HEAD SPACE
A SIMPLE BUT CONTROVERSIAL TREATMENT COULD PUT AN END TO CHRONIC PAIN. ALL IT REQUIRES IS AN ADJUSTMENT – NOT TO YOUR SPINE, BUT TO YOUR MIND
Could the solution to chronic pain actually come down to a change in thinking?
CHRONIC BACK PAIN has ruled our lives since my husband discovered he had two bulging discs after a snowboarding accident some 11 years ago. He had surgery — a trimming of the discs, if you will — which was initially successful. The pain subsided and all remaining medication was firmly locked away. He returned to work as a builder and life went on. Until intermittently, it didn’t. Every so often, his back would spasm and he’d be overcome with immobilising pain. When he wasn’t able to work, financial burdens would add to the stress. But then, gradually, his pain would subside and he would slowly recover.
He’s one of more than three million Australians who live with chronic pain, which is defined as pain that lasts for three months or more. Earlier this year, a report titled The Cost Of Pain In Australia, conducted by Deloitte and commissioned by Pain Australia, found that more women than men suffer from chronic pain. It can come in many forms with differing impacts on a person’s physical and mental wellbeing, often making it difficult — if not impossible — to work, sleep and maintain relationships. Treatments are costly and, for many, ineffective. As a nation, the pain price tag was at $139 billion as of 2018, and is set to rise to more than $215 billion by 2050. This includes healthcare system costs, productivity losses and other expenses such as aid and care.
During yet another cycle of pain, more inconclusive MRIS and a visit to the surgeon, my husband and I became increasingly desperate to find a solution. A girlfriend of mine recommended the book Healing Back Pain: The Mind-body Connection, written by the late, and controversial, Dr John E Sarno. She’d known of two people who suffered from chronic pain who, within three weeks of finishing the book, had completely recovered.
While Sarno’s CV was rooted in Western medicine — he was a professor of clinical rehabilitation medicine at New York University and an attending physician at The Rusk Institute Of
Rehabilitation Medicine at the university’s academic medical centre — he was considered dubious because his philosophies were based on anecdotal proof from his patients, rather than the hard evidence usually expected of doctors. His theory was that most instances of non-traumatic chronic pain (including back pain, gastrointestinal disorders, headaches and fibromyalgia) are physical manifestations of deep-seated psychological anxieties. With nothing to lose — and a genuine curiosity — my husband and I began reading the book together.
Essentially, Sarno believed that our brain uses pain to distract us from experiencing negative emotions, namely repressed anger. (I know, stay with me here.) In essence, our brain goes into protection mode and decreases blood flow to certain muscles and nerves, resulting in oxygen deprivation, which is then experienced as pain. This “physical” pain is easier for the brain to deal with than the kind lurking in our repressed emotions. The symptoms are as real as real can be, but the origin is emotional, not structural. Anything can trigger this kind of pain response: change of circumstance, a difficult relationship, work stress, childhood psychological trauma. Sarno coined the term tension myositis syndrome (aka tension myoneural syndrome, or TMS) to describe these types of chronic pain.
Psychotherapist Hal Greenham has dealt with TMS personally as well as seen dozens of cases as the clinical director and co-founder of Australia’s Freedom From Chronic Pain, an online neuroscience-based pain recovery program. “In a classic presentation of TMS, something has triggered a [psychological trauma from] childhood, and that’s when all of those feelings start coming to the surface,” he explains.
Sarno was revered by some as a saint, yet was derided by his professional peers, and the medical community has not validated his theory. In fact, when I reach out to the Australian Medical Association for a comment, they simply reply: “This is not an area that the AMA is involved in.” Interestingly, while researchers and doctors generally don’t find Sarno’s theory convincing, Audible sales indicate that more than 500,000 people have turned to his book for help. “It’s a cultural and intellectual problem that we have,” says Greenham. “People push away from it, but my estimate is that Dr Sarno’s protocol helps hundreds of thousands of people around the world recover from pain without drugs or surgery. That’s why it’s so important for us to change this culture of belief about how powerful the brain and the mind are when it comes to our physical health.”
Sarno understood that many people are susceptible to disc bulges, herniations and degenerations, particularly as they age. He determined these are normal conditions and not, in fact, the source of pain. He referred to them as “normal abnormalities”. In 2015, a study published in the peer-reviewed The American Journal Of Neuroradiology supported this theory, concluding that a large proportion of people do in fact have normal abnormalities in their spine and experience no pain.
A key component of TMS is that your chronic pain has no known physical cause. If you have a solid diagnosis and effective treatment plan for your chronic pain, TMS is likely irrelevant. But here’s where it gets tricky: many people have MRI results that conclude that something is pressing on a nerve, and they’re told that’s why they have pain. Others are stuck in a pain cycle because there’s no clarity around their diagnosis. “Doctors are obliged to practice in an evidence-based way,” Greenham says. “Now, in neuroscience, we’re seeing overwhelming evidence that chronic pain is not [always] caused by damage. That [idea] is very slowly filtering through the medical system. It’s important to determine whether you have organic damage or not. However, if there’s no [physical] damage, don’t treat your pain as though there is. And remind yourself that even if there has been an injury, the body [can] heal itself.”
When it comes to treatment techniques, simply learning about TMS and understanding the stressors and emotions that have been ignored can be enough to cure many people’s symptoms. Others require psychotherapy to unpack the repressed emotions that generate their chronic pain. If you fall into this latter category, you will need to consult a doctor who has studied TMS and identifies with your condition. My husband has been one of the fortunate ones who read the book and found complete pain relief by simply understanding, accepting and reminding himself that his brain has been vastly creative in its ability to produce symptoms. After much reflection, he believes that it was becoming a father in the months between his accident and his surgery that stirred up complex repressed emotions and triggered TMS.
When you’ve been relying on pain medication and doctors, it can be a hard mental shift to focus on unpacking bottled-up emotions. But when it comes to TMS, being open-minded is part of the healing process — any modicum of doubt can perpetuate the fear-pain cycle. In short: if you don’t believe this process will help you, it won’t.
My husband’s new treatment consists of reading a list of mantras each day: his pain is not a structural abnormality; it is harmless; it is distracting him from his emotions. This process takes five minutes over a morning coffee, and by simply repeating these mantras, he’s rewriting his neural pathways. As left-of-centre as it may sound, this daily ritual has been a total game-changer for him (and me). At the time of Sarno’s death, the day before his 94th birthday in 2017, he had published four books and, according to Forbes, changed the lives of thousands of people. When you consider that the number of Australians dying from accidental drug overdoses is now higher than the national road toll, anything is worth a try.
“IF THERE’S no PHYSICAL DAMAGE, DON’T TREAT YOUR PAIN as THOUGH THERE is”