations" with pain, it's
clear that most of the time, pain is not an enemy to be killed, but an overzealous, often
misunderstood ally that believes (sometimes mistakenly) that it is protecting the patient
from further harm.
For example, one patient complained that despite all attempts at therapy, his back pain
had ruined his life, destroyed his career and ended his marriage. As in most relationship
disputes, the other side (the image of his back pain) had a completely different
perspective. It told him, "When you first injured your back by lifting a load that
was too heavy, I gave you pain to let you know that this was a problem. At first, you
listened and stayed in bed for a day, so I turned the pain down. The next day, though, you
returned to work, which I didn't understand at all since you were still injured. So, I
turned the pain back on and you responded by taking pills and ignoring my message. I had
no choice but to turn the pain up even higher, and you responded by getting injections so
that you could get back to work. This made no sense at all to me, and since you still
didn't seem to get the message, I turned the pain up even higher and began running it down
your leg. This does seem to work because when you overexert, it's the one way I can get
you to lie down and stop hurting yourself. This works for me, and I'm not going to turn
the pain off since you can't be trusted when I do." This mutual mistrust is a common
scenario when looking at the pain relationship. Patients don't trust their pain, and their
pain doesn't trust them. Perhaps we don't help when we tell patients, "Tough it out.
Don't listen to your pain. Do it anyway. No pain, no gain."
So, how does one establish trust in a relationship? It happens only when both parties
act with integrity over time. When someone is consistently honest, keeps agreements and
reliably does what they say they are going to do, we begin to trust them. It takes a lot
of time to establish trust, but only a few seconds to destroy it.
From this perspective, I encourage my patients to develop a new kind of relationship
with pain, one that is characterized by open, honest communication, integrity and a sense
of mutual cooperation. Rather than remain embittered and resentful, I invite them to
communicate with their pain, take care of their pain, give their pain random acts of
kindness and then to see what happens.
For example, if a patient in pain is on the fence about whether they are up to doing
something, they typically complain, "If it weren't for that *$#&! pain, I'd be
able to do this easily." I recommend they try an attitude adjustment, and give their
pain a gift by not doing it. I urge them to tell their pain, "This one's for you. I'm
going to pass because I want to listen to you and take better of myself."
I'm not suggesting that people surrender to pain, or give in to it. It's not about
fighting, winning or losing. It's about having good communication, working together,
mediating disputes and watching out for each other's interests. It's about developing the
best relationship you can have.
Patients ask me, "Does it really help to talk to my pain?" I tell them,
"How successful have you been trying to fight with it your way? Have you 'conquered'
it? Why not try it my way and see what happens? It's about 'rock turning.' When you turn
over rocks, what do you see? Some dirt, maybe a few bugs, and once in awhile, a treasure.
I can't promise you'll find a treasure if you turn over rocks, but I can promise that you
won't find a treasure if you don't try it."
Like any other relationship, the pain relationship is always enhanced by clear, honest,
direct communication. When patients are able to make their pain relationship more
positive, their tolerance to pain, and subsequent functionality is often dramatically
enhanced.
One patient visualized his lumbosacral pain as a swayback donkey with an aching back.
During his dialogue, the donkey said he had been carrying too heavy a load for too long a
time. The patient replied, "I can relate to that." This began an important
dialogue that led the patient to a rehab program that embraced a different attitude of
greater compassion for his back.
To learn more about Interactive Guided Imagerysm and how it can be used to facilitate
inner dialogue, contact the Academy for Guided Imagery at 800-726-2070 or
www.interactiveimagery.com. For further reading, I recommend my book, Free Yourself From
Pain (Awareness Press, 2000) and Guided Imagery for Self-Healing by Martin Rossman, MD
(H.J. Kramer-New World Library, 2000).
David E. Bresler, PhD, LAc, Dipl Ac, QME, is an associate clinical professor for
the UCLA School of Medicine and serves as executive director of The Bresler Center. He can
be reached at 30765 Pacific Coast Hwy., #355, Malibu, CA 90265.
— Jan/Feb 2001
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