Prolonged Pain: From Misery to Management

Hi Karisha,
Hi Makiko.

Welcome to Rays of Light in the fictional village of Sunnyside.
We hope you enjoy your time with us today.
If you have a friend who might benefit from this episode, please share it.

When Joel Norgaard arrives back in Sunnyside on a chilly overcast winter day, the village seems deserted. He’s staying with a friend until he can rent an apartment, and he hurries there, hoping it’ll be possible to go straight to bed.

Early tomorrow he’s scheduled to work at the coffee shop he started with his friend Gwen six years ago, and he’s exhausted, with a throbbing pain in his back. He’ll be working every day for the next two weeks, while Gwen takes a vacation. That’s his penance for leaving abruptly to follow Avery, the woman he thought was the love of his life, across the country.

To his relief, Joel finds an envelope taped to his friend’s door containing the key and instructions to make himself at home. After a hot shower to help with his back pain, he texts Gwen to assure her he’ll be at work the next day, then falls asleep. His back feels like it’s screaming when he wakes two hours earlier than intended, and he’s unable to relax enough to drift off again.

He shifts around in misery until it’s time to get up. Despite his difficult night, Joel’s delighted to be back among friends at the cafe. Gwen shows up right before closing time and gives him a big hug.

“How’s your vacation so far?” he asks.
She laughs. “Marvelous! I can’t believe I have two weeks to watch you work. Who says being too broke to travel’s a bad thing?”
“Not me,” Joel says. “I’m never leaving Sunnyside again.”
“Yeah, right. You look exhausted, by the way.”
“I hurt my back last week, and it’s just getting worse. I’m barely sleeping.”
“Oh, that’s too bad. Good thing our motto is, ‘coffee’s so strong you can stay up all night and still call yourself a morning person.’ Hey, why didn’t you join in? We’re back, baby!”
“I’m glad to be back, Gwen, but coffee will not help my back. Puns intended.”
“Hope you feel better soon. I’m off to the gym. See you at Heather’s tonight.”

Joel tries to enjoy the welcome home dinner with his closest friends, Gwen, Heather, and Brent, but the pain in his back has gone from throbbing to searing and is starting to shoot down his legs.
“Is this from when you were helping Avery move her ridiculously heavy cross-trainer up a flight of stairs?” Gwen asks after Joel groans himself onto the floor in Heather’s living room.
“Did I tell you about that?”
“You did, right before saying you wish you’d never left Sunnyside. Gave me hope.”
“Avery’s final gift,” Heather jokes. “Put your legs up on the couch, Joel. That might help. And are you ever going to tell us what happened with you two?”

Joel says flatly. “How can it feel like you’re truly connecting with someone, but there’s really nothing there at all?”
“The mystery of life,” Brent says after a moment. “Although it probably didn’t help that you moved to the house she lived in with her husband.”
“Where” Heather adds dramatically, “Her two bitter, brooding sons sat around glaring at you.”
“And that’s a direct quote from the group text,” Gwen adds.
“I complained a lot?,” Joel asks.
“You did,” Heather and Brent say at the same time.

Over the next few months, Joel tries heat, pain relievers, and muscle relaxants on his back. All help to some extent, but only temporarily. He has a number of medical tests done to rule out serious issues and is told that sometimes there isn’t a clear reason for why pain remains after the injury heals.

Gwen suggests he try hypnotherapy. “But not with my therapist,” she adds.
“You’re the reason I needed help in the first place.”
Joel gives her a hurt look. “I’m suffering, you know. It’s not all in my mind.”

M: So it’s definitely not all in the mind. Pain is a real bodily sensation interpreted by the brain. At the same time, there’s a deep mind-body connection. So based on past experiences and learned patterns, the subconscious can amplify the sensations like pain, not limited to pain, but like itchiness, any other sensations. It can be exaggerated by those past patterns. In the pain management training that we’ve received,

K: From the wonderful John Melton of HMI from Northern College.

M: It’s often taught that up to 70% of the pain experience can be influenced by emotional and subconscious factors. That doesn’t make the pain imaginary. It’s very real, for sure. It just means that part of the intensity may be amplified by learned responses, which is why hypnotherapy can be effective in reducing the, you know, exaggerated component of the pain or the sensation.

K: Which makes such a big difference.

M: Yes.

A few weeks later, Joel tells Gwen that he’ll have to have a medical acknowledgment before he can see a hypnotherapist.
“That makes sense,” she says. “Are you going to get one?”
“I guess so. I’m sick of this miserable life. It hurts every moment I’m awake. And probably when I’m asleep, too, as I wake up 20 times a night.”
“And everyone’s sick of hearing about it,” Gwen says chipperly. “Do you have a diagnosis?”
Joel shrugs. “Chronic pain, I guess.”
“And that just means the pain goes on and on?”
Joel rolls his eyes. “It means go away. We can’t help you.”

M: Just to clarify, when there is a possibility of a medical cause to your presenting issues, then hypnotherapists often ask for a medical acknowledgment from your primary physicians or whoever that you went to for that particular issue to make sure it’s safe to proceed with hypnotherapy. Because symptoms are signals from the body, and reducing or masking them without understanding the underlying cause could potentially aggravate the physical issue.
And this acknowledgment simply means that the client’s physician has evaluated the condition and agrees that hypnotherapy is appropriate and safe as part of the care.

K: And so Joel has chronic pain, but both acute and chronic pain are options for hypnotherapy. Pain can occur due to an injury or bodily damage, or it can occur without evidence of either. Sometimes, like in Joel’s case, it begins with an injury and continues even though the injury appears to be completely healed.

M: Right.

Gwen says, “Well, let me know if Reina thinks hypnosis can help.”
“I already talked to her. She says it can. She asked me so many questions about everything. It took way longer than I expected.”
“Wow, pain must be more complicated than business partner-induced trauma,” Gwen jokes.
“Hey, I’m suffering,” Joel says. After a pause, he adds, “I did feel like Reina knew what she was doing, which gives me hope. I’m terrified of ending up addicted to pain medication.”

“Has anyone even offered you pain medication?” Gwen asks.
“Well, no, but if this goes on and I really beg them, I’m sure they will, and then I’m doomed.”
“I’m glad you’re not dramatic or anything.”

K: Bruce Bonnet, another wonderful instructor at our hypnotherapy college, gathers and shares research articles and other resources about hypnosis. In the show notes, we’ll include a link to a short video by Dr. David Spiegel of Stanford Health, who promotes replacing opioid use with hypnosis for pain.

M: That’s awesome.

Brent stops by the cafe on Tuesday to see how his friend is doing after his first hypnotherapy session.
“The pain went from a 10 to a 4 during my session yesterday,” Joel tells him, “which was amazing. It hurt more again last night, but after I listened to my session recording, I could sleep again. I’m supposed to listen to it three times a day, which I’m going to try to do.”
“I’m glad it helped,” Brent says. “You and Gwen should come over Friday and have leftovers.”

K: I want to promote a new word to replace leftovers that my sister Shaylona came up with.
It’s re-delectables. So Shaylona and I both love leftovers, and I was like, I wish there was a better name to call them, something more appealing than leftovers, and she came up with re-delectables because she’s brilliant. Please spread it around.

M: That’s so cool. So when Joel says his pain went from a 10 to a 4, he’s referring to what’s often called a subjective unit of discomfort scale, which therapists may use, well, depending on the therapist, but we often use it, where zero means no pain at all, and 10 represents the worst pain imaginable in this case, but it doesn’t have to be pain because it’s a subjective unit of ‘discomfort’. And it’s a simple way to track changes in intensity rather than measure pain objectively, whether before and after hypnosis or over time.

K: And it’s really useful because otherwise we don’t often realize the difference when we feel better. We can’t actually tell if we haven’t given ourselves some, like a number or something to base it on. Exactly.

M: The thing is, hypnotic state is naturally very relaxing and parasympathetic, and when the body is in a calmer state, pain often becomes less intense due to the reduced level of stress, muscle tension, and other related factors, and that’s a good thing because it allows the client to experience relief firsthand during the session.

K: Right. So that they really understand it’s possible and believe it.

M: Yeah. They can just really feel it, that it makes a difference.

K: Right. So wonderful.

At Brett’s apartment three days later, Joel ushers his friends to sit down at the kitchen table.
Then, standing in front of them, announces dramatically that he has something to reveal about himself. First, he says, “we’re going to do a short visualization activity.”
Gwen rolls her eyes while Heather laughs. Brent asks if anyone wants a drink.
“Not yet,” Joel says. “This will be fast. Visualize a giraffe eating leaves off a tree. Do you have that picture in your mind?” They all nod.
“You can see it?” They all nod again.
“You do not have aphantasia,” Joel says. “Aphantasia is when someone can’t visualize, and I have it.”
“Is he waiting for applause?” Heather asks Gwen.
“It sounds like it.”
“So when you think of a giraffe,” Brett begins.
“I see nothing.” Joel interrupts.
“Oh, no,” Brent says.
“So have you ever been able to visualize?” Gwen asks.
“Nope.”
M: So Joel might be going a little, you know, extreme here, but just to add a bit of context, when people say they’re not visual or that they can’t visualize, that doesn’t necessarily mean they have aphantasia. For many people, imagery is simply faint or abstract, maybe intermittent, or comes through other senses better rather than as clear pictures.

M: I’m actually a good example of this. I consider myself more visual, but I don’t see clear images. It’s simply the sense that it’s a bit stronger or more developed than others, like auditory. I do have auditory sense, but not as strong. And so that’s very different from not having images at all.

M: True aphantasia is much rarer and refers to a consistent absence of mental visual images, and it’s estimated to affect only like 2 to 4% or a very small percentage of the population, while a much larger group would describe themselves as less visually oriented. Like I think maybe, you know, 30% or so of the people would describe themselves having a hard time to have clear pictures. Because of that, equating non-visual experience with aphantasia can be misleading.

K: You have to consider how dramatic and how much does the person talking like to exaggerate.

M: Yeah, exactly. I mean, I don’t even know where Joel got this word aphantasia.

K: Oh, I’m sure he looked it up online, you know, like we all do. Actually, I know he did.

M: Yeah, you wrote it!

Heather asks, “Did you just figure this out?”
Joel shakes his head. “When I was a teenager, my sister was describing a gift she was getting from my parents, and she asked if I thought it would look good on the mantle in our living room. I said I had no idea. She told me to picture it as if it were there, and I couldn’t.”

“She thought I just wasn’t interested, but we eventually talked to our parents about it. My mom could only see blurry images when she tried to visualize, and I saw darkness, nothing. My dad saw vivid movies, like my sister.”

“It’s not something I really think about, but during my first hypnotherapy session, Raina asked if I could visualize, and I said no. She asked if I could pretend, in this case if I could pretend that my arm was there or something, with my eyes closed, and I could.”

“So how’s your back pain?”
“It’s mostly less, and sometimes I don’t feel it at all, which is more than I expected after one session. Other times it’s the same. It’s been hard to listen to the recording three times a day. I did that once, and it helped a lot, but for some reason I just don’t want to, even though it’s very relaxing.”

“That’s so you,” Gwen says.

M: Not all hypnotherapists automatically provide session recordings, but you can always ask if they do, and even if they don’t, you can also ask whether it’s okay for you to record the session yourself.

K: So I’ve talked before about my hypnotherapist, Lois Lorbach. She’s very wonderful. I record the sessions myself with her, and I love to listen to the recordings. Pretty much every single day I will listen to a recording, unless I have a totally crazy day, because it just gets me… Well, repetition is very important, first off. That’s really, really, really important to get something set in our mind, to have quicker change. But even without that, even if I wasn’t working on anything in particular at the time, just getting to that state of relaxation is just so wonderful, and it just makes everything else in my life better.

Two weeks later, Joel invites his friends to a housewarming party at his new apartment.
“I’ve learned some interesting things,” Joel says when Brent asks how he’s doing.
“It seems obvious now, but when I’m less stressed about it hurting, it hurts less. I was tensing up in fear of it hurting more, which increased the pain.”
“You look better,” Heather says.
“Thank you. I’m sleeping great and being overall less annoying at work, according to Gwen.”

“I was reading some studies on hypnosis and chronic pain,” Brent says. “My boss has suffered from it for years, but I’m not sure if he’d be willing to try hypnosis. I’m going to think of a way to show him the studies.”
Heather suggests Brent introduce his boss to Joel.
“Good idea,” Gwen says.

“I’m impressed with you, Joel. He’s listening to his recording at least two times a day now.”
“Right before and right after work,” Joel says.
“Although he’d love to use it as an excuse to take longer breaks.”
“Hey,” Joel complains, “I’m supposed to be surrounding myself with positivity.”
“Did Reina say that?” Brent asked curiously.
“No,” Joel says, “But she should have. Maybe I need to complain about Gwen more.”
“You’re stuck with me,” Gwen says. “Avery was your only op… Sorry, too soon?”
Joel covers his flinch with a laugh, and he doesn’t tell them the pain in his back has suddenly returned.

M: So session recordings are meant to be listened to in safe, relaxed settings. Because people often enter a hypnotic or deeply relaxed state, they shouldn’t be used while cooking, driving, or doing anything that requires full attention.

K: So I probably should be in hypnosis when I cook because I get really impatient. You definitely don’t use heavy machinery or, you know, be taking care of children or anything.
M: Right. And, you know, even cooking, I mean, if you’re just putting stuff in the oven, that’s fine. But if you’re like using a stovetop, then you really should not be in hypnosis.

K: No, you’re totally right. I was joking. Yeah. Don’t do anything that might be risky when you’re in hypnosis.

K: So oh, by the way, in our show notes, we’ll include links to a few of the many studies on the success of hypnosis and pain management. These studies were rounded up by John Melton and Bruce Bonnet.

A month later, Joel asked Gwen if she’s had any venting dreams.
“What?” Gwen asked, distracted by their employee Bridger waving goodbye.
“The dreams in the early morning when you vent out what you no longer need.”
“Oh,” Gwen says, “Yeah, I’ve had some. I didn’t remember to write them down, though.”
“I had an amazingly strange one.”
“Therapy is where you get a drone on about your dreams.”
“It’s the interpretation Reina helped me with that’s so interesting. It will inspire you to write yours down,” Joel says.
“All right, but you have to keep cleaning while you talk.”

“OK, so I was at this gas station sitting in my red convertible Porsche and this very familiar looking woman comes up and offers to put gas in my car. I say, sure, thanks. I’m smoking a cigar.”
Gwen interrupts. “You’ve been watching too many old music videos.”
“I haven’t,” Joel protests, “Although it was all sepia toned and we were surrounded by sand and cacti. Anyway, instead of sticking the nozzle into my gas tank, the woman starts bashing my car with it. I’m obviously freaked out. And when I turned to look at her, a huge pile of ashes fall out of my cigar onto my leg and my pants start on fire.”
“How in the world did you get anything out of this ridiculous dream?” Gwen asks.

“Well, we took out what had never happened, which was all of it. I’ve never had a Porsche or any red vehicle. I’ve never been to a full service gas station. I’ve never smoked a cigar, never had my pants catch on fire, never been in it…”
“I get the idea. None of this ever happened.”
“Anyway, Reina asked how I felt during the dream and I said I felt humiliated. So then I realize,” Gwen groans,

“Wait, I’m almost done. So in the dream, I realized Kimberly, my first girlfriend when I was 16, is sitting next to me and she’s laughing hysterically about my pants being on fire and I start crying and then wake up.”
“Was the woman hitting your car, Avery?”
“No. I didn’t know who she was at first, but later in the day, I realized she was the math teacher who was mean to me around that time.”
“Got it,” Gwen says. “You never had a relationship last over 16 months because when you were 16, you had a mean math teacher.”

Joel glares at her. “If you’d let me finish.”
“One more question. Were you crying in real life or just in the dream?”
“Just in the dream, I think,” Joel says.
“So wait,” Gwen interrupts again. “Can I guess before you tell me?”
“No! Lots of humiliating things happened in high school, especially around the time Kimberly and I broke up. The math teacher said the class was too advanced for me. I started crying in school, which the other kids teased me about. So that’s what we’re focusing on in sessions now, processing all these things that are apparently still bothering me one way or the other.” “That’s cool,” Gwen says.

“I think I’m over all my breakups. Maybe because each one was a really long, hard process I went through at the time, sometimes a really long one. I’ll bet you just kind of moved on, although you cried, so that’s something.”
“Yeah, but I denied to myself that I cared, and I don’t think I ever cried again in front of anyone after that.”
“Ah, unhealthy.”
“I know.”
“So how’s your back?”
“It’s pretty good. Once or twice a week, it starts to hurt, but I’m not worried about it. Mostly it just goes away, sometimes I listen to my recording. I’m working on other things now.”
Gwen asks, “But aren’t they all connected?”
“Possibly,” Joel says. “I’m just going with what comes up and feeling grateful I can sleep.”

M: So, it seems that Gwen actually forgot that she did have a venting dream.

K: Yes, Gwen is the one who forgot.

M: So if you are interested in what kind of dream she had, then you can go back to that episode. And it was, I thought it was hilarious, you know, the dream that she had, but anyway. And so we talked a little bit about venting dreams, but just to recap, during sleep, the brain sorts through all kinds of things from the day, experiences, feelings, and stimuli, and dreams seem to help with that process. The venting dream is often the one you may remember right before waking up or, you know, in the early morning.

M: It’s kind of like a release, letting go of stuff that are no longer needed, or patterns or emotions the brain doesn’t want to keep anymore. And that’s also why so many dreams don’t make any logical sense at all, because the subconscious isn’t about logic. It’s all about images and feelings and associations. And so that’s why, you know, I get dreams like from one scene, and then all of a sudden, I’m like in a totally different place with totally different people. But anyway, and these dreams, the venting dreams can be very useful in hypnotherapy because they show what you are letting go of. This isn’t about looking up symbols in a dream dictionary.

M: Each venting dream is totally unique to the person, the images, the emotions, everything tied to what their subconscious is working through. Personally, I don’t remember my dreams very often. But strangely enough, right after I have my hypnotherapy session, then either like the next morning, or maybe the morning after, I do tend to remember the dream upon waking up. But the memory of those dreams is very fleeting. And so I would have to write it down like right away if I want to remember and share the contents of the dream with my therapist in the next session.

K: Right.

After Joel meets Brent’s boss and fails to convince him to try hypnotherapy, the two friends take a brisk walk around their favorite park where evergreens keep the otherwise dreary winter landscape lively.
“Are you going to keep doing sessions?” Brent asked Joel.
“We did something last week to help with the rejection I feel over my relationship with Avery. Even though I guess it was my idea to end things mainly, accepting that I still felt rejected helped.”

“I wish I ate less ice cream,” Brent says suddenly. Joel laughs.
“I started making myself root beer floats after lunch and after work. It’s getting bad.
“It’s so cold, though,” Joel says.
“I know. I’m huddled in blankets and three layers of clothing hunched over a children’s dessert. It’s no way to live. But I also look forward to them like nothing else.”
“Gotta have something to look forward to,” Joel says.
“If you can get help with back pain, I can probably get help with root beer floats,” Brent says.
“Oh, yeah, sure. I see what you’re saying. You should really be relying on some kind of fancy coffee for your obsession anyway.”
“Or you could add ice cream to your menu,” Brent says. “Cold brew floats are already a thing, but not for me. I’ve gained a lot of weight around my stomach and I’m not feeling my best. Also, Heather wants us to do a 5K run for a fundraiser in May.”
Joel sighs. “I guess I have no excuse now that my back’s better.”

M: By the way, hypnotherapy can also help with building new habits like, you know, getting into a workout routine or practicing mindfulness and also breaking old ones like smoking or stress eating or that root beer float habit Brent talked about.

K: Where did that idea come from? I don’t know.

M: It was lovely having you with us in Sunnyside again. If you like our show, please leave us a little review.

K: We’d like to thank High Street Jack for providing our theme song.

M: And thank you, Karisha, for writing our stories.

K: And thank you, Makiko, for dealing with all of our post-production work, our website and our process management.