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