Making Peace with Chronic Pain: A Whole-life Strategy

American Journal of Clinical Hypnosis,  Apr 2003  by Handel, Daniel L

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Making Peace with Chronic Pain: A Whole-life Strategy. Marlene E. Hunter. New York: Brunner / Mazel, Inc. (1996). 174 pages, $22.95 (paper). Reviewed by Daniel L. Handel, M.D., National Institutes of Health.

This concise book is, as its title implies, a treatise for patients with chronic pain on building a successful management strategy. In its brief 174 pages, it builds the case for understanding the nature of pain and identifying factors that precipitate or augment chronic pain. The book's basic tenet is that pain understood is pain more easily tamed and tolerated. In so doing, this text scores the choreography of "The Dance" of pain, intending to change both the players and the choreography. The author is a family physician who has led both the Canadian British Columbia Division of Clinical Hypnosis and the American Societies of Clinical Hypnosis, and who has a rich experience in treating patients with intractable pain problems. Dr. Hunter has authored two other hypnosis texts for the public, each written in a style similar to that found in this book.

Each of its eight clinical chapters briefly details its basic concept, which is often reinforced by case examples. The chapters range from 10 to 30 pages, averaging 18 pages. At the end of each chapter is a list of pertinent points, and a worksheet designed to make the reader an active participant in these lessons. Following these eight chapters is a brief but helpful final chapter, an important review of the research literature on chronic vain.

The first chapter defines the problem of pain. Pain is noted to be a "response" that, when chronic, intrudes into one's life. Hunter notes that pain has both a physiological (sensory) component and a suffering component. This emotional or psychological component has more to do with the meaning of the pain in the context of the sufferer's life experience. She also notes that pain invites dissociative experiences, in which the sufferer is less involved with their day-to-day world of experiences. The chapter ends with a discussion of pain relief techniques, including medication, thermal and positional techniques, and surgical interventions. Dr. Hunter then describes psychological techniques, aimed at the subconscious, that are more likely to relieve the suffering component of pain. These include ways to release muscle tension, dissociation and distraction through biofeedback or hypnotic techniques. Chronic pain syndrome is defined, and is noted to be where The Dance takes over.

Chapter Two defines the types of pain and furthers the choreographic metaphor. This involves people, factors, or situations that have relationships to one's pain-- whether to onset, maintenance, aggravation, or to its relief. This "relationship" enables one to view cause and effect relationships, as well as more subtle forms of manipulation of pain by other forces in one's life. The "Dance" expresses emotions, often anger or other negative emotions, in patients who cannot give language to those feelings. Dr. Hunter notes in this chapter the importance of exploring subconscious factors in the chronic pain patient. The worksheet at the conclusion of this chapter actually asks the participant to define the pain as a Dance, illuminating length of this dance and ways in which it has changed over time.

The next chapter directly analyzes the role of pain in the life of the patient- the purpose of the dance. It begins by noting simply that chronic pain becomes chronic, in part, because it has reason to remain in one's life. While seeming simplistic, this fact defines "the purpose of the Dance" as the communication that is the inherent function of the pain. She notes that this message varies, depending both in the type of sensory pain, and the context in which it is experienced. Dr. Hunter states that "the message varies depending on the type of pain one experiences: for acute pain, the message is help; for persistent pain, do something; and for chronic pain, I am suffering." (p. 38). She also emphasizes the importance of language in interpreting and modifying pain experiences.

Chapters Four through Six form the heart of the book, with Chapter Four identifying triggers to pain, Chapter Five naming the "pain players" in one's choreography of pain, and Chapter Six exploring ways of changing the dance in order to suffer less and function at a higher level. In Chapter Four, Dr. Hunter explores reasons, people, and situations that have any relationship to the pain. These become the dancers, the director(s) and the choreographer(s) Most obvious are those characters with significant relationships to the patient-family, friends, neighbors, coworkers, and others. Dr. Hunter then introduces the "interior troupe" of ego states who dance with this outer troupe in the choreography of pain. Several case examples drive these concepts home quite nicely. The chapter then outlines the likely "Inside Dancers", or ego states, and states that the director's role often falls to an Outside Dancer, while the choreographer role falls most often to an Inside Dancer. Again, the purpose is for the patient to identify the relationships between the inner and outer pain experience and the key players influencing one's life of pain.