Mariclare Dasigenis on Alternatives for Pain Management

Mariclare Dasigenis (LCSW) is a psychotherapist and pain coach based in Los Angeles, California. She began working with chronic pain clients at the Pain Psychology Center in Los Angeles where she received extensive clinical training in Pain Reprocessing Therapy. To help clients overcome chronic pain, She utilizes mindfulness-based somatic approaches, cognitive-behavioral, as well as psychodynamic and emotionally-focused interventions. Mariclare also specializes in working with patients with anxiety disorders, depression, trauma, and relational issues. She is passionate about assisting clients in building understanding and insight, and in connecting more deeply with themselves in order to improve their lives and heal.

Q; How did you first get interested in pain?

A: I first became interested in pain while learning about Intensive Short-Term Dynamic Psychotherapy. This treatment focuses on connecting with, experiencing, and expressing emotions effectively to help clients reduce their suffering. I also learned of how emotions could manifest as physical symptoms and pain in the body. Emotions such as anger and grief can feel so intolerable to some people that they are unconsciously repressed. This process of emotional repression can cause the experience of anxiety and pain.  

During my training, I looked back on my own history and realized a number of symptoms I’d experienced were mind-body caused. Soon after, I joined the Pain Psychology Center and pain has been my focus ever since. 

Q: Why is pain so challenging to treat?

A: Pain can be so challenging to treat because it’s multifactorial.  There can be layers of contributors to pain and to fear. First and foremost, there is the Pain/Fear Cycle, which is driven by fear of the pain itself. Often, clients have been given scary diagnoses and negative messaging about their symptoms by medical practitioners in the past. And on the most basic level, we are evolutionarily wired to associate physical pain with physical damage. So, it’s no wonder that our natural and learned response to pain is often fear! But there are a variety of other factors that can also contribute to fear, such as emotions, core beliefs about self, personality traits, and past traumas. There is often a need to help patients change the way they relate to their bodies, and also help them find new ways to relate to themselves in general. In other words, it’s important to find safety in the body, but also find safety more globally. 

Q: Some of your work has focused on the relationship between trauma and pain. Can you talk about the relationship between the two? 

A: Absolutely, trauma and pain are intimately related. 

There is research that demonstrates that trauma impacts the brain (specifically the amygdala, or the fear center of the brain) and can make it more responsive. The Adverse Childhood Experiences (ACEs) study shows that people who endure childhood adversity are more likely to experience a number of poor health outcomes and somatic symptoms later in life, including chronic pain. 

For folks who have experienced trauma, the amygdala can, understandably (and often adaptively!) become sensitized. This sensitization is useful when someone is in a dangerous situation. It’s helpful to be hypervigilant and more protective when you have been hurt, to avoid further hurt. However, this state of high alert can persist long after the danger has passed and one can become overly responsive to situations that are not dangerous. 

This is incredibly similar to the process that we see with pain. Pain is a danger signal. Oftentimes, the brain can respond with a physical danger signal when there is no damage or long after the damage has healed. Similarly, the system becomes more responsive and more protective. 

Addressing chronic pain and trauma go hand in hand. Recovering from both is, at the core, about finding safety. We work to help patients find safety around the symptom itself but also find safety more globally. Safety can look like changing the narrative around a chronic pain symptom. It can also look like expressing emotions, setting boundaries, and finding self-compassion. Creating safety in these ways can help reduce anxiety and promote a regulated nervous system, all of which can help with pain reduction.

I often find it valuable to help clients develop compassion and even gratitude for this protective system. Their brain is ultimately looking out for them. Our work is to show the brain that it doesn’t need to protect them anymore. The threat has passed. 

Q: What are you working on now that has you the most excited?

A: I was just part of a pilot program with United Health Research and Development where we implemented Pain Reprocessing Therapy in a pain clinic setting in Las Vegas, Nevada. It was wonderful to offer this treatment to folks who had never heard of another treatment for chronic pain, other than what is conventionally offered. I’m optimistic that projects like this one will foster broader education about the role of the brain in pain. As different types of practitioners are being trained in this modality, such as physical therapists, clients might be given a different message than in the past. I’m hopeful that more people will find out about neural circuit pain, and that it is treatable and reversible.
Q: What do you like to do for fun when you aren’t trying to cure pain? 

A: When I’m not working, I love to learn new things. I’ve been teaching myself guitar and French. Otherwise, you can find me running outside, cooking fun dishes, loving my sweet dog, or visiting a botanical garden. 

Q: Where can people find you and learn more about your work?  

A: You can find my private practice website and contact me here.

I’ve also teamed up with two of my colleagues in a group private practice that focuses on pain. You can find out more about that here. 

Please feel free to reach out to me if you would like to chat and see if we are a good fit!