An even larger number are treated with drugs that come with a long list of side-effects and provide short-lived and, in many cases, partial pain relief. Pills and surgery clearly aren't providing the lasting pain relief that people desperately need, so what can?
My answer? Tapping.
First developed 30 years ago by psychologist Dr Roger Callahan, tapping has been used by tens of thousands of people to successfully relieve chronic pain. The technique brings together the best of Eastern and Western medicine, targeting both the emotional and the physical aspects of pain. It involves verbally expressing emotions, usually out loud, while tapping with your fingertips on specific meridian points on the body.
After witnessing the results tapping produced in his patients, Callahan began teaching his method, which he called Thought Field Therapy, to other professionals. One of his students was Gary Craig, an engineer at Stanford University, who simplified Callahan's method and renamed it Emotional Freedom Techniques (EFT). The EFT sequence includes nine key tapping points, which most tapping experts use today. Craig's EFT sequence, along with Dr Patricia Carrington's Choices Method of tapping, have, as she says, made tapping "the people's method", rather than a tool available only to highly trained professionals.
Proof of the mind-body connection
To better understand why tapping is so effective for pain relief, we can look to the late pharmacologist Dr Candace Pert and her monumental discoveries around the mind-body connection.
A female doctoral candidate working in the male-dominated laboratories at the US National Institutes of Health (NIH) in the 1970s, it was her success in measuring the opiate receptor that provided a scientific basis for what Pert calls the 'bodymind'. As she explained in her book Molecules of Emotion (Simon & Schuster, 1999), "Technological innovations have allowed us to examine the molecular basis of the emotions, and to begin to understand how the molecules of our emotions share intimate connections with, and are indeed inseparable from, our physiology. It is the emotions, I have come to see, that link mind and body."
The opiate receptors Pert measured are like keyholes. They bind with very specific keys, called peptides, which, she explains, "are indeed the other half of the equation of what I call the molecules of emotion". When the opiate receptor, which floats on the surface of a cell like a lily pad on a pond, binds with its perfectly fitting peptide, that cell's behaviour can change. In other words, at any given moment, a cell's behaviour can shift based on which peptide 'keys' are attached to its opiate receptors.
"On a more global scale," said Pert, "these minute physiological phenomena at the cellular level can translate to large changes in behaviour, physical activity, even mood."
Pert's research findings have provided a scientific basis for the idea that we can heal diseases in the body by targeting emotions. As Pert shares, "It is this problem of unhealed feeling, the accumulation of bruised and broken emotions that most people stagger under without ever saying a word, that the mainstream medical model is least effective in dealing with."
The root cause of pain
John Sarno, MD, author of Healing Back Pain, has seen Pert's discoveries clinically play out throughout most of his career. In his work with thousands of patients, Sarno identified a bodymind disease he calls 'tension myositis syndrome (TMS)'; myositis means physiological alteration of muscle.
According to Sarno, we all naturally feel negative emotions, especially anger, as a result of the many stressors and demands of everyday life. When that anger builds over time and remains unexpressed, it can become buried in the unconscious mind. As he explains, "Accumulated anger is rage, and frightening, unconscious rage leads to the development of physical symptoms."
This process is completely normal, but it's not easily controlled by the conscious mind using conventional therapies. As Sarno explains, "Most people, if given the choice between coming to terms with difficult feelings or experiencing intense physical pain, would choose to deal with the feelings. That's logical. But the way the human emotional system is now organized dictates how it will react; at the unconscious level it is often illogical."
As a result, instead of processing negative emotions like anger, we often unconsciously bury them. Once repressed rage has reached a certain level in the unconscious mind, the brain begins to create physical symptoms, such as chronic pain, by limiting blood flow to one or several areas of the body.
So, let's say you went through a horrible divorce years ago. It needed to happen and you now know you're better off as a result. You feel as if you're over it but, in fact, while the divorce was happening, your unconscious mind buried your rage without your realizing it. That's what the unconscious mind does-it takes over without our knowledge or consent. Over time, that repressed rage limits oxygen supply to your muscles. That oxygen deprivation then leads to muscle constriction, which spreads to nearby muscles.
You experience that process every time you clench your fist. First the muscles in your hand tighten and, almost immediately after, the muscles in your lower arm tighten also. As time goes on, when your muscles remain tight and constricted, you experience pain.
According to Sarno, the only way to treat TMS is by addressing the underlying emotions that originally caused the pain: "When patients become aware of the presence of rage or unbearable feelings, these feelings can cease their struggle to become conscious. Removing that threat eliminates the need for physical distraction, and the pain stops."
Sarno's work shows that we can treat physical pain by finding new ways to access the bodymind and process our emotions in a more complete way.
Pain, the brain and emotions
There are many different ways the brain and body can create, increase and prolong pain. In some cases, a physical event, like picking up something heavy and hurting your back, is what initially triggers pain. In that case, nearly everyone experiences pain immediately or soon after the injury occurs. Immediately after that, the brain's networks and neurons begin to rewire in an effort to protect you from similar future injuries-putting you on 'higher alert' to avoid pain.
The brain's ability to rewire is known as 'neuroplasticity'. The neuroplastic changes that occur in the brain immediately after an injury vary significantly from one person to another and from one event to another. Some experts believe that the nature and timing of the specific neuroplastic changes in the brain that happen after an injury may affect where, and for how long, you experience pain from that injury. In other words, your emotional state at the time of injury, or during the hours immediately after the injury, may help to determine whether your pain will become chronic, whether it will occur in several places or just one, and so on. Research using functional magnetic resonance imaging (fMRI) has shown that emotions such as fear and anxiety can increase pain. Negative emotions may also turn short-term pain into a chronic condition.
In one study involving women who'd been diagnosed with fibromyalgia, a condition that involves chronic pain, Dutch researchers induced pain with an electrical stimulus in two separate circumstances: while the women recalled an emotionally neutral event; and as they remembered an event that made them feel sad and/or angry. Higher levels of pain were consistently felt when the women were recalling memories that made them feel sad and/or angry.
The evidence also shows that expressing emotions helps to lower pain. In one randomized controlled trial of more than 150 patients, those who were given cognitive behavioural therapy, allowing them to express their emotions, experienced less pain, fatigue and functional disability than did those who were simply put on a waiting list.
Obviously, if you are experiencing a new, acute pain that has no evident explanation, be sure to consult a physician before you use tapping for pain relief. Pain is your body's way of talking to you, and medical tests may be necessary to correctly interpret what it's saying and whether a condition has developed that will worsen without medical intervention.
Tapping into natural painkillers
In a double-blind study conducted by Dawson Church, PhD, tapping was shown to produce, on average, a 24 per cent drop in cortisol after just one hour of tapping. During that same hour of talk therapy without tapping, participants showed a much smaller drop in cortisol levels.
That drop in cortisol may be partially responsible for the pain relief tapping provides. One randomized controlled tudy of patients suffering from tension headaches at the Red Cross Hospital in Athens showed a more than 50 per cent decrease in the intensity and frequency of headaches after tapping.
A different study of 216 healthcare workers showed they experienced a statistically significant drop in physical pain after a one-day tapping workshop, while other studies involving veterans as well as fibromyalgia sufferers have also shown significant decreases in physical pain after tapping.
Research has shown that acupuncture, and acupressure as well, provides pain relief by increasing endorphin levels in the body. Since tapping engages acupressure points while also lowering cortisol, it's likely that tapping, like acupuncture, allows the body to release the endorphins that then relieve pain.
The incredible results that tapping has shown in alleviating chronic pain may be explained, at least in part, by its ability to access what are called 'meridian channels'. While knowledge of these channels dates back to ancient Chinese medicine, it wasn't until the 1960s that these threadlike microscopic anatomical structures were first seen by stereomicroscopy and electron microscopy. These images showed tubular structures measuring 30 to 100 micrometres wide running up and down the body. First described in a published paper by North Korean researcher Kim Bong-Han, they are also referred to as 'Bonghan ducts'. As a point of reference, one red blood cell is 6 to 8 micrometres wide, so these structures are tiny.
You can think of meridian channels as a fibreoptic network in the body. They carry a large amount of information, often electrical and often beyond what the nervous system or chemical systems of the body can carry. By accessing these channels while processing emotions and thoughts as well as physical conditions like pain, some suggest that tapping is able to get to the root cause of chronic pain more quickly than other approaches can.
Because tapping sends calming, relaxing signals directly to the amygdala, it may also help us to override the brain's negativity bias more rapidly. By using tapping to neutralize what the amygdala concluded were threats to its survival, we may be able to reprogramme the brain to support more positive experiences, such as pain relief, pleasure and relaxation.
Tapping away the doctor's diagnosis
Since being diagnosed with scoliosis in her 20s, Vickie had tried it all-Rolfing, chiropractors, acupuncture, physical therapy-"anything and everything I could find that might allow me to avoid pills and conventional medicine," she explained. Her back pain got so bad, however, that she'd finally agreed to see a spinal surgeon. After the surgeon walked into the examination room without even saying hello, he quickly blurted out: "You're now at a 50-degree curve. Your spine is collapsing. You've shrunk one and a half inches. It's going to keep going in this direction. Surgery's not an alternative. At your age, it's life-threatening; you don't qualify. Wait another 20 years, when you'll probably need a wheelchair, and we'll see what we can do then."
He exited the room soon after, leaving Vickie alone with her distress. To begin processing the trauma of those moments when she'd first heard the diagnosis, I led Vickie through several rounds of tapping on the shock and fear she had felt that day, as well as the brutality she had experienced from her doctor.
We also tapped on her feeling of hopelessness, finishing with, "But maybe there is a sliver of hope... that's all I need to get started . . . so I can relax . . . and find a way to heal."
By the end of our tapping session, Vickie's low back pain had gone from an 8 out of 10 to a 5 out of 10. And thanks to the 'sliver of hope' she'd gained during these rounds of tapping, during a call with me several weeks later, her pain was down to a 0. By releasing the trauma of her diagnosis and tapping through the tremendous stress she was feeling, she finally quieted down her amygdala's high-alert signals, and her pain went away.
Managing everyday stress
Mark had a sharp, stabbing pain in his lower back and a burning pain in his upper back, and said he felt stuck in several areas of his life. "Give me one example of an area where you feel stuck," I said.
"Financial matters," he immediately replied. "There are several fairly important things I need to tend to, but when I think about them, I get this feeling of dread."
We then spent several minutes tapping on his anxiety around finances, specifically around how overwhelmed he felt about planning for the future. As we tapped through the points, we asked questions like "What is this stress around finances all about?" and "What is this pain all about?" In addition to being a powerful tool for resolving issues, tapping is great for uncovering memories and emotions that are still impacting us, but which have become buried over time. When you come to a question that you can't answer, try asking yourself the question repeatedly while tapping through the points.
After a few minutes of asking himself these questions while tapping, Mark remembered how his dad had used money to control him and his brother when they were growing up. One memory in particular came to Mark's mind-a morning when Mark was 18, soon after he'd returned from an extended trip to Europe. Without saying a word, his dad walked into his room, threw a stack of bills on his bed and then walked out. Mark didn't know what to make of his dad's gesture. He remembered being terrified of the consequences, unsure if his dad would make him find a way to pay the bills or cut him off financially, or if there would be physical consequences.
I then asked Mark to retell the story while tapping through the points, running through it several times until the intensity of the memory was lower. When you're trying to clear a memory or event, run a 'movie' of that event-including sights, sounds, smells and any other details you remember-through your mind over and over again until you can recall it without feeling the emotional charge it once had. That's when you know you've cleared it.
As we kept tapping, Mark's fear and anxiety turned into anger at his dad for not telling him what he'd done wrong and what he needed to do better. We continued tapping on his anger, using reminder phrases like "all this anger at my dad" and "all this stress and anger in my back". Our final rounds included phrases like "I choose to release all this stress and anger in my back now" and "I choose to release all this anger at my dad right now".
When we were done tapping, Mark's back pain and anxiety were gone. I asked him to think about his finances again. "I don't feel any anxiety," he said. "I actually feel like I want to go get some work done."
What's the emotion behind your pain?
To begin, get your journal and a pen or pencil. Close your eyes, take a deep breath and begin tapping through the points as you ask yourself: What emotion is behind my pain? When I see, hear and smell the story of my pain, what emotion(s) comes up?
There are no right or wrong answers here. Just keep tapping while asking yourself these questions repeatedly. If you get an answer like anger, fear or guilt, ask yourself how intense that emotion feels on a scale of 0 to 10. Also, take note of your pain and give it a number on a scale of 0 to 10.
Once you pinpoint an emotion, keep tapping while asking yourself a more specific question, such as: Fear of what? Anger at whom? Guilt about what? When you have your answer(s), slowly open your eyes and write down the emotion(s) and the emotional intensity number, as well as any other ideas, thoughts or impressions that came up as you were tapping.
A step-by-step guide to tapping
1- Close your eyes and take three deep breaths. Feel yourself grounded in your body and focused on the present moment. Feel your feet firmly planted on the ground, rooted to the earth.
2- Focus on your pain (or whatever issue is bothering you most). Write down in your journal what kind of pain you're feeling (such as sharp, dull, hot or cold) and where it's located.
3- Rate the intensity of your pain on a scale of 0 to 10, with 10 being the most excruciating pain you can imagine. This is called the SUDS (Subjective Units of Distress Scale). Note this number in your journal.
4- With your SUDS level in mind, craft what's called the 'setup statement'. This focuses on the energy and nature of your pain. The basic setup statement might go like this: Even though I , I deeply and completely love and accept myself. So, you could say "Even though I have this hot, sharp, stabbing pain in my lower back, I deeply and completely love and accept myself" or "Even though I have this dull, throbbing pain in my jaw, I deeply and completely accept myself". Your setup statement should resonate with what you're experiencing as you begin tapping.
5- Tap on the karate chop point (see right) while repeating your setup statement three times, then tap through the eight points below (see right) in sequence while saying the reminder phrase out loud:
2 Side of eye
3 Under eye
4 Under nose
7 Under arm
8 Top of head
Tap five to seven times at each point, but don't worry about counting or doing it perfectly; it's a forgiving process. You can tap with either hand on whichever side of the body feels best to you, as the same meridian channels run down both sides of the body.
7- Once you have finished tapping the points in sequence, take a deep breath and check in. Again, rate the intensity of your pain using the 0-to-10 scale to check your progress.
8- Test your progress by making the movement that caused pain, or focusing on the memory or emotion that increased your pain.
9- Continue tapping as necessary to get the relief you desire.
In your journal, write down the shifts you experienced in your pain and note any changes in pain intensity as well.
Shouldering the entire burden
When I first asked Nicole to raise her right arm, she hesitated and then tried it, but winced after it was only a few inches away from the side of her body. Her right shoulder had been frozen and painful for almost three years from repetitive overhead work.
Since the injury, her life had been severely limited by her shoulder pain. She'd also undergone two shoulder operations, but still hadn't got the pain relief and mobility she desperately wanted. "Some days, all I can do is lie down," she said.
We began with some general tapping, focusing on "all this pain in my body". Next I asked her to tap through the points while telling the story of what happened at the time of her injury, focusing on emotions as well as sights, smells, sounds and colours from that time.
The basic idea here is to tap as you're talking, which allows you to connect to the stuck energy, trauma and emotions from that time. By allowing yourself to feel and voice it while tapping, you're able to release it.
As she tapped, she shared that, before her injury, she'd been working in her dream job as a purser on a cruise ship. Her mother had become ill, however, and she'd had to quit that job and work instead at an agency, doing odd jobs and working long hours to make up the money she'd lost on the cruise ship. Her mum then developed dementia, and Nicole had been forced to take care of her while also working intense hours.
"It was a very emotional and stressful time," she explained. "I had no help, and I was caring for my mum while also suffering and in pain and also working a lot of hours . . . It feels better just talking about it," she added.
We began tapping on the trauma she'd experienced during that time and how it had stayed with her in her frozen shoulder. "When I was caring for Mum, I really had no help from anybody," she explained. We tapped on her anger and rage at her family for not helping her, for how they treated her. We also tapped on releasing that anger and rage, on unfreezing her shoulder and on letting go of the pain.
In just 20 minutes, her shoulder pain had gone down significantly. She was able to raise her hand to a 45-degree angle for the first time since her injury, and she'd pinpointed the true source of her pain-her anger and rage at her family for not helping her during her mother's illness and dementia.
The brain's negativity bias
The human brain has evolved to focus more on negative outcomes than on positive ones. For our own protection, it was built to always assume the worst. In his book Hardwiring Happiness, Rick Hanson, PhD, explains: "Our ancestors could make two kinds of mistakes: (1) thinking there was a tiger in the bushes when there wasn't one, and (2) thinking there was no tiger in the bushes when there actually was one. The cost of the first mistake was needless anxiety, while the cost of the second one was death.
Consequently, we evolved to make the first mistake a thousand times to avoid making the second mistake even once . . . the default setting of the brain is to overestimate threats, underestimate opportunities, and underestimate resources both for coping with threats and for fulfilling opportunities. We then update these beliefs with information that confirms them, while ignoring or rejecting information that doesn't.
"There are even regions in the amygdala specifically designed to prevent the unlearning of fear, especially from childhood experiences. As a result, we end up preoccupied by threats that are actually smaller or more manageable than we'd feared, while overlooking opportunities that are actually greater than we'd hoped for. In effect, we've got a brain that's prone to 'paper tiger paranoia'."
Most of us can relate to what Hanson says is "the special power of fear" because it's been hammered into our unconscious minds for millennia. Think about your daily routine. As you go about your day, if you make a movement that causes you pain, if you're like most people, you remember to avoid that movement for months afterward. If you also do something that soothes your pain or even feels good, you might not remember it as readily. That's your primitive brain at work. In other words, because of how our brains have evolved, negative experiences routinely outweigh positive ones.
The psychologist Daniel Kahneman received the Nobel Prize in Economics for showing that most people will do more to avoid loss than to benefit from an equivalent gain. In intimate relationships, we typically need at least five positive interactions to counterbalance every negative one. And for people to begin to thrive in life, they usually need positive moments to outweigh negative ones by at least a three-to-one ratio.
The amygdala, the part of the brain that's activated when we're under stress and involved in emotions as well as physical pain, typically is activated more by negative experiences than by positive ones. When your body is under stress or senses a threat, it secretes the hormone cortisol, which is also referred to as the 'stress hormone'. The threat you're experiencing can be physical, like getting out of the way of an oncoming car, or emotional, such as feeling anxious, angry or afraid.
When you experience ongoing stress for a long period of time, your body releases excessive amounts of cortisol, which may make you more susceptible to pain and less likely to heal from injury or experience pain relief. When you're feeling more positive, the body is in a more relaxed state and cortisol levels naturally go down. The body is then better able to support healing in the body as well as pain relief.
1 Arthritis Care Res [Hoboken], 2010; 62: 1377-85
2 Psychology, 2013; 4: 645-54
3 Explore [NY], 2013; 9: 91-9
4 Depress Res Treat, 2012; Article ID 257172, 7 pages; doi: 10.1155/2012/257172
5 Pain Manag Nurs, 2014; 15: 539-50
6 J Acad Med Sci, 1963; 10: 1-41; PLoS One, 2010; 5: e9940