pain may seem to be a contradiction in terms.

But Ms Lainie Andrew-Koolkin claims that as pain is not only a sensory experience but also a perceptual one, a psychologist can be of great help.

Describing herself as a psychologist specialising in behavioural medicine, she helps people living with chronic pain or stress to acquire some feeling of control over their minds as well as their bodies.

And it is new technology -- in this case, computer-assisted bio-feedback -- that is used by Ms Andrew-Koolkin in a combination approach to pain management. The highly sophisticated equipment measures muscle tension levels that affect muscular pain and body temperatures, which serve as indicators of pains, such as migraine headaches or backache.

Relaxation, says Ms Andrew-Koolkin, is a key factor in managing pain. She teaches the art of relaxation, encouraging clients to practise simple techniques that can be used anywhere, at any time -- even, she says, standing in the queue at the supermarket.

Sometimes, however, people do not realise their muscles are tensed. It is then that they are seated comfortably, in front of a computer screen. Then the client is "hooked up'' with small sensors attached to their fingers, forehead or neck.

"People, especially kids, like to see the `line' that streaks across the screen, indicating tension levels. It helps them to increase their awareness as to whether they are really relaxed or not. The green line shows muscle tension and the purple line shows hand temperatures.'' She explains that thermal readings, which indicate body temperature, are useful in treating the miseries of migraine headaches, which can totally incapacitate people for several days at a time.

"There is a strong belief that migraines are a disorder of the central nervous system and people become over-stimulated. So I try to teach them through relaxation, or bio- assisted relaxation to slow everything down, so that blood vessels dilate. People don't mean to tense their muscles, it happens subconsciously and if they can see the tension recorded on the screen it's a first step in dealing with the pain.'' Ms Andrew-Koolkin says that her relaxation techniques can often be applied to migraine sufferers who get "aura'' symptoms: "This is thought to be brought on by a neural interruption, so that aura could be the time to sit down and do the relaxation exercises. Some people have other symptoms, such as craving certain foods, so I work with them to try and find out when they are in a pre-headache phase. Relaxation may not totally prevent a migraine but it certainly reduces the pain and the vomiting that often accompanies it.'' Most important, she says, is preventive relaxation, used regularly, on a daily basis, before there is any sign of a headache or backache.

Emphasising that her methods in no way replace medical treatment, the psychologist says it is, in fact, very important to maintain a close relationship with a client's physician.

"I have to know what medication has been tried, what works and what doesn't work. Sometimes, people also abuse medication -- even aspirin -- so then we have to work with the physician to reduce dosage over a specified period of time.'' "A person's pain can be very real, but we know now that a headache, for instance, may be caused by what we call `referred pain' -- we often find that it is tension in the back or shoulder muscles that is, in fact, causing the pain felt in the head.'' People who suffer pain often have great stress in their lives. But, she hastens to add, "I hate the word stress, as we all have stress. It takes stress to keep your heart pumping, and if that stops, we're dead! So we need stress. It's only a problem when there is an over-load of stress.'' We have to remember, she emphasises, that one person's unacceptable stress is quite normal in someone else.

People who feel unhappily "stressed out'' are encouraged to look at their lifestyles.

"Some of this is just common sense, but we forget to use it. For instance, someone who stays out late every night and has to get up early and do a full day's work is going to feel that she's had a stressful day. Or if you don't eat, but drink black coffee all day, that's not going to help. We have to understand that our physical state, such as fatigue or hunger, will affect stress levels. The arousal of emotion, like a quarrel or your car breaking down are all factors.'' One way to cut negative stress is to schedule time sensibly.

"Learn to say `no'! By not being assertive in the morning and refusing to take on extra schedules, you are going to add to your overall stress by the end of the day.'' Ms Andrew-Koolkin points out that stress (and accompanying muscle tension) can also arise from happy events, such as getting married, or moving to a new house.

She feels that perhaps too little attention is paid to the physical stresses of modern life, such as living in a crowded, dirty city.

"Even though Bermuda is a wonderful vacation resort, it can sometimes be difficult working in an environment where a lot of people are just taking it easy. And Bermuda has its own problems, in that it's an expensive place to live and that sometimes means a person has to hold down two jobs and that can be very stressful.'' Pain, believes Ms Andrew-Koolkin, is decidedly "a variable experience''. Her techniques may not eradicate pain but, she claims, can alter people's perception of it.

"People usually find pain easier to bear when they know it will eventually end. The classic example of this is childbirth. And for some reason, some of the worst pain doesn't register at the time, like the soldier who has his legs blown off may have no immediate sensation of that happening to him.'' Relaxation comes into its own when dealing with chronic pain on a long-term basis. This includes such illnesses as chronic fatigue syndrome, which can be associated with a lot of muscle pain, or Herpes, which often erupts when stress is present, and the nerve pains of diabetes.

Relaxation techniques for cancer patients on chemotherapy treatment can be very helpful in reducing reactions or side-effects.

"It is also important to learn how to pace yourself. People with chronic pain may feel terrible for a few days, then suddenly feel better -- and half-kill themselves trying to clean the house.'' Lainie Andrew-Koolkin, who has just joined Ashton Associates, spent 15 years as a general psychologist before specialising in pain management. After attending Emerson College in Boston, and Vermont College, she has almost completed her doctorate at North Eastern University and is just completing her thesis. She spent one year in clinical studies at the Pain Programme at Spalding Rehabilitation Hospital and a one year research and theory programme at the Graham Headache Centre in Boston.

SWITCHED-ON PSYCHOLOGY -- Psychologist Ms Lainie Andrew-Koolkin uses the latest technology to help in the management of long-term pain.