Coping With Psychogenic Pain

In the fall of 1990, Robert Post reached into the refrigerator, heard a pop and felt a sharp pain in his right knee. Within six months, his shoulders, hips and back were also aching. The simple act of reaching for the mayo had ignited a chain of physical and psychological events that kept him prisoner in a cycle of pain that would last three years.

The 54-year-old professional comedian saw doctors, physical therapists and psychologists. He was twice tested for multiple sclerosis. But tests were negative, x-rays normal. He took medication, did rehab exercises, practiced yoga and meditated. Post did everything he could to fix the problem, but it only became worse.

He began compromising his posture to accommodate his shifting but persistent pain. He climbed stairs like a man decades older than he was.

Eventually, Post was forced to cut out some of the more demanding physical aspects of his performances. His friends stopped asking him to play golf, one of his favorite pastimes. But that was the least of his worries. “I was no longer thinking much about golf,” he says. “I was thinking, ‘Are they going to put me in a wheelchair?’”

Timely Encounter

Then, one day in 1991, Post was preparing to board a flight home to Ohio after a performance in Maine, but he was so wracked with pain that a friend suggested he take a later flight and get a massage. The massage therapist suggested he see Craig Williamson, MSOT, a Portland, Maine–based occupational therapist with a reputation for helping people find relief from chronic, mysterious pain.

Williamson, author of Muscular Retraining for Pain-Free Living, pioneered “somatic integration,” a form of therapy that includes hands-on techniques, corrective movement exercises, kinesthetic retraining, body-alignment education and psychophysical repatterning. Over the next two years, with Post commuting to appointments, the two developed a healing relationship that brought Post lasting pain relief.

The success of treatments like somatic integration, Rolfing and ortho-bionomy for treating chronic muscle pain can be traced to the notion that mind and body are connected, or that our emotions have physiological expressions and can “live” in our bodies.

Post eventually came to understand his pain as psychogenic, or psychosomatic. In other words, the tangible byproducts of suppressed emotions were causing his pain — and ridding himself of his pain’s tyranny meant learning to release and resolve, rather than ignore, those feelings.

What Is Psychogenic Pain?

Psychogenic pain does not refer to pain that is imaginary or “all in our head.” In fact, the pain triggered by emotional factors is no less real — or potentially debilitating — than pain caused by a bulging disk or a sprain.

All pain has certain psychogenic aspects. “Pain is the mind trying to get your attention. If emotional issues are repressed, they can manifest in the body as pain or illness,” says Deb Shapiro, author of Your Body Speaks Your Mind: Decoding the Emotional, Psychological and Spiritual Messages That Underlie Illness.

“Pain is the mind trying to get your attention. If emotional issues are repressed, they can manifest in the body as pain or illness.”

There is little argument that thoughts and feelings have physical consequences. Consider how sadness elicits tears. Or how fear or anger gets our heart racing. The biological and the emotional are closely linked through the autonomic nervous system (ANS), the body’s wiring for survival. This is the system that can inspire you to fight, flee or freeze with a quick infusion of cortisol, adrenaline, peptides and other very real chemicals.

Every emotional state or reaction carries its own biochemical and neuromuscular signature. But the ANS does not discriminate between the stress of daily life and that of an imminent physical threat. It sends stress signals throughout the body in either case. Over time, these stress chemicals can overload our systems, flipping on dormant genetic switches, causing illness, anxiety, depression or — you guessed it — physical pain.

John Sarno, MD, author of Healing Back Pain: The Mind-Body Connection, posits that emotions follow physiological pathways, causing constriction of arteries around muscles, joints and nerves. This constriction deprives specific areas of oxygen and can ignite our body’s pain receptors.

But by learning the language of the “body-mind,” says Shapiro, we can begin to decode the underlying messages and release the emotions and the physical pain.

Translating Pain

Because trauma and chronic stress reside in our bodies, traditional talk therapy does not always help alleviate pain or other physical manifestations of suppressed emotions. “You can talk and talk and talk and still not reach the limbic system,” says Maggie Scarf, author of Secrets, Lies, Betrayals: The Body/Mind Connection.

The limbic system is the area of the brain where emotions churn. It’s also involved in memory, which could explain why a Vietnam War veteran may feel anxious on a rainy, humid day. Memories of the jungle spark a physical response to something that happened long ago. “The body is always talking to you, but many people don’t know how to listen,” says Scarf.

“The body is always talking to you, but many people don’t know how to listen,” says Scarf.

The exact mechanism for alleviating psychogenic pain is not well understood, however. “Information enters the limbic system through different senses and experiences — physical, emotional and spiritual,” says Ron Tarrel, DO, director of the Neurocritical Care and Stroke Services Program at Abbott Northwestern Hospital in Minneapolis. “But there’s no one formula for successful treatment because psychogenic pain’s causes and manifestations are different in each individual. But we do know that certain treatments work for certain people.”

(See “How Movement Therapy Can Heal Traumatic Stress” to learn how movement therapy can offer hope.)

Window to the Mind

Williamson combined a variety of therapeutic approaches with Post: helping him identify and shift dysfunctional movement patterns; teaching him slow, mindful movements to help him tune in to the parts of his body that had become “mute”; and drawing his attention to the ways that stress created painful and destructive patterns in his body. “I realized that my pain is a signal to tap in to my emotions,” Post says.

By bringing consciousness to both physical and psychological expressions of stress, it’s possible to let go of the dysfunction that causes pain. A growing body of research shows that thought alone can alter the physical structure of the brain. Jon Kabat-Zinn, author of Full Catastrophe Living and founder of the Center for Mindfulness in Medicine, Health Care and Society at the University of Massachusetts in Worcester, discovered that regular mindfulness meditation reduces both the experience of pain and its inhibition on everyday activities.

Post still remembers the relief he felt when his pain began to lift. “It was the most extraordinary feeling: The pain finally began to go away,” says Post. “The first time I swung a golf club again, I felt like I was flying.”

How Do I Know If My Pain Is Psychogenic?

The following examples suggest a strong possibility that your pain is psychogenic, according to Craig Williamson, author of Muscular Retraining for Pain-Free Living:

• There is no evidence of a structural cause to the pain (that is, scans are negative or show negligible injury), and the pain is not affected by treatments that have been proven effective.
• Pain began at, or shortly after, a time of significant emotional stress.
• Pain occurs bilaterally. (That is, it exists in the same place on both sides of the body. For example, both shoulders, both hips, both elbows.)
• Your pain level increases and decreases from day to day, but you do not find that the intensity is connected to certain activities. It does not seem to respond to rest.
• You feel pain in an area that is habitually tense, even when you’re at rest.

6 Tips to Help With Psychogenic Pain

Craig Williamson, MSOT, a Portland, Maine–based occupational therapist, provides these tips for managing psychogenic pain.

1. When you feel pain, remind yourself that even though the pain is real, it is not an indication of damage or injury to your body.
2. When you feel pain, remind yourself that the physical is an expression of an uncomfortable emotion or disturbing thoughts of which you are not fully aware. Even if you cannot identify the precise emotion, remind yourself that you are open to becoming aware of any emotional feelings you may be suppressing.
3. Do not avoid physical activity because you are afraid it will hurt. But don’t “push through” the pain either.
4. Relax as you move.
5. Sit quietly for 10 minutes each day. Pay attention to what you are feeling. Keep a notebook to write it down.
6. Throughout the day, stop and take a few seconds to take note of notice your emotional state.

Psychogenic Pain Treatment Options

Below is a sampling of successful treatment options for psychogenic pain.

• Somatic Integration: Craig Williamson’s method of muscular retraining and therapy that combines corrective movement exercises, hands-on therapy, kinesthetic retraining, body-alignment education and psychophysical repatterning. www.somaticintegration.com
• Rolfing: A system of soft-tissue manipulation and movement training developed by Ida Rolf in the 1940s. Shown to relieve pain and chronic stress and create lasting changes in the body’s alignment. www.rolf.org
• Ortho-Bionomy: Working with the body rather than against it, practitioners use gentle, osteopathic-based touch to help reeducate the body to function efficiently, reduce pain and heal injuries. www.ortho-bionomy.org
• The Rosen Method Bodywork: Distinguished by gentle touch, Rosen Method practitioners use their hands to “listen” to chronic muscle tension to help guide clients to awareness of habitual tension. www.rosenmethod.org/#bodywork
• Mindfulness-Based Stress Reduction (MBSR): An easy-to-use meditation practice popularized by Jon Kabat-Zinn. Shown to reduce the perception of and limitations caused by chronic pain. www.umassmed.edu/content.aspx?id=41252
• Trager Approach: Utilizing gentle, nonintrusive, natural movements, the two-part Trager Approach helps release deep-seated physical and mental patterns and facilitates deep relaxation, increased physical mobility and mental clarity. www.trager.com
• Hellerwork Structural Integration: Joseph Heller developed this combination of deep-tissue structural bodywork, movement education and dialogue to explore feelings and thoughts. The three-pronged approach has found great success in alleviating pain. www.hellerwork.com
• Feldenkrais Method: A form of somatic integration that uses focused gentle movement to increase range of motion and flexibility. Movement sequences are said to bring clarity to a sense of self as attention is brought to movement. Ease of motion and alleviation of pain are among the benefits of this method. www.feldenkrais.com
• Alexander Technique: A combination of hands-on guidance and verbal instruction help students recognize habits of tension that interfere with good posture and efficient movement that can lead to pain. www.alexandertechnique.com and www.alexandercenter.com
• Gyrotonic: Combining principles of Kundalini yoga, swimming, gymnastics, tai chi and dance, this exercise system teaches the body to move in an integrated, graceful manner. Paying special attention to the healthy functioning of the spine, this three-dimensional and circular system strengthens the mind-body connection while it alleviates pain. www.gyrotonic.com

This article has been updated. It originally appeared as “Head Case” in the April 2008 issue of Experience Life.