Pain - The Mind-Body Connection
In this article, Pain – the mind-body connection, I’d like to point out that I’m presenting evidence and theories and by no means saying you shouldn’t seek medical advice or treatment for pain. I also want to clarify that not all forms of chronic pain have an unidentifiable cause. Or that if you have temporary, acute pain, like a muscle strain then short-term rest is the best approach. I also believe some people’s bodies are more susceptible to injury than others. However, the pain I’m discussing in this article is related to long term chronic pain which doesn’t have a clear cause.
I must admit when I first heard about pain – the mind-body connection, I initially felt I’m not imagining my pain, it is real, it’s not all in my head. Then as I began to understand more about how our mind and emotions can affect our physical bodies I felt differently. I now believe that some of the chronic pain I experience is because my muscles are tense either from muscle memory of an old injury, or as subconscious response to stress. For some people just understanding this connection can help them to feel pain relief but for others like myself some other action is required.
If you feel the chronic pain your experiencing doesn’t have a clear identifiable cause or hasn’t been treated effectively continue to read my full article Pain – The Mind-Body Connection below. At the end of the article you will find a link to request a leaflet that I’ve produced looking at actions you can take to address the problem, in terms of yoga practice and other advice.
Pain – the mind-body connection
Do you suffer with chronic pain? You may have tried lots of different conventional and complementary treatments to resolve your pain. You may have been diagnosed with a medical condition, had all the treatment that should have resolved your pain but found they haven’t worked. Some of these treatments may have helped a bit but you may still get pain flair-ups or regular discomfort. Your doctor might have run out of options, they might have referred you to a pain clinic or a psychiatrist, giving you the idea that your pain isn’t real but that it’s all in your head.
Many people are discovering that the pain in their body may not have been diagnosed correctly. There is a condition called TMS (Tension Myositis Syndrome) that you might be suffering from. Tension myositis syndrome (TMS), also known as tension myoneural syndrome or mindbody syndrome is a name given by Dr John E. Sarno. TMS is a painful but harmless change of state in muscles, myositis means physiologic alteration of muscles.
TMS is a condition that causes real physical symptoms that are not due to pathological or structural abnormalities in the body and are not explained by diagnostic tests. This is not to say that the pain is “all in your head” or that it is not real. TMS symptoms are very much real it’s not something created in the mind, your muscles are actually in an altered state which is causing the pain. It is thought that TMS pain symptoms are caused by mild oxygen deprivation via the autonomic nervous system.
Often people can experience TMS a few years after an accident or injury where there was once structural damage. However, the body has an amazing ability to repair itself, so it is unlikely that the original injury is causing the current pain. So why can the pain re-occur?
There are pathways in our subconscious minds that may associate certain actions with pain (like washing up). The body can respond to these actions by altering muscles to protect the area in the same way it did when you were injured. Even through there was a structural cause to the pain in the past, often the body has healed, and the reoccurring pain is caused by the muscles responding to the action by tightening, causing restrictions in oxygen and pain. This is sometimes referred to as muscle memory.
Pain – the mind-body connection – Emotions
Another explanation for TMS is that pain symptoms are caused as a result of repressed emotions and psycho-social stress. For lots of people this may be difficult to comprehend.
However, we know our body responds to our emotions, when we have a physical reaction like our face turning red when we’re embarrassed. If we are asked to speak in front of a room full of people, our stomach might tighten up. We may get a headache If we’ve had a stressful day. These are all physical reactions brought on by our mental state. TMS can often occur during stressful periods of our lives, when emotions are triggered that cause our bodies to react by producing physical symptoms.
Your subconscious mind may have learnt to respond to stressful events by distracting yourself from the uncomfortable emotions, leading to a buildup of tension in muscles and physical pain. There may be an accumulation of unresolved stress, possibly from your childhood, or from stressful events in your adulthood, or from your present circumstances. People who are more likely to experience TMS are those who bottle up or brood over emotional stresses rather than express how they feel. You may be more likely to experience TMS depending on your personality traits, particularly in how you respond to stress and how much pressure you tend to put upon yourself.
Whatever the cause of TMS you’re not imagining or making up the pain. You may not have a serious disease, but you do have a medical condition. And you’re not alone, in fact, you’re not much different from most people.
It’s no wonder that we have learned ways to supress our emotions, as many aren’t easy to cope with. Robert Plutchik’s theory[i] says that there are eight basic emotions, fear, anger, sadness, joy, disgust, surprise, trust and anticipation. At least four of these are difficult emotions to acknowledge and often people can bottle them up or distract themselves from feeling these not-so-comfortable emotions. These difficult emotions have a purpose and if we can accept them as being useful for our survival we’d be less likely to supress or distract ourselves from them. “Destressing feeling can teach us valuable lessons, once we stop trying to smother them with positive affirmations or rationalisations” Susan David, Emotional Agility.
Lower Back Pain – the mind-body connection
TMS can be associated with many different symptoms including sciatica pain, RSI, fibromyalgia, chronic fatigue syndrome, migraines, irritable bowel syndrome, and a wide array of other symptoms. One of the common problems people with TMS experience is lower back pain. More than 540 million people suffer low back pain, the commonest cause of disability in the world.
Three research papers were published in March 2018 in the Lancet medical journal [ii]. One of these papers stated that most people suffer an episode of low back pain at some point in middle age, said Prof Martin Underwood from Warwick University’s medical school, one of the authors. “In the vast majority of cases we don’t know what the cause is,” he said. Only 1% are linked to serious disease such as an infection or cancer.
“There has to be a cause,” he said. “There is an injury – using the word in the medical sense –of some sort that sets it off.” But it is rare that doctors can establish what that is. Psychological, social and economic factors can all play a part. Many people have other pain as well and there are lifestyle links, such as lack of activity. Most episodes don’t last long, but one in three people will have a recurrence within a year.
The authors state that most low back pain is unrelated to specific identifiable spinal abnormalities. Often lower back pain can be diagnosed as ‘vertebral disc degeneration associated with wear and tear’ or ‘osteo-arthritis associated with aging’ however if these are happening to all aging bodies why doesn’t everyone with these abnormalities experience pain?
Research has shown that most people over the age of 30 will show up as having wear and tear on an MRI of our spines. Jensen[iii] found that MRI tests do not accurately depict when a person has back pain, there is no correlation between spinal abnormalities and back pain. There have been several other studies coming to the same conclusions.
What can you do if you think you have TMS?
TMS treatment is based on two principles, which Dr. Sarno stated in Healing Back Pain:
The acquisition of knowledge, of insight into the nature of the disorder.
The ability to act on that knowledge and thereby change the brain’s behaviour.
As a reminder, Sarno says, “It is important to see a medical professional before starting this treatment approach to rule out any serious medical condition.” You may have already got a diagnosis and have had treatment but if you haven’t found it to be effective you may have TMS and I’d recommend looking into it in more detail as you may find it helps you manage your pain.
In the UK, the NHS has guidance for doctors on non-specific lower back pain that promotes physical exercise and recommends against surgery.
The authors of the Lancet series call for health professionals and patients to adopt what they call a “positive health” approach, defined as “the ability to adapt and to self-manage, in the face of social, physical, and emotional challenges”. That involves changing beliefs about back pain, so that doctors help patients to live “meaningful, high-quality lives” while people become less likely to expect a diagnosis or a cure.
Often the reason someone recovers from chronic pain is that they are empowered to heal themselves rather than a doctor prescribing a pill or referring for surgery.
Practicing yoga can help you to feel empowered to actively address your situation, you will gain confidence with movement and gradually build up strength and flexibility. Yoga can help you to bridge the disconnection that you may have with your body. By exploring movement and sensations, often in a subtle way, we can develop a stronger mind-body connection. Practicing and studying yoga can help us to reflect on our actions and can help us to recognise how we may get stuck in patterns of thought or movement. Through practicing yoga, you learn that you have the ability to change both physically and mentally. My teacher always said yoga will change you whether you want it to or not.
Fortunately for some people just understanding their pain has no serious structural basis can help relieve pain. However, for most people you will need to do something differently to change these well used mental pathways. However, in the majority of cases, you won’t have to go back and figure out all your unresolved emotional issues, to help you to break the connection between your mind and your physical pain.
There are several resources of how you can understand and develop a more helpful mind-body connection which will complement yoga and other self-inquiry practices. If you would like to know more about TMS research and resources I have found, please contact me to request an information leaflet.
[i] Plutchik, Robert (1997-01-01). The circumplex as a general model of the structure of emotions and personality. American Psychological Association. pp. 17–45. Available online from http://psycnet.apa.org/record/1997-97129-001 [Accessed March 2018]
[ii] Lancet Low Back Pain Series Working Group [March 21, 2018] Series of three papers: What low back pain is and why we need to pay attention. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Low back pain: a call for action. The Lancet. pp. Available online from http://www.thelancet.com/series/low-back-pain [Accessed March 2018]
[iii] MC Jensen – 14 Jul 1994 – Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med. pp 69-73 Available online from https://www.ncbi.nlm.nih.gov/pubmed/8208267 [Accessed March 2018]