Dr John E. Sarno: quack or Jedi Master?

This was my first thought upon coming across this man’s work. He had written a book that other’s raved about and told me was the truth and the light. Sounds a bit like the Bible, eh?

At the present time I can only go on my personal experience. A major part of me accepting the TMS theory involved noticing anomalies in my pain whenever I employed Sarno’s mind over matter tactics. Suddenly I would have windows where I became completely pain free and loose, no longer a ball of tension and discomfort. Meditation helped a lot with this. One day I recall being totally fine enjoying my pain free day and whilst sitting on the toilet I experienced an almighty sphincter spasm unlike anything I can remember. Proctalgia fugax* is the term I found that most suitably fits the situation.

Proctalgia fugax involves fleeting rectal pain. This disorder occurs more commonly in women and in people younger than 45 years. Although the exact cause of the pain is not known, many doctors believe spasm of the anal sphincter muscle is the origin of this pain.

Another medical condition that is idiopathic, i.e. no known cause.

What was interesting is that 20 seconds into this episode of pain, I began to recall Sarno’s teaching.

Like Luke Skywalker hearing Obi Wan’s ghostly voice I said into myself, ‘don’t panic, this too shall pass’. Then I began to think about life stressors and how I was going to deal with them at that moment. 10 seconds later the pain was gone. This is highly anecdotal but those who have experienced Sarno’s work will attest to having these little ‘Aha!’ moments. It is as if the pain had revealed itself as the great and powerful Wizard of Oz, the Emperor with no clothes lying naked for the world to see.

My foot pain was a similar experience, as if someone had driven a nail into it and it also became swollen. It was hard for me to put this down to TMS but one experience lead me to that conclusion. I experienced two days of sickness and my foot had been fine. I was really poorly and hadn’t got out of bed the entire time. Eventually my bladder screamed out and as I got up to go to the bathroom I nearly fell, such was the difficulty of walking on that foot. Unbelievable! Over the course of the next few weeks, the pain receded as I employed the techniques and made a point of running and placing weight on the foot.

Conceptualising Pain

I now think of pain in a whole new light. If I stub my toe on a table leg of course I will experience pain immediately and understand the cause.

However, if I develop a nagging pain in any area of the body and no obvious reason for it exists now I know why!

Dr Sarno’s legacy is reclaiming pain from reductionism. Western medicine is fantastic but we can’t see the forest for the trees when it comes to pain. My own conception of how pain should be viewed (at least partially) is that it is a type of sixth sense. When we pour scalding water on our arm it inevitably results in a reflex action (pulling away the limb) to save the skin from damage. Your sense directly inform you that this is not a good idea.

Chronic pain, in my opinion and experience, serves the opposite purpose. It is designed to keep the person preoccupied so as not to recognise the very real fears they have about their personal lives and futures. You are perpetually stuck in fight/flight mode with your body acting as a conduit for your emotional state. Instead of experiencing your own emotional baggage and processing it, the body instead expresses this emotion for you. It’s pretty hard to believe but that’s what happens.

It will come to be viewed as a sixth sense or perhaps as another variation of synaesthesia (people whose unconscious thoughts are expressed as pain). There does seem to be a lot of overlap between this TMS condition and those who are highly sensitive and attuned to the world around them. My major mistake is over consuming of media/news/information in general, my mind and body thus become overwhelmed by it all. It’s important to get away and isolate my thoughts regularly as I can catastrophize quite easily given my extensive past experience.

Everything considered, I feel this quote sums things up quite well.

“The organs weep the tears the eyes refuse to shed” — Sir William Osler, 18th-century physician.

*please do not go self-diagnosing and stay away from the internet/TV as much as possible. Your body will actually take on symptoms via the Nocebo effect.

If you have persistent pain make sure to keep a diary and show to your GP, ask them to assess a potential cause. If no cause is found TMS is almost guaranteed to be the problem.

 

A polar bear in the headlights

Dear Doctors/Physios/Health professionals interested in pain,

Correct diagnosis is half the cure. As a young man who went from pillar to post seeking a remedy to unrelenting back pain that progressed into neck/foot/hip/knee pain/tension headache/benign arrhythmia/TMJ/ I have run the gauntlet of what medicine had to offer.

3 pain specialists, a Rheumatologist, 3 highly rated Physiotherapists, 3 chiroquackters(one a conman), and all offered their own take on my problem.  I had accepted I was damaged and resigned to a life of pain. I am naturally inclined to trust health professionals and didn’t really question what I had been told. At a low point I decided to really dig in and look at the current science of pain and if anyone knew what the hell I was suffering with. Reluctantly, I read a book that claimed to know the mechanism behind chronic pain and how to tackle it. It was written by a Professor of Rehabilitation Medicine at NYU, Dr John E. Sarno.

I believe this is the missing link that our current medical model is overlooking but it is catching up. It took me 8 months after buying the book to read it because I thought it was utter nonsense. This year the Royal Society of Medicine London hosted a conference on Pain principally based on the work of Dr John Sarno. The concept summed up is ”your body is creating pain/symptoms in order to distract your conscious mind from emotions that are too difficult to deal with”. Sounds properly nuts, eh?

”The body says what the mind cannot”

This is not applicable for everyone however and it should be noted the approach advocated is applicable only to those who have been thoroughly screened for disease/cancer. The grey area with this approach is the fact that many people can have abnormalities of the spine and experience no pain, but someone who has no ‘defects’ has pain.

Please check out the rest of the blog for more background and links which go into a lot more detail(this is a rushed post aimed at #Irishmed). This is just some advice if you have a patient(or are a sufferer) in care whom you think may benefit from this approach. I have zero medical authority and this is more for my own record of a ”how to”. Add this to the fact I had an idyllic childhood and never wanted for anything.

Give the patient an ACE questionnaire as childhood traumas strongly correlate with pain syndromes.

Use this check-list of 33 symptoms  known to be part of what is being termed ‘Mindbody syndrome’.

Making this type of diagnosis is fraught with difficulties, and given MBS is not yet recognised as a medical condition. If anyone wants further info please look on TMSwiki.org where Physicians who incorporate this approach into their practice contribute every so often.

It really is a last resort approach as not even opioid s could relieve the pain I was experiencing, strange as that may sound!

As this is not yet a recognised condition but the root cause of many current diagnoses(Fibromyalgia etc) there is no official term. Tension Myoneural Syndrome is the most popular but is also referred to as Psychogenic Pain Disorder or Mindbody Syndrome. I realise Doctors are bound by strict codes of ethics so this is aimed at being more informative and expanding the utterly depressing/defeatist narrative surrounding chronic pain and other idiopathic syndromes like CFS(personally have had some fatigue but nowhere near the scale someone with CFS experiences). It must be repeated this is not ”all in your head”, the body is physically in this state.

Please feel free to ask questions, this is possibly the most important thing I’ve learned in my life from a health perspective and there exists different interpretations of how to overcome the condition. I don’t expect any Doctor reading this to incorporate it into their practice but I would plead with anyone who has an interest in treating pain to really explore it. I have tonnes of material on the subject I can make available for your reference.

Thanks,

CM

Having a ‘Painful’ Personality

Please note the title is not about those really annoying people you can’t stand to be around(although if you suffer chronic pain it can make you incredibly irritable and not that much fun to spend time with).

Tension Myoneural Syndrome is purported to be behind most chronic pain conditions.

Think of it like a maladapted stress response. Thoughts in our minds are enough to trigger the fight or flight response that is usually reserved for fighting off a physical threat or fleeing from it. With the countless things that many of us see as required for modern living, we can end up creating innumerable fictitious threats in our own minds. As an example think of hearing of a news story in which two people have died in a car crash in a certain area of town. Just that morning you had been speaking to two friends who said they had planned to go shopping in the same area. Straight away the instinct would be to worry for the safety of your two friends. Some people in these types of situations can let their imaginations run wild and are already thinking of what type of wreath to get for the funeral. A short time later both friends turn up and all is well with the world again.

For some people, relationships with family, friends and colleagues can take on this dimension where imagined scenarios/intentions/deeds are concocted by the mind leading to all sorts of difficulties. A friend could comment on a negative aspect of your new partner and instead of enjoying their company you can end up fixating on the flaw that was revealed to you by your friend. We have all experienced this phenomenon to a greater or lesser extent.

The problem becomes amplified when the person doing the thinking is a perfectionist, people pleaser who has low self-esteem and cares too much about others. This is a vastly simplified descriptive phrase but helpful nonetheless.

Essentially they are worrying about everyone else without thinking of themselves and their own needs,wants or desires. A truly toxic recipe. Over time this becomes ingrained and could even be the cause of chronic pain in some people. An important aspect to also consider is the role of the Unconscious mind. The Unconscious is illogical, irrational and has no sense of time. Something that was not fully resolved at the time is usually compartmentalised away for future reference. Dr John Sarno’s theory states that the pain begins in order to keep powerful emotions generated by the person at bay as a sort of ”campaign of disinformation” carried out by the brain. The person will focus on the pain(as is the brains intention) and continue fixating in order to distract away from things they really don’t want to think about. This is yet to be validated by evidence based medicine but from personal experience I can attest to some of the incredible developments in my life since I became aware of the extent of the mindbody connection.

These patterns are learned in childhood and the personality traits are not all bad. In fact, many of the people who have experienced Tension Myoneural Syndrome have had incredibly successful careers or achieved great feats in life. See here.

It should be pointed out that Myers-Briggs and Enneagram personality testing is not an exact science but useful in figuring out what type of personality category you fit into. Dr Sarno noticed that patients he was treating with chronic pain all seemed to be polite, eager to please and very driven. This observation led to him entertaining the idea that perhaps these traits generated such internal stress/tension that the body somehow created pain as either a warning or distraction. One other author coined the term ‘Autonomic Overload Syndrome’ which gives you an idea but I’m not sure if that term is right either.

His Freudian interpretation dealt with Id, Ego and SuperEgo was influenced by being educated in the 1950s, a time when psychosomatic medicine and the role of the mind in health was more widely acknowledged. Conditions like Neurasthenia aka Americanitis was a popular diagnosis in the late 19th century and early 20th century. When Biomedical techniques progressed in the 60s and 70s then many illness ascribed to Psychosomatic causes were found to have a pathological basis. They threw the baby out with the bathwater and have been doing it ever since.

“In the 110 years of its existence fibromyalgia evolved from a regional pain disorder to a multiple symptom disorder that was indistinguishable in most respects from neurasthenia, a disorder of the 19th century that was abandoned in the 1930s with the recognition that it was a psychological illness.

Many doctors think Fibromyalgia is at least partially psychologically based and there is evidence to suggest a strong correlation of trauma and onset of the condition. There is evidence to show the condition is real and activating pain receptors in the brain. The insinuation therefore that it is ”all in your head” is deeply offensive to someone in chronic pain and both sides of the argument are united under the Tension Myoneural Syndrome umbrella. It is Physical AND Psychological.

This is so important to understand and why some types of people develop these conditions. The pain and muscular spasms/symptoms are totally real and localised in the tissues.

Steve Ozanich in his book, The Great Pain deception called it the ‘Type T personality’, a blending of Type A and Type B characteristics. His book is the Bible of TMS and highly recommended to people who have already read several books on the subject. Another must read is ‘Pathways to Pain relief’ , a book written by two Psychologists who worked with Dr Sarno and his patients for many years. Their insights are invaluable in order to gain a deeper understanding of what TMS is and how to recover from it. Here is a website set up to promote the book and it provides a helpful introduction to both authors. It is worth noting both are highly sought after speakers within the Psychoanalytic and Somatic realms.

These are some of the personality traits to look out for(bear in mind everyone is affected by Mindbody symptoms but these people seem to have the most extreme manifestations).

  1. Perfectionism
  2. People Pleasing
  3. Very driven to achieve
  4. Low Self Esteem
  5. Stoical(prone to hold in emotions)

The TMS wiki site develops these further here. This is a general guide and it is important not to get too caught up with it as I and many others didn’t initially identify with many of these traits.

Remember that due to these personality traits powerful emotions are being generated in the Unconscious mind and the Conscious mind simply cannot deal with these emotions. The brain then activates neural pathways in order to have the individual fixate on an ‘external’ stimuli resulting in the emotional issue remaining buried.

In essence the body/brain is translating the pain felt in the Unconscious mind into physical symptoms because the person feels unable to fully express these powerful emotions.

The body is so fed up with the person behaving in these ways that it calls a halt to proceedings through the creation of muscle spasms and severe pain. Utterly bizarre, but from what I understand it is an accurate depiction of the underlying mechanism of this disorder.

In fact , calling it a disorder is unfair. It is part and parcel of the human condition and something that has been forgotten down through the years. In 100 years we will probably look back and wonder how we had become so disconnected from this simple truth.

Do you have a ‘painful’ personality?

Of Testimonials and Anecdotes

On my path to try to find a solution to 7 years of severe chronic back pain (and associated conditions), I had read endless convincing testimonials and anecdotes about how  [insert treatment/supplement/drug] had eliminated their chronic pain. At the last count I think I had tried around 30+ treatments with varying results. Testimonials raise your expectations and when yet another treatment fails to deliver the desired effect, it adds another layer to the ongoing demoralization that is part and parcel of the ‘Chronic Pain Experience’.

All had one thing in common, they didn’t offer any long term relief. CBT is often touted as an excellent treatment for chronic pain patients. This is based on the accurate idea that how you perceive the pain alters the perception of the pain, adding to the misery. My aversion to trying it out was based on the fact that CBT did not offer any explanatory framework for WHY I had pain and how to reverse. Like the dreaded ‘Pain MGMT’ idea you are left to essentially cope and move on, accept you have pain and tell yourself ‘life is tough’. My reasoning was along the lines of ‘I am depressed because I have pain, if I am less depressed I will still have pain’. In other words, what the hell is the point?

Upon closer inspection however, I was pleasantly surprised and it allowed me to examine just how ‘wonky’ some of my thought processes had become in response to the constant pain stimuli. What I hadn’t considered however was the possibility that the way I thought about certain things, my perfectionist tendancy/people pleasing/stoic nature could be the actual progenitors of pain. I visited 3 NHS Pain specialists and asked each one why I had pain, not one of them even hinted at the possibility of psychosomatic phenomena being a potential cause. My level of desperation was apparent to the last one as I presented a folder full of pain patterns, past injuries and attempts on my behalf to understand WHY I had pain.  So I slipped back into the demoralisation as not even Pain doctors could tell me what was wrong.

When I read Dr John E Sarnos theory on chronic pain and his TMS diagnosis a lightbulb went off.

The Tension Myoneural Syndrome diagnosis really hit home with me because it offered,

1. An actual diagnosis that was plausible

2. A reason why there is pain in the first place

3. It is benign and not harmful thereby alleviating a huge amount of anxiety.

4. How to get rid of it, entirely!

5. You can have spinal abnormalities yet be 100% asymptomatic.

Sounds too good to be true, eh? The ultimate snake oil I told myself.

The Sarno TMS concept is heavily reliant on anecdotes for the time being. In pure scientific terms, testimonials and anecdotes are not enough to change the medical world’s view of chronic pain. If you have a purported cure for anything the first thing that will be demanded is a Double-blind, placebo controlled Randomized Controlled Trial (and rightly so!). Dr Howard Schubiner is the main man in this regard with his trial dealing with Fibromyalgia patients.

I have zero authority to tell Doctors that he is right and they are wrong. Leading Pain researchers & neuroscientists like Lorimer Mosley and VS Ramachandran are making great strides but it will be a long time until it gets round to what Sarno (amongst others) is advocating. At present we recognise really odd phenomena like Synaesthesia and recent discoveries of Mirror Neurons are intriguing. A colleague of Lorimer Mosley is Physiotherapist Peter O’Sullivan who does an excellent job of dispelling popular myths   that have become ingrained in our culture.

Other people familiar with Sarno’s ideas are much more optimistic, pointing to the recent phenomenon of meditation becoming popular. There is also the ‘wisdom of the crowd’ concept that points to his ideas becoming more widely accepted. At some point in the near future, Sarno-eqsue approaches to Chronic Pain treatment will be adopted en masse. They will use slightly different language but the skeleton will be the same. Just recently the Irish Independent published this article to help dispel some of the myths surrounding chronic back pain. One major error is the idea that ‘everyone gets back pain’ and feeds into the notion that evolution has gone wrong leaving us susceptible to back pain. We are in danger of becoming Cyberchondriacs but on the flip side the web is being used by like minded people to tell of their experiences with chronic pain and how they tackled it.

Sarno readily accepts most people will just ignore him. With each passing year the chronic pain epidemic seems to get worse and is costing our economies an absolute fortune. The statistics are eye watering.  I wonder how many people could be spared if his work was fully looked into and validated?

I did the whole skeptic thing for a long time but finally concluded he was right based on personal successes with this approach. Having been kept prisoner in my own body for such a prolonged period of time lead to the belief that this was permanent and irreversible, ably assisted by the medical profession who don’t know the real cause. They unwittingly perpetuate misery.

‘Magic’s just science we don’t understand yet’’ Arthur C. Clarke.

This sums up Sarno’s approach for me. I was 100% convinced this was a structural injury of some description replete with all the joint crunching/cracking and neuropathic symptoms to go with it. Medical professionals still fail to provide an accurate diagnosis in 85% of cases and it has really perplexed them. The best Doctors intuitively know a lot of chronic pain is indirectly related to major stressful events but have no template by which to interpret and communicate such a diagnosis to the patient. A pet hate among Chronic Pain sufferers is being accused of making it up or using it for  ”Secondary gain”.

Success stories are absolutely crucial at this period of medical history to give someone the impetus to read Sarno’s work and give it a fair hearing. Many notable successful people have come out in support of his work. John Stossels infamous 20/20 clip is well known. John’s brother Tom Stossel is a Harvard trained MD, a noted skeptic and a debunker of the Big Pharma conspiracy. He rejects Sarno and still suffers chronic pain to this day funnily enough. Perhaps he is right?

Then you have Howard Stern and Larry David, two huge names. I especially love Larry David who wrote ‘Seinfeld’ and ‘Curb you enthusiasm’, the latter being my favourite.  For me, Edward Siedle’s contribution was as important as any other. He works in the cut-throat world of finance and business where you need to be tough and not allow anyone gain an edge on you. The same applies to Greg Gutfeld who works in journalism, another tough game.

These are all people who “came out” with their stories because they felt it could help a lot of people. They took a big risk laying down their own story, especially the guys who work in the media and business. People could lampoon them for believing in ‘woo’ and embracing ‘voodoo’. They marched onward.

Once you’ve lived with pain for such a long time and had relief via Sarno you can understand why so many of us can become evangelical. It reassures you that you are not broken, allows you to really understand what is going on and how you can resume a normal life.

Another Siedle article calls Dr Sarno, America’s greatest Doctor. I would tend to agree.

Some of the others.

Brooke Hewes – Writer for NewWest.net has a great explanation in this piece.

Janette Barber – Comedienne and former writer for the Rosie O’Donnell Show

Clay Warnick – Journalist who explains the concept really well.

Cynthia Kuni – A professional Harpist and discoverer of Sarno whose disclaimer I fully agree with.

Greg Gutfeld -Media commentator who overcame 15 years of pain and sheepishly explains to his Conservative audience how he did it. This line nails it in regard to his inexplicable back pain of 15 years.  ”I found out, however, from John Sarno that this was normal for freaks like me.”

Oprah Magazine(I know) contributor June DeMelo – talks of how she fixed her migraines with the TMS concept.

Tony Schwartz – An accomplished writer who relates his story here.

Stanford Computer Genius Aaron Iba – personal favourite story that details everything he tried to overcome RSI.

Shaddin  Dughmi – Top Standford PhD Computer Science graduate shares his experience.

Harvard alum Rachel Podolsky who set up Harvard-RSI upon discovering and utilising TMS knowledge.

Hugh Howey, a writer that has made the Amazon best seller list tells his story.

Dr Wayne Kampers, a Psychiatrist who works in the Priory Group London whose recovery story  is especially powerful as he had access to the top medical brains before reluctantly seeking out Georgie Oldfield. Bear in mind he had read the books with no success and like many needed the professional guidance to really overcome TMS.

All these people have one thing in common, Succ-stress!

The personality type seems to be the driving issue here and once you understand how this process works the more you will see improvement. I am going to devote my next blog post to the personality traits involved and why this is a hallmark of Tension Myoneural Syndrome.

Then there is the purpose built website made by Sarno patients who wanted to keep a record of success stories. http://www.thankyoudrsarno.org/ How many Doctors can make that boast?

In an odd way I am proud to hold such esteemed company and happy to finally have a path out of misery.  If I can replicate a smidgen of the success they have achieved I will be a happy man.

Please remain sceptical and consult with your Doctor. It only took me 7 years before I was ready to accept that the pain may have a Bio-psychosocial basis and not physical.

Have a gander round my Youtube channel where I have uploaded work by Dr Schubiner , Schechter and Dr Sarno.

It can be miraculous for some people who can read the book and get better within days, most people however aren’t so lucky. The first few weeks I improved by around 70% and this allowed me to even entertain the notion that perhaps after-all the pain wasn’t with me for life as one of my Doctors had informed me. It took me the guts of a year to first buy the diagnosis and second to actually do the work required.

It is really about becoming less reactionary to little things, focussing on how strong the body actually is and remembering to stop beating yourself up. Deceptively simple.

Maybe I am experiencing a placebo effect but now when my foot starts hurting(X-ray found nothing) I think what is really on my mind/stressing me out. I do find myself lapsing back into doubt but remind myself of what I’ve experienced directly from learning this new information. For now unfortunately it will be resigned to ”alternative medicine” oblivion and pushed by less credible individuals than actual Doctors.

I’m also a big fan of Quantitative Stressing which may explain my problems with cash-flow 🙂

If you’re sketpical but in pain and have tried everything else enter ”Healing back pain pdf” into Google search and you can get a free copy of the book. You have nothing to lose!

The quest for relief from Chronic Pain

This post is intended to be a personal record of treatment approaches tried before I came across Dr John Sarno’s work so people can understand how much life with Chronic pain sucks. Some of the treatments I looked into were of the ‘quack’ variety but I was willing to try anything for relief.

List of Diagnoses

My initial instance of lower back pain was in late 2006 and in June 2007 I obtained an MRI scan.

Pinched nerve, trapped nerve, bulging disc, degenerative disc disease, leg length discrepancy, pelvic tilt, tight hamstrings, schmorl’s nodes, slight squaring, features observed in Ankylosing Spondylitis and so it goes. A follow up MRI in March 2014 showed not much had changed, but the pain was worse than ever. It did not make any sense but I was growing increasingly anxious about my future and what I would be like at 40. The question was why?

Symptoms

Parethesias or numbness/tingling sensations (hands,feet,legs,arms,skull), insomnia (including horrible nightmares), restless leg syndrome (two nights in a row after stopping morphine patches), benign fasciculation(fancy word for muscle twitches).TMJ and bruxism(grinding teeth) to the point I can feel worn parts on my front teeth and molars. Neck, upper,mid, lower back pain that was a constant 3/4 and on certain days could go to 7. Morning stiffness that was resolved momentarily by popping the spine in several places(this is harmless but a bad habit to get into). Depression was a big one also and is a big feature of people suffering with chronic pain. I also suffered a lot of anxiety as I wasn’t getting anywhere in terms of diagnosis and had all these strange neurological symptoms adding to my fears of the Doctors having missed something. Then I began having severe palpitations and was diagnosed with Wenkebach syndrome, a benign heart arrhythmia. I became fairly wreckless and almost dependant on alcohol in social situations. I neglected myself healthwise because my attitude had become warped in the sense of ‘what’s the point, my body is screwed either way so party on’.

Treatments tried or considered

Acupuncture

You must have some sort of faith in a given treatment for it to work, which is why acupuncture failed for me. I even got it on the NHS!! My first experience was in 2009 with a guy who also performed adjustments. This was a bad experience and later I learned why. I tensed a muscle in my spine because the way a needle had went in. It was like a jolt of lightening went through me and made my muscle spasms worse. This same guy appeared in local newspapers soon after and it transpired he was a con artist!

Please do not try acupuncture unless with someone truly professional and licensed. Being 19 I had assumed anyone sticking pins into a human being would have the requisite qualification. This was the beginning of my demoralisation as I had deteriorated yet again and did not know why.

Aromatherapy

Obviously I didn’t take this seriously but one useful tip was using Lavender oil on my pillow. It has a calming effect to help me doze off at night. Also I purchased actual Frankincense resin and began to burn it on a regular basis. Similar to the incense used in religious ceremonies and I found it rather pleasant.

Alexander Technique

I considered this but after reading about it I put it aside as it didn’t make sense that it could work. For me, any treatment needs to sound logically possible. This wasn’t the case in this instance.

Alkalising Diet

For years I believed that my pain was down to inflammatory processes and had taken Ibuprofen to no avail. Some People think eating more alkaline foods and ‘re-balancing’ pH of the body will decrease inflammation. At the time I thought his sounded suspect and it is. The human body maintains itself through homeostasis so any benefit derived from an alkaline diet is likely from eating good, whole food. If you think inflammation is the root cause, ask your Doctor to test your blood for indicators like C – reactive protein. I have since learned that very low carb diets have a marked impact on bodily inflammation. See work of Steve Phinney and Jeff Volek.

Backmagic

If you are still in the structural mindset I recommend buying one of these. Really good at opening up the lumbar spine.

Breathing techniques

Using a device I began training my lungs, the idea being to get more oxygen into my blood. Later I used the 4, 7, 8 technique to great success. Excellent at calming the body.

Books

Thomas Hanna Somatics: recommended read especially if you are into Yoga and another little push in the mindbody direction. Must read if you are against Sarno.

Esther Gokhale – 8 Steps: interesting concepts. I emailed a Stanford Professor about the specifics as he had provided a testimonial (which lead to me buying it). Definitely a must buy if you are fixated on posture and alignment. Excellent for learning how to sit upright comfortably and has a great method for sleeping with bad back pain.

Born to Run- Christopher McDougall. Due to my past with shin splints and orthotics I began to explore my biomechanical habits. Then I came across ‘barefoot running’ and claims it was fantastic for back pain. It offered me mild relief and I think the barefoot idea makes sense but I will only do it on softer surfaces like grass/beach. Trying to land midfoot/slightly on the front foot when running isn’t a bad compromise. There are no conclusive studies to show barefoot running reduces injuries but some data suggests the biomechanical load is reduced. In any case please research before trying this out and it should be phased in gradually so as to avoid transitory injury.

Pete Egoscue Pain Free book. Opened me up to idea the pain may be muscular. One statement that made me sit up. Bones are moved by muscles. I know that is plainly obvious but I had become locked in the mind-set that I had structural spinal issues that were permanent. Egoscue opened me up to the possibility that the pain is due to tightness of muscles leading to misalignment or caused by ligament issues/fascial tissue problems.

The exercises helped somewhat but it requires ‘to the end of your life’ commitment and that seemed like an unusual idea. If the exercises were corrective why must they be maintained? The circular reasoning brought me back once again to the idea that I was inherently structurally flawed. However, an important lesson had been learned and some mild relief I experience doing these exercises gave me hope.

Tim Ferris’ Four Hour Body: recommend checking this book out. A veritable smorgasbord of information on everything. Tim gets a lot of flak but I found this useful as he had his issues with chronic pain. In a Podcast with Joe Rogan they discussed Dr John Sarno very briefly before dismissing him (like any rationally minded person would). Joe found Sarno ‘a little insulting’ as many do initially. Tim details all the latest in sports therapy treatments and the most promising ones mentioned are Prolotherapy and MAT (muscle activation technique).

Peyton Manning used MAT to prolong his career and I seriously considered using it but it is really expensive and would have required a visit to London. Money was a big issue for me given I had student debt and other bills to pay.

Cognitive Behavioural Therapy

My GP had recommended this but my main gripe with all offered treatments was they didn’t tell me why I had pain nor was there a suggestion that this was ‘in my head’. My attitude to CBT was ‘sure, it might make me feel a little better but I’ll still have the pain’. So I dismissed it for so long that it became inevitable to use after becoming so incredibly depressed. After reading research on its impact on grey matter I finally gave it a go. Having previously discovered that chronic pain degrades brain tissue faster than natural ageing I jumped at it. During this process I uncovered a lot of bad habits/thought processes and I was pleasantly surprised at its ability to help you shut down negative thinking patterns.

I don’t buy into the hype surrounding it as it is only one small part of a much bigger picture in regard to mental well-being. However, I would strongly recommend it to someone with chronic pain or depression as it can slow down the death spirals we can find ourselves in.

Chiropractic

Tried three times with three different practitioners one of whom turned out to be a conman. First in 2009 then again in 2010.

Utter quackery that is impressive because of the satisfying cracks and pops. I gained some relief certainly but the main goal is to make money and no permanent solution is ever talked about. These guys are dangerous because they can exacerbate the Nocebo response by showing their frightening models to clients. There are some great chiropractors out there however and most do genuinely care.

Cupping

This is something I tried as an absolute last resort as it seemed to be nonsense. The idea that blood has become trapped in a certain area leading to muscle pain is flawed. I tried it because of a friend’s recommendation. He is in top shape but buys into the Chinese Qi idea which I think is nonsense (it might exist but has never been proven). As an allegory for emotion, then I tend to agree!

It was incredibly relaxing and felt incredibly good.

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In Islamic tradition they even make tiny incisions and allow the cups to fill with blood(above).

I actually investigated getting this done or if it was more effective such was my desperation for relief. I would put in on the same level as a decent massage as the therapist will give a massage at the same time as applying the warmed cups.  Worth a try, if only as a conversation piece. You are left with what looks like love bites all over your back.

Decompression Therapy

I used an inversion table which was purchased second hand for £30. Later on I bought Gravity boots for £30. I would hang upside down on either device for 15 minutes. It definitely gave me some relief but not total relief. Then there is the issue of damaging ligaments in your ankles/knees by being in such an unnatural position.

The idea behind this treatment is pulling the vertebrae apart gently with gravity to allow some respite for the disc material.

Earthing

Likely has no basis in science but what harm could be done walking barefoot in grass? The idea intrigued me and like all good quackery had some minor plausibility. The main thrust behind the movement seems to be the guys selling the special mats(alert!!). If anything the benefits are psychological and I would recommend walking barefoot or transitioning to barefoot type shoes.

However, Dr John Biffa provides a good overview from a skeptical standpoint.

EFT tapping

A good friend I trust recommended this approach. It is beyond corny and beyond the realms of common sense yet looking back I can see how this could work but only in conjunction with TMS knowledge. Much like practising affirmations, the claimed mechanism is likely false but the psychological benefit is significant and real. Like EMDR (eye movement desensitization and reprocessing). EFT has been used on combat veterans to help cope with PTSD.  Bear in mind that research was carried out by Dawson Church who has a significant personal interest in the success of EFT. A good talk to watch is this one with Nick Ortner who is a big proponent of Sarno.

Epsom salts

Claimed to help ease muscle tension and relax the body. Personally I found negligible difference between an Epsom salt bath and a normal hot bath. The Epsom salts contain magnesium which is supposed to be absorbed by the body. However, I take CALM magnesium supplement and found it to be highly beneficial for sleep and have experienced incredibly vivid dreams with it.

Foam Rolling

Recommend this approach for self-massage. It will not cure you or fix you but will offer temporary relief and release tension.

I became enamoured with the MELT method due to its claims surrounding chronic pain relief but it’s a money making scheme. They make exaggerated claims about being able to shift and ‘melt’ fascia tissue problems, which is total rubbish if you understand how tough this tissue is. Fascia is incredibly important but they are using this as a hook. Get a foam roller and get on YouTube. Tonnes of free content. Another example of when you are desperate you can wilfully self-deceive in the hope ‘Method X’ will cure you or relieve pain.

Feldenkrais

I investigated this method but decided I couldn’t afford it. After reading up on it recently I can see how it can work in a Mindbody sense. Please don’t feel like Sarno is the ‘be all and end all’, I just think he has nailed the real mechanism and many other therapies are skirting around it but achieving similar results.

Hyperbaric Oxygen Chamber

If I had unlimited resources I would buy one of these or attend a session regularly. Having never tried it I read many testimonials and the general principle made sense. Added to the Sarno ‘oxygen debt’ idea it makes me want one even more. I even spent a week researching how to build my own chamber! That’s the desperation folks. Would recommend despite not having tried it because of research and the general idea makes sense and would be good for general health if nothing else.

Lymphatic system

This will sound insane but another example to the extremes I was prepared to go to. I even considered buying a really expensive ‘rebounding’ trampoline, German engineered etc. These were used by NASA and really good for a low impact fully body workout. Cancer patients use them to help move lymphatic fluid around the body. Then I looked into Lymphatic brushing that cancer patients do. I began to do this in the shower in the vain hope of some relief. I gave up soon after as it felt ridiculous and unlikely to work.

Massage

At different stages I availed of deep tissue massage. It was OK but never offered any serious improvement. Good for some mild relief and relaxation. It is expensive so I never used this regularly, more of a last ditch effort if I was going through a particularly rough patch. If I had the spare cash I would love to try ROLFing as I am quite sadomachoistic in a way(which makes my chronic pain experience all the more ironic). It is not fun in any way whatsoever. ROLFing has a reputation as a painful form of massage so the benefits are probably perceived to be greater than typical massage.

Myofascial trigger point therapy

JFK’s physician came up with this approach and it makes sense. In order to self-target trigger points I bought a Backnobber II device which was pretty useful and good at working out knots in the muscles. Why were the knots there in the first place though? Hmmmmmm. Get the Backnobber if you have really deep knotting. I even looked into a way of measuring muscle tension. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3231268/

http://www.medgadget.com/2008/07/wearable_muscle_tension_sensors_know_more_than_what_you_feel.html

http://www.myoton.com/en/News/10/myotonpro-hand-held-digital-palpation-device-presented-at-the-third-international-fascia-research-congress-2012

The market exists for these devices in order to quantify a factor in injuries/disability and need for an objective diagnostic tool in a notoriously subjective area, pain reporting.

Medications/topical creams

Ibuprofen, Paracetamol, omeprazole (for protecting stomach) and finally Morphine (butrans) patches 5ug. None really worked but Butrans helped me sleep for one or two nights at my lowest point.

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My advice is to steer clear of opioids for as long as you can. When I came off Butrans I experienced horrible withdrawal and it was the lowest dose available.

Deep heat, Ice packs, freeze spray, Voltarol gel were also used to little or no effect.

Considered arnica and capsaicin cream but didn’t due to reasoning they wouldn’t work/too expensive at the time.

Meditation

Tried as a last resort and was pleasantly surprised. Still didn’t explain why I had pain or how to get rid of it but Shinzen Young’s Break Through Pain was instrumental in calming me down. A key thing to remember for Chronic Pain sufferers. Suffering is a function of pain and the degree to which the pain is being resisted. (S = P x R) . Prof Mark Williams eight week program is an absolute must. Validated by science and undergoing even more trials at present. It won’t cure but it will help you manage. One of the Pain specialists I visited rolled his eyes and called it the latest fad. Maybe, but it was indicative of the lack of understanding I have encountered time and again.

Neck Cushion

A bizarre device I bought which was cheap so I figured, why not? Did a good job at stretching my neck out. Pictured here along with other devices, my favourite being the Shakti mat. The only thing I would recommend, especially if you have insomnia. Hurts so good. The old Indian bed of nails updated for modern times.

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Pilates/ Yoga

Really recommend making this part of your routine. There is little factual evidence to say this will fix a bad back but the benefits are immense. Pilates was the initial prescription I received and was instructed to do an hour every day. This was during my first year at college so naturally I was too distracted by booze, women and ‘studying’ to really get into it. My assumption at that time was that my back was going to come round eventually and get better. Any-time I suffered minor injuries I stuck to what my Physios/Doctors told me because they are the professionals. Unfortunately as the pain became chronic I found their advice to be incredibly demoralising and ineffective to the point of absolute despair. By checking online I found that even the top Medical schools in the world have nothing more to offer than what I was told. The Mayo clinic seems to have the best approach and offers an intensive chronic pain programme.

 Supplements

Bromelain, Boswellia, Capsaicin extract(increasing chili content of diet), Turmeric(tablespoon a day), Raw garlic clove once a day, MSM sulphur, Vitamin B6,C , E, D3, Zinc, Magnesium, Omega 3 oil, Chondroitin, Glucosamine and alcohol. Seriously, some nights I would take a few measures of brandy/whisky to help me nod off. My advice is to avoid supplements(apart from Mg/O3 oil/sunlight) and really concentrate on a diet rich in Omega 3 fatty acids, leafy greens and good fat. Avoid processed food like the plague. It takes effort but the pay-off in terms of health, body and mind are immeasurable.

Surgery

A Rheumatologist gave me a thorough work up and found nothing untoward. He told me to resume activity and even asked if I might be depressed…mmmmm. Of course I dismissed the notion. So there was nothing major that could be achieved via surgery but this only heightened my frustration as I couldn’t find the CAUSE. Why, why WHY?!

Sleep

I had significant problems with getting to sleep and tried many remedies. Sleeping with a pillow between the knees, under the knees, avoiding sleeping on the belly etc. All rubbish and based on untested theory and ‘common sense’. I seemed to function better with harder sleeping surfaces but this was likely a product of my imagination.

Since then I have learned about circadian entrainment, wearing blue blocking glasses at sunset in order to help melatonin levels rise naturally like they are supposed to. Modern tech emits blue light which messes with this process. I purchased a Syrcadian Blue LED device to help during the day and a Lumie bodyclock dawn alarm to help in the mornings.

I have found falling asleep much less hassle and have more energy during the day. This is absolutely vital if you suffer from mood disorders or general health as even medications have been shown to be more effective taken at the proper time during the day. This will become commonplace in my opinion as more become aware of the benefits. Check out Bill Lagakos’ blog on how these cycles affect the human body. When properly entrained people actually lost fat mass without changing diet or exercise.

I wanted to build my own hammock at one point after reading many glowing reviews on how great they are to sleep in. Supposedly excellent for your back and help you nod off much quicker. At some point I hope to undertake that project as I feel it has some merit. Seems counter intuitive but the proper hammock set-up is different from the one we all picture in our minds. Also, Valerian root Tea is useful.

TENS treatment

Again, a treatment I was reluctant to try as there is no solid evidence of its efficacy. I was right and now I want my £20 back. It causes muscle contractions but was a distraction more than anything else. Some people claim this works but it is likely placebo or is minimally effective at helping heal acute tissue injuries. The Body Electric was a fascinating book I read during my early searches(2010) as I had a sense the pain had some other cause and was generally taken by its premise. Worth checking out for the regeneration experiments alone. Written by Orthapaedic Surgeon Robert O Becker.

Ultrasound

Several Physios performed this treatment and it felt really pleasant. I am unsure of the evidence base so cannot comment but it is supposed to promote healing. I had this done before on a slight muscle strain.

After all this experimentation and focus on the structural aspects of the pain, I found there to be no benefit overall and in fact I have developed more symptoms. The difficult bridge to cross when it comes to Dr Sarno’s approach is trying to convince yourself that the pain is not caused by a structural defect. This is really difficult to reconcile with years of pain and trying all the mainstream treatments based on the structural paradigm. It requires a minor leap of faith because TMS is not yet embraced by mainstream medical thinking. There are a number of reasons why I think Sarno is not a quack trying to make a quick buck and plan on making a specific blog post addressing that issue.

One lesson you learn when searching for the ‘answer’ is the number of positive reviews for treatments that could not possibly work. Just recently I saw an advert for a ‘snoring ring’ you wear to stop you snoring. Bollocks! 80% effective….according to by a manufacturers study.

Read the reviews for Dr Sarno’s book Healing Back Pain and you will have the same thought. Placebo is a big factor in many of these treatments but I don’t think that is what is going on with TMS or the Mindbody syndrome, the effect is too dramatic in my opinion.

My mission now is to try and convince academics and the medical/physio profession to inquire into this , define it/refine it and revolutionise the treatment of the majority of chronic pain sufferers.

Chronic Pain and the Mindbody Connection

Corpusmentis  translated means ‘BodyMind’. For many centuries we have believed mind and body to be separate due to a man called René Descartes who famously quipped ‘Cogito Ergo Sum’ or ‘I think, therefore I am’. One of the deepest and most enduring legacies of Descartes’philosophy is his thesis that mind and body are really distinct—a thesis now called “mind-body dualism.” He reaches this conclusion by arguing that the nature of the mind (that is, a thinking, non-extended thing) is completely different from that of the body (that is, an extended, non-thinking thing), and therefore it is possible for one to exist without the other. The mechanistic, wet mess of human tissue we call the human body was cut off from the actual thinking mind of the human being. Descartes viewed the human body as working like a machine and following the laws of physics.

Descartes was living in the age of vivisection. Animals were cut up to see how their bodies functioned. Humans were too. It resulted in William Harvey in 1628 discovering the circulation of blood. Descartes proposed that the body and brain of other animals were fundamentally different from human bodies. Animals did not communicate, according to Descartes. Nor did they feel that mental condition called pain. The animal’s body was a base machine. Humans, on the other hand, had feelings in the form of soul. Humans, Descarates argued, were dualistic: having a machine-like body with consciousness that other creatures did not possess. He associated this consciousness with soul. This view was profoundly influential in the field of medicine and still is to this day.

When we think of pain, we think of a cause(stepping on a nail) and effect(intense sharp pain). Pain signals travel through nerve fibres and the brain registers the pain impulse and the person becomes aware of the pain. For acute pain this is 100% accurate and makes logical sense. Chronic pain on the other hand is a different animal altogether. There may be an initial injury to an area of the body but for some reason the pain endures long after the injury was supposed to heal. Isn’t this odd given  the human body’s innate ability to heal itself?

Chronic pain has become a medical speciality(conundrum?) in its own right and most Doctors today are not entirely sure of how it arises or how to treat it. Typically you will hear of Pain clinics and Pain management techniques but before that happens you will likely be prescribed NSAIDs, painkillers or in severe cases opioid medication(personally I used Butrans). Whilst these are helpful to patients, many are still frustrated and exasperated as the pain has inexplicably stayed in place. This is a particularly infuriating aspect of life with chronic pain and has devastating domino effects on your entire life. That deserves an entire blog post on its own.

Thankfully there are some rogue voices in the medical hinterlands whose ideas are being validated to some degree by the scientific method. With the advent of fMRI technology and other neuro-investigative tools, researchers have been able to extensively investigate what happens in the brains of those who suffer from mystery chronic pain syndromes. One recent study demonstrated how the brains emotional response to pain can act as a predictor in the transition to a chronic pain state. Another study demonstrated how increased activity in a specific brain region could act as a predictor(with 85% accuracy) of who would develop chronic pain. A highly significant finding. This tells us that the brain is playing a crucial role in the genesis of the chronic pain state. It has been demonstrated that meditation can regenerate gray matter in the brain and interventions like CBT have also demonstrated this. In patients with chronic pain, gray matter density declines at a faster rate than the general population. Again, this is telling us something important. It is fair to assume that the degradation in these tissues is due to repeated pain signalling/elevated stress typical of those in chronic pain. Why do the brains of some people do this when others do not?

Chinese adolescents reported that their chronic pain was associated with the pressure to perform academically. My own personal onset was before I began University and very uncertain of what I wanted in life(I still am but don’t beat myself up about it anymore).

This is where the Mindbody concept comes into play. Typically, you will see this concept referred to as ‘Mindbody’ or ‘psychogenic’. These are essentially updated versions of the term ‘Psychosomatic’ which has become a loaded term. It insinuates that the patient is experiencing symptoms solely in the mind and they are experiencing a secondary gain because of their ‘illness’ (i.e. benefit payments,attention,sympathy from strangers etc). There is no doubt some people are hypochondriacs or malingers but brain imaging  backs up the chronic pain experience as valid. The key thing to realise is that all pain is real and that the brain can actually induce the chronic pain condition. Sounds strange, eh?

I first became interested in this concept having experienced significant relief of chronic debilitating pain by reading a book(Yes I know it sounds insane) written by Dr John E. Sarno(also Professor of Rehabilitation medicine) called “Healing Back Pain”. Had I only read it sooner I would have saved myself from incredible suffering and a journey into the abyss. If I had read it sooner I wouldn’t have believed it, a familiar conundrum for people who have been through a glut of specialists. When something sounds too good to be true it usually is, but this was the exception to that rule.

A book can relieve pain? surprisingly, the answer is yes. Not overnight or instantaneously but understanding why you have pain can lead to getting rid of it entirely. This is not some miracle cure but fundamentally alters the way we have come to view pain. Trying this unusual idea came after a long hard journey where I had tried virtually every treatment bar surgery. Ironically, we knew this many years ago. Where do you think the phrase ‘That guys/gals a pain in the ass/neck come from?’

With this blog I aim to inform the reader of Dr John Sarno’s idea’s and why it is SO important for global healthcare that he is recognised for his great contribution to medicine. A lofty aim you might say but if just one person reads this and is convinced to ‘Give Sarno a chance’ it will have been worth it! There are some minor disagreements on Sarno’s overall approach but the central thrust his argument is valid ( ‘The brain creates a REAL chronic pain state’ ).  Not imaginary or made up in your mind but REAL unrelenting, excruciating pain.

Being a young man who was previously intensely athletic, strong and fit it was humiliating to be reduced to being a ‘pain patient’. Every specialist I visited usually shrugged their shoulders, told me to get on with my life and wrote a prescription for ‘painkiller A,B,C’. I avoided most sports and became known as someone with a ‘bad back’ and accepted the general idea without question. Having made several attempts at coming back to sport I found I was exhausted and much sorer for several days after. My recovery would bleed into the next training session. My train of thought is typically, ‘if I can’t do it close to 100%, then it isn’t worth doing’. I didn’t like going through the motions whilst thinking I was doing myself even more damage leading to continued pain.

Having studied Engineering and being of a scientific bent  I became entirely focussed(obsessed) on the structural aspect of the pain, obsessively searching for the ideal posture and trying to figure out what had went wrong with my body. In this post I go into more detail about everything that I had tried. In March 2014 I presented my ‘Pain bible’ to yet another Pain Specialist who sighed and told me to expect this for the rest of my life and ‘that you will know real pain when you get married’. When you are in my shoes however this felt like another blow and confirmed all the fears that had been building for some time. I decided to keep looking for answers and having sceptically tried ‘body-scan meditations’ with some interesting results my frontiers had opened up.

Top Physiotherapist Peter O’Sullivan revealed that the much mythologised ‘core stability’ has little to do with chronic back pain. Another intrepid Aussie , Professor Lorimer Mosley runs a website devoted to developing understanding of the complexity of pain. In my view it is an absolute travesty that people like Dr Sarno have been derided by their peers rather than having their perspectives investigated robustly. If I had held a medical education rather than engineering its highly plausible I may have completely dismissed Sarnos ‘kooky concept’. Interestingly, the famous author Michael Crichton documented his frustrations with the practice of medicine in his book ‘Travels’ and how the emotional stress-ors involved with myocardial infarction were largely ignored. He finished his Harvard medical degree but never took up practice, instead pursuing a career as a writer.

I remember in 2011(my graduation year) watching a documentary about Chronic pain made by the BBC Horizon team. It featured a segment on Transcranial Magnetic Stimulation, a fairly new technology that is showing some promise in the treatment of chronic pain(and depression). Rebecca Key is an artist who suffers chronic pain and does a brilliant job of conveying the struggle of living this way. In this clip we see Rebecca use the ‘TMS’ equipment at Dr Turo Nurmikkos laboratory in Liverpool University. Seeing her reaction made me tear up as she had experienced a moment of relief from relentless pain, something that I had only dreamt of. I actually contacted Dr Nurmikko to see if I could take part in his research but sadly they had no studies open at that time. In late 2012 I decided ‘enough is enough’ and I would try anything to get to the root cause of the pain. During this research I entered ‘TMS chronic pain’ into google with the intention of seeing the latest developments in the research/possible opportunities to use this technology.

Google search threw up TMSwiki.org and I briefly read some of the information on the site. Of course I dismissed it and filed it away in the back of my brain. It wasn’t until a year later (Dec 2013) that I bought ‘Healing Back Pain’ and not until August 2014 that I actually read the book!!  this is the degree of skepticism I applied to Sarno’s diagnosis as the idea seemed incredibly unlikely. When I read the book I was only around 55% convinced and since that moment have experienced 85% relief from pain without drugs/surgery/exercises and no longer fear pain.

Pretty amazing considering opioids didn’t help one bit! Currently I’m around 90% convinced that the theory is valid(in spite of massive improvements) but needs further study and validation before the general populace takes it as read. Howard Schubiner has completed a clinical trial with Fibromyalgia patients already.  With this blog I hope to inform the reader of my thought processes, personal ideas around the subject and point them in the direction of things that have been helpful for me in implementing Sarno’s program. Some of the current Doctors/therapists who embrace the Mindbody concept are listed here. Notably Spinal Surgeon David Hanscom MD is a major proponent and has produced his own protocol to deal with the issue.

As an aside, this article in the BMJ argues that disabling chronic back pain is an Iatrogenic disorder. The message is getting through…one way or another.

The future is bright for those with chronic pain, at long last!

Good luck.

CM