By Dan Atkins
Chronic pain is an epidemic that affects millions of people in the United States alone, but the pain itself is only the beginning. Sufferers are hindered not only by the pain, but also by minimally effective, invasive treatments such as long-term opiate use and multiple surgeries. The fear of reinjury and further structural damage severely diminishes a person’s livelihood and limits their capacity to actively participate in life. The reduced quality of life typically leads to deeper feelings of hopelessness and demoralization. Even with the quantity of scientific research dedicated to the study of pain, it remains a mystery, which is why it is an entry point into the relationship between “mind” and “body.” Many have come to see the mind and body as social constructs created to view the individual through a particular paradigm; however these are not necessarily essential categories. These concepts may simply be ways to bracket our lived experience and make sense of it. The relationship between mind and body is rarely more poignant than it is when trying to understand chronic pain. What is chronic pain? Is it purely physical? Is it “all in your head?” Like most unsolvable dichotomies, the answer likely lies somewhere in the middle.
Within the field of chronic pain, there are modern theories surrounding holistic health or mindbody medicine that discuss, educate, and treat the psychological origins of chronic pain. To be clear, theories in support of a psychogenic process are not claiming the pain is superficial or “all in your head,” as many medical practitioners insinuate. The theories argue the opposite and support sufferers who live in fear of receiving invalidating messages from the medical community. The messages essentially translate to, “I can’t help you” and can leave sufferers feeling demoralized, alienated, and defensive about their condition. It is no wonder that individuals suffering from ambiguous, pervasive, and debilitating clusters of symptoms known as Chronic Fatigue Syndrome (CFS), Irritable Bowel Syndrome, Fibromyalgia, Whiplash, Carpal Tunnel Syndrome (and the list goes on) often feel hopeless, rejected, and defeated after receiving unhelpful messages from the medical community. Some individuals in the CFS or Fibromyalgia community have become militant about finding a medical cure because of the desperate need to be taken seriously, nurtured, and provided with hope. Many see the only option as a generic referral to therapy after months of medications, invasive surgeries, and ongoing physical rehabilitation with little improvement. As a result, many feel desperate for a biomedical answer, which can then be accepted by the medical community and validated by society. Unfortunately, a biomedical answer for vague pain disorders may not exist, but an alternative, effective, and noninvasive approach does.
One burgeoning theory in the field of mindbody medicine is that of Dr. John Sarno. Sarno was the leading physician at the Rusk Institute of Rehabilitation Medicine in New York City in the 1970s. He consistently saw patients struggling with chronic pain issues, largely in the back, neck, and shoulder areas. After years of unsuccessful treatment in this area, he began to question the medical assumptions he was taught about the nature of pain. He began to develop a theory, which involves the influence of stress, coping, and unresolved emotional conflict. The theory is fairly psychoanalytic in nature, building off of Freud’s notions of conversion in the 1920s, and was shunned from the medical community at the time. Sarno championed the diagnosis “Tension Myositis Syndrome,” now referred to as “Psychophysiologic Disorder,” which is essentially an umbrella term for individuals suffering from chronic pain that may be psychological in nature. The theory does not purport individuals are in any way malingering, feeling things that aren’t real, or are in some way mentally ill. The pain is very much real and an extension of the normal human condition. For example, when most individuals get embarrassed, their cheeks flush. When they get nervous, their hands may shake or tremble. When they experience stress, they are typically more susceptible to sickness. All of these experiences are acceptable examples of the powerful relationship between mind and body. However, when it comes to experiences like back pain, debilitating fatigue, or muscle weakness, suddenly the medical community and sufferers alike require a medical explanation and will not settle for anything less.
Sarno has written many books on the communication of emotional distress through physical pain, including: Healing Back Pain, The Mindbody Prescription, and The Divided Mind. His books have influenced, and even cured, thousands of chronic pain suffers through insight into the nonstructural nature of their condition. Currently, a burgeoning field founded on Sarno’s work is rapidly expanding with medical doctors, surgeons, psychologists, psychiatrists and many other mental and physical health practitioners that have experienced the power of Sarno’s work first hand either personally or professionally. One such practitioner is Dr. Howard Schubiner, a practicing medical doctor, author, and researcher in the field of mindbody medicine. His book, Unlearn Your Pain, delves into the many facets of the misunderstood field of psychogenic pain and explores the truly fascinating research and treatment that has brought relief to many and continues to do so. Chronic pain sufferers who present with a history of vague syndromes or disorders, unresolved pain symptoms not responsive to traditional forms of treatment, or pain that jumps around to various parts of the body without explanation are most likely to benefit from a non-invasive, psychoeducational treatment. In addition to unexplainable physical symptoms, TMS/PPD sufferers tend to exhibit traits of perfectionism, self-doubt, or self-defeat coupled with a difficulty expressing deeper feelings of anger and sadness.
In his book, Schubiner discusses the body’s natural stress response, which may communicate distress physically when it is unable to express discomforting feelings otherwise. The late 19th century physician, Henry Maudsley, famously stated, “The sorrow which has no vent in tears may make other organs weep.” Schubiner uses a more medically-friendly model to show how neural pathways in the brain may become habitually engrained to express physical pain in the face of emotional stress, therefore reinforcing a chronic experience of pain symptoms. Sarno claims, in a more psychoanalytic fashion, that the mind chooses to protect the ego from such overwhelming emotional experiences with distraction pain. His theory of the mind’s protective instinct is supported by the fact that many sufferers often describe the emotional expression process as more challenging than the physical pain. However, for many chronic pain sufferers who have lost their lives to fear and avoidance while still living, the work of Sarno and his followers is a miraculous path to unlearning your pain and regaining your health.
For more information about the TMS community, check out the wiki page at: www.TMSwiki.org.