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Mind over Matter?

FMS Community Newsletter #118

The following newsletter is rated M for content pertaining to menstruation, I apologize ahead of time to our male readers, and “R” for some religious content. With that said, we at the FMS Community do not promote any one religion or spiritual belief.

Editors Corner

As a fifty year old that has raised no less than twelve children, I thought I had experienced just about everything, physically and mentally. That was before I was caught off guard by a recent event that would change the way I was to interact with a member of my own family.
The week started normally enough, with me rising at 6 a.m. to get three kids up for school. As usual, my twelve-year old fought tooth and nail, refusing to rise until she only had scant minutes to dress, brush her teeth and make a run for the bus. This same child came home from school moody and sullen, ready to do battle over her right to refuse all chores. I treated her like every other child in the home, praising when possible and dealing with problems when needed. I saw her as a child, a bright, talented, artistic child, but still a child.
Then she dropped a bombshell, she had started her period. Once I got over feeling like I was 100 years old, we went into my studio to talk. I asked her if she had questions and we discussed her options, hormones and mood swings.
The shocking part came later when I realized that I was treating her different than I had earlier in the day. I started the day viewing her as a child, and ended it seeing her as a young woman, someone nearer my equal than a child.
How could this be? How could one event have such an effect on my thoughts and emotions? It was then that I began to ponder the power of the brain, if a single event could do this to my thoughts, how much could the brain help me over come chronic pain and depression.
We have heard time and time again, that a positive mental outlook can lead to better health, but how is one to achieve that?
There are as many ways to harness the power of the brain as there are people, in this issue will we touch on what I am sure, is just the tip of the iceberg.

Jane Kohler

Dealing with Chronic Pain: The Mind Body Solution

Hilary Tindle, M.D., M.P.H. Assistant Professor of Medicine, University of Pittsburgh School of Medicine.

When medical professionals talk about "persistent" or "chronic pain," they are referring to debilitating, day-in-and-day-out pain that is difficult or impossible to cure. Persistent and chronic pain affects approximately 30% of the United States population; for a significant portion of them, the pain is centered on the back, joints or other part of the musculoskeletal system. While this kind of pain remains a frustrating and difficult-to-treat condition, our understanding of what pain is and how it works has advanced greatly in recent years, leading to innovative and effective treatments. Many of these are so-called "mind body" therapies that aim to help people to control their own pain response.

The groundbreaking gate control theory of pain helped explain how psychological factors influence pain perception.3 Put forward in 1962, gate control theory says that physical pain is not a direct result of an assault from the outside on the pain producing neurons, (as is the case when you bang your elbow or break a leg), but rather the result of interaction between different parts of the brain and nervous system. The bottom line is that the brain controls the perception of pain quite directly, and has a proven ability to moderate or even turn on and off certain forms of pain. In earlier theories of neurochemistry, the role of the brain had not been taken into account; pain was thought to be a sort of one-way "alarm system" that always responded in the same way to the same stimuli.

Also, in accordance with the biopsychosocial model of disease, a late 20th-century alternative to the traditional ("biomedical") model of disease, in which medical conditions are seen as having biological, psychological and sociological aspects, there is now increasing attention on pain as not only a physiologic, but also a psychological phenomenon. This broader understanding of the complex interaction of mind and body has resulted in new approaches to pain treatment.

The Advantages of Mind Body Medicine in Treating Pain
In 1996, the NIH Consensus Panel on the Integration of Behavioral and Relaxation Approaches Into the Treatment of Chronic Pain and Insomnia recommended the use of mind body therapies for chronic pain. Since that time, increasing evidence has supported the use of mind body therapies. In addition, many mind body therapies are relatively inexpensive. When used appropriately, mind body therapies are generally safe. Finally, to the extent that mind body therapies emphasize self-care, they are economical and result in decreased utilization of the health care system.


Mind Body Medicine
Mind body medicine, as defined by the National Center for Complementary and Alternative Medicine (NCCAM) "focuses on the interactions among the brain, mind, body, and behavior, and the powerful ways in which emotional, mental, social, spiritual, and behavioral factors can directly affect health." Mind body medicine is one of the five major domains of complementary and alternative medicine, and mind body therapies are some of the most commonly used CAM therapies among US adults.

Mind Body Therapies

Mind body therapies are characterized by NCCAM as "techniques designed to enhance the mind's capacity to affect bodily function and symptoms.") Common examples include (see also Table 1):
• Relaxation techniques such as deep breathing, progressive muscle relaxation and the relaxation response,
• Guided imagery
• Biofeedback
• Hypnosis
• Cognitive behavioral therapy
• Mediation

Meditation is further divided into several sub-types, the two most commonly studied being transcendental meditation, and mindfulness meditation, (mindfulness meditation is also referred to as attentional training or metacognitive awareness). There is substantial overlap between different mind body therapies. For example, many guided imagery exercises begin with progressive muscle relaxation and involve deep breathing and meditation, while various forms of meditation incorporate breathing exercises and imagery.

Guided Imagery
Guided imagery involves the process of image generation for the purpose of improving health. There are active styles of guided imagery, where the patient mentally creates the image(s), as well as more passive styles in which the guide describes the images using a script, while the patient listens intently.

Biofeedback utilizes a device to amplify normal physiological processes (e.g., muscle tension) to make them more easily perceptible. Patients then receive feedback regarding their physiologic state (e.g., tension in a given muscle group) and learn to manipulate their own physiology (e.g., decreasing muscle tension), guided by cues.

Similar to passive style guided imagery, described by expert David Spiegel as "a natural state of aroused, attentive focal concentration coupled with a relative suspension of peripheral awareness." The hypnotic state includes three main components:
1.absorption (in an object of concentration),
2.dissociation (from an ordinary conscious perception) and

Cognitive Behavioral Therapy
Cognitive behavioral therapy is composed of cognitive and behavioral techniques that address the role of maladaptive cognitions and behaviors in disease. Cognitive therapy emphasizes correcting negative thinking patterns through a process called cognitive restructuring, while behavioral therapy rewards beneficial behaviors.

When used in clinical settings, meditation is the practice of consciously focusing one's attention on inner experience. It may also be described as the self-regulation of attention. Two main forms of meditation interventions that have been extensively studied for health conditions, are transcendental meditation, in which practitioners silently repeat a word or phrase (mantra), and mindfulness meditation, which involves non-judgmental attention to internal events such as thoughts, emotions and physical sensations on a moment-to-moment basis. Like other mind body therapies, meditation often brings about a hypometabolic state, or overall slowing down of bodily systems.

While most mind body therapies are considered to be a part of complementary and alternative medicine, cognitive behavioral therapy is an example of a mind body therapy that has gone main stream. Like other mind body therapies, cognitive behavioral therapy addresses the associated cognitive and emotional issues that accompany or enhance pain symptoms, such as a person's feelings of helplessness or associated depression.

Complementary and alternative therapies such as Qi Gong, Tai Chi and yoga share many of the features of mind body therapies (e.g., the use of imagery and breathing techniques) but are not always classified as such. For the purposes of this article, we will focus on the more classical mind body therapies in Table 1. Similarly, prayer also meets the criteria for a mind body therapy and is widely used by U.S. adults for health reasons. However, in research studies of mind body therapies and health, prayer is often considered separately because the characteristics of respondents who pray and the reasons for use of prayer may differ from those of other mind body therapies.

How do People Receive Mind Body Therapies?
Mind body therapies may involve group or one-on-one therapy, but they also lend themselves well to self-care. For example, many forms of relaxation techniques combine practitioner-based instruction, often on video or CD, with a home-study program. There are no hard and fast rules for types of mind body therapies to avoid, because they are generally safe. Therapies such as guided imagery or meditation may not be appropriate for those with untreated psychiatric conditions, (such as uncontrolled depression or active hallucinations), although one recent study safely used a mindfulness-based therapy for people with active depression and anxiety.

Mind Body Therapies Are in Widespread Use
According to three large, nationwide surveys, the use of mind body medicine by U.S. adults is surprisingly common. In 1997, one study surveyed 2,055 individuals and found that 16.3% used relaxation techniques such as meditation or the relaxation response. Chronic pain was the third-most common reason (19.5%) to use mind body therapies and was reported to be "very useful" for that condition by 55% of users.

Chronic pain may lead people to seek out mind body therapies. The 1999 and 2002 National Health Interview Surveys (NHIS) were conducted by the Census Bureau for the National Center for Health Statistics. In 1999, 30,801 U.S. adults were asked if they had persistent joint pain during the past year and if they had used a mind body therapy (including relaxation techniques, guided imagery, hypnosis and biofeedback) during the past year. People with musculoskeletal pain were almost twice as likely as those without pain to use mind body medicine and prayer. The 9% who used mind body medicine represents about 3.5 million U.S. adults.

The Effectiveness of Mind Body Therapies for Musculoskeletal Pain

Back Pain
Back pain is an area where we are beginning to have some data on the effectiveness of alternative therapies for pain. One study of behavioral therapy (such as cognitive behavioral therapy) for chronic low back pain in people ages 18 - 65 was conducted to determine if behavioral therapies were effective, and which therapies were most effective.

The results suggested that there was strong evidence to support respondent therapy (e.g., relaxation techniques or guided imagery) for a medium effect on pain. There was moderate evidence suggesting that progressive relaxation had a large effect on both pain and behavioral outcomes, but only in the short term. Interestingly, there was no evidence that one behavioral therapy was more effective than another for pain-related outcomes.

Breath therapy (a mind body therapy integrating body awareness, breathing, meditation and movement) for treatment of chronic low back pain was about as effective as physical therapy both in the short and in the long term in one study. Mindfulness meditation resulted in significant improvements in pain acceptance and physical function in a study of 37 older adults with chronic low back pain.

Headaches, Arthritis and Other Musculoskeletal Pain
Mind body therapies appear to be effective for some types of headache. Relaxation training, electromyography (EMG) biofeedback (the recoding of muscle activity at rest and while contracting) and a combination of the two therapies reduced the severity of tension headaches by half. Relaxation and biofeedback were as effective as the drug propranolol for the treatment of migraine.

Fibromyalgia is one area where mind body therapies have not been yet shown to be effective, or to have very limited effectiveness.

Several mind body therapies have also been studied for arthritis (both rheumatoid and osteoarthritis). The Arthritis Self Management Program uses cognitive therapy and relaxation techniques. People who used this self-management program had reduced pain and disability, though a study reviewing the overall results of over 20 trials of mind body therapies for rheumatoid arthritis found significant effects in the short-term on pain, functional disability, psychological status and coping with pain, but on follow up only moderate effectiveness for psychological status and coping with pain.

How Mind Body Therapies Treat Pain
The mechanism by which mind body therapies alleviate pain is not well understood, but it may result from their effect of increasing sufferers' sense of self control, which is known to influence how pain is experienced. Similarly, there is emerging evidence that mind body therapies facilitate a sense of empowerment. Mind body therapies may also modify the cognitive and emotional components of pain perception known as pain unpleasantness and pain affect; these are distinct from pain sensation52,53 and contribute significantly to suffering. The emotional components of pain often have the effect of magnifying pain severity.

Pain as a Complex Sensory Experience
Pain is not only sensory; it has a very powerful and unpleasant emotional effect. Pain researcher Troels Statehelin Jensen underscores the complexity of pain when he asks, "What is pain: a sensation, an experience, a symptom, or even a disease?"

Where We Are At the Moment
Mind body therapies are generally safe, inexpensive and already used widely by the U.S. public. Despite this, the effectiveness of most mind body therapies for pain has not been well tested and studied. While their effectiveness for musculoskeletal pain appears to be limited to moderate when used alone, when applied in combination with standard therapies, they may be considerably more useful.

Further study is needed to understand more fully how hypnosis and other mind body therapies for pain work in general and in particular. Some experts in the field have argued that the demonstrated effectiveness of many mind body therapies is more or less a "placebo effect." More studies need to be done to determine if this is the case, and to find the brain areas that are more or less active when mind body therapies are applied.

Finally, mind body therapies may be particularly suitable to certain populations, such as the elderly, where there is a higher risk of medication interactions, or in populations who prefer to use alternative therapies. This latter population is substantial, considering that in 2002 about 29 million people used relaxation techniques.

For those seeking more information about mindfulness meditation and guided imagery.

Academy for Guided Imagery ( to find counselors with guided imagery training, order tapes/CD's as part of a comprehensive pain management program
American Specialty Health
HealthyRoads Guided Imagery Series
•Belleruth Naparstek Imagery tapes and CD's for stress and pain, available at
For professional development in mindfulness meditation and guided imagery:
•Mindfulness Based Stress Reduction, University of Massachusetts Center for Mindfulness
•Mindfulness Based Cognitive Therapy, Textbook, MBCT for Depression (Zindel Segal), available at
•Clinical training in mindfulness with Dr. Zindel Segal (Omega Institute, Rhinebeck, NY)
•Guided imagery, Academy for Guided Imagery

When it comes to pain - mind over matter works

Medical Research News

According to experts in the U.S., they have strong scientific proof that mind over matter works for relieving pain.

They say positive thinking was as powerful as a shot of morphine for relieving pain and reduced activity in parts of the brain that process pain information.

The researchers at Wake Forest University, say their findings show that by merely expecting pain to be less it will be less.
In their study Dr Robert Coghill and his team looked at 10 normal, healthy volunteers who had a heat simulator applied to their legs to produce pain, while their brains were being scanned using functional magnetic resonance imaging (fMRI), to map brain activity.

Researcher Dr Robert Coghill says that before the subjects underwent brain imaging, they learned to expect mild, moderate, or severe painful heat stimuli following different signals. The stimuli were not hot enough to cause burns or damage the skin.

The researchers saw, during the brain imaging, that a small percentage of the severe stimuli were incorrectly signalled as moderate stimuli to create expectations of decreased pain.

It appears that when they expected lower levels of pain, all the volunteers reported less pain.

These expectations reduced reports of pain by more than 28%, which is similar to an analgesic dose of the potent painkiller morphine.

At the same time, activity in areas of the brain important to both sensory and emotional processing of pain decreased.These areas included the primary somatosensory cortex, the insular cortex and the anterior cingulate cortex.

Dr Coghill says it is clear that pain is not solely the result of signals coming from an injured body region.

It therefore needs to be treated with more than just pills, and as the brain can powerfully shape pain, that power needs to be exploited.He said the findings support the potential for the use of cognitive therapy for the treatment of pain, and to some extent explains the positive impact of psychological techniques in treating chronic pain.

Other experts have also recognised psychological factors such as expectations play a role in the perception and experience of pain, and say that the study is intriguing in that it has aimed to identify specific brain regions linked to both the pain experience and expectations associated with pain.

Dr Beverly Collette, president of the British Pain Society, says that most people who work in pain clinics use cognitive therapy to help people manage their pain better.
The study is published in the Proceedings of the National Academy of Sciences.

Mind over matter: Meditation helps ease pain for some patients

Pick up a raisin. Look at it -- really look at it -- like you've never seen a raisin before. Roll it between your fingers. What do you notice about its texture, its color, its heft? Hold the raisin to your ear. Squish it a bit. Does it make a sound? Bring it to your lips. Take note of any stray thoughts you might have, but always come back to the raisin itself. Place it on your tongue. When you finally swallow it, appreciate the fullness of its flavor. Now imagine that your body is exactly one raisin heavier.
Sound like an odd exercise? Then consider this: For thousands of people who suffer from chronic pain, spending quiet time with a raisin has proven to be the first step to recovery -- or at least to learning how to cope with their pain.

The raisin contemplation serves as an entree to the practice of meditation --an approach that is gaining in popularity among people in pain. In 1997, Americans made more than 100 million visits to alternative practitioners for relaxation therapies such as meditation, according to a study by Dr. David Eisenberg that was published in the November 11, 1998 issue of the Journal of the American Medical Association. Just how meditation relieves pain is not entirely clear, though researchers are beginning to enumerate and examine potential mechanisms. What is clear is that for millions seeking treatment for headaches, arthritis, and many other conditions, meditation seems to work.

Benefits for mind and body
"It changed my life," says Imogene Benson, who signed up for the stress reduction program at the University of Massachusetts in Worcester after a bad fall left her with neck and back injuries and who also suffers from a chronic, painful condition called fibromyalgia. "I've learned to relax and be more in control of my body, instead of having my body controlling me," she says.

An avid runner before the accident, Benson says that the pain kept her from working for months at a time and made negotiating even a short flight of stairs a nightmare. Meditation has not only given her a sense of inner peace, she says, it has improved her physical condition as well. "I have less pain, my muscles are more relaxed and I have much better mobility," she says.

Over the past 20 years, thousands of individuals have sought help at the University of Massachusetts Stress Reduction Clinic, which has pioneered methods for teaching meditation techniques to people with pain. Their symptoms vary -- from headaches and back pain to anxiety and eczema -- but their stories are remarkably similar.

"Most of the people we see have had long experiences with pain clinics, doctors and medications," says Elana Rosenbaum, a social worker at the clinic. "But nothing has relieved their suffering."

Before coming to the clinic, Benson tried medication, physical therapy and a device that electrically stimulates muscles to reduce pain: none offered more than temporary relief.

And then she tried meditation. "It's just wonderful. No matter how stressed you feel before, afterward you feel relaxed, calm and filled with energy," says Benson.

Since graduating from the program nine months ago, Benson sets aside some time each day, wherever she is, to practice her techniques. Closing her eyes, she stretches and does a body scan, slowing her breathing and gradually moving her attention to each part of her body. Meditation doesn't always require a mantra or mystical music; for Benson, the key is finding a quiet place to focus for half an hour.

Scientists weigh in
According to one early study by Jon Kabat-Zinn, director of the Stress Reduction Clinic, 65 percent of the patients who spent 10 weeks in his program reported that their pain was reduced by one-third or more. (The study was published in the April 1982 issue of General Hospital Psychiatry.)
Their mood improves and they experience significantly fewer overall symptoms, says Dr. Shreyas Patel, a neurologist who trained with Kabat-Zinn before joining the Marino Center for Progressive Health in Cambridge, Massachusetts. Indeed, an independent technology assessment panel, convened in 1995 by the National Institutes of Health (NIH), confirmed that behavioral approaches -- including relaxation techniques and hypnosis -- can be quite effective in the treatment of chronic pain.

But how might meditation work to relieve pain?
First off, the relaxation that's at the heart of meditation relieves the muscle tension that most certainly contributes to pain, says Dr. Howard Fields of the University of California, San Francisco, who sat on the NIH technology assessment panel. And the anxiety involved in anticipating pain --or thinking it will never leave -- causes additional muscle tightening, says Patel. Relieving that anxiety is another way meditation may make people better able to cope with physical sensations.

In addition, meditation most likely alters a person's emotional response to pain. Remember, pain is more than just a physical sensation -- it is an experience steeped in emotion. "I'm still in constant pain," says Benson. "But meditation makes the pain more bearable. It's taught me how to live with it and to find ways to better manage it."

Altering emotions and sensations
This makes sense, physiologically speaking, because the sensations and the emotions associated with pain are processed by different parts of the brain, says Catherine Bushnell, Ph.D., of McGill University. So relaxation techniques, including meditation and hypnosis, might allow people to tolerate pain they would ordinarily describe as unbearable. In her studies of hypnosis, Bushnell has found that people can be taught to reinterpret painful sensations, regarding them as "warm and pleasant" rather than "burning and unpleasant."

"So it's not just that people are being trained to ignore pain" when hypnotized or meditating, says Bushnell. She's concluded that relaxation techniques can alter the way the brain responds to a painful sensation and the way a person feels about it.

Further, meditation may also change the neural pathways that control the physical sensation of pain. Perhaps it works like morphine, says Bushnell, dampening pain by stimulating the inhibitory nerves that extend from the brain to the spinal cord, where they block the sensation of pain.
A raisin might not always be a substitute for morphine, but it appears that meditation can help people control their response to pain -- and their outlook on life.

"The raisin exercise makes you aware of sights, sounds, scents and tastes," says Benson. "Now I relax, slow down, and take time to appreciate things around me -- a bird or a cricket, the wind in the trees. Meditation makes my life a little more peaceful. It's made me a better me."

Prayer effective as painkiller?

By Anita Manning, USA TODAY
Americans have found a no-cost painkiller they say is as effective as prescription drugs: prayer.

More than half of those who responded to a USA TODAY/ABC News/Stanford University Medical Center poll released Monday say they use prayer to control pain. Of those, 90% say it worked well, and 51% say "very well."
Among a dozen therapies, including bed rest, massage and herbal remedies, only prescription drugs were as successful as prayer in easing pain: 89% report that such drugs work well and 51% say "very well."

This comes as no surprise to preachers and doctors who say they have seen the way personal faith can influence a patient's reaction to all kinds of pain, psychological or physical.

"Prayer enables you to take your mind and place it in a new perspective," says family doctor Harold Betton, who also is pastor of New Light Baptist Church in Little Rock. By focusing on prayer, he says, believers reduce stress and gain control over pain.

He says he's not suggesting anyone should expect miracles, "but you need to utilize what people have: their faith. Let your faith and prayer intercede, and your perception of pain decreases."

Why that might work is open to debate. Columbia University psychologist Richard Sloan says it has more to do with the power of distraction than the power of prayer.

"If you try to distract yourself by focusing on something else — prayer or something else — I do think it works," he says. "I don't think it's anything special about prayer. It's any kind of mental activity that serves to distract you from the pain-producing circumstances."

Hundreds of papers have been published on the possible link between faith and health, but scientifically, "it's very hard to measure," says John Tarpley, professor of surgery at Vanderbilt University.
Pain, in particular, is subjective and can be influenced by a variety of factors that are difficult to assess by scientific standards.

"What we have to worry about is the difference between showing association and causation," says Tarpley, who teaches a class on spirituality and medicine at Vanderbilt.

For some deeply religious people, pain can be redemptive, but faith also can carry an extra burden.

"In African-American belief, (often) pain is part of what we are expected to endure," says Glenda Hodges, director of a course in spirituality and medicine at Howard University's College of Medicine.

The feeling is that "if Jesus endured it, I should be able to handle it," she says. "So if I'm not able to handle the pain, there must be something wrong with the spiritual connection I have with God."

But "it doesn't work that way," says Harold Koenig, professor of psychiatry and behavioral sciences at Duke University. Faith and medicine "work beautifully together. Just praying alone doesn't work as well as if you're (also) taking your morphine."

Koenig and colleagues reported last month in the Journal of Nervous and Mental Disease that among sickle cell patients, those who go to church at least once a week had the lowest pain scores.

"People who are more involved with religious organizations seem to be able to cope with stress," Koenig says.

How the Mind Controls Pain

Physical pain also has an emotional component, which means we have some control over our response to it. (CORBIS/HEALTH)
Science is beginning to investigate and support the role of therapies such as biofeedback and meditation in pain control. The idea that the mind has power over the body may be especially useful to chronic pain patients who often find themselves without satisfactory medical treatments.

The emotional response to pain
Pain travels along two pathways from a source, such as an injury, back to your brain. One is the sensory pathway, which transmits the physical sensation. The other is the emotional pathway, which goes from the injury to the amygdala and the anterior cingulate cortex—areas of the brain that process emotion.

"You may not be aware of it, but you're having a negative emotional reaction to chronic pain as well as a physical reaction," says Natalia Morone, MD, assistant professor of general internal medicine at the University of Pittsburgh School of Medicine. Mind-body treatments that involve meditation and relaxation probably affect these emotional pathways. However, Dr. Morone admits that many doctors don't put much stock in this theory. "Anything to do with mind-body medicine around pain is going to be controversial. This is all very new."

Research is beginning to show the connection
In a 2005 study, researchers at Stanford University in Palo Alto, Calif., used functional magnetic resonance imaging (fMRI), which measures activity in different areas of the brain, to see whether subjects could learn to control a brain region involved in pain and whether that could be a tool for altering their pain perception.

Laura Tibbitts, 34, an event planner from San Francisco who severely injured her arm, shoulder and back when she was thrown off of a horse, participated in the study. In describing her pain, she says: "My muscles and nerves feel like a bunch of snakes that are all intertwined, but then I also get a stabbing and shooting pain. So you have that horrible, achy, uncomfortableness, but then you get these jolts of pain."

In the study, Tibbitts was asked to increase her pain and as she did, an image of a flame on a computer monitor became stronger and more vibrant. Then she was told to decrease her pain, which caused the flame to die-down. "Sometimes I would imagine that the pain was literally being scooped out from me, taken away and carried off. Other times I used water imagery, like it was flowing through me and taking it away," says Tibbitts. After the test, she learned that she had been able to produce a 30% to 40% reduction in her overall pain.

Giving control to pain patients
For Sean Mackey, MD, director of the pain management division at Stanford University School of Medicine and one of the study's researchers, the research revealed a striking element of empowerment. "Patients would say, 'A-ha! For the first time I could see the pain in my brain, and I could control it. And that was a very powerful experience," he says.

Dr. Mackey believes pain medicine is moving away from the concept of strict mind-body separation toward a more unified—and ancient-sounding—view in which "mind and body are really one."

The bottom line for pain patients is that they may want to pursue pain-control techniques such as biofeedback, yoga, and meditation. But they also need to be on the alert for scams and beware of claims made by therapists seeking to exploit their desperation. Before turning to one of these therapies, it's best to thoroughly research the practitioner you choose.

Lead writer: Suzanne Levy April 16, 2008

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