Shaking the Blues Away : Energizing spiritual practices for the treatment of chronic pain

1. �Shaking the Blues Away�:Energizing spiritual practices for the treatment of chronic pain � Amy B. Wachholtz, PhD, MDiv University of Massachusetts Medical School August 12, 2010�

2. A Different View Rather than calming contemplative, energizing contemplative

3. Bio-psycho-social-spiritual model of pain

4. Gate/Neuromatrix Theory of Pain

5. -Kevin Seybold has done some work on identifying the physiological pathways through which R/S may affect pain. Bio-psycho-social model of pain:::Gate control theory (Melzack & Wall, 1965)/ Neuromatrix theory of pain (Melzack, 1999) New model incorporates spiritual factors as well (McKee & Chappel, 1992; Sulmasy, 2002) Bio-psycho-social-spiritual model of chronic pain -Kevin Seybold has done some work on identifying the physiological pathways through which R/S may affect pain. Bio-psycho-social model of pain:::Gate control theory (Melzack & Wall, 1965)/ Neuromatrix theory of pain (Melzack, 1999) New model incorporates spiritual factors as well (McKee & Chappel, 1992; Sulmasy, 2002) Bio-psycho-social-spiritual model of chronic pain

6. Potential Pathways between Pain and Energizing Spiritual Practices

7. Hyperarousal & Altered Consciousness *Strong emotional experience + physiological arousal can lead to an altered state (Schumaker,1995) *Noise, movement, repetitive lyrics, sensory over stimulation, can trigger this altered state *Some symptoms appear to be closely related to the experiences of individuals on who take the drug known as X or ecstasy (serotonin pathway) including �feeling light, losing track of time, sensing electricity in the body, numbness, and feeling like one�s body is on fire� *Stress, hyperventilation, exertion, and hypoglycemia can increase susceptibility to auditory and visual stimulation that can trigger altered consciousness *Strong emotional experience + physiological arousal can lead to an altered state (Schumaker,1995) *Noise, movement, repetitive lyrics, sensory over stimulation, can trigger this altered state *Some symptoms appear to be closely related to the experiences of individuals on who take the drug known as X or ecstasy (serotonin pathway) including �feeling light, losing track of time, sensing electricity in the body, numbness, and feeling like one�s body is on fire� *Stress, hyperventilation, exertion, and hypoglycemia can increase susceptibility to auditory and visual stimulation that can trigger altered consciousness

8. Mock Hyperstress Hypothesis (Prince, 1982) Prince (1982)- artificial threats can be healing b/c cause release of endorphins- Think about why people watch scary horror movies- people are less �positive� about their experience at the movies if they were not adequately scared Think about the people who live on �drama�- the fear/hyperstress can have a �good� feeling on the outcome Fear activates the sympathetic nervous system (muscle tension, vasoconstriction) � which may be related to the initial reports of cold/numbness/tingling reported by individuals at the beginning of engaging in spiritually energizing activities Upon release of the endorphins- the body physiologically relaxes as the parasympathetic nervous system kicks in which may relate to later reports of electricity, warmth, and power flowing through the individual What research is just starting to explore- uncontrollable belly laughter can have many of the same effects Prince (1982)- artificial threats can be healing b/c cause release of endorphins- Think about why people watch scary horror movies- people are less �positive� about their experience at the movies if they were not adequately scared Think about the people who live on �drama�- the fear/hyperstress can have a �good� feeling on the outcome Fear activates the sympathetic nervous system (muscle tension, vasoconstriction) � which may be related to the initial reports of cold/numbness/tingling reported by individuals at the beginning of engaging in spiritually energizing activities Upon release of the endorphins- the body physiologically relaxes as the parasympathetic nervous system kicks in which may relate to later reports of electricity, warmth, and power flowing through the individual What research is just starting to explore- uncontrollable belly laughter can have many of the same effects

9. Serotonin PathwaysImage from: http://www.drugabuse.gov/pubs/teaching/teaching4/Teaching3.html Exercise, and positive mood are both related to increased serotonin. Increased serotonin is also related to decreased pain experience. The characteristics of exercise (fine motor trembling, dancing, clapping, physiological arousal) are also found in energetic spiritual practices and may relate to decreased experiences of painExercise, and positive mood are both related to increased serotonin. Increased serotonin is also related to decreased pain experience. The characteristics of exercise (fine motor trembling, dancing, clapping, physiological arousal) are also found in energetic spiritual practices and may relate to decreased experiences of pain

10. Endogenous Opioid Pathways The term endorphin consists of two parts: endo- and orphin, which come from endogenous and morphine, thus creating endorphin, a morphine-like substance originating in the body. The endorphins are released into the blood, and enter the brain in small quantities, and give a good feeling throughout the body. High quantity of endogenous opioid receptors related to auditory, kinetic, & visual perception Consider the runner�s high� this is a release of endorphins (or endogneous opioids) due to physiological arousal. Don�t know is if energizing spiritual practices is the same as the runners high or if there are qualitative and quantitative differences � but they likely share at least a few shared pathways.The term endorphin consists of two parts: endo- and orphin, which come from endogenous and morphine, thus creating endorphin, a morphine-like substance originating in the body. The endorphins are released into the blood, and enter the brain in small quantities, and give a good feeling throughout the body. High quantity of endogenous opioid receptors related to auditory, kinetic, & visual perception Consider the runner�s high� this is a release of endorphins (or endogneous opioids) due to physiological arousal. Don�t know is if energizing spiritual practices is the same as the runners high or if there are qualitative and quantitative differences � but they likely share at least a few shared pathways.

11. Traditional and Research Examples

12. Examples from Traditional Sources Lakota Sun Dance Pentecostal/Charismatic Christian Revivals Sufi Muslim Sema Dance Fire handling / Snake handling (1200 B.C.) Laughing Yoga Modern Firewalking All using highly focused (contemplative) meditations but using energizing experiences

13. Drumming and pain 30 individuals aged 65-102 over a 3 month study30 individuals aged 65-102 over a 3 month study

14. Rock Music/Drumming and Pain (Coleman, 1997) Not all individuals who experience spiritual elevation to escape the impact of pain on the body are members of a group or even use these practices as part of a faith tradition. Arthur Coleman- low back pain 7 years. tried multiple forms of physical treatment, physical therapy, medications, chiropractic manipulation, and massage w/ limited relief Finally, after an eye opening experience with his son that emphasized how opioid analgesics were damaging his cognitive and social abilities, he began searching for alternative medicine practices. He began to use �strong rock music� and drumming as a way to override his pain experience (Colman, 1997). Feeling of elation would disintegrate the back pain with both immediate relief while doing his �rock music therapy,� but also afterwards. Only by using the intense practices of rock music and drumming was he able to provide the cognitive distraction, and physiological relaxation that helped him continue to cope with his pain (Coleman, 1997). Not all individuals who experience spiritual elevation to escape the impact of pain on the body are members of a group or even use these practices as part of a faith tradition. Arthur Coleman- low back pain 7 years. tried multiple forms of physical treatment, physical therapy, medications, chiropractic manipulation, and massage w/ limited relief Finally, after an eye opening experience with his son that emphasized how opioid analgesics were damaging his cognitive and social abilities, he began searching for alternative medicine practices. He began to use �strong rock music� and drumming as a way to override his pain experience (Colman, 1997). Feeling of elation would disintegrate the back pain with both immediate relief while doing his �rock music therapy,� but also afterwards. Only by using the intense practices of rock music and drumming was he able to provide the cognitive distraction, and physiological relaxation that helped him continue to cope with his pain (Coleman, 1997).

15. Dance Therapy 16 week EDUCIZE Enthusiastic dance based exercise for RA Brief periods of physiological arousal pain both during & follow-up (Perlman, et al, 1990) Perlman, S. G., Connell, K. J., Clark, A., Robinson, M. S., Conlon, P., Gecht, M., et al. (1990). Dance-based aerobic exercise for rheumatoid arthritis. Arthritis Care & Research, 3(1), 29-35.Perlman, S. G., Connell, K. J., Clark, A., Robinson, M. S., Conlon, P., Gecht, M., et al. (1990). Dance-based aerobic exercise for rheumatoid arthritis. Arthritis Care & Research, 3(1), 29-35.

16. Applications for Practitioners

17. Dangers of hyperarousal Untreated illness or injury Exacerbated illness or injury New illness or injury Lawsuits have occurred

18. Applications for Practitioners Music Therapy Loud, fast music creates physiological arousal Emotionally powerful music creates arousal Pain relieving Active (vs. passive) participation = greater pain release Pentecostal Christians tend to have stronger emotional reactions to religious music (Miller & Strongmann, 2002)

19. Applications for Practitioners Encourage patients to use spiritual experiences as coping resource Energizing spiritual practices can mood May create psychological and physiological activation to pain

20. Conclusions Primary paradigm for psycho-social pain relief has been relaxation Energizing practices can create: physiological arousal + positive mood = pain Sufficient evidence to support further research on the bio-psycho-social-spiritual pathways that link energizing spirituality and pain Other than exercise, most psychotherapeutic treatments for pain involve calming rather than energizing practicesOther than exercise, most psychotherapeutic treatments for pain involve calming rather than energizing practices

21. Thank You Amy Wachholtz, PhD, MDiv University of Massachusetts Medical School Amy.Wachholtz@UMassMemorial.Org Special Thanks: UMass Faculty Development Grant