Tag Archives: chronic pain

Blog #37: Medical myopia and common sense

Deborah Amos, a reporter for National Public Radio, gave a talk recently about her work in the Middle East.  She was discussing the tense and contentious negotiations between the United States and Iraq regarding Iraq’s nuclear energy/nuclear bomb development program.  As an aside, Deborah noted that the Iraqi foreign minister developed acute back pain every time the negotiations hit a particularly tense spot.  The audience laughed and it seemed so obvious that this pain was causally related to the stress of the situation this man found himself in.  Simply common sense, it would seem.

Last month, there was a report on NPR’s Morning Edition about teenagers who are stressed.  The reporter described a growing trend of teenagers who are smart, highly motivated, and involved in many activities.  They tend to work very hard trying to obtain good grades in advanced placement classes, and are involved in several clubs, science projects, athletics, and volunteer work.  Unfortunately, they may develop signs of stress, such as headaches and stomach pains.  They are more likely to be young women who are conscientious, caring, and sensitive.  The report described one such young woman who decided to cut back on some of her activities and take fewer AP classes.  The result was that she felt better and her headaches and stomachaches went away.

These reports imply a relationship between stress and physical symptoms, such as back pain, headaches and stomachaches.  Simply common sense, it would seem.

Yet, when patients present to physicians with chronic symptoms, the concept that stress may be the primary culprit is not entertained, despite evidence to the contrary.

A report from the Kansas City Star this month described a growing trend of a disorder known as widespread pain disorder in young women.  This syndrome describes pain in one part of the body that spreads to many parts.  There is no known medical cause and there is no evidence of tissue damage.  The young women described in the article tend to be teenagers who are highly motivated, overly committed, and “stressed out.”  The article described a treatment program that centers on exercise and physical therapy, although it does include some family counseling.  These programs cost tens of thousands of dollars.  The physicians however are careful not to imply to the patients and families that this syndrome is caused by stress.

Similarly, an article in the New York Times this week described the syndrome of chronic pelvic pain that is being treated with an electrical wand that applies stimulation to trigger points in the muscles of the pelvis.  The wand must be applied through the rectum in men; and sometimes through the vagina in women.  Interestingly, the title of the article is “A fix for stress-related pelvic pain” and patients can buy the wand for $800 and learn how to apply it to themselves for $4300.  The protocol includes relaxation exercises, but avoids looking at the stress in their patients’ lives as a cause for the symptoms.

Finally, an article was recently published in the Journal of the American Medical Association on children with migraine headaches.  The research compared using medication plus cognitive behavioral therapy (CBT) to medication without CBT.  The study found that those who got CBT had fewer migraines than those who didn’t.  In an accompanying editorial, this comment seemed to sum up the view of modern medicine to these stress-related illnesses:

“Unless communicated carefully, suggesting a child see a therapist for headache treatment could inadvertently imply that the origin of chronic migraine is psychological.”

Modern medicine is myopic when it comes to stress-related illness.  Even when the evidence clearly points to stress as the cause of physical symptoms, we are loath to use common sense.  We attempt to avoid the simple explanation that stress causes real physical reactions in the body; that stress causes real pain.  Avoiding this concept leads to treatments that are expensive and don’t specifically target the cause.  Even if the patient gets better (it is interesting to note that none of the young women interviewed in the article on widespread pain syndrome were pain-free), they are not likely to develop the understanding and self-knowledge that they will need to deal with both current and future stressful situations.  They are also not likely to understand that physical symptoms that may arise in the future can also be stress-related, which is critical to avoiding costly and misleading medical workups.

If physicians and other health professionals used common sense, they would be more likely to help patients identify stress-related illnesses as being simply that: stress-related illnesses.  They could help their patients understand this and get treatment specifically directed at understanding the relationship between the mind and the body and dealing with thoughts and emotions that trigger pain and other symptoms.  Simply common sense, it would seem.

To your health,

Howard Schubiner, MD

 

MBS Blog #35: When the cure is worse than the disease: Exposing medical myopia

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.

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Blog #28: Report on a Mind Body Syndrome retreat at Kripalu Institute

About a year ago, the New York Times ran an article about the Kripalu yoga and health retreat center in Lenox, MA. The article’s theme was that Kripalu took chances and tried new ideas for health and healing. Those of us who are working with people with Mind Body Syndrome (MBS, or Tension Myositis Syndrome, as named by Dr. Sarno) are continually trying to find better ways to help our patients. I developed a comprehensive and structured 4-week program designed to uncover and address hidden emotional reactions that are linked to a variety of chronic painful and associated psycho-physiological symptoms. Maybe there would be some benefit from an intensive retreat format for getting people started on this work or to help them get unstuck in their progress.

I submitted a proposal to Kripalu, thinking that it would be a long shot. To my knowledge, no one has ever conducted such a seminar based upon the particular model initially proposed by Dr. Sarno. I didn’t hear from Kripalu for several months. One day, I mentioned the proposal to a close friend. Serendipitously, his sister, Annie Price, had just started working there and he called her to see if my proposal was being reviewed. She pulled it out of the pile and within a few weeks, I got an email asking if I could arrange to spend a week at Kripalu leading this retreat. Continue reading

MBS Blog #26–Update on social contagion and Mind Body syndrome

More on the “contagiousness” of Mind Body syndrome:

Over the past couple of years, a new line of research has been developed which documents that certain disorders are socially contagious.  Nicholas Christakis and James Fowler have published articles in the New England Journal of Medicine and in the British Medical Journal documenting that smoking, obesity and happiness all share the ability to be affected by those around us.  The more people you know who are smokers, the more likely it is that you will be a smoker.  The same is true for having contacts who are overweight.  And if you have more friends and relatives who are happy, you are more likely to be happy!  It seems obvious that these issues can be affected by being in close contact because these issues are generally thought to be caused by our values, our thoughts and our behaviors.  That is, we can choose whether we smoke, how much we eat and exercise, and how to respond to the stresses in our lives.

Reading these articles made me think once again about the contagiousness of mind body syndrome.  I wrote a blog about this last year (Blog #6, June 20, 2008), but we now have some data and a way to measure this construct that we call social contagion.  Can physical symptoms be contagious?  We know that the flu or the common cold are contagious, i.e. you can catch it by being in close contact with someone who has it due to being exposed to the virus which causes it.  We would never think that you can catch cancer or heart disease because these are diseases caused by something that goes wrong inside your body, not something you catch from someone else. Continue reading

MBS #25: Jacob’s story: The relationship between OCD and Mind Body syndrome

The relationship between OCD and MBS: Jacob’s story

 

I have learned so many things about the mind and the body over the past 5 years of working with patients with Mind Body syndrome.  One of the most interesting things is that disorders that we considered psychological, such as anxiety, depression, PTSD (post-traumatic stress disorder), and OCD (obsessive-compulsive disorder) actually are similar to (dare I say identical to?) Mind Body syndrome.  In other words, these disorders are caused by patterns of neurological response to stress and emotional reactions to stressful situations.  This leads to two conclusions: 1) that psychological disorders such as these occur as part of MBS and typically are exchanged (substituted) with pain and other typical MBS symptoms and 2) we can treat these disorders effectively using the same methods as we use for MBS. 

 

Read the story of Jacob, who had OCD, which morphed into chronic pain.  He learned that he had to deal with the OCD and the pain, but that they were connected by being components of Mind Body syndrome.

 

“About 10 years ago I had back pain for 2-3 years and read Dr Sarno’s book and also had a MRI which showed no problems and my back pain went away.  A couple years ago when having my second child I started getting high anxiety and really bad obsessive-compulsive disorder (OCD) about things like locking doors, chemicals around house and just about anything else.  Then about a year ago, I had surgery, and the pain after surgery started going away but lingered and then after taking numerous tests and seeing specialists and searching the internet about why the pain was not going away it started getting worse and worse.  Soon I was taking Vicodin for pain and searching for any cure I could find.  I even tried a pain clinic and had a nerve block which did not work and even made my back hurt for a few weeks (the doctor warned me that it was a possible side effect).  I was getting pretty desperate and depressed.  The pain was nearly unbearable.  I was taking sleeping pills at night to sleep and pain killers during the day. 

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