Is your BACK PAIN all in the MIND?
TODAY, Marie Lovell is a fit and healthy fortysomething. She runs, does Zumba and likes to swim in the sea. But four years ago she could barely shuffle from one end of her house to the other.
Like millions of others, she was living with chronic back pain — a condition conventional medicine had been unable to resolve. But thanks to a new approach, she is once again leading a normal life.
Marie’s problems began after the birth of her third child 16 years ago. Bending sideways to unlock her car bonnet, she felt a sharp pain in her lower back.
Two days later and unable to lift her baby, she went to her GP. But he simply told her she was overweight and that she would probably always have back pain.
Marie was devastated. Over the next ten years she continued to suffer intermittent lower back pain. Then, just before Christmas 2009, it became constant and was combined with sciatica (nerve pain) down her left leg.
By spring 2010, Marie could barely walk, and at night slept for no more than 30 minutes at a time before waking up in terrible pain.
Her GP prescribed increasingly powerful painkillers and Marie bought all kinds of gadgets, but nothing worked.
‘I’d reached the point where I thought my life was over and I just needed a way to end it that was not too distressing for the family,’ she admits.
Matters came to a head one morning in spring 2010 when her husband Tony, a freelance illustrator, had to summon an emergency GP. Marie was on the floor, crying in agony, unable even to move enough for the doctor to examine her.
The GP called an ambulance, and it was while on morphine in A&E that she had her first pain-free moments in months.
But the diagnoses from doctors were confusing: one told her she probably had structural damage to her back and booked an MRI scan; another thought she was merely ‘holding her muscles tense’ and should ‘go home and relax’. If only it were that simple, she thought. Back at home, Tony did an internet search on ‘back pain’ and ‘tension’ and came across tension myoneural syndrome (TMS), a term coined in the Seventies by Dr John Sarno, a former professor of rehabilitation medicine at New York University.
TMS refers to physical pain that has a psychological root. Proponents say the pain’s origin in the brain does not make it any less real, but it does require a different kind of treatment.
Further research led Tony to Georgie Oldfield, a former NHS physiotherapist and the main proponent of Dr Sarno’s work in the UK. She argues that chronic pain can be caused by repressed emotions (from past or present stress) which can manifest themselves in physical ways. Some people may find it hard to accept that emotions can cause physical pain. But, as Oldfield points out, blushing is a direct physical manifestation of emotion. Pain, she contends, can be the same.
She suggests that after injury or emotional stress, neural pathways — essentially, pain pathways — are created. These continue to register pain long afterwards, in the same way that amputees may suffer twinges that seem to emanate from a non-existent limb.
Oldfield aims to ‘re-route’ these neural pathways, thereby relieving or removing the pain.
The people she treats have all seen other doctors, often many times, so any physical cause should have already been identified if it exists. Oldfield’s approach does not involve diagnosis, but rather helping the patient to identify their main c a uses of stress (particularly what was happening generally in their life when the pain started), and any frustration or anger they have been unable to express.
She is not a psychoanalyst. Instead, she aims to help people gain a better understanding of their own responses to stress and to learn ways of dealing with them.
She uses a technique called ‘therapeutic journaling’. This i nvolves writing a l etter detailing exactly what you feel. The next step is to try to put it in context (for instance, recognising that in certain circumstances people behave differently) before ripping the letter FOR up and throwing it away.
some people it is apparently enough to acknowledge the emotional turmoil. For others, more help is needed, such as meditation, learning to be less critical or perhaps finding someone to talk to regularly.
Marie Lovell was deeply sceptical to begin with. ‘I couldn’t believe that writing things down could really help with this very physical pain,’ she says. ‘But I was desperate.’
She first described her medical history to Oldfield and was then asked about her life.
Marie is a mother of three, with one child on the autistic spectrum. She is her family’s main breadwinner (she helps train social workers), while also coping with her father’s dementia — so was, not surprisingly, stressed. She wrote her letter, then threw it away.
Not long afterwards she got a call from a hospital physiotherapist: her MRI scan had revealed a ‘massive prolapsed disc’ that would need surgery. But because Marie was beginning to feel better, they decided to wait, and Marie continued to see Oldfield.
Two months later, she was going for walks with her family (‘Something I’d thought I would never do again’) and riding a bike. In the end, she ANOTHER never had the surgery.
of Oldfield’s former patients is Dr Martin Johnson, a GP who is honorary secretary of the British Pain Society. He went to her in 2012 to treat neck pain and numbness in his hand when writing, believing that she was still working as a physiotherapist.
He expected ‘the usual clunkclick’ of physiotherapy, but found himself talking about the day he collapsed at work in the middle of writing a sentence and the fact there was so much change in his life.
‘It was helpful, and the intensity of the problem lessened — I was put to rights,’ he says. ‘Whether it was this that did it, though, I can’t be sure.’
Even the most conventional pain practitioners acknowledge that there is a significant psychological element in chronic pain. It’s known, for instance, that some people can have visibly damaged backs and no pain, while others show no damage on their scan, yet suffer dreadfully.
Dr Tony Davies, a consultant in pain medicine at the Plymouth NHS Pain Management Centre, says that to tackle such problems, pain clinics increasingly adopt a ‘biopsychosocial’ approach. That’s a combination of biological, psychological and social factors.
His team uses a range of techniques, including cognitive behaviour therapy and mindfulness, which focuses the mind on the present moment.
‘There is usually a physical pain trigger, but trauma, distress and negative emotions magnify the problem,’ he says. ‘There may be a small physical fire, then emotional distress pours petrol on the flames.’
For Marie, while she may still have a prolapsed disc and her life remains stressful, she is no longer in pain, save for a numb patch on one foot. But, as she says: ‘I can live with that.’