Pain and the Brain – Part 1. The Mind-Body Syndrome. (TMS – previously known as Tension Myositis Syndrome)
A few years ago a lady came to the office and said: “Remember that chronic pain I had? It’s gone.”
“What happened? “ she was asked.
“ I read a book.”
The book she had read was Dr. Scott Brady’s Painfree for Life which describes how the unconscious mind can aggravate, perpetuate, or even produce physical pain through the action of the autonomic nervous system, that part of the nervous system which is involved in the ‘fight, flight or freeze’ response to perceived danger.
When we heard her story we read Brady’s book and over a short period of time acquired a number of other books based on the work of Dr. John Sarno, a rehabilitation specialist, who discovered the role of stress or tension in causing back pain, and later extended this concept to a much larger group of functional conditions. We had known that pain always seems worse when one is frightened and that a lot of chronic pain sufferers had emotional trauma in their backgrounds, but we were not aware that the brain could reproduce or initiate physical pain in the absence of any actual disease process.
Since then we have had several patients whose pain disappeared or substantially diminished once they became aware of aspects of their personality, past experience, present circumstances, or psychological issues which triggered their pain.
Please note, I am not speaking here of malingering (faking the pain when you know that nothing is wrong), or of secondary gain (remaining in the sick role when it is to your advantage to do so because you can avoid work or something else unpleasant or obtain sympathy). Even secondary gain can be subconscious – it is well known, for instance, that the best predictor of a swift return to work after a back injury is whether or not the worker enjoys the job.
We are talking of an entirely subconscious process of real physical pain being produced (or reproduced) by the brain as a distraction, which allows the conscious mind to avoid dealing with intolerable memories or feelings by focusing on the pain instead of those other experiences. We are also talking about physical pain being produced by alterations in muscle tension, posture and blood flow brought on by emotional stress. Of course, we all recognize that stress can produce physical symptoms: sweating, nausea and diarrhea from “nerves” prior to giving a speech or writing an exam, for instance, or a tight jaw or shoulder knots when we are angry or frustrated. The same applies to musculoskeletal pain. Consider for a moment the metaphors we use in every day language: he’s a pain in the neck, she gives me heartburn, this job is full of headaches etc.
· Personality: you don’t have to have a dreadful trauma in your background or a psychiatric illness for the subconscious mind to produce pain. If you are a perfectionist, a people-pleaser (always trying to please other people and never feeling you completely satisfy them), or having impossibly high standards for yourself, you can set the stage for pain.
· Past: a past history of abuse, or severe emotional trauma or intolerable memories can be triggers for pain. 50% of people with fibromyalgia, for instance, have post-traumatic stress disorder (PTSD) and victims of assault or childhood abuse frequently develop a variety of chronic pain syndromes. Old pains long cured can suddenly recur when a subconscious memory is triggered by a sound, sight, aroma, or similar experience.
· Present: feeling trapped, vulnerable or powerless in the job from hell or an unhappy relationship or other circumstance can produce physiological changes, postures and muscular tension, leading to pain.
· Psychiatric illness such as depression or anxiety can also produce physical symptoms.
Examples from our clinical practice:
· One patient underwent counseling including EMDR by a skilled psychologist. When this was completed not only were her traumatic memories dealt with and her depression lifted, but her fibromyalgia was also gone.
· One young lady volunteered that her fibromyalgia resolved when she forgave her mother.
· Another found that journaling controlled her neck pain which functioned as a barometer for stress.
· An accomplished student athlete with a two-year history of incapacitating back pain despite multiple investigations, treatments and specialist consults, read up online about the personality traits that contribute to stress-related pain. After viewing some of the websites listed below the pain was gone.
We don’t suggest for a moment that all chronic pain fits into this category but simply that it is worth keeping an open mind about the possibility that stress may pay a large role in chronic pain.
Over the next few blog entries I hope to outline in simple terms how pain is processed and modified by the nervous system.
Stress Illness (Mindbody Syndrome or Psychophysiological Disorder) Resources:
(Disclaimer: we do not have any proprietary interest in any of these resources).
Books by John Sarno:
“Mind Over Back Pain”
“Healing Back Pain: the Mind-body Connection”
“The Mindbody Prescription: Healing the Body, Healing the Pain “ (also on video)
“The Divided Mind” this one is the most comprehensive but is quite academic.
Book and Video Course by Scott Brady: “Pain-free for Life”
Book by Marc Sopher: “To Be or not to Be – Pain-free”: the simplest and shortest of these books.
Book and Online Course by Howard Schubiner: “Unlearn Your Pain.”
Book by David D. Clark “They Can’t Find Anything Wrong.”
Book by Steven Ray Ozanich “The Great Pain Deception”
Workbook by David Schecter “Mindbody Workbook.”
Book by Nancy Selfridge and Franklynn Petersen “Freedom from Fibromyalgia”
Internet resource: www.tmswiki.org : multiple articles and links on this subject.
Abbass, A. Somatisation : diagnosing it sooner through emotion-focused interviewing MARCH 2005 / VOL 54, NO 3 · The Journal” of Family Practice
Fosha, D, et al “The Healing Power of Emotion”
EFT, Faster EFT, EMDR can all be researched online.
Pain: Management textbook:
Steven Waldman (editor) “Pain Management”
Understanding some of the chemistry:
A book by Candace Pert: “Molecules of Emotion “ explains the biochemical process behind emotion and pain.
David is a fan of books and no doubt will be sharing some good reads here.