Pain management not working? What to try next

Pain management stops working for people. Sometimes it is the medication, sometimes the physical therapy plateaus, sometimes the plan was never built around the person it was built for. If you are in pain management right now, this is also about how to get more out of it. I'm Eugene Berezin, a Registered Hypnotherapist in Washington, and pain is one of the areas where hypnosis actually has decent research behind it. Here is what I tell people who come to me at this point.

First, say it out loud to your provider

It sounds obvious and people don't do it. If the plan is not working, tell the person running it. A doctor, a physical therapist, a hypnotherapist, it does not matter who. "This is not working for me" is a complete sentence, and it is completely fine to change the plan and look for other ways to manage your pain. Good providers want to hear it. The ones who get defensive have told you something useful too.

When the pain stopped being only physical

There is something that happens with long-term pain, and with long-term opioid use in particular, that a lot of doctors are quietly worried about. The brain stops being able to tell whether what it is feeling is physical pain or emotional pain. The tissue may have healed. The pills keep getting prescribed, the dose creeps up, and at some point what is being treated is not the injury any more. It is everything the injury brought with it.

I am not a doctor and I don't prescribe. Prescribers know about tolerance and dependence and they have ways to manage it. What I am saying is: be open to that conversation with your doctor, and in the meantime look at what else in your life is feeding the pain. Because pain is never separate from who you are. Not from your identity, not from your race or your culture, not from your stress.

If you run a business, start there

A lot of the people I work with run businesses or carry high-stakes decisions for a living. When you run a business and you live with pain, the adversity never stops, and that is the first contributor you should look at. I am a business owner myself. My brain almost never shuts off, and it takes effort to calm it down. I don't have chronic pain, but I get stress headaches and the body aches that go with a bad week, and that is real. If you are recovering from an injury, or you have fibromyalgia or another chronic condition, the stress from your work is a contributing factor. You don't have to go looking far for it.

So find a provider who understands the life you actually live. In my practice I prioritise people who run businesses because I know what that nervous system looks like at eleven at night.

The rest of the picture

Pain is also tied to your past, to trauma, to psychological needs that are not being met. That has to be addressed too, not instead of the medical side, alongside it. And then there is how you look after your body: what you eat, when you sleep, and, for a lot of people, something spiritual.

I want to be careful with that word. Spirituality is not the same thing as high-control religion. Lisa Miller, a clinical psychologist at Columbia who has spent her career on this, writes in The Awakened Brain that people with a spiritual practice tend to be more resilient and more resourceful under stress, and that spiritual practice activates a particular network in the brain. The practice can be prayer, meditation, a walk in the woods without headphones, a ritual that means something to you. What people report from it is a sense of being held, looked after, not alone. If you are in pain, that is not a small thing.

Hypnosis can be a spiritual experience, and some clients want it to be. In parts work, which is the framework I use, we sometimes call on what the model names guides or higher wisdom; ego state therapy has a version of the same thing. If you are a materialist and you want none of that, we leave it out and work on the pain. It is always your call.

Medicine, physio, and this

None of this is an argument against medication or physical therapy. If the pills help, good. If swimming, massage or tai chi helps, wonderful. Hypnosis is the piece that works on the part of pain the other pieces don't reach: how loud it is, how much of your attention it takes, how braced your body is against it. Systematic reviews find moderate reductions in chronic pain intensity, clearest when the work runs eight sessions or more. That is what I plan for.

How a session with me goes

We talk first. I use motivational interviewing to line up what you actually want from this. Then hypnosis for the pain. Then a debrief, where we look at what happened and what you want to change between now and next week. My practice is informed by Internal Family Systems and I use pieces of ego state therapy inside the hypnosis, because parts work and hypnosis are a very natural fit. Every session ends with a recording made for you.

Pain management is complex and I always recommend working with a specialist, and keeping your doctor in the loop. If you want to try this, request an appointment and tell me what has and hasn't worked so far.

This is the written version of a Pain-Free Friday episode on YouTube, in Eugene's words, lightly edited for reading.