Many clients are uninformed about where to turn for help in treating their chronic pain. Some may turn to you, the massage therapist, for help.

Many clients are uninformed about where to turn for help in treating their chronic pain.

Repeatedly frustrated by the lack of answers from mainstream medical establishments, some may turn to you, the massage therapist, for help.

Others may have given up on asking health professionals for guidance and need you to initiate the discussion.

As a health practitioner, you are in a position to provide your clients with information that may help them overcome chronic pain—for good.

Like more than half of Americans, I suffer from chronic pain—a condition that has affected me for over a decade.

During this time, I have swirled through a confusing maze of doctors and bodyworkers, drugs and nutritional supplements, exercise programs and spiritual practices in search of the pain-free Holy Grail.

Clinical research has indicated massage therapy to be a leading source of relief from chronic, or recurrent, pain, an ailment that affects more than half of Americans and that interferes with their activities, mood and overall enjoyment of life.

The relief, unfortunately, is sometimes temporary.

I propose that massage therapists broaden their understanding of their role just enough to help clients see the big picture, one that involves referrals to multiple practitioners, if necessary.

While there has been a growing body of research on pain medication and management, few health professionals have been trained to offer comprehensive guidance through the confusing maze of resources available to people who suffer from chronic pain.

Nor have they been trained to listen adequately and respond appropriately to the particular needs of chronic-pain sufferers, leading to a potential exacerbation of these clients’ problems.

There are three steps you can take to assist clients through the maze: understand the emotional dimension of chronic pain, create a safe space for healing, and help them utilize other healing resources.

1. Understand the emotional dimension of chronic pain.

Chronic pain is a condition that “can really be a ravaging and damaging experience,” said Mark Young, M.D., chair of the department of physical medicine and rehabilitation at the Maryland Rehabilitation Center. “Not only is there a physical toll, but there is an emotional one.”

For people in chronic pain, adds Anasuya Basil, an acupuncturist and bodywork therapist, “the uncertainty of how their life will be is really, really difficult, so depression is a huge part of it. The same part of the brain that processes pain also processes emotion.

“That’s why pain also affects the part of the brain that has to do with our survival,” she adds. “When you’re injured, it just evokes questions of, ‘Am I going to be able to earn a living? Perform my family duties? Maintain my relationships?’ That uncertainty, in turn, exacerbates the pain.”

Adding to these layers of suffering is the trauma of dealing with an sometimes unsympathetic Western medical system.

“I see a lot of situations where the doctor can’t get to the source of the problem with chronic pain, because it’s difficult if not impossible to find—so the doctor said it’s all in your head.” said chiropractor and massage therapist Stan Ewald, who is also assistant professor at Southern California University of Health Sciences, in Whittier, California. “There are a lot of people who suffer through the ‘if we can’t find it, it doesn’t exist’ attitude.”

2. Create a safe space for healing.

The cumulative effect of physical and emotional distress requires massage therapists to demonstrate extra care and flexibility when working clients with to treat chronic pain.

You must have compassion,” emphasizes Mary Beth Bullock, a massage therapist in Oakland, California. “People suffering from chronic pain have been dealing with this for a long time, dealing with different personalities in the medical profession. You need to be aware there can be blockages based on defense. It’s a vulnerable place to be on the table, especially if clients have chronic pain, because chances are they’ve been dealing with a lot of people who haven’t been listening.”

The holistic approach to healing looks at what the practitioner can do to awaken the client’s natural healing system, David Simon, MD (1951–2012), co-founder of the Chopra Center for Wellbeing in Carlsbad, California, had said as of this writing.

“When we’re in a state that feels threatened, all of the life energy of a person goes to protecting their boundary, so that they don’t feel their boundary is violated.

“Therefore, the energy is to protect, not to heal,” Simon adds. “If someone feels a bodyworker is not tuning in to their delicate situation, then rather than opening the space of safety that allows that healing to occur, it actually closes down that space. It has a psychological effect of putting someone into flight-or-fight mode.”

To tune into the client, it is key to energetically ground yourself before beginning a session so as to be fully present, advises Basil, then, “when someone said that certain touch is not OK, or that something hurts, try not to take it personally or make it out that you’re incompetent or wrong or whatever.

“Back up and just use it as an opportunity to expand your awareness of where you are and where the other person is and where you meet.”

It is the job of bodyworkers to make that meeting place safe, she emphasized.

To that end, make sure you are flexible, tailoring every massage to each individual’s needs, instead of getting stuck in routine.

“Approach them with a lot of respect for their fear of being injured or reinjured or just touched,” Basil said. “No matter what protocol you have, and no matter what you were taught in school, your supreme teacher is the person on the table. You are adapting whatever protocol you learned to follow the person’s lead.”

“If they have been traumatized in their right shoulder, you do not touch their right shoulder,” adds Bullock. “Respect the boundary the client has set, and don’t impose your own idea of what a session should involve.”

Remember massage-school basics of initiating conversation about injured areas, pressure levels and other comfort-related matters, like putting a pillow under the knees rather than waiting for clients to speak up.

Also keep in mind that socialization and other factors may prevent individuals from being honest, even if you verbally check in.

“What I do is really tune into not just what they are verbally saying, but also what they are vibrationally saying,” Basil said. “As a bodyworker, you can’t just rely on the words, because they don’t always go along with the body language and energy. You have to pay attention to all of it.”

Move very slowly, she advises, and check in frequently. “Watch the person’s face. Tune in to sense if the person is staying OK with what you are doing, or if they are bracing against you, tuning you out, or leaving their body.”

Ultimately, she said, you need to be humble in your service and “trust that this person has the power to heal within themself.”

To this end, said Bullock, be careful not to inadvertently shame your clients for being where they are in their process. “There should be no judgment from practitioners, period,” she said, “no matter what you think you know.”

3. Help your client utilize other healing resources.

Beyond offering a safe and healing space for clients struggling to treat chronic pain, you can assist them in creating an action plan.

Educate yourself on what types of health-care practitioners work in your area, then initiate a conversation with your client, asking if she would like session time to evaluate what has and has not worked, and what other options are available.

“There are definite laws whether we can prescribe or diagnose,” Bullock cautions. “You can’t say, ‘You should do this because X, Y and Z is happening.’ Talk about it like a referral. You’re giving people options, not telling them what they should do.”

“Have a working conversation and relationship with someone who knows how to do X-rays or teach people body mechanics,” advises acupuncturist Lorenzo Puertas, director of the East Bay Pain Care alternative-medicine clinic in Oakland, California.

“Go out and find a caring doctor and a caring chiropractor and a caring acupuncturist,” adds Ewald, “people you can have lunch with once in a while, can team up with, people you trust. From that network, you have people to send clients to.”

Someone in chronic pain doesn’t have the energy to research treatment options, said Bullock. That’s where you can help.

Treat Chronic Pain: Improve Clients’ Quality of Life

It takes a systematic treatment plan to treat chronic pain, incorporating methodologies ranging from nutrition to meditation, exercise to hypnosis, and acupuncture to psychotherapy.

By building relationships with other holistic practitioners, and with local medical professionals at pain-management and integrated-medicine clinics (where services may be covered by a client’s insurance), you can help clients in pain build a supportive health-care team.

Had I known this information back in the day, I could have spent my 20s and 30s continuing life as the über athlete I once was—an avoid cyclist, jogger and swimmer, a self-defense instructor, and an adventure traveler—instead spending much of the next decade crumpled in agony in bed.

As a massage therapist, providing emotional safety, validation and support to those on your table, educating yourself on available resources, and referring clients out will do much more than make you a terrific massage therapist—it could greatly improve the quality of someone’s life.

When you broaden your understanding of your role as a health-care provider enough to help clients see the big picture of pain management, you may spare them from years of frustration and despair.

About the Author

After a decade of spinning through chronic pain hell, Loolwa Khazzoom self-healed through a dance method she created, Dancing with Pain®, featured in top media including The New York Times and ABC News. She has written about living with and healing from chronic pain, for top media including The Washington Post and AARP. Today she sings about healing, and heals through singing, with her band, Iraqis in Pajamas.

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