Tag Archives: chronic pain

MBS Blog #21–TMS Stories: Understanding the depth and breadth of The Mindbody Syndrome

Understanding the depth and breadth of The Mindbody Syndrome (TMS)

It is clear to most people that emotions can cause physical reactions in the body. When someone gets embarrassed, their face will turn red. When standing up to speak before a large audience, many people would have physical reactions such as sweaty palms, churning stomach, a more rapid heart rate or a dry mouth. These are physiologic reactions obviously caused by activation of the autonomic nervous system that are reversible and do not indicate that there is a pathological or tissue breakdown condition in the body.

Most people also recognize that they can get a headache or a stomach ache after a stressful day. Therefore pain can also be caused by stress and emotions. These immediate reactions are relatively easy to discern as being connected to stress and emotions. Among people who are afflicted with TMS however, the time lapse between when the stress that is responsible for the symptoms may be years or decades. And the symptoms of TMS can be amazingly varied and severe. Common symptoms of TMS include back and neck pain, headaches, abdominal or pelvic pain, TMJ pain, or widespread pain now known as fibromyalgia. TMS symptoms can also be related to ANS activity such as is the case with IBS and IC. Neurologic symptoms of burning, tingling, itching, and other paresthesias may occur. Generalized symptoms such as fatigue are common. Psychological symptoms such as anxiety, OCD, PTSD, and depression are very common manifestations of TMS. And insomnia is very common as well. How can we understand the great depth and breath of these varied symptoms and how can we figure out what precise events and emotions are the causative factors in the life of an individual with TMS?

After conducting hundreds of detailed interviews with TMS sufferers, it is my firm belief that we can determine what has lead to TMS in the vast majority of patients. However, in order to truly understand these individuals with TMS, it is critical to learn to dig deeply in the history and the minds of our patients.

If we are patient and take the time to listen, patients will lead us to an understanding of the source of their pain and other TMS symptoms. We need to learn how to take these sensitive histories and learn what clues to attend to in order to help patients gain the insight into the key issues they will need to cope with in their lives. Certain patients have such overwhelming histories of childhood abuse or neglect, which when coupled with additional trauma in adulthood, gives an obvious explanation of the emotional sources of TMS. However, in other patients, it is necessary to listen for more subtle clues to explain how and why TMS developed.

I have compiled a number of examples to illustrate the thesis that childhood events create specific emotional memories that when triggered later in life cause the onset of TMS symptoms. Typically, there are two other psychological factors in the development of TMS: One is a strong sense of obligation, high expectations, perfectionism, desire to be good, guilt, low self-esteem, and self-blame. The other is a suppression of lack of awareness of the emotions that are reactions to life stressors or the internal pressures that patients put upon themselves.

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#19–Emotions: What you don’t notice, can hurt you

Emotions, particularly those that are subconscious, were not seriously studied by the scientific community until relatively recently.  For much of the 20th century, psychologists were more interested in studying our conscious awareness and didn’t think that it really mattered what might be going on beneath the surface of consciousness. 

Paul Ekman has gained a great deal of notoriety recently (the new TV show “Lie to Me” is based on his work) and his pioneering work demonstrated that people from all of the different cultures of the world experience and show the same emotions via their facial expressions.  His work is detailed in his book, Emotions Revealed, and is fascinating reading.  Dr. Ekman and others have also conducted research that shows that emotions cause very specific reactions in the body that are distinct.  In other words, emotions are universal and they are indelibly attached to specific physical reactions.  This work has helped to explain why someone may develop back pain when angry and another person may develop headaches.

Another giant in the study of emotions has been Joseph LeDoux, a neuroscientist at New York University.  Dr. LeDoux has done studies to help us understand how emotions are generated and processed in the brain.  His excellent book, The Emotional Brain, details what we know about how the brain handles emotions and we have learned a lot!

We now know that emotions are part of our survival mechanism and are part of the brains of all creatures.  We are hard wired to constantly scan the world around us for danger.  We do this as part of being alive by subconscious brain mechanisms.  When we encounter something that might be dangerous, such as a snake, a menacing look, or a car heading towards us, we instantly react (even before we are truly aware of the danger) in order to avert the danger and save our life.  These reactions are controlled by the amygdala and the autonomic nervous system.  We pick up cues to potential dangers and these nerve signals are instantly transferred to these centers; the amygdala is the center that processes emotions such as fear and anger and the autonomic nervous system (ANS) controls our heart, lungs, bowels, bladder, blood vessels and muscles.  The ANS acts to generate the fight or flight reaction (actually the fight, flight or freeze reaction), which causes our bodies to react to danger.  These systems operate in all creatures on a subconscious basis, meaning we are not consciously aware of these systems.     Continue reading

Mind Body Syndrome in Musicians–MBS Blog #15

Have you ever noticed that musicians are more likely to have repetitive stress injuries?  Of course you have.  But are you sure that the cause is actually overuse? 

 

What about headaches, back aches, neck aches, abdominal pain, fibromyalgia and TMJ pain?  Do musicians have more than their share of these as well?

 

Consider the situation of Jill, a 35 year old cellist who suffered from chronic and recurring wrist pain that for year she attributed to overuse.   Here is her story in her own words:

 
”I have been an active freelancer in a major city for years. Since graduate school days, I have played in many orchestras and chamber groups, driven long distances, taught in various schools, and presented at conferences.Like many of us, I had lived with various aches and pains for years. One fall, preparing for some particularly demanding concerts, my whole upper body seemed to just shut down. I experienced overwhelming fatigue, pain, and various other symptoms. Somehow I kept performing through the 3 month wait for appointments, tests, and results. I was horrified when the specialist told me in all of 5 minutes that I needed 3 surgeries.

I was incensed at his bluntness and his unwillingness to come up with anything more than that. I made up my mind then and there that I would find my own way out of this, and consider surgery the absolute last resort.

For the next several years I went from one medical professional to the next, with discouraging results. I did exactly as I was told, paying large sums of money to see people not covered on my insurance, and yet nothing was improving. Playing caused symptoms – sometimes predictably and other times with no recognizable cause. I was also unable to do many other things I loved to do. I became very discouraged and ready to give up.
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Mindfulness and the Mind Body syndrome

MBS Blog —  #9 Mindfulness Meditation

 

I have been a devoted and passionate teacher of mindfulness meditation for about 15 years.  Many people have misconceptions about meditation.  The most common misperception is that meditation is about relaxing.  Of course, meditation may be relaxing at times, but not always and the intent is not relaxation, but obtaining a better understanding of yourself, and learning to respond to body sensations and thoughts/emotions more deliberately, and learning to live fully in the moments of our lives.  Mindfulness meditation is a form of meditation that asks people to simply pay very close attention to the here and now, to the present moment, to what is happening right now, whatever that may be.  One of the great things about mindfulness is that one can practice it at any moment, no mater what you are doing or what is going on.  That makes it quite useful as a way to cope with the ups and downs of life.

 

The reason to learn mindfulness meditation techniques for people with Mind Body syndrome is that it can help a great deal in learning to live fully in the present and to learn to let go of some of the things that tend to perpetuate MBS, such as fear, anxiety, sadness, issues from the past, or worries about the future. 

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Psychological aspects of MBS

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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