Why chronic pain won't go away, and what finally helps

Pain steals people's joy. When pain stays, it stops being only physical and starts working on you psychologically, because the mind and the body are not two separate things. This is the first piece in a series I'm calling Pain-Free Friday, and it is not a sales pitch for hypnosis. I want you to know your options and know what to search for next.

What living with it actually costs

Chronic pain affects your career, your relationships, your sexuality, your dreams, your productivity and your mental health, all at once. I'm Eugene Berezin, a Registered Hypnotherapist in Washington. One of my specialties, in my education and for years in practice, was people living with chronic and terminal illnesses and with sensory disabilities, and chronic pain was something I saw every day in that work. If I can bring a little relief, or just a little education about what is available, that is the point of this.

Why it won't go away

There is pain that is treatable and there is medication for it. Not everyone wants medication. Sometimes it stops working, and at some point many people have to come off it; opioid dependence is real, and some people come off on their doctor's recommendation, some because they don't want to depend on anything, some never start.

But here is the part that keeps people stuck. When pain persists, you start anticipating it. The fear of the pain and the anxiety about the pain become, for a lot of people, harder to bear than the pain itself, and the anxiety turns the volume up. Your brain learns that certain movements, certain times of day, certain seasons mean pain, and it starts producing the pain on schedule. In some cases the original tissue injury is no longer the main thing going on. That does not mean it is in your head. It is real, it hurts, and it is also learned. Neurons that fire together wire together, which is why pain changes you at the level of the nervous system, and why it takes your sleep and your desire with it.

Some conditions, fibromyalgia for one, don't have a reliable medical treatment yet. When I worked in case management I had clients on Medicare telling me the pool was the only thing that helped, or massage, and nobody listened, and insurance wouldn't cover it. That is a lonely place to be.

What else is on the table

I am not a medical doctor. If you are in chronic pain, work with your physician. Doctors are not the enemy and medication is not the enemy. But if you choose not to take it, or you need something alongside it, here is what exists.

• Psychotherapy for pain. Licensed psychologists, clinical social workers and counsellors who specialise in pain, using approaches like acceptance and commitment therapy and cognitive behavioural therapy. This is real and it helps people.
• Clinical hypnosis. This is what I do, with parts work and motivational interviewing built in. Hypnosis and psychotherapy are not rivals; they tend to go hand in hand, and one is not better than the other.
• Pain management clinics, physical therapy, the medical route. All still on the table, and for many people the foundation.

What I have seen hypnosis do

The research on hypnosis for pain is reasonably good. What I have seen personally is that it works on the anxiety that rides on top of the pain, on stress, and on how the body holds the injury; my clients recovering from injuries tend to feel better and, anecdotally, heal with less inflammation. It is not a magic pill. I cannot promise it will work for you, and I am not going to tell you my method beats everyone else's because of some certificate. Try it, is what I say.

What matters more than the method is the alliance. If you don't connect with your hypnotherapist, or your therapist, the work won't work. Pick someone you actually like.

How to try it without overcommitting

Try three sessions and see how you feel. The honest number for lasting change is eight to fourteen, eight at a minimum, and after that we decide together whether you are done, whether you move to maintenance, or whether the recordings carry you. Sessions are on video; I work with people internationally. After each one you get a personalised recording for your case, with nothing identifying in it, so if someone finds it on your phone it sounds like any guided audio. That is your support between sessions.

One more thing, for the gay and bi men reading

It can feel like your pain has nothing to do with your sexuality. But your pain touches every part of your life, including who you love and how. You don't need to ditch a good physician who treats you with respect and doesn't specialise in gay men. But for hypnosis or therapy, work with someone who sees all of you and what the pain is doing to the life you actually want.

If this resonates, request an appointment. If it doesn't, that is fine too; there are other roads, and I want you on one of them.

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