Chronic Pain: The Mind-Body Connection

Updated: Jun 7


Conventional medicine is beginning to recognize a very powerful relationship between mind and body. Naturopathic physicians, Chinese medicine practitioners, and alternative healers have known this all along.


Remind yourself of the time you got dumped.

How did your heart and gut feel?

Broken, tense, in knots?


These are physical sensations associated with physical changes to your body.

It may seem obvious to you that the mind influences the body, but you may be surprised to learn to what extent.


We're too often ignoring psychological, social, and environmental causes of disease. What good does it do to recommend a mushroom blend for immune support when the patient can't keep a roof over their head?! Medical professionals lack the knowledge, awareness, and tools to help people with chronic pain. It's easier to label the pain as “psychosomatic,” and send the patient out the door with some pain meds. It's clear this way of practicing medicine lead to the opioid epidemic causing more harm than good.


The urban dictionary definition of psychosomatic sums up our frustration as a patient seeking care from most conventional doctors. Below are examples:

The doctor diagnoses your problem as psychosomatic “when the doctor won’t take the time to find out what’s wrong with you and then proceeds to make you think you’re crazy."
"An example of a psychosomatic illness is when a doctor says you need to see a psychiatrist, because you were tired all the time and then another doctor runs some blood test and concluded you have mono.”

If you have chronic pain or chronic fatigue and the doctor isn't taking the time with you to figure out what's going on, find a different doctor who will. And if you're having difficulty finding one that will take the time, contact us at PCNM. If not us who are able to help you, we may be able to find someone in your area who can.

The word "psychosomatic" clearly has a negative connotation, a synonym for crazy, despite it's true meaning, "mind-body." Although it may be difficult at first to accept psychosomatic as a factor causing your pain, understanding this may be the shift you need to begin healing.


Let's take a positive perspective on the word psychosomatic.

"I know that Life alway supports me." This is the positive affirmation for back pain as talked about in Louise Hay's book, You Can Heal Your Life. According to Hay, low back pain may reflect a fear of financial support. She provided people with positive affirmations for physical maladies, connecting mind and body. Dr. John Sarno, most recognized as a back-pain medical doctor and author of, Healing Back Pain: The Mindbody Connection, supports the theory that emotions produce physical symptoms. He calls it Tension Myositis Syndrome, TMS. Chinese medicine also recognizes the power of the seven emotions to generate physical symptoms such as pain.


one way to treat low back pain

History

In the 2nd century, Western medical doctors believed emotions affect physical health. The mind and body were seen as one. Diseases were caused by nonmaterial forces. As a retaliation to these seemingly religious ideas, in large part due to Cartesian dualism, separation of mind and body grew in favor during the Renaissance and Enlightenment eras (14th-18th centuries). During this time, the scientific method was dogma, giving birth to the scientific revolution. Objectivity was at the basis for inquiry. The body among other things were broken up into pieces to be closely observed and rearranged into logical order. And this is how evidence-based western medicine is practiced today.






“Emergence of diseases that have psychological, social and environmental components as part of their aetiology… challenges the hegemony of biomedicine.” - Neeta Mehta, PhD





The past 30 years has proved to be fruitful, providing new research linking emotions to health. There are a growing number of US medical schools and centers with departments dedicated to mind-body research and treatment; such as, Harvard University, Columbia University, University of California, Los Angeles, and the University of Pittsburgh. They call it psychoneuroimmunology or psychoendoneuroimmunology, which to me, is pretty funny, because it's a bunch of 'systems' smooshed together... psycho-, endo-, neuro-, immuno-, and might as well be 'holistic.'


In the United States, the National Institute of Health (NIH) opened an Office of Alternative Medicine (OAM) to “facilitate study and evaluation of complementary and alternative medical practices and to disseminate the resulting information to the public.” In 1998, the OAM was elevated to the status of an NIH center, the National Center for Complementary and Alternative Medicine, later renamed in 2014 to the National Center for Complementary and Integrative Health due to ambiguity of the word, “alternative.” With new research, there are new treatment recommendations for pain. The Oregon Health Authority (OHA), a government agency in the state of Oregon overseeing programs related to health, is on the cutting edge of this research. Under the OHA, the Oregon Pain Management Commission (OPMC) requires seven hours of continuing education on pain for healthcare professionals (including naturopathic doctors and acupuncturists). One hour is reserved for a Pain Management Module, called Changing the Conversation about Pain: Pain Care is Everyone’s Job. The OPMC provides a Pain Care Toolbox. In the toolbox, there are six key domains: 1) Changing the conversation about pain, 2) Knowledge of pain, 3) Sleep, 4) Mood, 5) Activity, 6) Nutrition. It’s important to note that these six domains are in line with the naturopathic therapeutic order.


The OPMC says:


  • All pain comes from our brain.

  • Pain doesn’t equal harm.

  • Pain is a perceived threat.

  • Stress and pain are closely related, and when people understand their pain, it decreases.


While it is unclear whether or not an imbalanced emotional reaction puts people at risk for chronic pain, it is clear pain treatment includes addressing a person’s emotions.


More About Dr. John Sarno

Dr. Sarno, a medical doctor who was entrenched in the conventional medical community as a professor at New York University School of Medicine, and an attending physician at the Howard A. Rusk Institute of Rehabilitation Medicine, New York University Medical Center, came to the conclusion that emotions cause disease. The conventional medical community remained skeptical of his work. He believed tension myositis syndrome to be the “most common emotionally induced disorder in the United States.” According to Sarno, emotions can turn into tension in the body. This tension results in a physical manifestation of pain due to a reduction of blood flow and oxygen deprivation to the involved tissue. Dr. Sarno found successful treatment “depended on shifting concern from the physical to the emotional.” He educated his patients about pain and assured them nothing is wrong with their backs. While he worked primarily with back pain, he postulated TMS to be the cause of various disorders. Today, Dr. Sarno’s theory of pain may be more accepted than ever. Interestingly, his work parallels Chinese medicine theory of pain etiology, which I will briefly review next.


More About Classical Chinese Medicine

Chinese medicine practitioners assess for health by identifying patterns of imbalance. To use Western terms, we could call this active process of maintaining balance, homeostasis.


Disease is a state of disharmony or imbalance.


Optimal health is a state of harmony or balance. Factors known to cause disharmony are the environment, emotional responsiveness, lifestyle, and inherited constitution. When there is insufficient or excessive emotion for a long period of time, or an emotion arises suddenly with great force, imbalance is generated.


The goal of emotional responsiveness is harmonious reactivity





There are 7 emotions: elation, anger, sadness, grief, worry, fear, and fright.


Qi moves differently through the body depending on the emotion.






For example, low back pain indicates disharmony. The low back is associated with the Kidney due to channel/meridian and kidney-organ location. Fear is the associated emotion of the Kidney. Therefore, low back pain may be caused by an imbalanced fear reaction or sudden excess of fear. Fear will normally cause Qi to descend. When Qi is constantly descending, not flowing in a balanced state, this will cause blockages of Qi and Blood in the body. Pain is often the result of Qi and Blood blockage, resembling Dr. Sarno’s idea of TMS; tissues are deprived of what they need to function properly (Qi, blood, oxygen, nutrients).


Conclusion

Due the recent influx of mindbody research, we believe the interaction between patient and doctor will change. The word “psychosomatic” will become more accepted for its true meaning or simply replaced. Doctors will approach a patient as a whole person, rather than a diseased part. Instead of dismissing a patient prematurely with a diagnosis of psychosomatic, they will have a meaningful conversation about pain and provide tools. Mind and body are not separate and should not be treated as such.




Treat the mind to treat the body

Treat the body to treat the mind



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References

1. Hay L. Life Supports You. you can Heal Your Life.

2. Sarno JE. The Mindbody Prescription: Healing the Body, Healing the Pain. New York; 1998.

3. Brower V. Mind-body research moves towards the mainstream. EMBO Rep. 2006;7(4):358-361. doi:10.1038/sj.embor.7400671

4. NIH Fact Sheets - Mind-Body Medicine Practices in Complementary and Alternative Medicine. National Center for Complementary and Alternative Medicine. https://report.nih.gov/NIHfactsheets/ViewFactSheet.aspx?csid=102. Accessed March 12, 2019.

5. Mehta N. Mind-body Dualism: A critique from a Health Perspective. Mens Sana Monogr. 2011;9(1):202-209. doi:10.4103/0973-1229.77436

6. Urban Dictionary: Psychosomatic. https://www.urbandictionary.com/define.php?term=Psychosomatic. Accessed March 18, 2019.

7. Herrmann-Lingen C. The American Psychosomatic Society - integrating mind, brain, body and social context in medicine since 1942. Biopsychosoc Med. 2017;11:11. doi:10.1186/s13030-017-0096-6

8. Oregon Pain Management Commission. Oregon Health Authority. https://www.oregon.gov/oha/HPA/dsi-pmc/Pages/about-us.aspx.

9. Viniol A, Jegan N, Brugger M, et al. Even Worse — Risk Factors and Protective Factors for Transition from Chronic Localized Low Back Pain to Chronic Widespread Pain in General Practice. Spine (Phila Pa 1976). 2015;40(15):E890-E899. doi:10.1097/BRS.0000000000000980

10. Chou R, Shekelle P. Will This Patient Develop Persistent Disabling Low Back Pain? JAMA. 2010;303(13):1295. doi:10.1001/jama.2010.344

11. Valat JP, Goupille P, Védere V. Low back pain: risk factors for chronicity. Rev Rhum Engl Ed. 1997;64(3):189-194. http://www.ncbi.nlm.nih.gov/pubmed/9090769. Accessed March 12, 2019.

12. Wu K, Kaptchuk TJ. The Web That Has No Weaver: Understanding Chinese Medicine. Philos East West. 2006. doi:10.2307/1398510

13. Youbang C, Liangyue D, Kai Z, eds. Essentials of Contemporary Chinese Acupuncturists’ Clinical Experiences. Beijing, China: Foreign Languages Press; 1989.


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