Etiology of Pain

Photo Credit: Nemo

Photo Credit: Nemo

One of the most compelling explanations of pain that I have heard was authored by John Sarno, M.D. in his book Healing Back Pain, the Mind-Body Connection. In it, Dr. Sarno puts forth the revolutionary theory that up to 90% of neck, shoulder, and low back pain is the result of emotional stress, and repressed emotions. At first glance this may seem a little too simplistic to be true, but as you follow his line of reasoning, it begins to make a lot of sense. Lets take a deeper look.

We have always been taught that back pain is “physical”, that is, structural, and is typically the result of an injury, or a physical cause. Dr. Sarno sees this idea as one of the greatest impediments standing in the way of recovery, because all of the therapy is geared to the physical body, rather than to the real source or root cause of the pain, which he postulates is emotional. Dr. Sarno terms this pain syndrome, which primarily involves the spinal muscles of the body, as the Tension Myositic Syndrome (TMS). TMS involves the physiologic alteration in certain muscles, tendons, and ligaments resulting in pain.

As I mentioned, Dr. Sarno believed that TMS occurs primarily in the muscles of the neck, entire back, and the buttocks, known collectively as the postural muscles. They are so named because they maintain the correct posture of the head and trunk. Statistically, the low back/buttocks area is the most common location for TMS. The second most common area for TMS is the neck and trapezius muscles. I am in total agreement with this as these two areas are involved the greatest percentage of cases that I see in both private practice and while working for Kaiser Permanente’s chronic pain clinic. With the frequency that people sit in front of their computers a majority of the day, neck and trapezius area pain is replacing low back pain as the chief complaint that I see. Working with a computer significant time causes a sub-conscious tensing of these neck and upper back muscles. I think you will continue to see these numbers swell in favor of upper trunk pain because of the widespread use of computers.

With regard to the frequency of low back pain, I would like to extend this to include the lower abdominal area. This anatomical girdle completely wraps around the body and tense muscles in the lower abdominal cavity are responsible for irritable bowel syndrome (IBS), one of the most common digestive complaints seen in health clinics today. The Mind-Body connection between these areas in undeniable, and even allopathic medicine recognizes the “hardwiring’ that exists between the brain and abdominal area (gut-brain axis). IBS, in the eyes of allopathic medicine, is viewed as a psychologically rooted disorder. Deepak Chopra states that this area has “eavesdropping capability.” In other words, the muscles are reacting to the emotional stress by becoming tense, and as a result, dysfunction occurs.

When a muscle reacts to psychological stress it tightens. This tightening inhibits blood flow to the muscle resulting in oxygen deprivation to the muscle, or “ischemia of the muscle”. The classic symptom of this phenomena is a burning sensation. As these emotional stress patterns become sustained the severity of the pain increases and can even cause referral pain if the nerve becomes compressed by the tense muscle. I have lost count of the patients I have seen who develop sciatica during a particularly stressful period of their lives.

The one flaw in Dr. Sarno’s theory was that because he saw pain as primarily psychologically based, he believed in a psychological cure. His premise was that pain could be overcome and reversed by applying techniques to essentially reduce emotional stress. Unfortunately, reversing the physiologic changes in the structure of a muscle that has developed a focal spasm cannot be undone with purely psychologically based strategies. No amount of emotional stress unraveling will return a damaged muscle to its original relaxed state. It should certainly be a part of the long term strategy of dealing with pain, but a more physical based modality must be employed to bring about the changes necessary in the structure of the muscle. Acupuncture, particularly electro-acupuncture which we will discuss in length in a later chapter, is the most powerful tool to release tension in the belly of the muscle. No other system in the world has the anti-spasmodic effect that this technique provides. Other compression type massage techniques can also aid in helping relieve a muscle spasm (see Janet Trager’s work on Trigger Point therapy), but since massage oriented therapy cannot penetrate to the very belly of the muscle, they are less effective and long lasting.

So what about those MRI pictures that show bulging discs, degenerative disc disease(DDD) or spinal stenosis. Surely that must be the cause of one’s back pain. With over 40,000 patients visits to my credit, I can safely say in 80% of the cases I see, the pathologies that show up on typical x-rays are rarely the cause of one’s pain. I have come to almost discount the value of xrays with regard to their significance in forming a diagnosis on the cause of spinal pain. In fact, Harvard Medical School did a study on back pain that took 100 people asymptomatic for low back pain. MRI pictures were taken and revealed some type of pathology prevalent in 80% of these people, that literally had no symptoms whatsoever. You get the idea. Most people I see on their first visit begin by telling me of their confirmed diagnosis of arthritis, or “slipped disc”, or their sciatica. They want me to look at their x-rays to see if I can somehow make positive changes in whatever pathology that was revealed. I inevitably offer a different perspective on what I believe is causing their pain, which are changes in the soft tissue at the painful site. It is rare, in fact, when a spinal x-ray doesn’t reveal some pathology prevalent. But that doesn’t change the fact that these structural issues are seldom the cause of a person’s pain. John Sarno had it right when he postulated that it was in the soft tissue, or muscle that we should be looking at. It was just his view on corrective therapy that fell short.

This network of soft tissue including muscle, ligaments, tendons, fascia are all affected by our thoughts and emotions. When we become emotionally tense, our supporting tissue that hold our bones in place, react to this vibration. It is inevitable that the physical body will mirror and reflect the emotional one. To deny this reality is short-sighted at best, and negligent at worst. Acknowledging this, is the first step in taking the steps necessary in healing and recovery. Focusing on these structural diagnosis is looking at the wrong end of the elephant, and will lock you into a flawed, and hopeless outlook. If you are told by your chiropractor every time you are in pain, you are “out”, you will go through life feeling every time you have back pain it is because your spine is out of alignment. So every time you feel pain you go running to your chiropractor, many times on a weekly basis for years. In truth, the pain one experiences has nothing to do with one’s bones, it is merely this soft tissue that has become hypertonic and in spasm. A chiropractic adjustment merely stretches the contracted muscle and the pain occasionally subsides for a short period of time. The problem with this is that the muscle will surely tighten again because the adjustment cannot permanently relax a spasm in a muscle, but temporarily stretch it. It is a flawed system that locks people into a lifetime of unnecessary, and incomplete therapy that can seldom provide a lasting cure for the patient’s condition.

My next article will discuss the treatment modality that directly addresses the soft tissue of the body, and is the only system in the world that can impact vascular response. In short, it is the most powerful natural pain relieving tool in the history of medicine. Stay tuned.

Yours in health,

Rick J Bernard, L.Ac.

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