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

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s