A chaotic, even abusive upbringing predicts a long and harsh life. There are many chronic mental and physical health issues that occur that shorten lifespan and also markedly compromise quality of life. Raised in this environment, a child cannot reach his or her full potential when so much energy is consumed by trying to survive. Consider a young plant in rich soil with plenty of sunlight and water. Compare it to the same plant in poor soil, limited sunlight, little water. It may even look a different species.

Feeling unsafe

When we don’t feel safe, we’ll do whatever we can to achieve it. Feeling unsafe drives many, if not most destructive behaviors. Feel trapped causes us to react aggressively to solve the situation. The physiological response is called anger, which represents the body’s powerful last-ditch effort to regain control.

Since the most stressful problems are ones we can’t solve, sustained anger (threat physiology) turns into rage, destructive behaviors, and chronic illnesses as the body breaks down. Consider how many life situations are unsolvable. One of the deadliest and universal problems is feeling trapped by our thoughts.

We cannot escape our thoughts. Suppressing unpleasant thoughts fires up the threat response even more than experiencing them. Suppression causes the hippocampus (memory center) of the brain to shrink¹ and increases craving for opioids.²  Distracting ourselves with experiences, pursuing pleasure, adventures, and achievements also fires up the immune system.³

So how do we behave?

ADDICTIONS

Addictions create a sense of safety while engaged in the activity, but obviously are not long-term solutions. The reason addictions are so destructive is they temporarily mask mental and physical pain, and pursuing relief is compelling.

POWER

A deadly outcome of feeling chronically unsafe is the relentless pursuit of power in order to gain more control. It can’t and doesn’t work, but few of us are taught alternatives. The manifestations are almost infinite and infiltrate every domain of our lives and relationships with others. People closest to us are the most affected. No one wants to be controlled, yet trying to control others is almost universal. Anger is generated in those being controlled and also in those exerting control. There is never enough to assuage the unconscious brain. Unfortunately, anger is intentionally destructive, as it is your body’s last-ditch effort to survive emotionally or physically.

The data is deep, beginning in the schoolyard. We try to avoid anxiety, or – if we already have it – we try to get rid of it. Nothing enhances our feeling of control more than by gaining power in some way. This need is expressed in our interactions with each other; in fact, it dictates much of human relations.

Every child has significantly increased anxiety when they leave home to begin school, regardless of their family situation. They want to be accepted but there is also the greater need to diminish their fear. The need to get rid of fear and gain power is played out in forming cliques, excluding others, and overt bullying.

Researchers did a study of students who have been bullied versus the bullies to see if there was any difference in their physiological makeup. ⁴ They looked at the levels of a substance called C-reactive protein (CRP), which is elevated in the presence of inflammation; it’s often drawn to determine the presence of a hidden infection. Chronically elevated levels also indicate a stressed and overactive immune system. It is not desirable to have an elevated CRP.

The study revealed that children who had been bullied had significantly elevated levels of CRP compared to those who had not been bullied. Being bullied as your introduction to the real world is not a great start. What I find even more disturbing is that the levels of CRP in bullies was lower than the norm. As it turns out, there is both a social and physiological reward for possessing more power. How all of this plays out in adulthood is not subtle. Why would you want to give up power and control? Especially when feeling the pain of anxiety is the other option.

Every child has a strong need to be accepted, yet what should we make of the fact that it gives him or her more power (and self-esteem) to reject someone else? This is an endless loop, the root cause of which is the solvable problem of anxiety.

SELF-ESTEEM

The other as futile effort to counteract these deeply upleasant survival sensations is to pursue more self-esteem. This is problematic for seversal reasons. First, it is a gross mismatch of your unconsious brain overpowering your conscious brain by about a million to one. Anxiety and anger are hardwired automatic survival reactions over which we have absolutely no control.

Second, the unconscious brain never stops for a millisecond and is always on the lookout for danger. It is why we evolved and stay alive. The conscious brain’s attention is not sustainable and we quickly develop cognitive fatigue trying to stay happy. We also become physically tired as 20 to 25% of your entire body’s energy is used to run your brain.

Third, we are programmed by everyone around us about who we should be or not be. These voices in our heads become as concrete as any object and we act on them. Unfortunately, the “stories” in our heads are essentially all cognitive distortions. Self-esteem represents a huge distortion of labeling. We expend a tremendous amount of energy building up our ego, and then spend endless efforts defending it. The relentless pursuit of self-esteem disconnects us from the reality immediately in front of us. In other words, you lose awareness of other’s needs and relationships are compromised. Look at the human experience of how terribly we treat each other as individuals and societies. We have the resources to create a planet that could thrive yet we are at the mercy of our personal and societal “stories.”

What can you do?

Learn vulnerability. Being vulnerable is at the core of meaningful human relationships, but there is no reward in nature for being physically vulnerable.  Since emotional pain is processed in similar regions of the brain as physical pain, there are penalties for being emotionally vulnerable. Language creates a massive problem causing emotional pain that is much more complex than in other mammals. Anger, as unpleasant as it is, is powerful, addicting, and masks being vulnerable. Anger creates a sense of emotional safety, but no one around you feels safe. How do you learn to be vulnerable when you are used to dealing with a lot of anger?

DYNAMIC HEALING

Needing to pursue the above-mentioned destructive behaviors drops as you address the root cause of sustained threat physiology. You cannot control the survival reactions but there are numerous ways to regulate your physiology. When your body is bathed in safety physiology, you feel safe, connected, and incredibly relaxed. We use the term, “dynamic healing”, which addresses factors affecting your physiology.

• Input – dealing with life’s challenges in a manner that less impact on your nervous system.
• State of the nervous system – calm or hyperactive
• Output or the physiology – can be directly regulated from threat to safety.

The details of the Dynamic Healing model are beyond the scope of this discussion. The focus is on you and learning skills in each category to create “cues of safety”, and not on fixing or solving your pain. It is a healing process, and not “self-help”.

RUTs (repetitive unpleasant thoughts)

Regarding the onslaught of unpleasant thoughts, consider the metaphor of a hornet’s nest, with the nest being your brain, and the hornets your thoughts. At rest, the hornets are busy collecting food, building the nest, cleaning house, and reproducing. If the nest is shaken, the hornets will become aggressive and defend themselves. When your nervous system is inflamed and hyperactive, your thought patterns become intense, since your conscious brain interprets your internal physiology.

The usual approach is to use cognitive rational techniques to counter bad thoughts with good thoughts, which is an impossible task. Then we put up our “shield” (self-esteem, self-affirmations) to protect us. It also overwhelming and wears us down. Exerting increased control (suppression) is also futile. Then the more attention you pay to the thoughts your brain is fired up even more. It is a bi-directional process.

The answer lies in “quit shaking the nest.” The hornets will calm down and return to their usual activities. As your nervous system calms down, your unpleasant thought patterns will lessen, which in turn helps calm your brain. Although cognitive approaches lower the input into the nervous system, calming it down is a separate skill. There are endless other ways besides unpleasant thoughts that fire it up.

There are four aspects of creating a safe relationhip with your thoughts.

• Thought separation
• Calming the nervous system (processing anger)
• Creativity – stimulating new neurological circuits away from the unpleasant ones.
• Dissolution of the ego – once you learn to feel safe, there is less need for it.

Calming your nervous system allows you to feel safe. It allows you to break free of ruminating thought patterns frees you up to create and live life on your terms.

References

1. Hulbert JC, et al. Inducing amnesia through systemic suppression. Nature Communications (2016); 7:11003 | DOI: 10.1038/ncomms11003
2. Garland EL, et al. Thought suppression as a mediator of the association between depressed mood and prescription opioid craving among chronic pain patients. J Behav Med (2016); 39:128–138. 10.1007/s10865-015-9675-9
3. Cole SW, et al. Social Regulation of gene expression in human leukocytes. Genome Biology (2007); 8:R189. doi: 10.1186/gb-2007-8-9-r189
4. Copeland W, et al.” Childhood bullying involvement predicts low-grade systemic inflammation into adulthood.” PNAS (2014); 111: 7570-7575.

The post Our Need to Feel Safe first appeared on Back in Control.

The post Our Need to Feel Safe appeared first on Back in Control.

As a surgeon who has spent a lifetime dealing with patients with chronic pain, including me, have come to see that the MUS diagnosis is wholly inaccurate and should be immediately discarded. Every bodily symptom you experience results from an identifiable structural problem or from your body’s physiological response to  your surroundings. Symptoms don’t just happen. The correct diagnosis is MES (Medically Explained Symptoms).

Physiology

Physiology is the term that describes how the body functions. We stay alive because living creatures can maintain an incredibly delicate balance of the body’s acid/ base balance, electrolytes, blood pressure, temperature, heart rate, and the list is long. It is a dynamic process that changes by the second in response to input from your surroundings.

We require safety (rest and relaxation) to regenerate and build up our reserves. When we are under any stress (threat), the body responds with elevated activity in multiple different organ systems to increase the chances of survival. Fuel stores are depleted, and reserves are lowered as energy is shunted to muscles in the event of fast action is required.

Our bodies are intended to be mostly in “neutral” or what is called homeostasis. When you are going about your daily business without noticing how you are feeling, you are in homeostasis. It can be maintained for long periods of time because reserves are being replenished commensurate with your needs.

Any time your body is under any kind of mental or physical threat, your body’s physiology will react in a manner to bring you back into balance. There are three contributors of this scenario 1) your circumstances (input) 2) the state of your nervous system (coping capacity) 3) output (body’s total neurochemical response).

By definition, anytime your senses any level of danger from any source, you are under threat – even if it lasts for just a few seconds. When you are in homeostasis, your body responds so quickly, you won’t notice the changes. However, when the threats begin to overwhelm your nervous system’s coping capacity, you’ll experience unpleasant symptoms.

The threats can be mental or physical and there are almost always multiple physical and mental responses. The physiological manifestations include:

1. Changes in your immune system with increased inflammation.
2. Your body’s metabolism (the rate you burn fuel). You are either storing fuel (anabolic state) or consuming it (catabolic state).
3. Nervous system activity – you are designed to become more sensitized and alert when there is potential danger.

These are broad categories of the effects of threat. But, since there are so many organ systems required to keep you alive, numerous physical and mental symptoms are created. Every symptom that is not from an obvious anatomical problem is a result of this interaction of your body responding to sensory input from your surroundings that is interpreted as potentially dangerous. How else could you stay alive?

Defining threat

Examples of physical threats include viruses, bacteria, being attacked by a predator – human or animal, hunger, lack of shelter, poverty, lack of opportunity, being bullied at work or school, racism, authoritarianism, trapped in a difficult living or family situation, and physical maladies.

Mental threats are processed in a similar manner as physical ones with the same physiological response. (2). They are more problematic in that humans have consciousness and many of our thoughts and emotions are unpleasant, and unlike visible threats like tigers or a severe storm, we cannot escape our thoughts. Repressed thoughts and emotions are even more impactable on your body’s neurochemical state. Many of our unpleasant thoughts are based on cognitive distortions or “stories” about our lives. Unfortunately, whether the threat is real or perceived it has the same deleterious effect.

Physiologically explained symptoms

Unpleasant sensory input progressively impacts your body at three levels.

• Response
• Symptoms
• Illness/ Disease

When the threat is short-lived your response will be appropriate to the situation and quickly disappears when it has passed or resolved. Almost every internal and external action of your body is directing you in a manner, so you don’t feel unpleasant sensations. If you do sense danger, you are programmed to resolve it immediately. Examples are looking away from the sun, spitting out rancid food, pulling your bare foot back from hot pavement, frequently shifting in your chair to avoid skin breakdown, and avoiding an aggressive dog.

When threats are more prolonged, you will begin to suffer symptoms such as back pain, tension headaches, anxiety, poor appetite, nausea, urge to urinate, sexual dysfunction, burning sensations, skin rashes, dizziness, ringing in your ears, and insomnia. There are over 30 different physical symptoms that can occur. (3)

But when threats are sustained, you have a significant chance of becoming seriously ill or developing a disease. It is well-documented that stress kills people and unfortunately the symptoms of a chronic illness also add to the threat load. This is particularly true in chronic pain. (4)

The nature of your body’s physiology under threat

Environmental cues of threat set off a defensive response. Immediately, before you are even aware, your immune system girds for the possibility of injury by initiating inflammation (to protect cells against bacterial or other invasion), elevates metabolism to provide fuel for defense, increases the speed of nerve conduction–which increases your alertness but also your pain sensitivity, and elevates the levels stress hormones (cortisol, adrenaline, noradrenaline, histamines). Much of this defensive state is modulated by small signaling proteins called inflammatory cytokines.

So how do you think you feel when you are in this physiological state? Your heart is racing, you are sweaty, tired, anxious, overwhelmed, nervous, stomach feels tight, blood pressure is elevated, pain is worse, and your breathing is rapid. The bottom line is that you don’t feel great when your body is in this heightened neurochemical state. Are these symptoms imaginary? Not a chance. None of them.

The consequences

This is a list of some of the symptoms and illnesses that are connected with your body’s physiology being in a prolonged heightened state:

Symptoms

• Irritable Bowel syndrome
• Irritable Bladder syndrome (interstitial nephritis)
• Migratory skin rashes
• Tinnitus
• Burning sensations
• Migraine headaches
• Pelvic, neck, thoracic, and low back pain
• Insomnia
• Tendonitis

Illness

• Anxiety
  • Depression
  • OCD
  • Bipolar
  • Schizophrenia
• PTSD
• Fibromyalgia
• Chronic fatigue

Disease

• Autoimmune diseases
  • Colitis/ Crohn’s disease
  • Ankylosing spondylitis
  • Rheumatoid arthritis
  • Multiple Sclerosis
• Cancer
• Coronary artery disease
• Alzheimer’s disease/ Dementia
• Early death
• Suicide
• Addictions
• Parkinson’s disease
• Obesity
• Liver disease
• Osteoporosis

There is a wide range of “Medically Unexplained Symptoms/ Illnesses/ Diseases” that are created by your body’s  survival response. Dr. Stephen Porges has eloquently explained how the autonomic nervous system through the vagus nerve, modulates these various physiological states. (5)

Why is MUS such a deadly diagnosis?

The worst aspect of the diagnosis of MUS is that it creates despair; it takes away hope. Research has shown that hope, optimism, and a sense of purpose are anti-inflammatory and allow your body to regenerate. (6)  So, the diagnosis itself is inflammatory and adds to threat. Do not accept it at any level. The correct diagnosis is MES.

Any major reason MUS is so damaging is that many physicians assume it is untreatable, there is nothing more that can be done, and refer you to a psychologist for any number of reasons that most of you are familiar with. “It is in your head.” You don’t have much of a pain tolerance.” “You are just looking for drugs.” You have “secondary gain issues and don’t really want to work.” The labels keep piling on and none of them are helpful to your healing and they are just wrong. But MUS has a certain finality to it, and it is crushing. It is tragic because physicians have not been taught the link between mental/ physical threats to the physiological changes that cause physical symptoms. I feel the ultimate tragedy is that with the correct understanding, MES is one of the most treatable diagnoses with minimal costs and risks.

Beware of IES (Incorrectly Explained Symptoms)

When there is an obvious anatomical abnormality and the symptoms exactly match the lesion, that would be considered a structural identifiable source of pain. An example would be a painful inflamed tooth. It is a straightforward process to diagnose it by testing with hot and cold or pressure. A root canal or pulling the tool will quickly solve the problem.

But this discussion is complicated by the fact that there is an emphasis in modern medicine to explain reasons for pain from a structural problem when the anatomical abnormality is not actually the cause of it. Many symptoms are attributed to normally aging anatomy and the cause and effect are not supported by medical research.

For example, pain is commonly attributed to scoliosis and there has never been a research paper documenting that it even contributes to back pain unless the deformity is severe and unbalanced (your head is not directly center over your pelvis).

Degenerative disc disease, bone spurs, arthritis, ruptured discs, bulging disc, and spinal arthritis have all been documented in multiple research papers that none of these “diagnoses” are the cause of chronic neck or back pain. (7)

There is marked debate about small tears of the structures around the hip and shoulder. Even severe hip, knee, and shoulder bone-on-bone arthritis has little correlation with pain. There is actually more of a relationsip to stress. (8)

How can you figure this out?

First, it is always important to undergo a medical workup to make sure there is not a structural issue such as vascular disease, pinched nerve, tumor, or an infection.

Second, regardless of the findings of the workup, maintaining your body’s metabolic, immune, and nervous system balance is important. If you require a procedure, your odds of a good outcome will be maximized.

There are many ways to accomplish this. The DOC Journey is one platform that presents proven medical treatments in a way that allows you learn and implement these strategies. All three aspects chronic illness must be addressed.

Output (stimulation of the body’s anti-inflammatory response)

• Breath work
• Mindfulness/ meditation
• Humming
• Vagal stimulation
• Certain pitches of music

State of the nervous system (decreasing sensitivity and stimulating neuroplastic changes in your brain)

• Exercise
• Sleep
• ACT (Acceptance Commitment Therapy)
• Processing prior trauma

Input (what are you uploading into it and what are you holding onto?)

• Forgiveness
• Cognitive Behavioral Therapy
• Expressive writing
• Never discussing your pain or medical care

What really does not work is just “coping”, which is what most of us have been taught to do. It requires specific approaches and tools to effectively create the desired changes. Regardless of what approach you use, the key is to learn how to utilize these tools to consistently process threat in way to keep you in homeostasis or a state of safety.

Finally, you must commit to taking charge of your own body and health. The first step is understanding the nature of chronic disease. The solutions lie in implementing strategies we already know are good for our health–healthy diet, sleep, regular exercise, taking time for yourself, process addictive behaviors, and nurturing close relationships. The common theme with all of these interventions is that they lower inflammation. Ongoing inflammation directly destroys tissues throughout your body.  It sounds daunting but it is more doable than you think. Not taking control may have more severe consequences than you can imagine.

Chronic pain is one of the MUS diagnoses. It is one that is particularly untrue. By understanding the nature of chronic mental/physical pain and the principles behind the solutions, it is a Medically Explained Symptom (MES) and a consistently solvable problem.

MUS must go!

References:

1. Edwards T M, Stern A, Clarke DD, Ivbijaro G, & Kasney LM. (2010). The treatment of patients with medically unexplained symptoms in primary care: A review of the literature. Mental Health and Family Medicine, 7, 209–221.
2. Eisenberger NI, et al. An experimental study of shared sensitivity to physical pain and social rejection. Pain (2006);126:132-138.
3. Schubiner H and M Betzold. Unlearn Your Pain, 3^rdMind Body Publishing, Pleasant Ridge, MI, 2016.
4. Smyth J, et al. Stress and disease: A structural and functional analysis. Social and Personality Psychology Compass (2013);7/4:217-227. 10.1111/spc3.12020
5. Porges Stephen. The Pocket Guide to the Polyvagal Theory: The Transformative Power of Feeling Safe. Norton and Co, New York, NY, 2017.
6. Dantzer R, et al. Resilience and Immunity. Brain Behav Immun (2018);74:28-42. Doi.10.1016.j.bbi2018.08.010
7. Jarvik JG, et al. Three-Year Incidence of Low Back in an Initially Asymptomatic Cohort. Spine (2005); 30:1541-1548.
8. Wise BL, et al. Psychological factors, and their relation to osteoarthritis pain. Osteoarthritis and Cartilage (2010);18:883-887.

The post The Myth of MUS (Medically Unexplained Symptoms) – It’s MES first appeared on Back in Control.

The post The Myth of MUS (Medically Unexplained Symptoms) – It’s MES appeared first on Back in Control.

• There is deep basic science research that has revealed the nature of chronic pain and this understanding will allow you to discover your version of a solution. The essence of the problem is sustained exposure to threat and the core of the solution lies in finding safety.
• Create safety by learning skills to:
  • Stimulate neuroplasticity – create and shift to new neurological circuits in your brain.
  • Learn to regulate your body’s neurochemical response to threats (stresses).
• As you learn about chronic pain, it is helpful to simply get started using some of these core tools to “jump start” the healing process.
  • Expressive writing
  • Active meditation
  • Restful sleep
  • No discussing your pain or medical care with others – especially your family

Many years ago, I would spend hours explaining chronic pain to my patients in the office but it was too complicated and it wore me out. That is when I decided to write, Back in Control. Patients would have a better understanding but there was no action. The website, www.backincontrol.com was the action plan and evolved into a self-directed process that allowed hundreds of people to break free from their chronic pain. The DOC Journey is the next rendition of the program. But the healing process begins when you begin to use methods that stimulate your brain to change. During the last few years of my practice I would ask patients to simply begin to learn and use the basic tools as quickly as possible and the rest of the concepts would fall into place. This is the first lesson of The DOC Journey.

 The nature of chronic pain (mental and physical) – sustained threat vs. safety

The essence of chronic illness, including chronic pain, is your body’s reaction to sustained stress because it responds with profound elevations of stress hormones, metabolic activity (rate of fuel consumption), and inflammatory markers (destroys invaders and your own tissues). The result is many different disruptive mental and physical symptoms.

The solution lies in learning the tools to create sense of safety, which normalizes your body’s survival fight or flight reaction. Successfully implementing these strategies causes a shift your mood, pain, and other physical symptoms. I am suggesting to dive in and begin using some of these basic foundational strategies right away. Why wait?

Creating Safety

Neuroplasticity is a term that describes your brain’s capacity to change its structure. You can form new connections, grow cells, increase the insulation around the nerves (myelin), and shift from unpleasant to pleasant circuits. Your brain physically changes in shape and structure based on programming.

As you learn strategies to regulate your body’s responses to stress, you have regained control, which creates safety. There are many ways to accomplish this and with repetition the process becomes automatic. It is like an athlete or musician attaining a high-level of skill. It cannot be done by just reading a book.

Let’s begin with these core strategies – Now

• Begin expressive writing. It is the one mandatory step to start. People can improve without doing it, but I have rarely seen people go pain free without engaging in this exercise. It has been documented in over a thousand research papers to be effective in creating significant shifts in multiple organ systems. (1)
• Practice active meditation. This involves placing your attention on a physical sensation for five to ten seconds as often as you can remember. You are switching to neutral or pleasant sensory input which causes less of a reaction in your nervous system. It requires minimal time and effort.
• Adequate sleep is critical. Lack of sleep has been shown to cause chronic pain. (2) With a multi-pronged approach, restful sleep can usually be achieved within 4-6 weeks. Medications may be needed for a few months.
• Never discuss your pain or medical situation with anyone except your medical providers. The solution for chronic pain lies in rewiring your brain around your memorized pain circuits. Your nervous will develop and evolve wherever you place your attention.

Why should this program work?

An important early step is to acknowledge and embrace your skepticism. Why should this DOC Journey work? You have been bounced around, promised relief time and time again, undergone failed interventions, and your pain is worse than ever. There is not any reason to think that this is going to work. I agree. In fact, primate research has shown that you can induce a major depression by repeatedly dashing hope. (3)

Every treatment offered in this program has been well-documented by decades of deep medical research; implement what is already known. I have watched well over 1500 patients break free from chronic pain and not only regain their life but thrive at a level they had never experienced at any point in their lives. It happened by them learning and using this DOC Journey sequence that evolved from my experience coming out of severe chronic pain and discovering what was effective with my patients.

What is not helpful is “believing” in the DOC Journey or David Hanscom, using positive thinking, or affirmations. It is about connecting with your current reality, which is unpleasant enough for you to sign up for this Journey. You are rightfully angry, frustrated, and trapped. It is the starting point. Feeling and knowing where you are at allows you to learn the strategies that allow you change direction. One successful patient commented what you need is a, “suspension of disbelief.”

Anything is possible

The DOC Journey begins with acknowledging doubt, learning awareness, and allowing hope to re-enter. Research has shown that hope and optimism are anti-inflammatory. (4) There is a lot of hope in hearing about other’s successes. I am increasingly convinced you can stimulate your brain to rewire around almost any pain regardless of the source.

I got another reminder when a patient who I never personally treated resolved his pain largely through The DOC Journey approach. He is now in his late 60’s and had experienced severe pain for over 22 years. He lost his marriage and business, ended up addicted to high-dose narcotics and attempted suicide. During this period, he underwent 28 surgeries. He has not only been free from pain for over five years, but he is enthusiastic that he has not felt this good since he was 30 years old. Historically, I would never have thought that this was possible in light of the severity of his trauma.

Please acknowledge your disbelief, embrace it, start with using these basic tools, and you’ll learn as you go. Helping patients emerge from The Abyss of chronic pain has been the most rewarding phase of my career. I am continually inspired by the resiliency of the human spirit and I am honored to be a part of your journey.

Recap of Lesson one – “Let’s Start Now”

Healing your pain requires repetition of tools that simulate your brain to change (neuroplasticity) and calm down your body’s survival response. The sooner you can engage with these strategies, the quicker you can begin to heal. That is why you might as well begin to use them ASAP. You will learn more about the nature of chronic pain and the principles behind solving it in a logical stepwise sequence throughout the rest of the course.

The next lesson will expand on the concept of threat vs safety and then more detailed explanations of these basic tools will be presented as you progress through leg one.

References:

1. Pennebaker JW and JM Smyth. Opening Up by Writing It Down. The Guilford Press, New York, NY, 2016.
2. Agmon M and G Armon. Increased insomnia symptoms predict pain among employed adults. PLoS One (2014);9:e103591. doi:10.1371/journal.pone.0103591
3. Blum D. Love at Goon Park. Perseus Books, New York, NY, 2002.
4. Dantzer R, et al. Resilience and immunity. Brain Behav Immun (2018);74:28-42. doi:10.1016/j.bbi.2018.08.010

The post Let’s Start Now and Learn the Details Later first appeared on Back in Control.

The post Let’s Start Now and Learn the Details Later appeared first on Back in Control.

Safety

With cues of safety from your environment, your response will consist of hormones such as serotonin (anti-depressant), dopamine (rewards), oxytocin (bonding), growth hormone (regeneration), and GABA chemicals (calming, anti-anxiety). The immune response stimulates anti-inflammatory cytokines. Metabolism will be lower and the whole scenario allows the body to rest and regenerate.

Physically, the result is feeling relaxed, slower heart rate and breathing, muscle relaxation, and reduced speed of nerve conduction, which decreases pain. The more time that can be spent in this regenerative state the better.

Most of the time, your body’s goal is to maintain equilibrium (homeostasis) and keep your range of behaviors and chemistry in a stable zone. For example, the nociceptive (pain) system unconsciously guides you to avoid actions that would cause harm. When you experience an uncomfortable or unpleasant sensation from any source, it is simply signaling danger and then you are compelled to take action to remain safe.

Threat

Environmental cues of threat are met with mobilization of all of your body’s resources in order to defend yourself. It includes your immune system with elevations of inflammatory cytokines, elevated metabolism to provide fuel, and the secretion of stress hormones such as cortisol, adrenaline, noradrenaline, histamines, and endorphins.

Physically and mentally, you are on “high alert” with numerous bodily responses. The basic ones include an increased heart rate, rapid breathing, increased speed of nerve conduction (increases pain), elevated blood pressure, sweating, muscle tension, and a sense of danger that we call anxiety. There also numerous symptoms created by this physiological state. They include tension and migraine headaches, neck and low back pain, skin rashes, stomach cramps, depression, bipolar, burning sensations in various parts of your body, and over 30 additional responses. Although the chemical environment encompasses your whole body, each organ and organ system will manifest its unique response.

Symptoms, illness, and disease

Balance is needed between your stresses and your capacity to deal with them. When you processing your circumstances well, you’ll feel connected to what you are doing and often will feel contented and safe. When your coping mechanisms are overwhelmed, your whole body will rise to the occasion to defend you, and every cell in your body goes into different levels of high alert. You will experience the above-mentioned threat symptoms.

When the threat is transient or resolvable, the symptoms will quickly abate. When it is more prolonged, you may develop an illness(es) that are reversible with appropriate treatments or when the stress has been resolved. When threat is sustained, people will eventually develop serious illness and diseases that cause permanent tissue damage and create mental havoc. Diseases don’t “just happen.” What would happen to your car if you were driving a long distance down the freeway at 70 mph in second gear. The engine would be running at a very high speed and will break down quickly.

There are two aspects of the situation that affect the quality of your life.

• The state of your nervous system:
  • Your inherent coping skills
  • Your current degree of neurological reactivity
• Your circumstances including:
  • The magnitude and duration of mental and/or physical threat
    • Note the human inability to escape from unpleasant thoughts and emotions.

Solving/ Preventing chronic disease

The core principles in solving/preventing chronic diseases with chronic pain being just one of many, are centered around the following 1) developing and nurturing a more resilient nervous system (processing center) 2) learning methods to process your stressors so they have less of an impact on your nervous system.

Examples of approaches to increase your nervous system’s coping capacity:

• Restful sleep
• Exercise
• Acceptance Commitment Therapy (ACT)
  • Learning to feel threatening mental or physical sensations and training yourself “to be with them.”
• Education – understanding the nature of chronic pain allows you to choose your own way of escape.
• Addressing childhood trauma
• Meditation practices

Some methods that lessen the impact of your threat:

• Cognitive behavioral therapy (changing thought patterns)
• Not discussing your pain
• Mindfulness/ active meditation – changes sensory input
• Forgiveness
• Awareness – can be used as its own tool
• Getting organized
• Expressive writing – separates you from your thoughts

Safety vs. threat

Modern medicine has nullified these aspects of care in that we are not given the time nor are we encouraged to talk to our patients. From the beginning, we are not providing cues of safety. Consequently, we don’t know our patients and their coping capacity and really don’t know much about their circumstances. We are given only the time to treat symptoms. We are ignoring the root cause of the problem. It is similar to trying to put out an oil well fire with a garden hose. It can’t and doesn’t work. Indeed, there is an ongoing and growing epidemic of chronic disease – both mental and physical.

A general overview of the mechanisms of how you will effectively be approaching chronic disease involves:

• Lowering inflammation (output) – calming techniques
• Increasing the resiliency of the nervous system – neuroplasticity
• Input – choosing what data to download

There is a marked amount of overlap and these three categories are artificial designations. They are intended to create a framework for discussion around developing and applying various interventions. You will learn tools to stimulate your brain to change and also calm down your nervous system. There will be a major shift in your body’s neurochemical profile. You can program your brain around most anything. Remember, this is not, “mind over matter.” You will lose that battle. Think of it more like a sculpting process and you have the power to create whatever reality you choose. The DOC Journey will guide you through this healing process at whatever pace you are comfortable with.

In summary, the root cause of chronic disease states is unrelenting exposure to threat and the solution is learning methods to create safety.

The post Principles of Solving Chronic Pain first appeared on Back in Control.

The post Principles of Solving Chronic Pain appeared first on Back in Control.

Acknowledging the extreme complexity of this topic, I have three basic observations. One is that anger is powerful and addicting. It does serve an important purpose in that it keeps you safe. There are few, if any rewards from a survival viewpoint, for being vulnerable. The second reason people can’t let go of their anger is that they have not learned to be vulnerable. It is an intolerable feeling and why would you want to experience it? Because it is also the essence of relationships and being human. What a dilemma!!

The final reason is that people are not connected to their anger. They have dissociated from it and can’t feel or see it. It manifests in multiple ways. However, just because you are not aware of them doesn’t mean that they are hidden from those who are close to you.

Processing anger overview

I have changed my thinking and have observed that you can’t just jump to forgiveness from anger without understanding and addressing all aspects of it. I now use the term, “processing anger” and there are three categories of interventions to accomplish it. Keep in mind that anger is a necessary and powerful force to stay alive. Instead of fighting, suppressing, or trying to get rid of it, a better concept might be, “developing a working relationship with it.

This process is an ongoing learned skill with much overlap.

• Output – Lowering inflammatory markers and elevated metabolism (body burning fuel) is a necessary starting point. Sustained elevations cause illness, chronic diseases, and early death. Your brain is also “off-line” because it is inflamed and blood supply is diverted from the thinking centers.
• The nervous system–If the nervous system is hyperactive for any reason, it will consistently overstimulate every aspect of your survival response.
• Input–Anger is always linked to an event in the past that either gets replayed in the present or is continually interfering with your current reality. Forgiveness simply breaks that link. It does not get rid of it. That is why forgiveness is such a dynamic ongoing skill that you use multiple times every day.

Why this sequence?

Addressing the output first is critical for several reasons. Your brain is affected by inflammation. The supporting cells of your neurons, called glial cells, throw off inflammatory proteins call “inflammatory cytokines” and your brain is sensitized. The danger signals to your brain are magnified and you’ll experience more pain. The blood flow to your neocortex (human thinking regions of the brain) is also compromised and it is impossible to think as clearly. The only intention in this state is your own survival and not the needs of those around you (unless it serves you). So, the first step is to use methods that directly lower this response by stimulating your autonomic nervous system (via the vagus nerve) to secrete anti-inflammatory calming cytokines, so you can learn and implement these new strategies.

Addressing the status of your nervous system is the next important phase. If you were raised in a chaotic or abusive family that was devoid of safety and deep nurturing, you won’t have much capacity to nurture and care for yourself, much less allow yourself to feel vulnerable (anxious). This is also a learned process that you will allow to happen over your lifetime. One of the paradoxes is that you can’t force it. That would be the antithesis of vulnerability.

Finally, forgiveness is a multi-dimensional process that changes the input into your brain so there is less intensity being sent to your brain and there will be a calmer output in the form of anti-inflammatory cytokines and safety hormones. It is actually a selfish act in that you are making a powerful move to take back the present moment. You are breaking the neurological links to the unpleasant aspects of your past.

Addressing the three aspects

Output

• Breath work
• Calming music
• Mindfulness/ meditation
• Medical hypnosis/ biofeedback

These are  autonomic nervous system interventions that directly stimulate the parasympathetic nervous system (calming). It may take a few weeks to learn and consistently implement them before you begin to feel less anxious and agitated. There are many layers of these tools. It has been a better starting point than trying to jump straight to forgiveness. You can only do what you can do when you can do it.

The state of your nervous system.

This is a critical piece of the big picture. Your central nervous system is processing over 20 millions bits of information per second and directing your behavior in ways to keep you safe and functional. Most of this occurs at an unconscious level. It is programmed to recognize danger that you learned from past experiences. Anytime you are anxious or angry, something in the present is connected to an unpleasant learning experience from your past. Understanding the nature and source of these “triggers” is important and then retraining your brain to choose different reactions when you really are not in danger.

Your immediate environment also dictates your state of alertness. Lack of sleep, poor nutrition (inflammatory), little physical exercise, troubled relationships also are factors affecting your perception and processing of pain. Each and all of them make a difference.

Input

What you choose to put into and keep in your brain is up to you. You can decide to continue to complain about your pain and troubles. Any time you are complaining, you are now the victim of that person or situation. Or you can be critical of almost everyone, anything, including the news and yourself. How does any of this help calm your nervous system? This does become challenging in that most things we are upset about are valid–but you are the one who gets to suffer.

Forgiveness is another layer of decision-making that dramatically alters the input. It is the method where your links to the past can be broken so that your prior life experiences quit ruining your day (life).There are many aspects to it. It is a complex, but learnable skill. You cannot do it intellectually. It is too powerful. The goal is to understand and implement this set of tools to the point it all becomes almost automatic. The groundwork of diminishing the output and increasing the resilience of your nervous system are first steps and productively dealing with unpleasant input will launch you into a new reality. Processing anger really is the “Continental Divide” for healing your pain.

The post Three Aspects of Processing Anger first appeared on Back in Control.

The post Three Aspects of Processing Anger appeared first on Back in Control.

• They are, first of all, the same entity. Anxiety is the sensation generated by your autonomic nervous system’s response to a threat. Stress hormones and inflammatory proteins are elevated and when a given situation doesn’t resolve (chronic pain), more of these molecules are secreted in an effort to regain control. The result is anger, which is anxiety with a neurochemical chemical kick. It is a response to the environment and not primarily a psychological issue.
• Anxiety and Anger are universal, powerful and necessary for life. You are not going to get rid of them.
• Anxiety represents a feeling of vulnerability and helplessness. The intention is to be so unpleasant that it compels us to take action to decrease it. So, we are hard-wired to avoid this emotion at all costs. In nature, there are significant penalties for being vulnerable.
• Anger feels powerful and is often effective in regaining control. It is a rapid response that solves or masks anxiety. It also gives you the extra boost to resolve a threat.
• But what happens to your thinking when you are angry? The blood flow to the frontal lobes of your brain is diminished, the inflammatory proteins in your brain sensitize you to sensory input, and much of your reaction emanates from the more primitive centers of your brain. You are flooded with a barrage of angry, intense, and irrational thoughts. It is temporary insanity.

• Anger both masks the feeling of anxiety and also turbocharges the system, which created it.

Reasons to forgive

There are numerous reasons to process and let go of your anger.

• The main one is that you simply cannot heal when you remain angry. The essence of healing is normalizing your body’s neurochemical state to that of a safety profile, which is profoundly restorative. If you whole system is fired up and remains so, how can that happen? It can’t and won’t. You can improve somewhat without forgiveness, but the deep healing can’t occur until you can calm down and truly let go.
• Another core concept of solving pain is stimulating neuroplastic changes in your brain. You physically can cause your brain to change its structure based on where you place your attention (suppression doesn’t work). That means you have to move towards your vision of what you would like your life to be like instead of continually trying to fix your prior life. You cannot move forward until you let go of the past, especially your deepest wounds. Most people in chronic pain remain angry at the situations or people who have harmed them. The more legitimate your gripe, the harder it is to move on. But how does holding onto the past make your life more enjoyable.
• Anger is destructive, as it is supposed to be. It your body’s last ditch effort to escape threat. It is destructive in every direction, including self-destructive. It is the reason why many people completely neglect every aspect of their health. It is tantamount to slow suicide.
• Anger is abusive. It also destroys relationships. The key element of successful human interactions is awareness of your needs and others’ needs. How else can you constructively interact with those close to you. Anger completely blocks awareness at every level.
• Anger destroys families. We evolved language and the human consciousness through language and social interactions. It is ability to cooperate that took homo sapiens from the bottom to the top of the food chain. There is a deep need for human connection. Unfortunately, close family connections are also the strongest triggers. Why would you ever be unkind to someone you care for so much? Why is the incidence of domestic abuse so high? It is maybe the most disturbing paradox of our human existence.

• When you are angry, you are in the fight mode of the survival response of fight, flight, freeze, or faint. Your body’s response is to mobilize every resource to survive. The blood supply to your gut, bladder, and the frontal lobes of your brain diminishes and is shunted to your heart, lungs, and skeletal muscles. You can’t think clearly, although it might seem like you are. That is why it is so critical to, “take no action in a reaction.”
• The problem is that this reaction that blocks awareness also blocks the creativity needed to constructively solve the problem. It really does represent temporary insanity.
• Forgiveness is the most powerful and definitive move that you can make to take charge of your life. It is actually a selfish and bold act. You are no longer allowing someone you dislike (despise) continue to be in your head and run your life. You don’t have to like this person–ever. You are just breaking the link between the past and present.
• I often asked my patients that what is your day like when you are angry? Forget about your pain. It isn’t a great day. So regardless whether you are in pain or not, anger will compromise your capacity to enjoy your day. You are in Hell and you may be so used to being there that you might not even know it. Take a deep breath and think about this scenario for a while………

Why hold onto anger?

It keeps you safe. It protects you from both emotional and physical pain. There are few, if any, rewards in nature for being vulnerable and humans are part of this reality. In essence, you are being asked to give up your anger so you can experience anxiety. Raw anxiety is an unpleasant feeling. It is this interaction that may be the root cause of why it is commonly thought that you cannot really be open for change until you “hit bottom.” In other words, the anxiety is so out of control that it can no longer be contained by either functional or dysfunctional means.

So, it is not an unwillingness to give up anger that is the problem. It is inability to feel and tolerate vulnerability. That is why a critical aspect of The DOC Journey is the sequencing that allows you to learn tools that allow you to feel safe. You will learn how to regulate your body’s neurochemical reaction to both internal and external threats. Each person is unique and has to engage with the process on his or her own terms.

One of the antidotes to anxiety/ anger is control. But another one is to give up the need for control. That is what the whole DOC Journey is about–awareness, calming down, stimulating neuroplasticity, letting go, moving towards a vision, and enjoying your life. You can’t fix chronic pain, but you can crowd it out of your brain and life.

What do you want? What do you really want? Don’t try. Do it!!

The post Forgiveness–The Continental Divide of Freedom and Hell first appeared on Back in Control.

The post Forgiveness–The Continental Divide of Freedom and Hell appeared first on Back in Control.

There are two ways of stopping a deadly pandemic. One is through developing immunity, either by exposure to the virus or by inoculation with a vaccine. The other is to prevent people from dying. The key is to prevent the inflammatory response from reaching a level that destroys tissues and its host’s organ systems. The graph below illustrates the issue.

Cytokines

Cytokines are small signaling proteins that transmit higher-level signals and coordinate activities between cells. Consider them as the final off and on switches. They are central to modulating the immune system and inflammatory response. There are two categories of cytokines: pro-inflammatory (Pro-I) and anti-inflammatory (Anti-I). While Pro-I’s protect us by warding off acute perils, Anti-I’s keep us safe by allowing us to regenerate, thrive, and prepare us for battle with environmental enemies.

One term used to describe the excessive elevation of the inflammatory cytokines is “cytokine storm.” It is unclear whether there really is a “storm” or whether the normal rise of already elevated cytokines pushes people over a critical threshold into tissue edema and destruction.

Any real or perceived threat elevates Pro-I’s. That is the desired, normal response and is usually successful in protecting you from harm. However, COVID-19 virus can induce a powerful reaction that can kill you. The goal of treatment, aside from defeating the virus, is to prevent the levels of pro-inflammatory cytokines from crossing that fatal point of no return.

There are two ways to accomplish this goal. One is to arrest the activity of Pro-I’s before the level of inflammation reaches a crisis point. In the graph, the horizontal dotted line represents the level of inflammation where cytokines cause severe damage to body organs. Once that threshold is reached, mortality rate is high. The asterisk (*) represents the point where interventions to halt this “cytokine storm” are being explored. There are definite possibilities.

Graph by D. R. Clawson, MD

The other approach is to ensure that patients begin with a lower cytokine load in the first place so that, should the Pro-I’s rise as expected when faced with COVID-19, the level of elevation does not cross the critical threshold. There are strategies to this end that can be easily pursued by any of us. Presenting these approaches is the goal of this paper. First, it is important to understand the nature of threat. Download pdf for detailed discussion

 Threat

Any mental or physical threat is going to be met with a defensive response from your body. Much of this is mediated through the vagus nerve, at the core of the autonomic nervous system. The response is the well-known fight, flight, or freeze reaction. Dr. Stephen Porges has wonderfully presented the sequencing in his well-known, Polyvagal Theory. (Porges)

We are familiar with the physical manifestations of an increased heart rate, sweating, rapid breathing, muscle tension, elevated blood pressure, etc. But what you may not know is that the immune system also gets fired up and mobilizes many types of cells that fend off predators such as bacteria, viruses, and cancer cells. The result is inflammation where the “warrior cells” exit the blood stream through widened openings in the blood vessels to destroy the invaders (antigens). Cytokines are small proteins that are the “switches”, which activate and deactivate this activity.

Threat always activates pro-inflammatory (Pro-I) cytokines. Physical threats include allergens, parasites, bacteria, viruses, lions, tigers, bears, and people we perceive as dangerous. Less obvious but even more inflammatory are mental threats, because we can’t escape from them. The sustained inflammatory response destroys tissues and is the basis for chronic mental and physical disease. Examples of mental threats are memories, negative thoughts, suppressions, repressions, insecurities (social, financial, health, etc.), cognitive distortions, loss of life perspective, and purpose.

Discovery and acknowledgement of all our threats–whether real, imagined, anticipated, or repressed–is the first step towards addressing them. The second is choosing an adaptive rather than a maladaptive escape to safety, whether the threat be physical or spiritual. We are better at physical escapes to safety than we are at spiritual ones (Fredheim). If you don’t feel safe and peaceful, you are carrying elevated levels of cytokines. If you encounter the additional threat of a COVID-19 infection, you will have less chance of surviving, since you’ll already be closer to the critical threshold.

Lowering your cytokines

I am going to present an overview of the approaches and you can access this booklet that discusses each strategy in more detail. Each one has been document in medical research to lower your pro-inflammatory response (Pro-I’s) and improve your chances of surviving the COVID-19 infection. Using as many of them will increase your odds of surviving. Conversely, ignore them at your own risk. You may have noticed in the news that the people who are dying have “risk factors.” Every one of these causes an elevation of inflammatory markers. Poverty is one of them and there are a multitude of problems connected to living in this environment. But the essence of the problem is that it is a tremendous ongoing stress directly affecting your body’s ability to defend itself.

Below I have outlined ten areas to address in order to reduce your inflammatory cytokine load. I am going to summarize them, and you can access a more detailed discussion in this pdf.Each strategy will lower your pro-inflammatory response (Pro-I’s) and will improve your chances of surviving the COVID-19 infection.

1. Understand and treat anxiety. Anxiety is simply your body signaling danger. It is the sensation generated by elevations of your stress hormones, activation of the sympathetic nervous system, elevated Pro-I’s, and the inflammatory reaction. It is not a “psychological issue,” although mental threats are more likely to over-stimulate the nervous system than physical ones. With the correct approach, it is solvable.
2. Get adequate sleep. At least seven hours a night of restful sleep lowers your threat response and inflammation.
3. Employ expressive writing. You can’t control your thoughts and emotions but writing them down, tearing them up and discarding the paper separates you from them. The practice has a remarkable impact on both mental and physical symptoms.
4. Practice forgiveness. Anger creates a powerful neurochemical reaction with marked elevations of Pro-I’s and inflammation. There is no shortcut to overcoming anger but it needs to be dealt with quickly. You also must address your deepest wounds. Do you want the person or situation you hate to be what ultimately kills you? Who would win?
5. Follow an anti-inflammatory diet. This can make a remarkable difference in lowering Pro-I cytokines. This is a separate goal than from losing weight.
6. Decrease stimulation of your nervous system.
   1. Limit watching the news.
   2. Avoid watching violent and over-stimulating shows, especially at night. Just witnessing violence will increase Pro-I’s (ref).
   3. Stop negative talk, such as complaining, gossiping, discussing your medical problems or care, giving unasked-for-advice, and criticism.
7. Maintain an exercise regimen.
   1. At least 30 minutes a day
   2. Moderate and enjoyable
8. Stay on top of your medical problems.
   1. Control your diabetes.
   2. Take your blood pressure meds.
   3. Comply with all of your recommended medical treatments.
   4. Stay in touch with your doctor, even about issues you consider minor.
9. Directly address family issues. Families trigger each other, but there are effective ways to create structure that will minimize conflict.
   1. Living in chaos is not only unpleasant; it also has a negative impact on your health.
   2. Your family is usually the source of your biggest triggers.
   3. Be nice! Any member of your family who feels trapped is at higher risk for an illness or chronic disease.
10. Having fun is one of the most powerful ways to stimulate the production of Anti-I’s and relaxation hormones.

 Life is tough

 It is easy to drop into living life in a survival mode. Life is tough, competitive and challenging. For animals without consciousness, it is far more simple. You either learn the skill and cunning to survive–or not. There is also a lot of luck. Humans have the additional characteristics of language, socialization and can deal in the abstract. One of the curses of consciousness, is the only thing we know for sure is that we are not going to live forever. It is the ultimate fear. Yet we spend a lot of time distracting ourselves and trying not to think about it.

The paradox

Here is the paradox. The more anxious and frustrated you are, for any reason, you are adding to your threat load and there is a much higher chance that you will develop a severe disabling disease and die earlier. Additionally, while living in this state, your capacity to enjoy the time you have been given on this earth is compromised. You are living a chaotic and reactionary life and even forget to ask yourself, “where is the endpoint?” There is none. You cannot outrace your mind.

Instead of surviving and hoping to thrive someday, it is necessary to flip the paradigm. Thriving is a learned skill similar to learning a new language. Once you have learned it, your odds of surviving improve, regardless of the circumstances–including COVID-19. Thrive and survive.

Plan A: Thrive and Survive COVID-19 pdf

1. Porges, Stephen. The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, Self-regulation. Norton and Co. New York, NY, 2011.

Contributors: Polyvagal Work Group

David R Clawson, MD–Physical Medicine and Rehab, Seattle, WA

Stephen Porges, PhD––“Distinguished University Scientist” Indiana Univ Bloomington

Les Aria, PhD–Lead pain psychologist, Kaiser Northern CA, Sacramento, CA

Steve Overman, MD–Rheumatology, Seattle, WA

Matt Lederman, MD–Internal Medicine, Co-founder of Kinetin.com

Steve Lederman, MD–Cardiology

Ray Bunnage–Database and Visualization Developer, U of WA Medicine, Seattle, WA

Hara Marano–Senior editor-at-large, Psychology Today, New York, NY

James Taylor, MD–Anesthesiologist, Pain physician, Pinehurst, NC

The post Thrive and Survive COVID-19: The Polyvagal Approach first appeared on Back in Control.

The post Thrive and Survive COVID-19: The Polyvagal Approach appeared first on Back in Control.

It can be difficult for patients to accept that their problem is, essentially, “undetectable” while experiencing so much pain, it seems impossible that so many tests would come up negative. Here are some points to consider.

• Since people generally keep moving the injured part, the irritation will last a while. Although immobilization may calm it down more quickly, the resulting stiffness can also be a problem.
• Soft tissue pain can occur in any part of the body. Most musculoskeletal pain originates from the soft tissues and the diagnosis is made by the location of the symptoms, what movements make it better or worse, the time of the day, and response to medications.
• Rarely are imaging studies helpful. The problem is manifesting itself at a level below the sensitivity of any diagnostic test.
• Regardless of the source of the pain, it becomes memorized by your brain in about six to twelve months. Then the solution lies in addressing both the soft tissues as well as the nervous system. Soft tissue work alone won’t resolve it.
• Back pain is the most common reason for disability and chronic pain. The reason why is it that it hurts–a lot. The inflammation/ irritation can arise from the fascia, ligaments, tendons and the discs. The worst part it that intense muscle spasms may occur, which is the body’s guarding response. The intensity causes one to worry about the severity of the injury. Often, patients are told that their backs are in bad shape, which isn’t reassuring. The vast majority of the time, patients backs are fine, as the spine normally degenerates with age.
• So, physicians can make an exact diagnosis of the source of low back pain only about fifteen percent of the time. (1) Generally, we do not know the exact cause because of the nature of soft tissue pain.

“No one believes me”

Patients may become frustrated when pain from an “undetectable” injury doesn’t let up. They begin to feel that no one believes them. Unfortunately, this type of injury is far more likely to persist than, say, a broken bone. In the spine, once the soft tissues are irritated, they may stay irritated through normal daily activities, sometimes almost indefinitely. If you severely sprained your ankle and kept re-spraining it on a daily basis, how long would it remain painful? For a long time.  On the other hand, broken bones heal in three to four months. The prognosis for a fractured spine has been shown to be better than the prognosis for a muscle sprain.

My tennis elbow

One of my own muscle/tendon afflictions is tennis elbow. I may set it off when I lift too heavy of a weight at the gym or when I practice my terrible golf swing. I can suffer for six to 18 months with severe pain in either one or both my elbows. It hurts to shake hands, reach up and adjust the lights during surgery, use the surgical instruments, and countless other routine activities. The pain is as severe as any pain I have experienced, and it is persistent. Two years after my last episode, I could still push on the spot on my elbow and slightly feel the irritated area. Yet if I were to have an X-ray, MRI, CT scan, or bone scan of the area, the results would be completely negative. If I were to have a biopsy, there would might be some inflammatory cells in the tendon area. However, since a biopsy would not change treatment, there would never be a need to do one.

Although we often cannot identify the exact structural source of the pain, we do know that pain fibers are being stimulated and are sending messages to the brain. The intensity of the pain may increase if more pain fibers are stimulated or if the sensitivity of the brain increases. The final perception of the pain will depend on how many pain areas that are stimulated in the brain.

Additionally, as mentioned above, chronic pain evolves into a brain disease regardless of the source.

1. Nachemson, A. “Advances in low back pain.” Clinical Orthopedics and Clinical Research (1985); 200: 266-278.

The post B – Non-Structural Pain first appeared on Back in Control.

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