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 »

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 »

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.

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MBS Blog #4 – Psychological aspects of MBS

I have discussed the relationship between the mind and the body in prior blogs.  Briefly, it is important to realize that they are essentially one, i.e. there is no separation between the mind and body in the sense that physical stimuli (e.g. an injury) immediately produce changes in our minds (emotions, reactions, etc.) and emotional stimuli (e.g. a scare, a verbal criticism, etc.) immediately produce physical reactions.  The relationship between the mind and the body are immediate for survival.  It would take too long for thought processes to engage prior to reacting if we happen upon an angry bear.  Our survival instincts of an immediate reaction (running, freezing, etc.) are much quicker.  William James, the father of psychology, noted that it is not true that first, you see a bear, then your feel fear, and then you run.  He reasoned (and we now know he was correct) that you actually see a bear, then you run, and then you feel fear. 

Our minds and bodies are constructed (through the process of evolution) to maximize survival.  When an animal is frightened, it immediately goes into one of the survival reactions: fight, flight, freeze, or submit (play dead).  When we get overwhelmed in our life, our body will react in a way that is designed to help us out of the situation.  For example, I saw a woman who had a very difficult childhood with neglect and abuse.  Her reaction to this was to look for love and attention whenever and wherever she could find it.  She grew up and always attempted to appease others and tended to neglect her own needs.  Like many people with MBS, she had a very strong dose of the “shoulds” (as Dr. Sarno often refers to Freud’s superego or conscience).  As her life became more complicated and busy, she tried to do more and more for everyone else.  Finally, her body reacted by giving her severe migraine headaches and fatigue.  These reactions were her body’s way of trying to protect her, i.e. forcing her to rest, to lie down, to stop doing so much for everyone else and to do something for herself.  Unfortunately, she there was a great cost to this response, i.e. severe pain and fatigue.  I believe it is useful to view the body in this way, as trying to help us, to protect us, rather than as betraying us, which is a common thought that many people with MBS have. 

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#3—What is Mind Body Syndrome Part II

As I mentioned in the last post, MBS is not new.  As long as there have been humans, there have been physical symptoms caused by stress and emotions.  It is important to realize that physical symptoms, even very severe physical symptoms can be caused by stress and emotions.  In fact, the emotions that tend to have the largest effect on us are precisely those that we are unaware of.  There are two ways to think about how these symptoms can be produced. 

The first way is to understand how the neurologic system works.  Pain is a learned response, i.e. the body actually learns how to produce certain symptoms by experiencing them.  For example, I had a patient who fell and hurt her back as a teenager.  A decade later, she was in a very difficult situation in a job where she felt trapped and unable to get out of her problems there.  At that moment, suddenly her back seized up and she had tremendous pain.  The nerves that send signals from the back to the brain had been fired when she fell as a teenager and those nerve connections had been “learned” at that time.  When a significant emotional situation arose where she had no way out, her body responded in a way that it already knew, by producing the back pain it had learned 10 years earlier. 

A good way to understand how MBS works is by thinking about phantom limb syndrome.  In this syndrome, which is very common among amputees, pain or other sensations can be felt in the part of the body (arm or leg usually) that is missing.  There is obviously no disease in that area, yet we can feel pain (often severe) that appears to be coming from the missing body part.  What has happened is that the nerves that send signals to the brain have been sensitized and are continuing to fire and those signals are interpreted as pain by the brain.  A vicious cycle is formed of sensitized nerves that send signals to the brain, then those signals get amplified in the brain (by a structure called the anterior cingulated cortex; more about that area of the brain in upcoming posts), and then signals are sent out to the body by the autonomic nervous system (the fight, flight or freeze system).  This pain is real, very real.  However, there is no tissue breakdown, no tissue disease in the body.  This is exactly what happens in Mind Body Syndrome.  We may feel pain in an area of the body, for example, the head or back or stomach, yet there is no tissue breakdown, no tissue disease there.  Of course, pain can be caused by tissue breakdown or disease, such as occurs in cancer, infections, or fractures.  When the doctors are unable to find disease after a careful and thorough search, the diagnosis of MBS is usually correct.  It is important to realize that MBS is a physiologic process, i.e. a process that occurs due to normal reactions of the body.  When we get scared, our heart speeds up; when we get nervous, our stomach tightens up or we get clammy hands.  These are physiologic processes, normal reactions that are 100% reversible.  That is why MBS is curable.  It can be reversed by interrupting the vicious cycle.

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