A Journey down the Pain Pathway

The Pain Cure : The Proven Medical Program that Helps End Your Chronic Pain
by Dharma Singh Khalsa, M.D., Cameron Stauth

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A pain impulse usually starts its trip along the pain pathway when you suffer an injury or illness. Let's say you cut your finger.

Have you ever noticed that when you cut yourself, you usually feel the sensation of the cut before you feel the pain from it? That happens because you have separate nerves for touch and for pain - and the "touch" nerves send signals more quickly than the pain nerves. That's why you feel the cut before the pain.

Your fast "touch" nerves shoot signals toward your brain at about 200 miles per hour, while your pain nerves send signals to your brain at a relatively slow speed. Acute pain travels at only about 40 miles per hour, and chronic pain can travel as slowly as 3 miles per hour. This difference in speed occurs mostly because "touch"nerves are generally better insulated.

Whenever you injure your finger, you tend to grab it and squeeze it or rub it, don't you? That's a natural instinct. You do that because it decreases your pain. The reason it decreases your pain is that it shoots fast "touch" signals toward your pain gates, and those fast touch signals outrun the slow pain signals. By the time the pain signals arrive, your pain gates are already crowded with touch impulses, and the pain signals have a hard time squeezing through.

So already you know an excellent anti-pain strategy: Give your nervous system a competing source of input - especially one that can "outrun"pain signals.

There are many ways to provide a competing source of input, other than just rubbing a painful area. This can also be done biochemically, mechanically, electrically - and even with thoughts! Soon you'll know every strategy that exists.

One obvious lesson from this is: Don't be macho by trying to just ignore the pain when you first get hurt. Go after it! Beat it! It bothers me when I'm watching a baseball game and the batter gets hit by a pitch and just stands there, not rubbing the injured area, because that would "give the other team satisfaction."That appeals to the athlete in me - but not the pain specialist. As you'll soon see, once pain gets started, it can be hard to stop. However, if you take care of your short-term, acute pain right away, you can reduce the chance that it will become a long-standing chronic pain.

Now let's keep traveling along your pain pathway and discover more ways to stop pain.

When pain signals squeeze onto the "elevator" of your spinal cord, headed for your brain, they automatically trigger the release of several chemicals that help them travel to the brain. These chemicals, called neurotransmitters, are the biochemical messengers that carry pain signals from one nerve cell to the next. Your brain, as you probably know, also uses neurotransmitters to carry all of your thoughts and feelings.

The three primary neurotransmitters that "ship" pain signals to the brain are substance P, NMDA (n-methyl-d-aspartate), and glutamate. Of these, substance P seems to be the most active, and most important. Without these three substances - especially substance P - pain signals have a much harder time reaching the brain. However, if there is an excess of any of these three substances, pain signals have a much easier time reaching the brain.

So, again, we have another way to stop pain: by manipulating the levels of one or more of these neurotransmitters. This can be done in several ways. One way is with pharmaceutical and over-the-counter drugs, and another is with acupuncture. When you learn the details of my pain program, you'll learn all the ways.

Here's more good news: The body, in its natural, innate wisdom, has its own way of keeping these pain neurotransmitters from flooding the brain, and overwhelming us with pain. The body forces these pain chemicals to travel through a pain gate that sits near the back of the spinal cord. This pain gate is composed of a substance that has the consistency of jelly; it's called the substantia gelatinosa of the dorsal horn.

Thus we have yet another method of controlling pain: supporting the function of this gate. This is achieved by supporting the overall health of the nervous system. If the nervous system is exhausted, stressed, or nutritionally malnourished, this gate will lose its efficiency.

Thus, the better your nervous system functions, the higher your "pain threshold" will be. That's one reason, for example, why you feel more pain when you don't get enough sleep: your lack of sleep hampers the ability of your nervous system to close its pain gates.

However, no matter how well your pain gates are working, some pain signals are certain to reach your brain. This is natural and desirable, of course, because without pain we would constantly be in grave danger of injury.

When pain hits the brain, that's when your body and mind really go to war against it - if your body and mind are working efficiently, and in proper coordination with each other.

So far, you've just been "playing defense" against pain. But when your brain receives the first pain signals, and realizes that your body is fighting its most vicious enemy, your brain starts to "play offense."It launches a counterattack!

In the next few pages I'll tell you how to make that counterattack fierce.

Counterattack!

Pain signals enter your brain in an area called the thalamus. The thalamus is where your brain "sorts out" most of its incoming physical signals. For example, besides dealing with pain, your thalamus also handles things like hunger and thirst.

Instantly, your thalamus sends the pain signal to the two most important parts of your brain - your cortex, which does your thinking, and your limbic system, which governs your emotions.

When this happens, your thinking brain and your emotional brain have a dialogue, in which they "compare notes" on the pain signal. They try to decide how serious the pain is, where it's located, what it means, and how to deal with it. They analyze how strong the pain signals are, how frequently they're being sent to the brain, and how long the signals have lasted.

If, during this dialogue, your cortex and limbic system decide the pain signals aren't very serious, they tell your body to relax and tell your neurotransmitter system to pump out a calming brain chemical called serotonin. This causes the nerves that first picked up the pain signal to "quiet down,"and it causes the muscles around the injured area to relax. Also, your blood vessels - which had been constricted by alarm - begin to loosen up. Your body soon returns to its normal state. The acute pain soon subsides, and you feel fine again.

However, let's say that when you cut your finger, it really hurts, the cut looks deep, and blood is gushing out. Your cortex and limbic system scan your memory, and they don't like what they find. Your memory says, "This is the worst cut you've had in years. It's bound to hurt, and if you're not careful, the finger will get infected."When your cortex and limbic system hear this, they start yelling, "Red alert! Red alert! We've got a problem!"

The all-out counterattack begins!

Instead of telling your neurotransmitter system to pump out calming neurotransmitters, your cortex and limbic system put in an order for the stimulating neurotransmitter norepinephrine, which is a form of adrenaline. This always happens when your body is under assault. Suddenly you begin to experience the classic symptoms of the "fight-or-flight response,"which is also called the "stress response."Your blood vessels constrict, your heart pounds, your muscles tighten, and your nerves go "on edge,"as they wait for further problems.

This is when things can go very wrong. This is when chronic pain can begin. If your counterattack doesn't work properly, you can end up with chronic pain. Your counterattack has to be strong, but not too strong. If it's not strong enough, or if it's too strong, it can contribute to the neurological malfunctions that create chronic pain.

One thing your counterattack must accomplish is the creation of a reasonable balance between the production of calming serotonin and stimulating norepinephrine. When you're alarmed, your body badly needs serotonin to help calm down, and to begin to close some of the pain gates. Unfortunately, the more alarmed you become, the more those gates are likely to open up, and to even "jam open" indefinitely.

Soon, though, I'll show you how to create abundant supplies of serotonin, so that when you need it, you'll have it.

Another problem that can arise at this point, as mentioned before, is sensitization of the injured area. When pain registers in the brain, the brain begins to closely monitor the injured area, via the nervous system, as part of its counterattack. The nerves around the injured area become more sensitive. They can even start carrying pain signals from stimuli that normally wouldn't cause pain. For example, the skin around your cut finger might hurt when you touch it, even though it's not injured.

Sometimes pain signals can even "jump" bioelectrically from one pain-carrying nerve to a neighboring pain nerve that had previously been free of stimulation. When this happens, it increases the amount of pain headed toward the brain. And when the brain receives these new signals, it sensitizes the injured area even more, contributing to the cycle of pain.

However, the more you nurture your nervous system, with a comprehensive program that builds neurological strength, the less likely this will be to occur. One simple reason why: As your nervous system becomes healthier, the sheaths that insulate your nerves will grow thicker, and help prevent these neurological "leaks."

Another "big gun" in your counterattack against pain is the production of your body's own natural, morphinelike opiates - endorphins, dynorphins, and enkephalins. These substances are ten times stronger than morphine. However, you never build up tolerance to them as you do to drugs.

These natural opioids not only flood the brain - giving physical and psychological relief - but also travel to one of the pain gates in your spine. There they directly "battle" pain-carrying substance P, trying to keep substance P from entering the nerves that go to the brain.

Sometimes you have enough endorphins to overpower your substance P, and stop the pain signals that are trying to get to your brain. But sometimes you don't have enough. When that happens, pain has one less obstacle to overcome.

As you might imagine, though, there are ways to increase your output of endorphins. For example, you can do it with exercise. However, exercise is often avoided by people with chronic pain syndrome. That's a mistake - one you will need to correct to end your chronic pain.

If you don't produce enough endorphins, or enough serotonin, your pain signals begin to increase in intensity, frequency, and duration. When this happens, the signals themselves often "jam open" the pain gates.

Then pain travels freely from the injured area to the brain, and back again.

As this happens repeatedly - millions of times per hour - pain signals become "engraved"upon the nervous system. Pain signals literally become a physical part of the anatomy of your nervous system, just like the memories that are engraved in your brain.

As your injury heals, this engraved pain can remain. It no longer requires the stimuli of the injury. Tragically, it now has a life of its own. When this happens, the pain is not a symptom, it's a disease.

How Healing Can Hurt

Now let me tell you about another problem you face.

As the brain carries out its counterattack against pain, it also launches a counterattack against the injury itself. This counterattack is commonly referred to as the healing process. Unfortunately, the healing process can also contribute to the disease of chronic pain.

One way that healing contributes to pain is through the process of inflammation.

Inflammation is a natural part of your body's response to injury. However, inflammation can get out of control. When it does, it can cause great pain.

Inflammation starts when the brain sends "alarm signals" back down to the injured area. Those signals cause increased blood flow to the area, as your body tries to fight infection and repair damage. But some of this extra blood leaks out of its vessels and causes swelling, soreness, stiffness, and warmth. This blood also releases potent chemicals that make the area even more sensitive.

Normally, inflammation goes away when the injury heals. But when pain becomes engraved upon the nervous system, inflammation can remain. At this point it serves no purpose - it just hurts. It's no longer a symptom - it's a disease.

Inflammation is the major culprit in many kinds of pain.

However, there are many effective ways to fight inflammation. You can use anti-inflammatory drugs, such as ibuprofen, or certain nutrients. You can even stop inflammation before it starts, with nutritional therapy. I'll tell you how to do that in the next chapter.

Another way that the healing process causes pain is by creating muscle spasms. A muscle spasm starts out as a natural protective mechanism; it shields a distressed area by immobilizing it. In a way, it's like a plaster cast, or a splint.

Muscle spasms begin when your body experiences pain. When this happens, the body often contracts the muscles near the painful area. Frequently, though, those muscles remain tight, or in spasm. Part of the reason a muscle stays tight is that the spasm itself often hurts. Therefore, it's very easy to create a cycle of pain-spasm-pain-spasm.

If these spasms are ignored, they can become virtually permanent. Muscle tissues can even become, in effect, "glued" together.

Sometimes, ongoing muscle spasms are quite noticeable, and cause great pain. This often occurs in chronic musculoskeletal pain, including back pain and neck pain. At other times, however, the muscle spasms are subtle, and are confined to a very small area. These less noticeable muscle spasms can be insidious, though. One problem they often cause is "referred pain" - pain that exists in a location other than the immediate area of the spasm. For example, a small muscle spasm in the neck can cause a severe headache.

Fortunately, though, there are a number of ways to get rid of these spasms. One of the best ways is with massage, which I'll describe in chapter 3.

A third way that the healing process causes pain is when damaged pain nerves heal improperly.

When damaged pain nerves heal and regrow, they often do so imperfectly, and begin to fire spontaneously, sending pain signals to the brain for no reason at all.

Frequently the victims of imperfect nerve regrowth get blamed for "making up" their pain, because they no longer have an obvious injury. Often, even their own doctors tell them that their pain is all in their minds. The victims get treated as if they were just neurotic, or cowardly. How unfair! And how stupid!

In fact, there is one very obvious example of this kind of pain: phantom limb pain. Up to 85 percent of all amputees feel pain that seems to come from their missing limbs. In some types of amputations, more than one-third of all patients feel severe pain. This pain results, in part, from the improper healing of severed nerves.

However, poor healing of severed nerves isn't the only cause of phantom limb pain. Phantom limb pain is also often caused by the pain that often preceded the surgery - the pain from the injury or illness that necessitated the surgery. This pain, if it becomes engraved upon the nervous system, can continue to exist even after the original source of the pain has been surgically removed, with no significant damage to nerves.

Here's another interesting illustration of the fact that pain can become engraved upon the nervous system, including the brain itself. Sometimes paralyzed people feel pain in the parts of their bodies that can no longer move, and that no longer respond to external stimuli. When this happens, doctors sometimes partly sever the patients' spinal cords, to relieve their pain. Occasionally, though, even this does not stop the pain. Unfortunately for the paralyzed people, their pain is no longer in their bodies. It's in their brains.

I'll give you one more really fascinating example that indicates that chronic pain can become "centralized" in the brain. As you may have heard, it's possible to make people have vivid memories of past events just by stimulating different areas of people's brains with electrodes. When this happens, memories often come flooding back with crystal clarity. Knowing about this phenomenon, pain researchers tried to evoke pain in test subjects by electrically stimulating the area of their brains that first receives pain signals - the thalamus. However, researchers found that subjects with no history of chronic pain were not affected by stimulation of the thalamus. But when researchers stimulated this area of the brain in chronic pain patients, the patients felt intense pain. For example, one patient who had formerly experienced the chest pain of angina pectoris reported terrible pain in her chest when her thalamus was stimulated.

Thus, this angina patient discovered that, for her - as with other chronic pain patients - pain is in the brain.

The Brain Can Stop Pain

As I've indicated, one of the best ways to stop pain is simply to increase the power of the brain. This simple principle was portrayed dramatically to me shortly after the publication of my first book, Brain Longevity. In that book, I told readers how to optimize their brain power - but I said almost nothing in it about using the brain to defeat pain. Nonetheless, please note the following exchange of letters.

August 20, 1998
Hartford, CT
Dear Dr. Khalsa,

I have recently finished reading your book Brain Longevity. It has given me some hope. Recently I was diagnosed as having a form of dystonia called spasmodic torticollis, a condition that causes severe twisting of the neck, and great pain.

I was given two injections of botulinum toxin, which failed to make a difference. My neurologist has now put me on Tetrabenazine, which also does not seem to be helping. I am 38 years old, very active, and have two daughters. My neurologist has given me these medications - the only ones available to help me. A cure is not known.

I have started your Brain Longevity program. It seems to my unscientific mind that it makes sense to try to improve the working order of my brain. The nutritional side is something I can easily handle, but exercise is difficult, since I can't hold my head straight.

Anyway, I am forging ahead, and would love to hear if you think I have any real chance of helping my condition.

Sincerely,
J.M.

I wrote back to this woman - who had a severe neurological disease that is generally unresponsive to treatment - encouraging her to persevere with her Brain Longevity program. I recommended that she do mind/body exercises and see an acupuncturist, in addition to following a comprehensive program that boosts the power of the brain.

A few months later I received another letter from her.

October 19, 1998
Hartford, CT
Dear Dr. Khalsa,

All of my symptoms are gone! My neurologist had given up on me when the drugs didn't have any effect. I then decided to work on my own, in a holistic mode. I have been successful, and my inspiration came from you. Thank you very much. I continue to take all of the vitamins and supplements you suggested. I also continue with my mind/body exercises, meditation, yoga, good nutrition, and exercise.

Thank you again.
Sincerely,
J.M.

This case clearly illustrates that the brain can have a profound effect upon a supposedly intractable pain condition - even in the absence of a full-fledged pain program.

Furthermore, when the power of the brain is allied with the power of the body, and the power of the spirit - in a comprehensive pain program - almost anything is possible!

Now you have a basic understanding of how pain works, and how chronic pain can begin.

Therefore, you already understand - probably better than some doctors do - why the traits of chronic pain syndrome are so devastating to people with chronic pain.

As you'll recall, chronic pain syndrome is characterized by physical inactivity, inadequate sleep, depression, poor nutrition, fear, anxiety, reliance on medications, and mental lethargy. As you now know, these traits are almost certain to lock in - and amplify - pain signals that have become engraved upon the nervous system.

If you are now suffering from chronic pain, I can certainly see why you might have fallen victim to these traits. After all, pain wears you down, and eats away at your strength and your zest for life.

But now that you have a better grasp of how chronic pain gets started, and keeps going, you can probably see that these characteristics of chronic pain syndrome are literally poison for the nervous system. They reduce the natural ability of the nervous system to resist pain. And they allow the brain to focus on pain, and thereby increase the intensity and frequency of pain signals. Besides being "poisonous" to the nervous system, these characteristics also rob life of its most basic sources of joy: the pleasure of play, the satisfaction of work, and the love of other people.

This loss of joy is not only horrible in itself, but it, too, contributes to the cycle of pain. The less joy, satisfaction, and love you feel, the more you will indulge in harmful habits, and the more you'll focus on the only thing that's left in your life: pain.

The end result is suffering.

If you have been suffering for a long time, you may have come to believe that your only escape from suffering will be through death.

That's what my patient Scott thought. But he was wrong.

Scott Fights Back

As I described the physiology of chronic pain to Scott, we talked about the particular cause of his own pain.

His immune system, for unknown reasons, had turned against his own body, in an "autoimmune" disorder; it was destroying his muscles, and causing him terrible pain. Shortly after his disease had begun, the pain from his muscle deterioration had become engraved upon his nervous system. It had caused him to suffer almost constant, knifelike jabs of pain. His muscles were disintegrating. He was very thin.

Scott was adamant, though, about discontinuing the use of his medications, including prednisone, a steroid that depresses the immune system and slows the autoimmune attack. He loathed prednisone's side effects of acne, bloating, insomnia, and emotional agitation. He hated these side effects as much as he hated his pain.

But if he did stop taking prednisone, a specialist had told him, the disease might intensify, and cause even more agony.

It might also kill him sooner than expected. I asked him how he felt about that, during our first meeting.

"I'll take that chance,"he said. His eyes looked watery and regretful. His skin was the color of skim milk, and his body seemed to be a shriveled version of what it once had been. He looked physically and emotionally exhausted.

"How is your doctor monitoring the progress of your disease?"I asked.

"A nurse comes to my house and checks my CPK levels,"he said. He was talking about his levels of a chemical called creatine phosphokinase, an enzyme that breaks down muscle tissue. The higher the levels got, the closer he would be to death. "My nurse is part of the hospice program,"he said sadly. The hospice program was an in-home service for terminal patients who had only weeks or months to live.

"You'll need to taper off on the prednisone gradually,"I said, "because you can die from sudden withdrawal.

"And when you start tapering off on the prednisone, you're going to need an aggressive anti-pain program, because your pain may increase dramatically."

He nodded calmly.

I scanned his medical records. "You're also taking some tranquilizers?" "Xanax, lithium, and Ambien," he said.

Xanax is a minor tranquilizer, much like Valium, and Ambien is a sleeping pill. Lithium is generally used only for bipolar disorder, or manic depression, which Scott did not have. Xanax and lithium did not seem appropriate for a patient with chronic pain. With Scott's concurrence, I discontinued those two medications and placed him on a full pain program immediately. He began to institute major changes in his life. Even though he had been told he was dying, he participated in his program enthusiastically. I really admired that. In some people the human spirit is just unbeatable.

Here's a brief outline of the four levels of Scott's program:

Nutritional therapy. Scott began to force himself to eat regularly, and carefully. His diet - which I changed to one composed primarily of grains, vegetables, high-protein soy products, and fish - was designed not only to give his nervous system abundant nutritional support, but also to improve his general health. He ate foods that stimulated production of nerve-calming serotonin, and he took the supplements that his brain and nerves needed to achieve regeneration. In addition, he regularly ate nutrients that have anti-inflammatory properties. I'll tell you about those special foods in chapter 2.

Physical therapies. Scott engaged primarily in massage therapy, and yogic mind/body exercises. He also did light work around his house, and a bit of walking, which helped him begin his cardiovascular rehabilitation.

The mild cardiovascular exercise he did stimulated his production of endorphins, and also provided his beleaguered muscles with a much-needed infusion of blood-borne oxygen and nutrients.

The stretching and massage soothed his muscle pain, and helped his nervous system to "unlearn" its patterns of circulating, engraved pain.

The mind/body exercises stimulated his brain, and brought energy to the areas of his nervous system that help control pain.

Medication. This was probably the most important component of Scott's program, since his primary goal had been to stop taking pharmaceutical drugs. Scott's desire to overcome his reliance upon powerful pharmaceutical drugs, though, was not at all uncommon. In fact, at the most prominent pain clinics in America, the first goal of the attending physicians is usually to eliminate their patients' reliance upon drugs. As you'll see in chapter 4, pharmaceutical drugs can play a very positive role in pain management. But they are not panaceas - even though many general practitioners seem to believe they are.

Over the next eighteen months, Scott gradually stopped taking prednisone, and eliminated his use of tranquilizers.

He replaced those pharmaceutical medications with milder natural medications, including homeopathic remedies and analgesic herbs.

I'd feared that his pain might become unmanageable after he discontinued prednisone, but this didn't happen. The natural medications - combined with the other elements of his pain program - more than compensated.

Mental and spiritual pain control

Mental and spiritual pain control. To heighten his ability to cognitively reduce his pain signals, Scott began to confront his feelings of anger and worthlessness. These negative emotions increased his perception of pain, and reduced his brain's ability to "dampen" pain signals.

Scott had been reared by a difficult father who had convinced him that he didn't deserve to be happy, and never would be. Scott had internalized this neurotic outlook, but was seething with anger toward his dad. To overcome his self-hatred and anger, he used several of the methods of "cognitive therapy," a rationality-based form of psychotherapy that's often quite beneficial for pain patients. As Scott began to shed his sense of self-loathing and his anger, he became much more relaxed, physically as well as emotionally. This reduced his perception of pain, increased his ability to accept pain, and heightened his ability to cognitively distract himself from pain.

Having a more positive outlook also helped Scott implement the other self-help measures in his program. It made it much easier for him to rise above his chronic pain syndrome, and to do good things for himself.

I also taught Scott an advanced meditation technique, which I'll soon describe, and his meditation helped him to achieve deep personal insights, and to release much of the negative emotional energy that was heightening his pain.

In addition to his psychological therapy, Scott also began an earnest search for spiritual peace. He started his search the same way many patients do - by asking himself, "Why me?"

This in one of the most fundamental of all spiritual questions about suffering, because spirituality is, essentially, the search for meaning.

When patients first ask this question, they usually assume the answer to it will be negative; they assume that they must have been doing something wrong, or that there is something intrinsically wrong with them.

Often this is true, and whatever it is that's wrong must be corrected. But the negative answer is almost never the complete answer. Usually there is also a positive element to pain. For example, for many people, pain is the only force strong enough to make them back away from the "rat race" and really live.

When patients find a positive meaning for their pain, it invariably helps them recover. It reduces their stress response, and heightens the pain-fighting power of their minds. Often it enables them to perceive their pain as less threatening, and helps them forget about it.

Scott found a positive meaning for his pain. He found he could use his pain as a path to universal truths, and to greater understanding. From intense study of spiritual literature, he learned that many great holy men had experienced terrible suffering - but had needed this suffering to reach enlightenment. Those spiritually advanced people became Scott's role models.

After Scott found a positive meaning for his pain, he never again suffered from it quite so much. When he realized that some good was coming from his pain, he began to see it more as a challenge than as a curse.

Scott, who was a practical man, did not just sit down one day and contrive the meaning of his pain. Instead, he did a lot of hard work. Each day he meditated for a long time, and it helped him to make contact with his inner self. He told me that meditation also helped him to make contact with the realm of the divine spirit.

In addition, each day Scott read extensively in spiritual literature - everything from Buddhism to the Bible. He prayed with conviction and fervor.

He also began a powerful practice called naad yoga, which employs the chanting of particular mantras. These ancient mantras were devised centuries ago, not only for their literal meaning, but also for the particular vibrations they create in the head, chest, and throat. My own spiritual teacher, Yogi Bhajan, has said that these vibrations stimulate optimal function of the brain and the endocrine glands, which produce hormones. Scott's favorite mantra was Ra Ma Da Sa Sa Se So Hung, which means "The healing power of God is in every cell of my body."

For Scott, the turning point in his spiritual exploration was when he finally "gave up"and surrendered to the inescapable fact that sooner or later he would die. When this happened, he remarked to me, "Now that I've given up, I feel like I've received everything."By this, he did not mean that he had received some sort of "free pass" to immortality. He meant that each day, for at least several blissful moments, he had begun to experience his own infinity.

The net effect of Scott's spiritual growth was that he developed an unshakable inner peace. This inner condition was so profound that it had various physical manifestations. One of them was the raising of his pain threshold.

Another manifestation was Scott's physical appearance. After several months he began to look different. His skim-milk skin tone began to be replaced by the luminous, incandescent glow that you sometimes see surrounding holy men. Even the look in his eyes changed. They no longer looked tormented; instead they reflected great compassion, and a deep sense of self-knowledge.

The change in Scott's appearance was very dramatic.

As you can see, there was nothing terribly exotic about his pain program; it was just a combination of good medicine, common sense, and Scott's own hard work.

After he had been on the program for about six months, I got a call from him. "My cardiologist just phoned me," he said. "It was about my CPK levels. We need to talk."

I felt a sick jolt in my stomach. If Scott's CPK levels were becoming dangerously high, his heart muscles might be in danger of immediate failure.

"What did your cardiologist say?" I asked.

"I'd rather talk in person."

The Final Chapter

As soon as I saw Scott arrive, I blurted out, "What did he say?"I was nervous. I know that some doctors can remain detached and don't become emotionally involved in their patients' lives, but I've never really understood that.

"He said my CPK levels are going down,"Scott said, flashing a smile as bright as lightning. "Way down. As in normal."

"Yes!"I jabbed my fist into the air. "My cardiologist goes, 'I don't know what you're doing, but keep doing it!'" Scott said, beaming. "The cardiologist said, 'I've read some of that Deepak Chopra stuff, but frankly I just don't get it.' I told him, 'There's nothing to get. It's not an intellectual thing, it's an experiential thing. You've just got to do it.'"

"How's your pain?"I asked.

"Fine. I don't think about it all that much. Actually, now that I do think about it, it's not fine. My muscles still hurt some. But pain just isn't the be-all and end-all now. I'm working again. Did I tell you that?"Then he was off on a story about work, and I had to steer him back to his medical condition.

"So you still have some residual pain?"I asked.

"I do,"he said, "but I know a bunch of ways to rise above it. I know every trick in the book."

"Has it been hard?"I asked.

"You bet. Sometimes it was even harder than being sick. I had to change so much - my habits, my diet, my psyche. I had to accept the fact that for forty-two years, most of what I'd been doing was wrong - because look where it got me.

"But having to make so many changes was a blessing,"he said. "The greater the changes in your life, the greater your healing."

That was three years ago.

Scott's disease is still in remission, as of publication.

Of course, it would be ludicrous of me to purport that my pain program is a miracle cure for polymyositis.

The fact is, Scott transformed his own life - body and soul. And when he did, his immune system stopped trying to destroy him, for reasons that are as mysterious as why the disease began in the first place.

As I have said, the body has an almost magical power for self-healing. But no one can control that power. It's a power that can only be served - not commanded.

When I saw Scott again recently, I told him, "I'm so proud of you."

He replied simply, "Thanks, Dharma."

He is very proud, too - that's quite obvious. But he is proud in a way that does not involve his ego. His pride is deeper than that, and more profound.

He loves life now, and his pride - like that of someone who is proud to be in a wonderful family - is the pride of a person who is proud to be a part of life.

© 1999 by Dharma Singh Khalsa, M.D.

About the Author

Dharma Singh Khalsa, M.D. was born in Cleveland, Ohio and raised in Miami Beach, Florida. After travelling the USA for educational purposes (Omaha, San Francisco), he settled in Albuquerque, New Mexico in 1978. In 1979 he started practicing Kundalini Yoga with Yogi Bhajan and in 1981 converted to the Sikh lifestyle replete with full beard and turban.

CAMERON STAUTH is the author of nine critically acclaimed books, a former editor in chief of the Journal of Health Science, and a journalist who has written more than a hundred articles for the New York Times Magazine, Prevention, Natural Health, and other publications.