Chronic Pain Relief

Gender issues and MBS—Why does MBS occur more commonly in women?–MBS Blog #16

Scientists have known for many years that women are more likely to develop certain illnesses, which we now understand to be caused by Mind Body Syndrome.  These disorders are irritable bowel syndrome and migraine headaches, which are seen about three times more frequently in women than in men.  Irritable bladder syndrome (christened Interstitial cystitis by modern medicine), TMJ disorder and fibromyalgia are diagnosed in women about 4 to 6 times more commonly than in men.  An interesting comparison is back pain, which is seen equally between women and men (actually woman even have slightly higher rates of low back pain than do men; approximately 29% in women versus 25% in men).  Researchers have been silent for the most part on why these differences occur.  The usual fall back position is that it must be genetic.  But these are not primarily genetic disorders (see MBS blog #8 for details on the genetic aspects of MBS).  They are learned and they develop due to stress and emotional reactions to stress over a lifetime. 

I have been pondering the discrepancy between women and men in the MBS set of disorders and I have some thoughts that might help to explain the differences.  I must state at the outset that no one really knows the answer and my thoughts are just that; thoughts to get the field started, so that hopefully we can learn enough to make some definitive conclusions at some point.

First of all, we know that certain factors lead to the development of MBS.  Those are who are exposed to childhood traumas, such as emotional, physical and/or sexual abuse, fear, shame and guilt are particularly susceptible to MBS later in life.  The reason for that appears to be a resetting of the autonomic nervous system to become over-reactive.  When stresses occur in our lives during situations in which we are powerless and vulnerable, they are more likely to create MBS.  It is not only the life stresses that create MBS, but it is also the pressures that people put upon themselves; these internal pressures are extremely important as they magnify the life stresses greatly and are difficult to get away from since they are self-imposed.  Finally, there are certain societal expectations and learned “sickness roles” that can play a part in the development of MBS.

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Have you ever noticed that musicians are more likely to have repetitive stress injuries?  Of course you have.  But are you sure that the cause is actually overuse? 

What about headaches, back aches, neck aches, abdominal pain, fibromyalgia and TMJ pain?  Do musicians have more than their share of these as well?

Consider the situation of Jill, a 35 year old cellist who suffered from chronic and recurring wrist pain that for year she attributed to overuse.   Here is her story in her own words:

 
”I have been an active freelancer in a major city for years. Since graduate school days, I have played in many orchestras and chamber groups, driven long distances, taught in various schools, and presented at conferences.Like many of us, I had lived with various aches and pains for years. One fall, preparing for some particularly demanding concerts, my whole upper body seemed to just shut down. I experienced overwhelming fatigue, pain, and various other symptoms. Somehow I kept performing through the 3 month wait for appointments, tests, and results. I was horrified when the specialist told me in all of 5 minutes that I needed 3 surgeries.

I was incensed at his bluntness and his unwillingness to come up with anything more than that. I made up my mind then and there that I would find my own way out of this, and consider surgery the absolute last resort.

For the next several years I went from one medical professional to the next, with discouraging results. I did exactly as I was told, paying large sums of money to see people not covered on my insurance, and yet nothing was improving. Playing caused symptoms - sometimes predictably and other times with no recognizable cause. I was also unable to do many other things I loved to do. I became very discouraged and ready to give up.
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Several people have asked me how they can deal with troublesome thoughts and emotions that arise.  These thoughts and emotions, such as doubts about really having TMS/MBS or worry if you’ll ever get better or fear about developing pain, are extremely common.  Everyone has those from time to time or even very frequently. 

So, how can you deal with doubts, fear and worry?  You may worry about having some medical/physical problems instead of MBS/TMS and how do you deal with others when they challenge your view of MBS/TMS and suggest that there is some medical/physical problem going on.  These questions boil down to two main issues, I think.  The first has to do with doubt about the diagnosis of MBS/TMS.  The second has to do with the issue of the power of thoughts and emotions.

Dr. Sarno always (correctly) says that we need to “erase doubt.”  People always do better in the MBS/TMS program when they are convinced that their physical and psychological problems are due to emotions, stress and reactions to stress, both conscious and unconscious.  However, we are in this boat because we are human, i.e. we have minds and bodies and they constantly interact.  Because we have minds, we will frequently have thoughts that make us wonder if we’re on the right track.  I spoke to a lady today who told me that she must have something physically wrong because her pain was so severe, despite the fact that her pain had gotten much better after one week of working with the MBS/TMS program.  So, it is important to erase doubt, but some doubts will undoubtedly creep in.  Severe pain can definitely impair your ability to think and process emotions.  It can lead to depression and more emotions, which can further impair your ability to cope with pain and which can itself lead to more pain.  Some doctors also suggest that severe pain can lead to decreases in efficacy of anti-depressant medications, thus compounding the problem further.  The more pain, the more doubt and then things can get spiraling out of control.  In those cases, you really need to stop and go back to the beginning.  You may need to seek medical advice for reassurance that there is in fact nothing more serious going on and you may even need some more testing to confirm this. 

This leads to the second issue: the power of thoughts and emotions.  It is critical to realize that thoughts are uncontrollable, i.e. one can never choose what thoughts will come into their heads.  The mind will continually come up with a huge variety of thoughts, many of which are unproductive, weird, wild, inane, or beautiful.  If we can’t control out own thoughts, one certainly cannot control other people’s thoughts, and therefore we must learn ways of dealing with thoughts and reacting to thoughts or else we will be at the mercy of every stray thought that we (or someone else) comes up with.  And, of course, it is not only thoughts that we need to deal with, but emotions as well, which are basically thoughts that are connected to important material from our past. 

After doing a lot of research on how the brain works, I have developed a model to explain how MBS develops in the brain.  You can watch a video about this on my web site, www.yourpainisreal.com.  When pain occurs, it activates nerve pathways which send those pain signals to the brain and particularly to the amygdala, which is the emotional center of the brain and the area that can immediately activate the autonomic nerve system (ANS), which is the unconscious connection to the body to create the fight, flight or freeze reaction.  These reactions are immediate, so that if you feel the pain of a burning match, you will immediately pull your hand away before you can even think about what is happening.  This reaction occurs within 12 milliseconds, much faster than could occur if you had to send those signals up to the frontal cortex where you would become aware of them consciously.  This reaction protects us from danger and happens without our conscious awareness. 

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MBS Blog  13

The layers of wellness: levels of coping with TMS/MBS

I have spoken to so many people who are frustrated that their TMS symptoms have not gotten better yet.  They have read so many accounts of people who have read Dr. Sarno’s books and immediately gotten better.  They wonder why they haven’t had the same response.  This can lead to increased worrying: worrying about what’s wrong with them, if they really have TMS or not, if they are making themselves sicker by worrying, and this vicious cycle can go on and on.

On the TMS Help Forum and other web sites, there are many excellent suggestions about methods of self-help and books that people have used to vanquish their TMS symptoms.  Most of these are great resources and can be helpful to many.

I was talking about this the other day with a good friend and excellent psychologist, Mark Lumley from Wayne State University.  He and I actually ended up writing a little poem about the layers of work that many people may need to do to get better.  I must warn you, neither of us are poets, so the so-called poem isn’t very poetic.  But we like it because it means something important to us.  Here it is.

Things to do:

Notice what has been hidden;

Understand what has been a mystery.

Speak what has been unspoken;

Confront what has been avoided.

Accept what needs to be accepted;

Forgive what needs to be forgiven.

Change what needs to be changed.

Howard Schubiner, MD and Mark Lumley, Ph.D.

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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 »