Why does trauma therapy hurt so much

The Influence of Chronic Pain by Psychological Pain Therapy Procedures and EMDR (2005)

Claudia Erdmann

EMDR in post-traumatic stress disorder and pain

The EMDR (Eye Movement and Desensitization and Reprocessing) method, published in the 1980s by the American psychologist Francine Shapiro, includes as a central component that the patient's attention is directed to a traumatic memory and the thoughts and feelings associated with it, while at the same time rhythmic eye movements be induced. (Shapiro 1998)

EMDR is significantly well suited for the treatment of post-traumatic stress disorder (PTSD). This is a disorder syndrome, mostly consisting of vegetative overexcitation, numbness, insomnia, anxiety and depression, which often occurs after very stressful events or severe threats, such as serious accidents, natural disasters, torture, sexual abuse, rape, etc.

The disorder of PTSD shows great similarities with the chronic pain syndrome. Chronic pain can be seen as an independent trauma with one's own body as victim and perpetrator. Often there are also trauma in advance or accompanying. Chronic pain is significantly associated with post-traumatic stress disorder, anxiety disorders, depression and other mental disorders.

EMDR is now also used with good success for other diseases, e.g. addictions, depression, anxiety and obsessive-compulsive disorders. Convincing successes have been achieved in the treatment of even very young children with various mental illnesses. (Tinker, Wilson 1999)

So far, however, there has been relatively little research into the effectiveness of EMDR in acute pain, chronic pain and in the field of psychosomatics. However, it is known that EMDR is suitable in acute pain to reduce the fear that often accompanies pain and, in addition, in chronic pain to increase pain tolerance, for more relaxation, for positive cognitive strategies, for desensitization and for distraction. (Groth, Rogers 1994).

EMDR leads to verifiable neurological changes and associated positive changes in the symptoms reported by the patient. (van der Kolk 2000)

According to initial studies, EMDR can also be used successfully for the treatment of phantom pain. (Wilson after Tinker, Wilson 2000)

Pain syndromes

The most common chronic pain syndromes include back pain, tension-type headaches, migraines, drug-induced headache, facial pain, pain associated with rheumatic diseases, osteoporosis pain, musculoskeletal pain, drug-induced pain, polyneuropathies, postherpetic neuralgia, complex pain, phantom disaffection syndrome, and regional pain syndrome - and cancer pain, post-operative pain, post-traumatic pain such as post-accident pain, abdominal pain and gynecological pain, psychogenic pain.

EMDR and Psychological Pain Therapy

The EMDR treatment of chronic pain includes many practices of psychological pain therapy and can be understood as the interplay of various factors that are assumed to be effective by representatives of different psychotherapy methods, e.g. learning psychological principles, imaginative exposure, free association, non-directive processes, emergence and change of emotions , Dealing with dreams and archetypal elements, working with cognitions, developing positive narratives, interrupting stereotypical physiological reaction patterns through distraction strategies, focusing attention, exposure, relaxation reactions, regression and desensitization processes.

Differences to psychological pain therapy:

  • In the EMDR treatment, the thought of a trauma event that represents the chronic pain itself, that may have preceded it and accompanies it, is explicitly taken up and processed. (Shapiro 1998)
  • EMDR emphasizes the primary role of affects and feelings and the modulation of feelings and emphasizes them explicitly in the treatment protocol. Even approaches based on relaxation, such as progressive muscle relaxation, biofeedback and systematic desensitization, are primarily aimed at relaxation in the face of stressful thoughts, combined with the hope that the emotions will then also change. The main aim of EMDR treatment is to reduce physiological and emotional tension. (Tinker, Wilson 2000) It is now known from brain research that affects and feelings are of much greater importance - also in the psychotherapeutic treatment process - than previously assumed. (Le Doux after van der Kolk 2000)
  • The EMDR protocol specifies a clearly structured treatment process and a task consisting of two parts: the patient should simultaneously perform bilateral eye movements and follow an internal process until his emotional tensions drop.
  • Combat metaphors are missing from the EMDR protocol. Psychological pain therapy often says "war on pain", relaxation methods are dubbed "invisible projectiles" against the "enemy pain", or treatment programs have names such as "pain immunization training" or "pain relief". The effect and influence of words heard 'unconsciously' has long been known. This knowledge is used in a targeted manner in hypnotherapy and in NLP (neurolinguistic programming). (Schiepek 2003)
  • The treating psychotherapist follows the patient's process. The EMDR work prevents the psychotherapist from penetrating the patient's thought and emotional processes and thereby hindering his natural development and healing. (Tinker, Wilson 2000)

EMDR Treatment of Chronic Pain

Shapiro's ideas:
Shapiro (1998) points out that the psychological stress of a (chronically) physically ill person is similar or even higher than that of a person traumatized by war events, rape or other disasters.

She emphasizes that most seriously ill people have PTSD and the feelings that go with it:

  • to have been betrayed by one's own body,
  • being abandoned by friends / family members of the medical system,
  • to be at the mercy of pain
  • of anger, disappointment, self-hatred, helplessness, lack of opportunities.

It shows the importance of the psychological components of the somatic illness and how often the physical complaints improve or completely resolve simply by processing and reducing the psychological complaints.

The goals that Shapiro (1998) considers essential when working with somatically ill people are expanded upon in the following:

  • Processing of the most urgent problems (drug abuse, clarification of comorbidities, social, financial, professional problems, problems in social relationships, etc.
  • Strengthening the self-healing powers and the immune system, strengthening the feelings of competence and decision-making options (by reducing emotional stress, reducing feelings of guilt and failure, reducing aggression and helplessness, etc., also by building up the ability to imagine as well as stress and pain reduction techniques)
  • In the event of the patient's imminent death: reconciliation with family, friends, reconciliation with one's own fate
  • Building quality of life (despite the chronic disease that may not be curable)
  • Learning to make peace with illness and one's own life.

As possible topics and intervention techniques to be worked on, Shapiro suggests: Stresses (trauma) that preceded the illness, accompany it or are anticipated in a future vision and lead to high psychological stress, to be dealt with using EMDR with the inclusion of visualization techniques, e.g. according to Simonton ( 1998). Shapiro emphasizes that eye movements alone can reduce pain. Shapiro also considers it indispensable that further measures in the medical-psychological field have to be stimulated, such as therapeutic diets, massages, etc.

Starting issues

  • Previous trauma (accidents, operations, childhood trauma)
  • unnecessary and failed medical treatments and interventions, such as unnecessary surgical interventions that lead to further pain
  • Problems in the social field, partnership problems, problems at work
  • Victimizations (those suffering from pain as "simulant", "doctor-shopper", "pensioner neurotics")
  • Work on pain itself as trauma

Contraindications

EMDR treatment should only be used after clarity about the diagnosis and possible abuse of pain medication, after clarity about possible medical mismanagement as well as upstream, previously unaccounted for psychiatric illnesses or comorbid disorders, such as depression, anxiety or a post-traumatic stress disorder as a result of upstream traumatic ones Adventures. It is also important to pay attention to dissociative disorders and to any persistent pain that may indicate a further illness.

The EMDR pain therapist

If the psychotherapist in the case of PTSD treatments, especially after one-off trauma, is used to surprisingly quick and lasting successes, the treatment of chronic pain sufferers is usually viscous and demands a high degree of perseverance from the therapist and a willingness to be activated again and again . In the former case, the psychotherapist often finds himself in the seductive spheres of omnipotence fantasies, the treatment of those suffering from chronic pain quickly and permanently brings him back down to earth.

The chronic pain patient has usually gone through a career of several years as a pain sufferer, various operations and interventions behind him, various doctors and institutions, received many diagnoses and medications. Chronic pain sufferers often suffer from various additional organic and psychological complaints, such as hormonal disorders, problems in the urogenital and gastrointestinal area, weakened immune system, depressed feelings of powerlessness and helplessness, hopelessness and suicidal thoughts. The many previous treatments have usually helped them little or no help, and often even made the pain worse. Chronic pain patients are therefore massively disappointed and often depressed and anxious. In addition, there is the offense of ultimately having to see a psychotherapist. Chronic pain syndrome is much more concerned with the medical system and its downsides than with the treatment of PTSD or the affective or neurotic disorders.

For the EMDR psychotherapist and his treatment planning and strategy, this means taking into account the various traumas and their accompanying circumstances. The accompanying circumstances to be considered include:

  • the constant (new and re) creation of a "safe space" that allows talking
  • the awareness and the constant willingness to stay on the ball even in the event of devaluations by the patient and also in the event of setbacks and failures
  • listening carefully, even to the "hidden notes", since pain patients often do not want to talk about their pain. You have learned that talking about pain is socially undesirable. Very often pain is therefore an understatement and consequently not adequately treated. Particular attention must be paid to these aspects when treating old people
  • World views and beliefs of the pain sufferers as well as their coping styles. They are the key to understanding chronic pain and must be examined again and again. The pain can, for example, aggravate a previously only latent psychopathology. But even without psychopathology, self-deficits in the patient, e.g. a lack of communication skills, can make pain management more difficult, and they have to be felt and changed.
  • Cooperation with doctors from different disciplines, teamwork in pain conferences, etc. Cooperation should be sought and intensified, although it may prove difficult, as psychological knowledge and know-how are still being sacrificed in favor of the established medical worldview. The same goes for the patients with their years of pain careers in the field of medical perspectives and procedures. They require the psychotherapist to constantly grapple with their own worldviews and to actively grapple with more holistic paradigms, such as the "information process paradigm" as the background for EMDR.
  • Prejudices that the psychotherapist has to recognize, e.g. the prejudice that if no cause can be found for the illness, then something is wrong with the patient's sanity. Another common prejudice is the patient's belief that only medication helps, or that medication of any kind is addictive. If necessary, the psychotherapist must provide information about the use of morphines, their effectiveness and harmlessness when allocated correctly, e.g. time contingent, in accordance with psychological learning principles.
  • Lack of mindfulness, perhaps the greatest obstacle to managing chronic pain, for both the practitioner and the patient. The treatment of chronic pain requires the psychotherapist, as well as the doctor, physiotherapist, physiotherapist, constant management and an overview. This also implies the constant, creative search for detours, if there are obstacles blocking the way. The process has to flow and keep going. And it is the small differences that make the differences and are significant, as we already know from Milton Erickson's hypnotherapy.

The EMDR Protocol for the Management of Chronic Pain

EMDR treatment for chronic pain can relate to the stress or trauma associated with, previous or anticipated pain. In this case, the standard protocol can be used as a basis or, if necessary, special protocols. (Special protocols see Schubbe 2004)

Chronic pain in the focus of treatment, modified pain protocol

In this protocol presented by the author, the pain itself is the focus of attention. Protocols by Francine Shapiro (1998) and Marc Grant (2004) are linked to their own considerations.

The pain currently felt is chosen as the starting point after it has been broken down into various qualities and modalities. (Drawing, inquiries about size, shape, weight, color, consistency, temperature).

Based on David Grand (2003), from the author's point of view it is helpful and accelerates the process if a constant resource is introduced into the treatment process in the form of a positive body feeling that accompanies the entire treatment.

1. Medical history and treatment planning

  • Establishing a sustainable therapeutic relationship and planning specific measures to stabilize the external situation of the pain sufferer and to secure his or her basic needs
  • Clarification of possible contraindications for EMDR treatment (drug abuse, unclear diagnosis, retirement procedures, comorbid disorders)
  • Clarification of whether EMDR can be helpful at all or whether the chronic pain is not perhaps ecological and vital, e.g. indicates another organic underlying disease
  • Conveying a realistic objective about the outcome of the treatment, e.g. that a complete resolution of pain is often not possible, but better pain management, more self-confidence, a resolution of depression and anxiety, an increase in mobility or the willingness for meaningful activity as well as more joy in life and life quality
  • Conveying the view that health does not mean the absence of illness, but the ability to cope with illness (Nietzsche)
  • Teaching exercises such as visualization exercises to influence the immune system, exercises to increase mindfulness, exercises to influence negative emotions, etc. for the work of the patients at home. (Simonton 1982; Reddemann 2003)
  • Suggestion for keeping a pain diary

2. Preparation

  • Instruction of the patient to learn certain exercises that are suitable for him (e.g. "safe place exercise", "5-4-3-2-1 method") in order to be able to calm down and relax at home
  • Testing of bifocal stimulation. In pain patients, slow, bifocal stimulation as alternating pressure in the palms of the hands is usually experienced as very pleasant (beware of chronic polyarthritis or diseases of the hands)
  • Agree on a stop signal, emphasis on constant feedback
  • Presentation of a metaphor as an aid to observing the process, e.g. observing the process as a scientist or e.g.sitting in the train watching everything that is happening
  • Offer a paradigm about information processes: According to this, pain normally has the function of a "barking watchdog" (Ziegelgänsberger), in the case of chronic pain, however, a process of independence with changes in the nervous system occurs. These changes keep the pain going. As with post-traumatic stress, the danger of chronic pain is long gone. The pain has become independent and is recorded as blocked information in the 'brain' system. EMDR is a means of stimulating the nervous system in such a way that the pain response changes. All material that is not ecological can then be reprocessed as accelerated information processing. With this procedure, the unconscious "knows" which pain is still necessary and must therefore continue. In this way, the pain continues to function as a warning where it is needed.
  • Ask the patient to give as precise feedback as possible about how the pain feels right now, regardless of whether it has changed or not. Informing the patient that the pain can also increase in the short term.

3. Assessment

Pain picture

The patient is asked to describe the chronic pain as precisely as possible, how the pain is felt at this point in time, e.g. in the categories "size", "shape", "color", "temperature", "texture". Ask the patient to draw a picture of the pain. Question: "Which perception is the worst part of the situation?"

Pain severity scale 0-10

"How bad is the pain right now?"

Pleasant body sensation (AK)

(Building a permanent resource) "Where in the body do you have a good / neutral feeling? How exactly does the feeling feel? Please describe the size, shape, color, temperature, texture".

Negative cognition (NK)

Formulation of a negative self-cognition in connection with the perception of pain. "Are you observing any thoughts about yourself that accompany the pain?" or: "Which words about yourself go with the pain?"

Positive self-cognition (PK): VOC scale 1-7

Formulation of positive self-cognition in connection with pain perception. "What would you like / ideally say about yourself when you think about your pain?" "How true is this now?"

Emotions: SUD scale 0-10

Assessment of the emotional state of mind in view of the initial topic: "Are you currently experiencing a feeling or several feelings that accompany the pain?" "How strong is this feeling / are these feelings?"

Pain location

Where do you feel the pain in your body?

Pain question

The question: "Assuming the pain can speak, what does it say to you?"

4. Desensitization and reprocessing

Now the patient is asked to imagine the pain and the associated negative sensations, feelings and cognitions, while simultaneously perceiving the pleasant body sensation ("just as your breath always goes with it, the pleasant body sensation always goes with it"), while at the same time series of eye movements or others bifocal stimulation series begin. It is important here that the patient not only reports back the intensity of the pain, but also especially the quality.

Ex: "Now I would like to ask you to focus your attention on the pain in the way you just described it and at the same time to look at my fingers in front of your eyes (to feel the mutual pressure in your palms) and whatever happens, let it happen ... ".
The occasional reminder of the pleasant body sensation is important. "Does the pleasant body feeling run along with you?" And then on: "What are you watching now?"
Don't settle for: "It feels better" or "It's ok", always ask: "What feels better, how does it feel, where does it feel like, describe it in more detail, etc. "
Don't accept answers like "nothing" or "it's the same as before". Inquire here: "Yes, ok, but I need to know exactly what you are currently experiencing, please describe it in more detail ..."
If the patient reports changes, ask: "What is where the pain was before?"
If there are positive changes, anchor them bifocally.

5. Anchoring in general

If the patient reports little or no change after many bifocal stimulation series or towards the end of treatment, strategies can be woven in, such as: "Think of something that could alleviate or cure the pain. It can also be unrealistic and fairytale. Let it be Just let your imagination run wild. " The bilateral stimulation is continued until the patient feels a changed quality of pain perception. This quality can be labeled with a word and anchored by eye movements. Further possibilities can be offered to the patient, for example to carry out a mental training and to provide the painful body part with color, shape, tones and to change the modalities or a "migration" of healthy energy in the healthy body part into the sick part with many modalities, eg from where to where, warmth - cool, light - heavy, wavy, colored - not colored, small - large, with image, color, sound, symbol. Change processes can then also be anchored through eye movements.

Look for something as concrete as possible (smaller, softer, rounder, more pleasant - warmer / cooler, etc.) If the change continues after another series of sets, ask: "What does that remind you of?" "Is there a word / heading that goes with this feeling you are experiencing now?" Always anchor a significant drop in values ​​bifocally.

The stimulation series are continued until the pain scale and SUD values ​​drop as significantly as possible and the VOC value is high. According to Grant (2004), small pain scale and SUD values ​​or high VOC values ​​are often not possible for people with chronic pain.

Anchoring positive cognition

"Now when you think about your ailments / your pain, how true are these words on a scale of 1-7?" (Name the PK) If the PK is high, it is anchored together with the possible residual pain or possible negative body sensations by means of a short bifocal stimulation.

6. Body test

If necessary, the patient is asked to mentally feel his body in view of the positive cognition.
If further negative body sensations appear, they are resolved as far as possible in bifocal stimulation series.

7. Graduation

If necessary, the patient is brought back to a balanced state, e.g. by means of the "safe place exercise", the "luminous flux method" of the "safe exercise" (Schubbe 2004).

The patient is asked to write down what works in the meantime until the next psychotherapy session.

8. Review and reassessment

Particular attention should be paid to the following factors throughout the treatment process and in preparation for the end of treatment:

  • Maintaining mindfulness and exercises that help the patient orient, stabilize and strengthen
  • Maintaining sensible activity learned in the course of therapy (balanced management with the rejection of passivity, fainting or overactivity), e.g. sensible sporting activities, stress-reducing and immune system stabilizing procedures
  • Connection of the remaining pain with a healing consideration and an arrangement or a reconciliation of the patient with the remaining pain.
  • Pain management that should increasingly be free from unnecessary worries, fears, negative attitudes or incorrect information
  • At the end of therapy, the patient must be prepared for possible setbacks and given the opportunity to refresh what they have learned if necessary.

literature

Birbaumer N, Schmidt R (1996) Biological Psychology. Springer, Heidelberg

Egle UT, Nickel R, Hoffmann SO (2004) Psychodynamic psychotherapy for chronic pain. In: Basler HD et al. (Ed) (2004) Psychological pain therapy. Springer, Berlin

Fischer G, Riedesser P (1998) textbook of psychotraumatology. Reinhardt, Munich

Flor H (1991) Psychobiology of Pain. Huber, Bern

Flor H (2003) Neural Plasticity. In: Schiepek G (Ed) (2003) Neurobiology of Psychotherapy. Schattauer, Stuttgart

Flor H, Hermann C (2004) Cognitive-behavioral therapy. In: Basler HD et al. (Ed) (2004) Psychological pain therapy. Springer, Berlin

Grand D (2003) Natural Flow EMDR: Clinical, Creative & Performance Enhancement with EMDR. Unpublished working paper on the occasion of the Hydra-EMDR retreat of the Institute for Trauma Therapy

Grant M, Threflo C (2004) EMDR in the Treatment of Chronic Pain. EMDRIA Germany circular no.4: 37-52

Hasenbring M, Pfingsten M (2004) Psychological mechanisms of chronification - consequences for prevention. In: Basler HD et al. (Ed) (2004) Psychological pain therapy. Springer, Berlin

Kolk van der B, McFarlane A, Weisaeth L (Eds) (2000) Traumatic Stress Basics and Treatment Approaches. Junfermann, Paderborn

Kröner-Herwig B (2004) The pain - a description of the object. In: Basler HD et al. (Ed) (2004) Psychological pain therapy. Springer, Berlin

Kröner-Herwig B, Frettlöh J (2004) Treatment of chronic pain syndromes: a plea for a multi-professional therapeutic approach. In: Basler HD et al. (Ed) (2004) Psychological pain therapy. Springer, Berlin

Peter B (2004) Hypnosis. In: Basler HD et al. (Ed) (2004) Psychological pain therapy. Springer, Berlin

Reddemann L (2003) Imagination as a healing force. Pfeiffer, Stuttgart

Rehfisch HP, Basler HD Relaxation and imagination. In: Basler HD et al. (Ed) (2004) Psychological pain therapy. Springer, Berlin

Revenstorf D, Peter B (Ed) (2001) Hypnosis in Psychotherapy, Psychosomatics and Medicine. Springer, Heidelberg

Schiepek G (Ed) (2003) Neurobiology of Psychotherapy. Schattauer, Stuttgart

Schubbe O (Ed) (2004) Trauma therapy with EMDR. A manual for training. Vandenhoeck & Ruprecht, Göttingen

Shapiro F (1998) EMDR Basics & Practice. Junfermann, Paderborn

Simonton C (1998) On the Mend. Reinbek, Hamburg

Tinker R, Wilson S (2000) EMDR with children. Junfermann, Paderborn

Wadell G (1998) The Back Pain Revolution. Churchill Livingstone, Edinburgh

Patient information

Chronic pain and EMDR

Paradigm about information processes

(Acute) pain usually has the function of a "barking watchdog" (Zieglgänsberger). In the case of chronic pain, however, a process of independence occurs with changes in the nervous system. These changes keep the pain going. As with post-traumatic stress, the danger of chronic pain is long gone. The pain has become independent and is recorded as blocked information in the "brain" system. EMDR is a means of stimulating the nervous system in such a way that the pain response changes. This means that all material that is not ecological can be reprocessed. With this procedure, the unconscious "knows" which pain is still necessary and must therefore continue. In this way, the pain continues to function as a warning where it is needed. During EMDR treatment, it is always important to give you feedback on how the pain is feeling at the moment.

Pain Relaxation Exercise

  1. Lie down or sit down as comfortably as possible and loosen tight clothing. Hands and arms are loose, legs slightly apart.
  2. Pick a point to fix your eyes on until you feel relaxed. Don't exert yourself, just look relaxed and breathe in your normal breathing rhythm. Maybe you close your eyes.
  3. Breathe in a little slower than usual through the whole body, from the bottom up and say a relaxed word, such as "calm" or "relaxed" or "safe" or "carefree" and then breathe a little slower than usual from above down from. Feel your body relax as you exhale.
  4. Continue to breathe calmly and serenely and start tensing and loosening your various muscle groups. It should always be a good, pleasant tension. For each muscle group, contract the muscles as you inhale and relax the muscles as you exhale. As you exhale and the muscles relax, say your word ("calm" or "relaxed" or "safe" or "carefree").
  5. Go through the following muscle groups in sequence: each hand, each forearm, each upper arm, the shoulders, the stomach, each leg, each foot and finally the face by grimacing.
  6. Then, for a while, observe the good feelings and sensations that you aroused.
  7. Count backwards from five to one and open your eyes.
  8. Extend and straighten yourself extensively (like a cat) and yawn deeply.

Help exercise

HELP = Healing Light Energy Process
For children, teenagers and adults

To reduce negative emotional reactions, reduce fears, reduce feelings of guilt, depression, physical pain, to improve the functioning of the brain, to eliminate anger, anger, anger, aggression, self-hatred

1.

Recognize problem, e.g .: when, where, with whom, in which situations am I angry, angry, sad, desperate, etc.
how mad I am now when I think about it (SUD raise 0-10)
I do this exercise to reduce my negative feelings, e.g. my self-hatred.

2.

Place the left leg over the right leg at the level of the ankle on top of each other. (Left-handed reversed). Stretch your arms forward, palms facing each other. Turn your palms outward, thumbs down. Place your right hand over your left, interlocking the fingers of both hands. Bend your arms towards your body so that your folded fingers are under your chin, with your thumbs pointing upwards. Place your tongue behind your teeth on the roof of your mouth and breathe in and out evenly through your nose. Inhale and exhale at least three times. Remember to turn off negative feelings.

4.

Paint a picture (real or in the imagination) of the light (sunlight, moonlight, starlight) that burns away negative feelings, eats them up, etc. Look at the picture and anchor with right-left stimulation.

5.

Find out sentences with the child, adolescent or adult, such as "Even without my anger, I'm a whole guy." Or: "The way I am, I'm okay." Anchor this and similar sentences with right-left stimulation.

6.

Check the SUD and stop when the negative feelings are resolved.

7.

Conclude the exercise with sentences like: "Whenever I put my tongue back in the future and take three deep breaths, I can positively influence negative feelings. Anchor this with right-left stimulation."

Inner child exercise

Concept of the inner child from transactional analysis, including forms of psychotherapy
Help with negative emotions
Helpful on the path to healing diseases
General: Turning negative into positive
Developing patience, acceptance, understanding
On the ground of relaxation, hypnosis
Each step is anchored with right-left stimulation

  1. Seek out negative emotions (e.g. anger) and rate SUD from 0-10. Then seek out the emotion in the body as a body feeling. (e.g. noticeable as tension in the stomach)
  2. Visualize inner child with precisely this emotion (e.g. the child's anger) at a certain age, in a certain place. As precisely as possible, pictorial, auditory, olfactory, kinesthetic.
  3. Pay full attention to the child.
  4. Get into emotional contact with the child, e.g. breathe in the child's emotion (anger) and envelop the child with affection, understanding, respect, love with each exhalation or e.g. hug the child, comfort him, show him something beautiful, sing something to him, etc. Repeat this until the child feels noticeably better or really comfortable.
  5. When the child feels good, breathe in his good feelings, his zest for life, his liveliness, his feeling of happiness and breathe out affection. Allow your own good feelings and those of the child to merge.
  6. Thank the child for communicating with us and tell them that we would like to stay in contact with them and that if they call us or we say their name, they can come right away.
  7. SUD check whether the negative emotions have decreased. Repeat the exercise if necessary.

Activity diary

date
Time




Pain 0-5



Bracing
tion 0-5




Wellbeing
find 0-5


What have I been doing for the past two hours, what have I been thinking?
What have I been thinking about for the past two hours?





















date
Time






Pain 0-5





Bracing
tion 0-5





Wellbeing
find 0-5





What have I been doing for the past two hours, what have I been thinking?
What have I been thinking about for the past two hours?
Pain relief
action, e.g.
Medication,
Deflection,
Sporting activity,
Exercises





















date
Time






Pain 0-5





Bracing
tion 0-5





Wellbeing
find 0-5





What have I been doing for the past two hours, what have I been thinking?
What have I been thinking about for the past two hours?
Pain relief
action, e.g.
Medication,
Deflection,
Sporting activity,
Exercises





















Chronic pain contact addresses

Finding pain therapists (medicine, psychology): Homepage of the German Society for the Study of Pain
www.medizin.uni-koeln.de/projekte/dgss

The German Pain League e. V. In addition to extensive information and tips on the subject of pain, it offers help in the search for pain therapists and self-help groups.
Tel. 06171 / 2860-53 (Mon - Fri 9 a.m. - 12 p.m.)
Email: [email protected]
www.schmerzliga.de

The Pain SHG Directory was created in cooperation between the Berlin startup Sparmedo and several pain self-help groups and, with the Bildatlas for Germany, offers a good tool when looking for a self-help group.
www.sparmedo.de/selbsthilfegruppe/bei/chronische-ache

German Cancer-research center: Patients can also call 06221-422000 daily from 12 noon to 4 p.m. and keep an online pain diary on the website.
www.ksid.de

Link collection on the subject of pain therapy Pain Forum Koblenz (Pain therapy facilities, self-help groups, magazines, etc.) the most extensive German-language link collection!
www.schmerz-online.de

Pain academy: Platform for patients, relatives and practitioners. Pain therapists directory, discussion forums, list of links, references
www.schmerzakademie.de

Recommendations for the diagnosis and treatment of back pain, headache, facial pain and tumor pain based on scientific studies and expert consensus of Medicines Commission of the German Medical Association (PDF files) as well as links to brochures from health insurance companies on this topic (to be found under therapy recommendations and guidelines)
www.akdae.de

You can find useful information about all forms of rheumatic diseases on the homepage of German Rheumatism League Association e.V.
Tel. (02 28) 7 66 06-0
Email: [email protected]
www.rheuma-liga.de

More useful information on fibromyalgia including a forum for those affected to share experiences
www.fibromyalgie-aktuell.de

Pain therapy outpatient Network Cologne (STAN). Contains short therapy instructions for doctors, psychotherapists and nursing staff for head and tumor pain.
www.medizin.uni-koeln.de

Pain Therapy Colloquium STK
www.stk-ev.de

migraine - Migraine self-test as well as information brochures and headache diary
www.migraene-online.de

German Arthrosis Forum - Extensive information, links and chats on the topic of osteoarthritis
www.deutsches-arthrose-forum.de

DGSS (German Society for the Study of Pain e.V.):
www.dgss.org