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.

2013-11-21 12.52.43 2013-09-22 18.50.38

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.

photo

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.

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