The Pain Cure: The Proven Medical Program that Helps End Your Chronic Pain

Chapter 1

Why You Hurt

Pain is a more terrible Lord of mankind than even death itself. —Albert Schweitzer

Torture Victims

If you are in chronic pain, you probably feel alone and frightened. You may feel helpless. You might even feel as if life's no longer worth living. I understand. I understand completely. You have the worst medical problem a person can have.

Chronic pain is the most devastating physical malady that exists. It's even more overwhelming than having a terminal illness, according to patients of mine who have suffered from both conditions.

Being in pain, hour after hour, day after day, rips away your strength, your hope, your personality, and even your love.

Chronic pain is a demonic force that can destroy everything it touches.

But people are strong. I'm constantly amazed by their courage. When life knocks them down, they struggle back up. They do it again and again, all their lives.

If you're a pain patient who is reading this page right now, you must certainly be strong, because you're still trying to find a way out of your suffering. Despite everything, you still have hope. I salute your bravery. In my eyes, you're a hero.

But you can only stand so much, right? You're human: that's your blessing, but it's also your vulnerability. You probably suffered stoically for months or even years, but after a while your endurance gave out and the pain took over. Finally, you probably began to feel alone and helpless.

By now, you may even feel like a victim of torture. Researchers have found that torture victims and chronic pain patients endure a very similar experience—a horrific experience that can kill the will of even the strongest person.

Right now, you may be hoping that I'll say, "The good news is, I can help you."

It's true. I can help you. Your pain can probably be cured.

But I have even better news than that: You can help yourself. If you read this book carefully, and put its advice into your life, you'll no longer need me. Your own body has a healing force that will enable you to rise above your pain, and feel whole and happy once again.

When I tell this to my patients, some are thrilled—but others are disappointed. They want me to tell them that I'm the hot new medical pioneer with the miraculous new potion for their pain. That attitude is understandable, because modern medicine has packaged itself as a purveyor of technological miracles. Many of today's doctors enjoy being seen as latter-day sorcerers who can fix every ill with a magical pill.

That may be good marketing, but it's not good medicine—because it's just not true.

There is "magic" in medicine. But this magic—this almost supernatural force—won't come to you in a bottle. It will come to you when you do the honest hard work of tapping into your own inner resources.

When you do this, you will conquer your pain.

The human body performs the greatest miracles of modern medicine all by itself. As physicians, we will never be able to replicate the body's natural healing force. The body's own power lies far beyond the pale mimicry of human engineering.

Your body can heal the pain it now feels. When you cut your finger, you fully expect your body to heal the injury, don't you? You should not expect less of your body in its fight against pain. Your body's inner healing power is unimaginably strong.

Working with my patients—today's true medical pioneers—I have developed a comprehensive, proven program for chronic pain that gives them access to their own inner healing power. I believe that helping patients reach this power is the greatest thing a doctor can do.

About fifteen years ago, when I first began to develop this approach, it was considered very avant-garde. My pain program at the University of Arizona's teaching hospital in Phoenix was the first holistic pain management program in the southwestern United States.

Since then, though, many of the most prominent pain clinics in America have adopted the therapies I employ and have enjoyed superb results.

However, even though my approach has been accepted by many mainstream pain clinics, most of the individual physicians in America are still uninformed about this approach to pain, and therefore they often fail to cure pain. One reason they fail is that they do not address the role that the brain plays in pain. That's a big mistake. The brain helps start chronic pain—and the brain can help stop it.

If you read my first book, Brain Longevity: The Breakthrough Medical Program that Improves Your Mind and Memory, you know that I consider the brain one of the most amazing entities in the universe. In that book I showed that if the human brain is properly nurtured and medically supported, it can overcome terrible chronic conditions—even Alzheimer's disease.

In this book I will show you how your brain can help you cure your chronic pain.

Your brain, in fact, has virtually no limits, other than those you impose with your own human frailty.

I can show you ways to overcome that frailty. I can show you a path that will lead to your mastery over pain.

But it's up to you to walk that path. It won't be easy. But good things never are.

On this path, you'll have to give up many of the special indulgences that your pain may have granted you: a sedentary lifestyle, a sense of privilege, drugs that temporarily make you feel good, and the pity of others.

But all of your sacrifices will be repaid many times over. You will regain your sense of personal power, and your ability to control your own life. You'll once again have the energy to do the things you love, and to do things for the people you love. You'll even get reacquainted with a very special person: your own true self.

I have seen this happen many, many times. In fact, when patients work hard, it happens most of the time. I have helped cure many hundreds of "hopeless" cases of chronic pain.

I have been able to achieve "impossible" victories against pain for one central reason: my pain program has evolved far beyond the old-fashioned, traditional approach to pain. Unlike many doctors who treat pain, I don't rely on just pills, injections, and surgery. That limited approach, which I and many other doctors now consider outdated, often gives temporary relief but rarely stimulates the permanent healing of chronic pain.

My program is different. It battles chronic pain on every level: the biochemical level, the structural level, the psychological level, and the spiritual level. This thorough approach is absolutely essential—because if you have chronic pain it has probably invaded every part of your life.

To get your life back, to get your true self back, and to overcome the pain that has violated your body, mind, and spirit, you will need to engage in a comprehensive, coordinated program.

My program can be your path to recovery. It will oppose every possible aspect of your pain, and help you reach new heights of mental, physical, and spiritual well-being.

My program, as you will soon see, is unique. It still has components that are not yet commonly used by even the best pain clinics. For example, my program employs many advanced brain-enhancing modalities—some of which were described in Brain Longevity—that will give you the extra brain power you'll need to defeat your pain.

In addition, my program draws upon not only the very latest discoveries from modern technological medicine but also employs ancient healing methods that have withstood the test of time.

This combination of modern medicine and ancient healing is still not widely used in America, but it's incredibly potent. It will enable you to marshal your own healing power, and cure your pain.

If you're suffering now, it might be hard for you to imagine feeling whole and happy again. But that feeling—though deeply buried—already exists within you. It's waiting for you.

You can return to a life of feeling great. Others have. Others will.

Now it's your turn.

Let's begin!

Pain Is Not Suffering

Pain and suffering are different things.

Pain is a physical sensation. Suffering is one possible reaction to that sensation. But suffering is not the only possible reaction to pain.

It's possible to experience pain without suffering from it.

When you learn to experience pain without suffering, you will be set free. You will be able to love your life again, even though your life may still contain some pain, as all lives do.

When you reach this point, your chronic, disabling pain, for all practical purposes, will be cured.

In addition, when you achieve the ability to experience some pain without suffering from it, you will gain much more than just freedom from constant hurt. You will attain a power of mind and spirit that is rare in this world. Generally, this power is achieved only by enlightened yogic masters and by other people who are very spiritually evolved. Why just them? Because, as a rule, only they are motivated enough to do the hard work that creates this power.

But you have your pain for motivation, and pain is the most powerful motivator of all. Your pain may now be a curse, but when you learn to harness it as a motivator, you will transform your curse into a blessing.

I remember once telling an elderly arthritis patient that his pain need not cause suffering, and he blew up at me. "That's easy for you to say," he snapped, waving a gnarled finger in my face, "but if your hand hurt like this hand hurts, I don't think you'd say that. You don't know how this feels!"

"I don't know how you feel," I told the elderly man, "but I do want to help you, and I think I can. So let's start right now. I'd like you to imagine a hypothetical situation. Let's say you're a kid again, and you're attending a very strict, old-fashioned school. Imagine that you have a mean teacher who constantly singles you out for punishment. One day he asks you a question, and you give the wrong answer. So he stands you in front of the class, makes you hold out your hand, and slaps your palm with a ruler. Smack! It really stings! On this day he dishes out the punishment again and again, and you're powerless to stop it. Pretty soon you're so depressed and angry that when lunchtime comes, you don't even feel like eating your lunch or playing with your buddies. All you can think about is how much your hand is throbbing, and the more you think about it, the more it hurts. You're really suffering.

"Finally, you're saved by the bell—school's out. You go to your Little League baseball game, but you don't even feel like playing. You do play, though, because you're a tough little kid who won't give up.

"You're the catcher. You're a good catcher, the only one who can handle your team's best fastball pitcher. The first time he zings one in, though, your poor hand feels like it's going to explode. But the batter is way behind the pitch and he strikes out. Everybody cheers. So you keep calling for fastballs, and you start to dominate the hitters. Three up, three down! Boom, boom, boom! You could call for some curves or change-ups—to give your hand a break—but your pitcher's fastball is really hopping, so you stick with the hard stuff. Pretty soon you own the batters, and you feel great. Every time the ball slaps into your mitt, you feel like a hero. You're not thinking about your hand anymore, or your teacher, or anything except how good it feels to be in the game. You love the cheers from the crowd, and the smell of the grass, and the friendship of your teammates. Nothing else exists.

"Finally, last out. Game's over. Your coach comes over and pats you on the back. He says, 'Great game! How's your catching hand?' You tell him it's fine, but when you pull off your mitt, your hand looks like a pink balloon. Your coach says, 'Better put some ice on that.' You tell him you will, but then you start playing a pickup game with your buddies. Your hand is hot and sore. But you want to keep playing. You have pain, but you're not suffering."

The elderly arthritis patient nodded. He got my point, and looked encouraged. He was a strong man, and that was good, because he was in for the fight of his life.

"My pain program," I told him, "can help you feel good enough to get back in the game, so to speak. Then your own spirit is going to take over. And when that happens, I don't think anything is going to stop you."

"What will happen if I don't get back into the swing of things?" he asked.

"If you don't, you'll continue to suffer. It might get worse."

I was understating. In fact, if he didn't get back into a proactive, take-charge lifestyle, he would probably fall victim to the worst nightmare that pain patients face: chronic pain syndrome.

Chronic Pain Syndrome:
Your Worst Nightmare

Chronic pain syndrome is the terrible force that turns chronic pain into constant suffering. It is the biggest threat pain patients face.

Chronic pain syndrome is a group of physical and mental characteristics that often accompany chronic pain. It consists of negative behaviors and attitudes that gradually pull pain patients away from their lives, into a ceaseless whirlpool of pain.

Chronic pain syndrome is highly destructive, in and of itself. It also greatly magnifies the physical sensation of pain.

To find out if you have chronic pain syndrome, complete the following questionnaire.
Do you have chronic pain syndrome?

1. I've had persistent pain for at least three months, despite my doctor's treatment. T F
2. I frequently act as if I'm in pain, by groaning, crying, wincing, or massaging the area that hurts. T F
3. I'm not physically able to do as many things as I was before my pain started. T F
4. I'm not as interested in my hobbies as I was before my pain began. T F
5. I often feel very depressed, or have considerable anxiety. T F
6. My nutritional habits have deteriorated. I either have no appetite, or I eat too many "fun foods" to make myself feel better. T F
7. People don't seem to enjoy my company as much as they did before my pain began. T F
8. It often takes real willpower for me to control my irritability. T F
9. My pain interferes with my work at some point during almost every day. T F
10. I'm frequently tired. T F
11. My medication is my most powerful weapon against pain. T F
12. My pain often interferes with my ability to concentrate. T F
13. I wish I could take better care of the people in my family, but it's hard enough for me just to take care of myself. T F
14. My sleeping patterns are often disrupted by pain. T F
15. My nerves are so touchy that I tend to overreact to minor things, such as sudden loud noises. T F
16. I've gone from doctor to doctor, looking for someone who can help. T F
17. When I have an important day coming up, I worry that my pain will interfere.
18. I've lost the feeling of control over my life. T F
19. I've begun to feel that my life has been ruined by my pain. T F
20. I spend more time thinking about my pain than any other single aspect of my life.

If you answered "true" to only questions one, two, and three, you are suffering from chronic pain, but not from chronic pain syndrome. If that's the case, you are a person of unusual courage and wisdom.

If you answered "true" to at least ten of the twenty questions, you have moderate chronic pain syndrome. If you answered "true" to fifteen questions, you have advanced chronic pain syndrome. If you answered "true" to eighteen or more questions, you have severe chronic pain syndrome.

If you have any degree of chronic pain syndrome, you will almost certainly need help to overcome it. I can provide much of that help with this book.

You probably developed chronic pain syndrome gradually. When you first began to suffer from chronic pain, you may have consciously chosen to adopt some of the chronic pain syndrome behaviors, thinking that they would spare you further pain. For example, you might have decided to limit your involvement with your work or hobbies, to save your energy, and to save yourself from extra pain.

But most of the syndrome's characteristics probably invaded your life against your will. You didn't choose to become depressed, irritable, or tired. It just happened, because of your pain's biological and psychological impact.

One of the awful things about chronic pain syndrome is that it makes the physical feeling of pain much more intense. It increases the brain's perception of pain. Just one example: Arthritis patients who suffer from depression are approximately twice as sensitive to painful stimuli as nondepressed arthritis patients.

Thus, chronic pain syndrome—which is caused by pain—also causes further pain. It contributes to a physical phenomenon called the "cycle of pain," which haunts the lives of many pain patients.

To break this insidious cycle, you will need to follow a careful, constructive program, such as the one I describe in this book. It's up to you to actively implement this program in your own life, and to defeat chronic pain syndrome (which is also called "Pain Disorder with Psychological Features").

There are many elements in my pain program that intervene in the cycle of pain, and you can start the program by engaging in almost any of them.

My pain program consists of four fundamental treatment modalities, or levels. Each of them helps break the cycle of pain and eliminate chronic pain syndrome.

The four levels are: (1) Nutritional Therapy (including dietary modification, and ingestion of specific nutrients); (2) Physical Therapies (including exercise therapy, acupuncture, massage, light therapy, magnetherapy, chiropractic, and advanced yogic mind-body exercises); (3) Medication (including use of pain medications, nerve blocks, injections, and brain-enhancement medications); and (4) Mental and Spiritual Pain Control (including stress reduction, treatment of anxiety and depression, psychological therapies, and spiritual development).

The vast majority of the pain patients I have treated over the past fifteen years have reported a dramatic reduction in the pain that created their chronic pain syndrome. Their pain diminished to the point where it was no longer a significant element in their lives. Many of them still had occasional pain, as all people do, but their debilitating chronic pain, and the suffering it caused, was cured.

In many other patients the pain disappeared entirely.

In some cases this disappearance of pain occurred because of the successful treatment of the neurological problems that were perpetuating the cycle of pain.

In other cases, though, the pain disappeared because the underlying problems that caused the pain were eliminated. For example, I have treated arthritis patients whose pain vanished because their arthritis went into remission. This type of occurrence is very rare among patients of conventional "allopathic" (or anti-disease) medicine, because allopathic medicine is generally ineffective at reversing long-standing degenerative diseases, such as arthritis. However, the form of medicine that I practice is not solely anti-disease, but is also strongly pro-health. It stimulates the body's own natural healing force. This form of medicine combines conventional Western medicine with Eastern medicine, and is known as "complementary medicine" or, as I now prefer to call it, "integrative medicine."

Integrative medicine can be quite effective against degenerative diseases. A slowly developing degenerative disease is often caused by mistakes in lifestyle; when those mistakes are corrected by integrative medicine, the patient's body is often able to overcome the disease.

One of the simplest examples of this is the elimination of low back pain caused by obesity. When the patient sheds his or her extra pounds through an integrative medicine program that includes nutritional therapy and exercise therapy, the pain often vanishes. However, if the obesity is not corrected, conventional allopathic treatment generally fails.

As you can see, integrative medicine is not always magical or mysterious. Often it's just a good commonsense treatment.

Even if a patient's pain cannot be totally eradicated, though, the patient can still break the cycle of pain, overcome chronic pain syndrome, and begin to feel great. If you doubt that someone who experiences frequent pain can still feel great, consider the lives of professional athletes. Most pro basketball players, for example, feel an assortment of serious pains virtually every day, owing to the extreme rigor of their sport. As a matter of fact, when Michael Jordan first retired from basketball to play baseball, he cited pain as a major factor in his decision, noting that he was "tired of hurting all the time." And yet, Michael Jordan—despite his pain—had remarked throughout his career that he felt great on most of the days of his life. He was almost always able to rise above his pain and do what he loved to do. He loved it so much that he quickly ended his retirement, even though he knew he was returning to a life of daily pain. Like many people, including many of my own patients, he was master of his pain instead of its victim.

I recall clearly one patient of mine who was never able to totally eradicate his pain, but who still managed to reduce it dramatically, turn his life around, and feel great. The first time I saw him, though, I didn't feel very hopeful. The poor guy was really suffering. He was so overcome by chronic pain syndrome that I hardly knew where to begin.

Scott's Story

His name was Scott, and as he began to tell me his story, there was venom in his voice. Pure hatred. He said he hated his doctor. But I could see he hated life itself. Considering the life he was living, I could hardly blame him.

Every day he was being tortured. It lasted for hours and left him sick, weak, afraid, and hateful.

The source of his torture was a chronic disease called polymyositis, a widespread inflammation of the muscles that causes excruciating pain. Scott's doctor had told him that he would escape his torture only through death.

Scott hunched uncomfortably in a chair in my office, leaning slightly forward, his fingers clenched white, as he told me his story.

"Last time I saw my doctor, this doc said to me, 'You're dying, you know.' I said, 'Oh, thanks for telling me.'" Scott's face flushed with anger. He felt betrayed—by his own body, by the doctors he'd once trusted, and even by God. "So this doctor looks down his nose at me and says, 'What do you want me to do?'

"I said, 'That's what I'm supposed to ask you.'" Scott sighed and slumped. "I'm in bad shape," he said simply. "Look at my face." It was red, fat with water, and pitted with acne caused by the anti-inflammatory steroids he was taking. "My back is so thick with acne that I can't even lean back in this chair," he said. Scott was in his mid-forties, but he looked much older. He was withered, frail, and weak. His eyes were hollow with depression.

"The last thing this . . . esteemed physician . . . said to me was, 'Scott! Look at everything you've got in your life that's good. Your wife. Your kids. Your friends. Your work. The only bad thing you've got is your pain. Focus on the good.' I almost laughed out loud. But laughing hurts, too.

"So I said, 'The only bad thing, huh? The only thing? Okay, how about this? My wife can't stand me anymore, because all I do is bitch and moan. My kids are scared to death of me. My friends? What friends? To them, I'm the Elephant Man. My work, now that's funny. I've got no career left. I can't even think straight. The only job I've got now is fighting with my insurance company. I'm always tired, but I can't sleep. Food makes me sick, because of all the pills I'm taking. Forget about sex. Forget about fun. Oh yeah, I almost forgot—I'm also in agony all the time.'

He looked for a moment as if he would cry, then his face went cold. He hunched further forward, and his eyes froze into a thousand-yard stare.

Scott's responses clearly indicated that he suffered from intense chronic pain and severe chronic pain syndrome.

I looked him straight in the eye.

"I can help stop your suffering," I told him, "but you're going to have to work like an athlete training for the Olympics. Can you afford to make that commitment?"

"I can't afford not to,"he said.

"Good!" I liked this guy. He was a fighter. "Then let's begin where I always begin. With a goal. What do you most hope to achieve?"

Scott had apparently given this a great deal of thought, and he answered quickly. "My doctor told me that pretty soon I'm going to be in a wheelchair, and that then I'll contract pneumonia and die, because the muscles that support my breathing will fail.

"If I die,"he said, "I want to die on my terms. Which means no more drugs. I hate this damn stuff they're giving me. It makes my skin crawl. Can you get me off all these drugs? Even the pain medications?"

"You're not taking any pain medications."

"What about the tranquilizers? My doctor said they killed pain."

"They really don't."

Scott looked exasperated. "Then why would he tell me that?"

"Most people,"I said, "don't really understand how pain works. Unfortunately, that includes many doctors."

I began to explain the physiology of pain to Scott. He listened intently—like an athlete listening to his coach.

How Pain Works

I had some wonderful news for Scott. The crux of it was this: Pain travels along a complex pathway in the nervous system, and all along that pathway—in the nerves and in the brain—there are biological "gates"that can be closed, to shut off pain.

When these biological gates are closed, the pain is reduced or eliminated.

This concept is called the "gate theory,"and it has revolutionized the field of pain management. I am proud to say that I was among the first doctors to clinically incorporate holistic modalities utilizing this theory into my treatment of pain patients.

This theory is now becoming increasingly accepted by pain specialists, but it's still relatively new. Therefore, many doctors who do not specialize in pain management don't really understand it, and don't incorporate it into their treatments of pain. Because of this, their treatments often fail.

In fact, many doctors don't even fully understand what chronic pain is. Some of them think that chronic pain is basically the same thing as short-term "acute" pain. They believe that chronic pain is just acute pain that lasts longer.

That's not true.

Chronic pain and acute pain are vastly different. Short-term acute pain is almost always a symptom. It's a warning that something is wrong. When you fix whatever is wrong, the pain usually goes away.

But chronic pain is generally not a symptom. Most often it is not a warning that something is wrong. For the most part, chronic pain is a disease. Most chronic pain is caused by a malfunction of the nervous system—the nerves and the brain. To a large extent, chronic pain is in the brain.

I explained this to Scott but assured him that it did not mean his pain was "all in his mind. Much of his pain was in his brain, but his brain was much more than just his mind. His brain didn't just think—it also governed every function of his body, including the processing of all his pain signals.

Processing pain signals is a very complicated task, and sometimes our brains make mistakes in this process, just as they do when we add numbers or play the piano.

But those mistakes can usually be corrected.

In Scott's case, I believed that only part of his pain was caused by the ongoing damage from his illness. The rest of it—probably most of his pain—was being caused by malfunctions of his nervous system.

Therefore, I believed that if I could correct those malfunctions, and close his pain gates, I could relieve his suffering.

During his previous treatment, his doctor had ignored these pain gates, and the results had been disastrous.

When all of the gates in the nervous system's pain pathway are allowed to remain wide open, pain can begin to "circulate" in a ceaseless cycle.

This cycle begins at the original site of the pain, generally because of an injury or illness. Then pain travels up the spinal cord to the brain. The brain processes the pain signals, then sends nerve impulses back down the spinal cord, to the original site of the pain, sensitizing that area, and causing inflammation. This sensitization and inflammation help protect the damaged area, by forcing us to favor it, and it also rushes healing chemicals to the area. But it magnifies the pain, and even creates more pain. This new pain then travels back to the brain&3151;and the cycle begins again.

The pain impulses can literally begin to have "a life of their own," as pain itself continues to cause more pain.

As I've mentioned, this cycle of pain can be reinforced by many of the elements of chronic pain syndrome. Some of these elements tend to jam open the gates of the pain pathway and to magnify the sensations of pain.

Also, chronic pain syndrome often makes pain patients feel passive and defeated, and discourages them from doing the many things they must do to make their pain go away.

Now let's take a trip along the pain pathway, and I'll point out all the various gates where pain can be reduced, blocked, and eliminated.

Then, later in this chapter, I'll tell you about my pain program and show you how to close those gates.

A Journey down the Pain Pathway

A pain impulse usually starts its trip along the pain pathway when you suffer an injury or illness. Let's say you cut your finger.

Have you ever noticed that when you cut yourself, you usually feel the sensation of the cut before you feel the pain from it? That happens because you have separate nerves for touch and for pain—and the "touch" nerves send signals more quickly than the pain nerves. That's why you feel the cut before the pain.

Your fast "touch" nerves shoot signals toward your brain at about 200 miles per hour, while your pain nerves send signals to your brain at a relatively slow speed. Acute pain travels at only about 40 miles per hour, and chronic pain can travel as slowly as 3 miles per hour. This difference in speed occurs mostly because "touch" nerves are generally better insulated.

Whenever you injure your finger, you tend to grab it and squeeze it or rub it, don't you? That's a natural instinct. You do that because it decreases your pain. The reason it decreases your pain is that it shoots fast "touch" signals toward your pain gates, and those fast touch signals outrun the slow pain signals. By the time the pain signals arrive, your pain gates are already crowded with touch impulses, and the pain signals have a hard time squeezing through.

So already you know an excellent anti-pain strategy: Give your nervous system a competing source of input—especially one that can "outrun" pain signals.

There are many ways to provide a competing source of input, other than just rubbing a painful area. This can also be done biochemically, mechanically, electrically—and even with thoughts! Soon you'll know every strategy that exists.

One obvious lesson from this is: Don't be macho by trying to just ignore the pain when you first get hurt. Go after it! Beat it! It bothers me when I'm watching a baseball game and the batter gets hit by a pitch and just stands there, not rubbing the injured area, because that would "give the other team satisfaction." That appeals to the athlete in me—but not the pain specialist. As you'll soon see, once pain gets started, it can be hard to stop. However, if you take care of your short-term, acute pain right away, you can reduce the chance that it will become a long-standing chronic pain.

Now let's keep traveling along your pain pathway and discover more ways to stop pain.

When pain signals squeeze onto the "elevator" of your spinal cord, headed for your brain, they automatically trigger the release of several chemicals that help them travel to the brain. These chemicals, called neurotransmitters, are the biochemical messengers that carry pain signals from one nerve cell to the next. Your brain, as you probably know, also uses neurotransmitters to carry all of your thoughts and feelings.

The three primary neurotransmitters that "ship" pain signals to the brain are substance P, NMDA (n-methyl-d-aspartate), and glutamate. Of these, substance P seems to be the most active, and most important. Without these three substances—especially substance P—pain signals have a much harder time reaching the brain. However, if there is an excess of any of these three substances, pain signals have a much easier time reaching the brain.

So, again, we have another way to stop pain: by manipulating the levels of one or more of these neurotransmitters. This can be done in several ways. One way is with pharmaceutical and over-the-counter drugs, and another is with acupuncture. When you learn the details of my pain program, you'll learn all the ways.

Here's more good news: The body, in its natural, innate wisdom, has its own way of keeping these pain neurotransmitters from flooding the brain, and overwhelming us with pain. The body forces these pain chemicals to travel through a pain gate that sits near the back of the spinal cord. This pain gate is composed of a substance that has the consistency of jelly; it's called the substantia gelatinosa of the dorsal horn.

Thus we have yet another method of controlling pain: supporting the function of this gate. This is achieved by supporting the overall health of the nervous system. If the nervous system is exhausted, stressed, or nutritionally malnourished, this gate will lose its efficiency.

Thus, the better your nervous system functions, the higher your "pain threshold" will be. That's one reason, for example, why you feel more pain when you don't get enough sleep: your lack of sleep hampers the ability of your nervous system to close its pain gates.

However, no matter how well your pain gates are working, some pain signals are certain to reach your brain. This is natural and desirable, of course, because without pain we would constantly be in grave danger of injury.

When pain hits the brain, that's when your body and mind really go to war against it—if your body and mind are working efficiently, and in proper coordination with each other.

So far, you've just been "playing defense" against pain. But when your brain receives the first pain signals, and realizes that your body is fighting its most vicious enemy, your brain starts to "play offense." It launches a counterattack!

In the next few pages I'll tell you how to make that counterattack fierce.

Counterattack!

Pain signals enter your brain in an area called the thalamus. The thalamus is where your brain "sorts out" most of its incoming physical signals. For example, besides dealing with pain, your thalamus also handles things like hunger and thirst.

Instantly, your thalamus sends the pain signal to the two most important parts of your brain—your cortex, which does your thinking, and your limbic system, which governs your emotions.

When this happens, your thinking brain and your emotional brain have a dialogue, in which they "compare notes" on the pain signal. They try to decide how serious the pain is, where it's located, what it means, and how to deal with it. They analyze how strong the pain signals are, how frequently they're being sent to the brain, and how long the signals have lasted.

If, during this dialogue, your cortex and limbic system decide the pain signals aren't very serious, they tell your body to relax and tell your neurotransmitter system to pump out a calming brain chemical called serotonin. This causes the nerves that first picked up the pain signal to "quiet down," and it causes the muscles around the injured area to relax. Also, your blood vessels—which had been constricted by alarm—begin to loosen up. Your body soon returns to its normal state. The acute pain soon subsides, and you feel fine again.

However, let's say that when you cut your finger, it really hurts, the cut looks deep, and blood is gushing out. Your cortex and limbic system scan your memory, and they don't like what they find. Your memory says, "This is the worst cut you've had in years. It's bound to hurt, and if you're not careful, the finger will get infected. "When your cortex and limbic system hear this, they start yelling, "Red alert! Red alert! We've got a problem!"

The all-out counterattack begins!

Instead of telling your neurotransmitter system to pump out calming neurotransmitters, your cortex and limbic system put in an order for the stimulating neurotransmitter norepinephrine, which is a form of adrenaline. This always happens when your body is under assault. Suddenly you begin to experience the classic symptoms of the "fight-or-flight response," which is also called the "stress response." Your blood vessels constrict, your heart pounds, your muscles tighten, and your nerves go "on edge," as they wait for further problems.

This is when things can go very wrong. This is when chronic pain can begin. If your counterattack doesn't work properly, you can end up with chronic pain. Your counterattack has to be strong, but not too strong. If it's not strong enough, or if it's too strong, it can contribute to the neurological malfunctions that create chronic pain.

One thing your counterattack must accomplish is the creation of a reasonable balance between the production of calming serotonin and stimulating norepinephrine. When you're alarmed, your body badly needs serotonin to help calm down, and to begin to close some of the pain gates. Unfortunately, the more alarmed you become, the more those gates are likely to open up, and to even "jam open" indefinitely.

Soon, though, I'll show you how to create abundant supplies of serotonin, so that when you need it, you'll have it.

Another problem that can arise at this point, as mentioned before, is sensitization of the injured area. When pain registers in the brain, the brain begins to closely monitor the injured area, via the nervous system, as part of its counterattack. The nerves around the injured area become more sensitive. They can even start carrying pain signals from stimuli that normally wouldn't cause pain. For example, the skin around your cut finger might hurt when you touch it, even though it's not injured.

Sometimes pain signals can even "jump" bioelectrically from one pain-carrying nerve to a neighboring pain nerve that had previously been free of stimulation. When this happens, it increases the amount of pain headed toward the brain. And when the brain receives these new signals, it sensitizes the injured area even more, contributing to the cycle of pain.

However, the more you nurture your nervous system, with a comprehensive program that builds neurological strength, the less likely this will be to occur. One simple reason why: As your nervous system becomes healthier, the sheaths that insulate your nerves will grow thicker, and help prevent these neurological "leaks."

Another "big gun" in your counterattack against pain is the production of your body's own natural, morphinelike opiates—endorphins, dynorphins, and enkephalins. These substances are ten times stronger than morphine. However, you never build up tolerance to them as you do to drugs.

These natural opioids not only flood the brain—giving physical and psychological relief—but also travel to one of the pain gates in your spine. There they directly "battle" pain-carrying substance P, trying to keep substance P from entering the nerves that go to the brain.

Sometimes you have enough endorphins to overpower your substance P, and stop the pain signals that are trying to get to your brain. But sometimes you don't have enough. When that happens, pain has one less obstacle to overcome.

As you might imagine, though, there are ways to increase your output of endorphins. For example, you can do it with exercise. However, exercise is often avoided by people with chronic pain syndrome. That's a mistake—one you will need to correct to end your chronic pain.

If you don't produce enough endorphins, or enough serotonin, your pain signals begin to increase in intensity, frequency, and duration. When this happens, the signals themselves often "jam open" the pain gates.

Then pain travels freely from the injured area to the brain, and back again.

As this happens repeatedly—millions of times per hour—pain signals become "engraved" upon the nervous system. Pain signals literally become a physical part of the anatomy of your nervous system, just like the memories that are engraved in your brain.

As your injury heals, this engraved pain can remain. It no longer requires the stimuli of the injury. Tragically, it now has a life of its own. When this happens, the pain is not a symptom, it's a disease.

How Healing Can Hurt

Now let me tell you about another problem you face.

As the brain carries out its counterattack against pain, it also launches a counterattack against the injury itself. This counterattack is commonly referred to as the healing process. Unfortunately, the healing process can also contribute to the disease of chronic pain.

One way that healing contributes to pain is through the process of inflammation.

Inflammation is a natural part of your body's response to injury. However, inflammation can get out of control. When it does, it can cause great pain.

Inflammation starts when the brain sends "alarm signals" back down to the injured area. Those signals cause increased blood flow to the area, as your body tries to fight infection and repair damage. But some of this extra blood leaks out of its vessels and causes swelling, soreness, stiffness, and warmth. This blood also releases potent chemicals that make the area even more sensitive.

Normally, inflammation goes away when the injury heals. But when pain becomes engraved upon the nervous system, inflammation can remain. At this point it serves no purpose—it just hurts. It's no longer a symptom—it's a disease.

Inflammation is the major culprit in many kinds of pain.

However, there are many effective ways to fight inflammation. You can use anti-inflammatory drugs, such as ibuprofen, or certain nutrients. You can even stop inflammation before it starts, with nutritional therapy. I'll tell you how to do that in the next chapter.

Another way that the healing process causes pain is by creating muscle spasms. A muscle spasm starts out as a natural protective mechanism; it shields a distressed area by immobilizing it. In a way, it's like a plaster cast, or a splint.

Muscle spasms begin when your body experiences pain. When this happens, the body often contracts the muscles near the painful area. Frequently, though, those muscles remain tight, or in spasm. Part of the reason a muscle stays tight is that the spasm itself often hurts. Therefore, it's very easy to create a cycle of pain-spasm-pain-spasm.

If these spasms are ignored, they can become virtually permanent. Muscle tissues can even become, in effect, "glued" together.

Sometimes, ongoing muscle spasms are quite noticeable, and cause great pain. This often occurs in chronic musculoskeletal pain, including back pain and neck pain. At other times, however, the muscle spasms are subtle, and are confined to a very small area. These less noticeable muscle spasms can be insidious, though. One problem they often cause is "referred pain"—pain that exists in a location other than the immediate area of the spasm. For example, a small muscle spasm in the neck can cause a severe headache.

Fortunately, though, there are a number of ways to get rid of these spasms. One of the best ways is with massage, which I'll describe in chapter 3.

A third way that the healing process causes pain is when damaged pain nerves heal improperly.

When damaged pain nerves heal and regrow, they often do so imperfectly, and begin to fire spontaneously, sending pain signals to the brain for no reason at all.

Frequently the victims of imperfect nerve regrowth get blamed for "making up" their pain, because they no longer have an obvious injury. Often, even their own doctors tell them that their pain is all in their minds. The victims get treated as if they were just neurotic, or cowardly. How unfair! And how stupid!

In fact, there is one very obvious example of this kind of pain: phantom limb pain. Up to 85 percent of all amputees feel pain that seems to come from their missing limbs. In some types of amputations, more than one-third of all patients feel severe pain. This pain results, in part, from the improper healing of severed nerves.

However, poor healing of severed nerves isn't the only cause of phantom limb pain. Phantom limb pain is also often caused by the pain that often preceded the surgery—the pain from the injury or illness that necessitated the surgery. This pain, if it becomes engraved upon the nervous system, can continue to exist even after the original source of the pain has been surgically removed, with no significant damage to nerves.

Here's another interesting illustration of the fact that pain can become engraved upon the nervous system, including the brain itself. Sometimes paralyzed people feel pain in the parts of their bodies that can no longer move, and that no longer respond to external stimuli. When this happens, doctors sometimes partly sever the patients' spinal cords, to relieve their pain. Occasionally, though, even this does not stop the pain. Unfortunately for the paralyzed people, their pain is no longer in their bodies. It's in their brains.

I'll give you one more really fascinating example that indicates that chronic pain can become "centralized" in the brain. As you may have heard, it's possible to make people have vivid memories of past events just by stimulating different areas of people's brains with electrodes. When this happens, memories often come flooding back with crystal clarity. Knowing about this phenomenon, pain researchers tried to evoke pain in test subjects by electrically stimulating the area of their brains that first receives pain signals—the thalamus. However, researchers found that subjects with no history of chronic pain were not affected by stimulation of the thalamus. But when researchers stimulated this area of the brain in chronic pain patients, the patients felt intense pain. For example, one patient who had formerly experienced the chest pain of angina pectoris reported terrible pain in her chest when her thalamus was stimulated.

Thus, this angina patient discovered that, for her—as with other chronic pain patients—pain is in the brain.

The Brain Can Stop Pain

As I've indicated, one of the best ways to stop pain is simply to increase the power of the brain. This simple principle was portrayed dramatically to me shortly after the publication of my first book, Brain Longevity. In that book, I told readers how to optimize their brain power—but I said almost nothing in it about using the brain to defeat pain. Nonetheless, please note the following exchange of letters.

August 20, 1998
Hartford, CT
Dear Dr. Khalsa,

I have recently finished reading your book Brain Longevity. It has given me some hope. Recently I was diagnosed as having a form of dystonia called spasmodic torticollis, a condition that causes severe twisting of the neck, and great pain.

I was given two injections of botulinum toxin, which failed to make a difference. My neurologist has now put me on Tetrabenazine, which also does not seem to be helping. I am 38 years old, very active, and have two daughters. My neurologist has given me these medications—the only ones available to help me. A cure is not known.

I have started your brain longevity program. It seems to my unscientific mind that it makes sense to try to improve the working order of my brain. The nutritional side is something I can easily handle, but exercise is difficult, since I can't hold my head straight.

Anyway, I am forging ahead, and would love to hear if you think I have any real chance of helping my condition.

Sincerely,
J.M.

I wrote back to this woman—who had a severe neurological disease that is generally unresponsive to treatment—encouraging her to persevere with her brain longevity program. I recommended that she do mind/body exercises and see an acupuncturist, in addition to following a comprehensive program that boosts the power of the brain.

A few months later I received another letter from her.

October 19, 1998
Hartford, CT
Dear Dr. Khalsa,

All of my symptoms are gone! My neurologist had given up on me when the drugs didn't have any effect. I then decided to work on my own, in a holistic mode. I have been successful, and my inspiration came from you. Thank you very much. I continue to take all of the vitamins and supplements you suggested. I also continue with my mind/body exercises, meditation, yoga, good nutrition, and exercise.

Thank you again.
Sincerely,
J.M.

This case clearly illustrates that the brain can have a profound effect upon a supposedly intractable pain condition—even in the absence of a full-fledged pain program.

Furthermore, when the power of the brain is allied with the power of the body, and the power of the spirit—in a comprehensive pain program—almost anything is possible!

Now you have a basic understanding of how pain works, and how chronic pain can begin.

Therefore, you already understand—probably better than some doctors do—why the traits of chronic pain syndrome are so devastating to people with chronic pain.

As you'll recall, chronic pain syndrome is characterized by physical inactivity, inadequate sleep, depression, poor nutrition, fear, anxiety, reliance on medications, and mental lethargy. As you now know, these traits are almost certain to lock in—and amplify—pain signals that have become engraved upon the nervous system.

If you are now suffering from chronic pain, I can certainly see why you might have fallen victim to these traits. After all, pain wears you down, and eats away at your strength and your zest for life.

But now that you have a better grasp of how chronic pain gets started, and keeps going, you can probably see that these characteristics of chronic pain syndrome are literally poison for the nervous system. They reduce the natural ability of the nervous system to resist pain. And they allow the brain to focus on pain, and thereby increase the intensity and frequency of pain signals. Besides being "poisonous" to the nervous system, these characteristics also rob life of its most basic sources of joy: the pleasure of play, the satisfaction of work, and the love of other people.

This loss of joy is not only horrible in itself, but it, too, contributes to the cycle of pain. The less joy, satisfaction, and love you feel, the more you will indulge in harmful habits, and the more you'll focus on the only thing that's left in your life: pain.

The end result is suffering.

If you have been suffering for a long time, you may have come to believe that your only escape from suffering will be through death.

That's what my patient Scott thought. But he was wrong.

Scott Fights Back

As I described the physiology of chronic pain to Scott, we talked about the particular cause of his own pain.

His immune system, for unknown reasons, had turned against his own body, in an "autoimmune" disorder; it was destroying his muscles, and causing him terrible pain. Shortly after his disease had begun, the pain from his muscle deterioration had become engraved upon his nervous system. It had caused him to suffer almost constant, knifelike jabs of pain. His muscles were disintegrating. He was very thin.

Scott was adamant, though, about discontinuing the use of his medications, including prednisone, a steroid that depresses the immune system and slows the autoimmune attack. He loathed prednisone's side effects of acne, bloating, insomnia, and emotional agitation. He hated these side effects as much as he hated his pain.

But if he did stop taking prednisone, a specialist had told him, the disease might intensify, and cause even more agony.

It might also kill him sooner than expected. I asked him how he felt about that, during our first meeting.

"I'll take that chance," he said. His eyes looked watery and regretful. His skin was the color of skim milk, and his body seemed to be a shriveled version of what it once had been. He looked physically and emotionally exhausted.

"How is your doctor monitoring the progress of your disease?" I asked.

"A nurse comes to my house and checks my CPK levels," he said. He was talking about his levels of a chemical called creatine phosphokinase, an enzyme that breaks down muscle tissue. The higher the levels got, the closer he would be to death. "My nurse is part of the hospice program," he said sadly. The hospice program was an in-home service for terminal patients who had only weeks or months to live.

"You'll need to taper off on the prednisone gradually," I said, "because you can die from sudden withdrawal.

"And when you start tapering off on the prednisone, you're going to need an aggressive anti-pain program, because your pain may increase dramatically."

He nodded calmly.

I scanned his medical records. "You're also taking some tranquilizers?" "Xanax, lithium, and Ambien," he said.

Xanax is a minor tranquilizer, much like Valium, and Ambien is a sleeping pill. Lithium is generally used only for bipolar disorder, or manic depression, which Scott did not have. Xanax and lithium did not seem appropriate for a patient with chronic pain. With Scott's concurrence, I discontinued those two medications and placed him on a full pain program immediately. He began to institute major changes in his life. Even though he had been told he was dying, he participated in his program enthusiastically. I really admired that. In some people the human spirit is just unbeatable.

Here's a brief outline of the four levels of Scott's program:

Nutritional therapy. Scott began to force himself to eat regularly, and carefully. His diet—which I changed to one composed primarily of grains, vegetables, high-protein soy products, and fish—was designed not only to give his nervous system abundant nutritional support, but also to improve his general health. He ate foods that stimulated production of nerve-calming serotonin, and he took the supplements that his brain and nerves needed to achieve regeneration. In addition, he regularly ate nutrients that have anti-inflammatory properties. I'll tell you about those special foods in chapter 2.

Physical therapies. Scott engaged primarily in massage therapy, and yogic mind/body exercises. He also did light work around his house, and a bit of walking, which helped him begin his cardiovascular rehabilitation.

The mild cardiovascular exercise he did stimulated his production of endorphins, and also provided his beleaguered muscles with a much-needed infusion of blood-borne oxygen and nutrients.

The stretching and massage soothed his muscle pain, and helped his nervous system to "unlearn" its patterns of circulating, engraved pain.

The mind/body exercises stimulated his brain, and brought energy to the areas of his nervous system that help control pain.

Medication. This was probably the most important component of Scott's program, since his primary goal had been to stop taking pharmaceutical drugs. Scott's desire to overcome his reliance upon powerful pharmaceutical drugs, though, was not at all uncommon. In fact, at the most prominent pain clinics in America, the first goal of the attending physicians is usually to eliminate their patients' reliance upon drugs. As you'll see in chapter 4, pharmaceutical drugs can play a very positive role in pain management. But they are not panaceas—even though many general practitioners seem to believe they are.

Over the next eighteen months, Scott gradually stopped taking prednisone, and eliminated his use of tranquilizers.

He replaced those pharmaceutical medications with milder natural medications, including homeopathic remedies and analgesic herbs.

I'd feared that his pain might become unmanageable after he discontinued prednisone, but this didn't happen. The natural medications—combined with the other elements of his pain program—more than compensated.

Mental and spiritual pain control. To heighten his ability to cognitively reduce his pain signals, Scott began to confront his feelings of anger and worthlessness. These negative emotions increased his perception of pain, and reduced his brain's ability to "dampen" pain signals.

Scott had been reared by a difficult father who had convinced him that he didn't deserve to be happy, and never would be. Scott had internalized this neurotic outlook, but was seething with anger toward his dad. To overcome his self-hatred and anger, he used several of the methods of "cognitive therapy," a rationality-based form of psychotherapy that's often quite beneficial for pain patients. As Scott began to shed his sense of self-loathing and his anger, he became much more relaxed, physically as well as emotionally. This reduced his perception of pain, increased his ability to accept pain, and heightened his ability to cognitively distract himself from pain.

Having a more positive outlook also helped Scott implement the other self-help measures in his program. It made it much easier for him to rise above his chronic pain syndrome, and to do good things for himself.

I also taught Scott an advanced meditation technique, which I'll soon describe, and his meditation helped him to achieve deep personal insights, and to release much of the negative emotional energy that was heightening his pain.

In addition to his psychological therapy, Scott also began an earnest search for spiritual peace. He started his search the same way many patients do—by asking himself, "Why me?"

This in one of the most fundamental of all spiritual questions about suffering, because spirituality is, essentially, the search for meaning.

When patients first ask