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.
Her back began to hurt began to hurt after engaging in weight training exercises (specifically squats) and the pain became significant. She had an MRI which showed a very small bulging disc. Her doctors told her that it was a small disc, but that it was probably causing her pain. They also told her that the disc was worse on the left side of the vertebra. Following that news, she developed new pains in her left hip and leg. Despite the pain, she worked even harder to prove herself a worthy employee and never stood up for herself. Over a year, the pain worsened and spread. She developed pain in her upper back, shoulders, neck and jaw. The muscles of her back tightened up and formed several knots that were extremely painful. She couldn’t exercise anymore, yet continued to try to work. Eventually, she had to quit work, yet the pain continued.
Her medical treatments consisted of pain medications, anti-depressants, and muscle relaxants. She had physical therapy, massage therapy and acupuncture. She had a close friend in medical school and together they searched far and wide for a cure and didn’t give up. Eventually, they found a doctor who suggested dry needling. This technique consists of putting needles directly into the muscle knots and stimulating them by moving the needles up and down within the muscle tissue. It was extremely painful. The cost was $240 per session; she had 80 sessions; total cost of $19,200; for what might seem to be almost medical torture. Wouldn’t one think that if something doesn’t work after 5 or even 10 or 20 sessions, that it’s not going to work?
After two years of severe pain and even torture, this young woman was given one of Dr. Sarno’s books to read. Upon reading it, she immediately recognized herself and her problems within the pages of that book. With the knowledge that she didn’t have a horrible disease (diagnosed as myofascial pain syndrome, which of course simply means you have pain in your muscles and tissues), she altered her understanding and her attitude. She began to move with the knowledge that she was actually healthy and her tissues were not diseased. Miraculously, her pain began to diminish. The knots in her muscles simply melted away. She began to exercise again and she has reclaimed her life.
When you don’t understand the problem, the cure can be worse than the disease. When our first President, George Washington, became ill, his doctors decided that he needed to be drained of several pints of his blood. When he didn’t improve, they simply drained more blood, thus hastening his death. Thousands of women died after childbirth because doctors didn’t believe Semmelweis even after he proved that hand-washing saved lives.
For people with chronic pain and other conditions (e.g., fatigue, insomnia, anxiety and depression) that are “medically unexplained,” current medical treatment often leads to worse outcomes rather than healing. How many unnecessary surgeries are performed each year? How much money is spent on worthless treatments? (It is currently estimated that the U.S. spends $1 trillion per year on back pain treatments.) How much suffering is caused? In my opinion, the medical profession is not acting out of mal-intent. Of course, there are financial incentives to continue to prescribe medications, surgery, injections, and other treatments. However, I believe that the primary problem is that the medical profession is unaware of the true underlying causes of these conditions.
A group of medical and mental health professionals has recently formed an organization to try to educate the public and the medical profession about these conditions. We are calling ourselves the Psychophysiologic Disorders Association. We are dedicated to bringing credibility to disorders that have been known as Tension Myositis Syndrome (TMS), Mind Body Syndrome, or Stress-related illness. These disorders have also been called psychosomatic disorders, medically unexplained illness, somatoform disorders, and conversion disorders. It doesn’t really matter what one calls them. But it matters a great deal if one understands them.
Check out the website of the association at ppdassociation.org or take a look at the tmswiki.org. You will find information that can help so many. We have not had a technological development to help understand the majority of back and neck pain, fibromyalgia, migraine and tension headaches, irritable bowel and bladder syndromes, pelvic pain syndromes, insomnia, fatigue, anxiety and depression. However we do have a new understanding that can make the difference between a life in pain without hope of cure and a life lived. Dr. John Sarno retired last month after over 50 years of practice. He wrote several books that posited a new understanding of most back pain and associated disorders. Thousands of people give credit to him for saving their lives as exemplified in my patient’s story (also see www.thankyoudrsarno.org for hundreds of these stories). Yet, the medical profession has not embraced this idea. Please join us in working to get these ideas accepted. Educate your doctors; join our association or the tmswiki; post on forums. We can work together to stop unnecessary and ineffective medical interventions!
To your health,
Howard Schubiner, MD