Chronic Pain Relief

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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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 »

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 »

#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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#2—What is Mind Body Syndrome?  Part I.
June 3, 2008

It is important to realize that Mind Body Syndrome is not a new diagnosis.  When Dr. Sarno described Tension Myositis Syndrome (TMS) in the 1970’s, he created a new name for a syndrome that has actually been known for hundreds of years.  I agree with Dr. Sarno that we do need a name for this syndrome (and I will explain why in future blogs).  However, when you look at the history of medicine you will find many examples of MBS.  I highly recommend the book by the University of Toronto historian, Edward Shorter, From Paralysis to Fatigue: A History of Psychosomatic Medicine.  Dr. Shorter uses the term psychosomatic, which is commonly used in medicine, but a term that I do not prefer to use because it has a connotation of being unkind to the patients, implying that they are somehow less than normal, or somewhat “crazy.”  As I often say, I know that people with MBS are not crazy because I have MBS and I know I’m not crazy.

In any case, the reason people get MBS, or physical (or psychological symptoms) due to emotions which are often unconscious, is that they are human.  They have a human brain that processes emotions in certain ways and they have human existences that often cause great stress in our lives.  That is why there has always been MBS and there will always be MBS.  However, the type of symptoms that the brain creates in our bodies does change over time. Read more »