Chronic Pain Relief

This is the second part of a blog about back pain.  This blog deals with the MBS approach to understanding back pain.

How can back pain occur in the absence of something wrong with the back?

There is a way to explain this based on new research into how the brain changes over time (neuroplasticity).  One way is to consider what happens in phantom limb syndrome.  In this situation, there is pain in the area of the body that is missing; that has been amputated.  Clearly, there is nothing wrong with the area where the pain is felt, yet there can be severe pain.  In this case, the pain appears to be due to sensitization of nerve fibers that go back to the brain, amplification of pain in the brain and a conditioned response of nerve fibers going back to the body.  The brain and body have in essence learned to have this pain.  The nerve connections have gotten fired after the amputation, but then have gotten “wired” and keep sending pain signals, which are felt to be in the amputated limb.  It is likely that back pain (and other pain syndromes, including headaches, abdominal and pelvic pain, whiplash, fibromyalgia and TMJ pain) is caused in many people by similar nerve pathways. 

What triggers this type of back pain to start and become chronic?

The answer is surprising and even offensive to some people and that is stress and emotional reactions to stressful events.  A classic study showed the Boeing employees over four years and found that psychological stress predicted back pain much more than any other variable, including how much they used their back on their job.  Other studies in Sweden, Holland, and England showed similar findings.  In fact, job satisfaction is the most important factor that appears to determine if someone will develop chronic back pain or return to work after back surgery.  Read more »

Conventional “knowledge” tells us that we were not meant to walk upright and that backs typically degenerate over time which leads to chronic back pain.  If back pain was caused by degeneration of the back and the discs between the vertebrae, then it would make sense that back pain would increase with age.  This is not the case however.  Back pain actually drops a bit after age 65.  We have been told that back pain will occur more often in people who use their backs more often.  However, in studies from around the world, more people have back pain in industrialized, modern societies than in rural, agrarian societies. 

What is the cause of back pain?  There are several serious medical conditions that can cause back pain, such as a vertebral fracture (usually a compression fracture seen in the elderly or those with osteopenia), cancer of the vertebrae (seen in those with metastatic breast, lung or prostate cancer), serious abdominal conditions such as rupture of an abdominal aortic aneurysm, pancreatic cancer, rupture of a duodenal ulcer, or infections such as osteomyelitis, epidural abscess or diskitis.  Fortunately, these conditons are relatively rare and easy to diagnose with modern imaging techniques (X-ray, CT or MRI). 

  Read more »

Dear Dr. Schubiner,

For so many years, I have been taught and “programmed” to please others and basically ignore what I was feeling; because I didn’t matter.  I denied myself things such as food (anorexia), pain medications and even rest.  I even felt that I didn’t deserve to have feelings and lived with tremendous guilt.

I started to have pain at the age of 13 and I am now 49 years old.  I had a very difficult childhood with severe abuse and neglect and it has been reflected in pain for all these years.  I now understand that my subconscious mind caused me to have severe headaches.  They began gradually and occurred about twice a month.  But they were severe and forced me to lie in bed and cry.  The headaches started to occur more often, until they came daily and lasted for the next 20 years!  I forged on with my life; marrying, working and starting a family.  The pain finally got so horrible that I had to quit a job that I loved and held for 21 years. 

I was devastated, but I decided to become the best wife possible.  I was determined to be the best coupon shopper to find sales on all items, sometimes dragging two toddlers with me across town just to save 50 cents.  I tried to be the best housekeeper and stay at home Mom.  I was obsessive about everything, to the point of exhaustion.  Finally, I had a nervous breakdown and was hospitalized for three weeks. 

Since taking your workshop and beginning therapy, I have come to an amazing revelation.  My internal child was telling me, “Hey, I matter and if you won’t listen to me, then I’ll just have to force you to pay attention.  I want some nurturing too.  Quit trying to please everyone else and be kind to me.  I deserve it.”

Read more »

MBS Blog –  #9 Mindfulness Meditation

I have been a devoted and passionate teacher of mindfulness meditation for about 15 years.  Many people have misconceptions about meditation.  The most common misperception is that meditation is about relaxing.  Of course, meditation may be relaxing at times, but not always and the intent is not relaxation, but obtaining a better understanding of yourself, and learning to respond to body sensations and thoughts/emotions more deliberately, and learning to live fully in the moments of our lives.  Mindfulness meditation is a form of meditation that asks people to simply pay very close attention to the here and now, to the present moment, to what is happening right now, whatever that may be.  One of the great things about mindfulness is that one can practice it at any moment, no mater what you are doing or what is going on.  That makes it quite useful as a way to cope with the ups and downs of life.

The reason to learn mindfulness meditation techniques for people with Mind Body syndrome is that it can help a great deal in learning to live fully in the present and to learn to let go of some of the things that tend to perpetuate MBS, such as fear, anxiety, sadness, issues from the past, or worries about the future. 

  Read more »

MBS BLOG # 8

Genetics and Mind Body Syndrome

Everyone knows that genes “controls” our lives.  But how powerful an influence do our genes play in our lives?  Of course, these issues have been debated for many years since the discovery of genes and the classic experiments of Gregor Mendel in 1865 on pea plants genetics.  We wonder not only at the similarities of facial features of children and their parents, but also at their personality quirks that seem to be passed down through genes.  There have been many books that purported to show that genes control everything.  So, when we are told that a certain disease is genetic.  We often assume that we are destined to be affected and that treatment may have little effect.

First, you must realize that there are certain genes that do have powerful effects that will produce diseases if those genes are present.  For example, cystic fibrosis and sickle cell anemia are diseases produced by inherited genes.  If you have those genes, you will get the disease.  However, it is also clear that different people with the same genes can have differing levels of that disease, even in CF and sickle cell.

Other diseases have some contributions from genes, but these contributions are either minor or variable.  For example, breast cancer has been found to have genetic components, but most people with breast cancer do not have the breast cancer gene.  There are genetic contributions to asthma and migraine headaches, but these are relatively small contributions in comparison to the effects of genes on height, ADHD and schizophrenia, which have heritability factors of 0.8-0.9.  The heritability factors of asthma and migraine headaches are in the range of 0.4-0.5, i.e. much smaller effects. Read more »

June 21, 2008

Letter to Dr. Schubiner from Paul Mazzafero, Davie, Florida

I first suffered excruciating back pain in 1984 as a 20-year-old young man. I had searing back and calf pain. I eventually had surgery in 1988 to remove a synovial cyst off my sciatic nerve. However, post surgery the pain was still there. I was scared I would be like this for life and was in pain management. I eventually picked up a book by Dr. Sarno and read it. I went to the Dr. and he assured me my back was fine. I was so emotionally damaged at this point I did not know what to do since I had already been to 21 doctors and had every test, steroid, epidural, etc. I eventually said, “I am fine and this is psychological”. I proceeded to workout like a madman and eventually the pain left me for 16 years. In fact I went on to compete as a boxer and was very active.

Fast forward to 2004, when I was throwing 100 pound logs and felt the dreaded pop and searing calf pain. “Uh oh,” I said and went to my GP and he ordered an MRI which was negative.  However, I still had the calf pain. P.T. did not work…..Epidurals did not work……Massage did not work….Chiropractic did not work….Books, exercises, you name it and nothing worked. I was on prednisone and gained weight. I stopped working and contemplated ending it all. I am a vociferous reader and came across your program and within doing the 1st night of journaling I felt relief, not 100% but I felt like a layer was being peeled off an onion. I realized I was in a miserable job when this happened and that I am a perfectionist and I could understand how these factors played an important role in my back pain. Anyways, long story short: within 3 weeks of doing the online program, I was feeling 90% better but still skeptical a little. However, after 6 weeks, I have been pain free 100%. Dr. Schubiner’s course was an introspective look at what makes me tick. I do not think the pain will come back. In fact the 1st week when I started to feel better, an old neck injury and pain mysteriously returned…..I laughed out loud. When I am stressed, I pull out my notebook and read my journal and sometimes re-watch the videos.

  Read more »

#6—Mind Body Syndrome is contagious

When I first started learning about Mind Body Syndrome a few years ago, I was struck by an account by someone who had what is known as repetitive stress injury.  He wrote an eloquent account of his story, which was published on Kim Ruby’s excellent web site (www.tarpityoga.com) on MBS or TMS, as Dr. Sarno coined the term, Tension Myositis syndrome.  In his account, he spoke of having had RSI many years before, but it got triggered after going to hear a lecture about it. 

Medical students are well aware of how the suggestion of the symptoms of an illness can produce those symptoms.  It even has a name, “medical studenitis,” since it is quite common to develop some symptoms of the disease you are studying. 

Dr. Jean-Martin Charcot in France in the 1800’s had a clinic for what was known as “hysterics” in the day, although these disorders (now we realize are forms of MBS) were considered to be genetic at the time.  In his clinic, people with headaches, abdominal pain, anxiety, etc. would arrive and Dr. Charcot had “discovered” that there was a progression to this disorder in distinct stages: motor tics (brief, rapid tic-like movements), clowning (striking bizarre poses and holding them), hysterical seizures (shaking as if in a seizure).  Amazingly, when people entered his clinic, they would almost inevitably pass through these stages, confirming Dr. Charcot’s beliefs.  There was a young woman with headaches who came to the clinic.  Her roommate was in the tic stage, and the next day the young woman had developed the same tics.  The power of suggestion is can be extremely strong, especially when given by a powerful person.

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#5—Modern Medicine’s Blind Spot

The rapidity of advances in medicine has been staggering over the past 50 years.  It has been amazing to see the proliferation of research that has helped us understand how individual cells work, how DNA is translated into proteins that recognize other cells, that repair damaged cells, that create new cells to fight infections, and that communicate with all the cells in the body.  We have learned a tremendous amount about how smoking, high cholesterol, and diabetes cause heart disease and about how cancer cells replicate and spread.  These advances have created new technologies and medications to fight heart disease, stroke, and cancer by looking at the minute details of cells and proteins.  This view of how medicine will advance is now universal; we will find the answers to how the body works and can be healed by looking at the individual areas where the disease is presumed to be.  This has worked well so far.

But the problem lies in applying this theory to disorders like Mind Body Syndrome (MBS).  In MBS, there is no tissue breakdown in the body, so by looking closer and closer at the “problem area”, we are actually missing the problem.  In this case, the problem is in the relationship between the mind and the body.  Phantom limb syndrome is a situation where real and severe pain can be caused by the connections between the mind and body, yet there is no “disease” in the area where the pain is felt (i.e. the missing arm or leg).  In people with back pain, if there is a fracture, an infection or a tumor, we are best served by applying the techniques of modern medicine; i.e. find the source of the pain in the painful area and treat it with medications or surgery or physical therapy.  However, for those with chronic back pain and no fracture, infection or tumor, trying to treat the source of the pain in the painful area can lead to more harm.  Why have back surgery for a problem in the nerve connections between the brain and body?  Actually, this has been tried in phantom limb syndrome.  They tried amputating the limb at a higher spot to try to decrease the pain, but this didn’t work.

  Read more »