Posts Tagged ‘back pain’
The history of medicine consists of two major themes: development of new techniques to study the body and attempts to understand why illness occurs. Often these two themes lead to a synergism that creates a great advance, such as the development of the microscope so that we could actually see bacteria that cause disease. Before such technological breakthroughs occur, we are stuck trying to explain disease in the absence of being able to actually see the problem and therefore we develop theories on what is causing the problem. Sometimes these theories are correct, sometimes they are horribly wrong.
Ignaz Semmelweis was a Hungarian physician who noted that women who gave birth in the hospital setting had very high rates of post-partum infections (often fatal), while women who gave birth at home had much lower rates. The doctors at the time were doing autopsies and going from one procedure to another. Semmelweis thought that the doctors might be transmitting something to their patients thus causing the infections. He did an experiment to show that hand washing (using lime salts) actually did reduce the rates of death to below 1% (they were as high as 35%). However, he could not show why this worked and doctors didn’t believe him (despite being shown the research evidence). Sadly, Semmelweis ended up dying in an asylum in 1865 after becoming mentally ill. When one doesn’t understand the problem, the solution can be right in front of your face and yet you can’t see it.
I saw a woman this week whose story is shocking. She had a great childhood with loving parents who taught her that people could be trusted, the world was good, and that she should act with kindness and caring towards all others. She learned to sweep emotions under the rug and work harder when problems arise. She did not learn to speak up for herself. Her life was great until high school when she started a 3-year relationship with a boyfriend who came from an abusive household. Over time, he became jealous and possessive. She continued to make excuses for him and tried to be a good girlfriend, thus acceding to his increasingly controlling ways. He pushed her away from her family and her friends. He didn’t let her go out unless he was there. He even hit her on two occasions. And she continued to make excuses for him and cover up her pain and distress. She tried to be an even better girlfriend and hoped he would change. He didn’t; and finally (with the help of her sister) she broke up with him. She went off to college and did well. Her life was back on track. She was an active athlete and even ran in marathons. In her first job, she desperately wanted to prove herself and become the best employee in the company. However, her boss was someone who took advantage of that attitude and her inability to speak up for herself. The boss piled more and more work onto her, causing her to work evenings and weekends. The boss did less and less. Yet my patient never spoke up to ask for some changes to be made. She felt trapped and her feelings were similar to how she felt when in a relationship with her abusive high school boyfriend. It was during this period in her life that her pain started.
It has become very clear to me over the last year or so that one of the biggest impediments to recovery from Mind Body syndrome (MBS) is fear. It seems to be a part of the experience of so many people that it should be considered as a normal part of the MBS experience and therefore everyone will probably need to deal with fear at some point in their recovery. In this blog, I will take a stab at identifying the sources of fear, the meaning of fear and offer some thoughts and methods on dealing with fear.
Where does fear come from? We should recognize that fear is part of the normal experience of life. We are born with a brain system that is built to protect us from danger and harm, i.e. to help us survive in a dangerous world where we may become stalked by a predator or endangered by one of our own species; another human being. This system resides in the deeper parts of the brain (sometimes called the “reptilian brain”), it operates all of the time by constantly scanning the environment for danger, and it is clearly in the subconscious (or unconscious) part of the brain, i.e. we are not aware of its actions until after it has acted. When we sense danger, the brain sends immediate signals from the amygdala (the emotional center of the brain) to the hypothalamus (where the autonomic nervous system resides) to cause some kind of action in our bodies. Again, this occur without conscious awareness and our bodies are programmed to react to danger by activating the fight or flight reaction pathways. After our body reacts (with muscle tension, gut or bladder tension, and many other reactions), we THEN become aware of the sensation of fear. Interestingly, studies have shown that people who are paralyzed have lesser degrees of the sensation of fear (and other emotions). Read more »
Many people find that fear of not being able to recover from MBS and fear of pain are major factors preventing their recovery. In order to address these issues, I offer the courageous story of Brad in his own words. Following that (in the next blog), you will find my comments on dealing with fear and several methods that can help.
“In the late 1980s, I became totally crippled with back pain shortly after an incredibly stressful four-month period. I couldn’t do much besides lie around. I saw several doctors, who gave me a variety of diagnoses, and I realized they were just guessing, so I went to the library do some research. By chance (thank God!) I saw Dr. Sarno’s first book, Mind Over Back Pain, on the shelf. I took it out, and after reading it I knew that my pain had been caused by my recent psychological tensions. I also concluded that I had become literally phobic about many movements and decided that the only way to break the phobia was to challenge it with graduated exercise. So I began to exercise and lift weights. However, I was very timid and therefore didn’t exercise as aggressively as I could have. Read more »
Naming an illness can be one of the most critical aspects of caring for someone, especially if the illness falls into the category of stress-related illnesses. It is a universal truth that anyone with medical symptoms wants and in fact, needs to know what is causing it. So often in modern medicine, our answer is “We don’t know.” We don’t know why some people get cancer and others don’t. Many people with heart attacks have normal cholesterol levels and no obvious risk factors for heart disease.
For stress related illnesses, such as migraine and tension headaches, fibromyalgia, TMJ syndrome, irritable bowel and bladder syndromes, fatigue, and most people with chronic neck and back pain, it is absolutely critical to be able to name the illness correctly. Doctors who are unfamiliar with the powerful role the mind has in being able to produce significant and sometimes severe physical symptoms will always label the illness as a purely physical one. Hence, we see the proliferation of illnesses named as a syndrome or with a description that doesn’t help the person understand the true underlying cause of the illness. Fibromyalgia is a good example of a severe syndrome who’s name literally means “pain in muscles and tendons.” Unfortunately, people with this disorder already know that they have pain. The name helps to legitimize the disorder, but it doesn’t help to solve the problem of helping them get rid of their pain. In fact, the name can become a prison of sorts and can give them the impression that they will always be in pain, because the medication and physical therapies usually do not work.
Therefore, for stress-related illnesses in which there is no tissue destruction in the body (e.g. not cancer, or stroke, or heart disease, or diabetes, or lupus, or rheumatoid arthritis), it can be extremely helpful to learn that one actually has a mind body issue, which Dr. Sarno terms Tension Myositis Syndrome, while I tend to use the term, Mind Body Syndrome. These terms mean the same thing; that the symptoms are caused by reactions in the body to stress and emotions, which can be both conscious and/or subconscious. The reason I don’t use TMS as often is that it implies some inflammation in the muscles (the definition of myositis), and there is no inflammation in the muscles in TMS/MBS. Dr. Sarno has started to use the term, Tension Myoneural Syndrome more recently, which keeps the same letters of TMS, but takes out the inflammation reference. Read more »
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.