My arms reach upward as the mind and hair are disintegrating, reaching through burning into the light. Grounded in the earth, I dance. My heart lifts up, surrendering into light, moving with the energy, letting go of resistance, opening to the possibility of a new layer of growth, channeling wild fury and mad aliveness. I am here to be bold and to show the real, raw intensity of what my past two months have been like. I have had a rash on my skin from an unknown cause that erupts as red welts on my arms. Ouch. I am in process of getting tested to discover the underlying root cause, but in the meantime, enduring outrageous jumping-out-of-my-skin irritation *%?#*! Yikes! I am using this intense experience to build endurance and stamina… to practice staying grounded and present in the midst of such reactivity, this is for real. Just as in nature, there are wild storms as well as peaceful meadows, I see this energy may be an aspect of shadow anger that has been suppressed that is now erupting, in my body as well as in the collective….what if I can welcome even this and thus become more whole.

This intense description of suffering reflects several important concepts. This type and pattern of pain is uniquely difficult to endure.

First point is that there is a clear cause for the skin rashes. When your body’s physiology (how it functions) is in a flight or fight mode, inflammatory mast cells are activated. Each cell has many granules of inflammatory chemicals that released that create intense reactions. They include:

• Allergic reactions – migratory skin rashes with burning/ anaphylactic reactions
• Irritable bowel syndrome – stomach pain, diarrhea, constipation
• Burning, itching, hot, cold sensations throughout your body
• Irritable bladder (interstitial nephritis)

Mast cell releasing histamine during allergic response – Dr_Microbe/AdobeStock

MUS or MES?

There is testing is being done to find out the cause, but most of medicine is looking in the wrong places. The diagnosis of MUS (medically unexplained symptoms) may be applied to this situation. It is a common diagnosis that could not be more wrong. When your body is in sustained flight or fight, everything is wrong. Every cell in your body is bathed in this stress chemistry bath and the reason why there are so many different symptoms. The correct term should be MES (medically explained symptoms).

The next point is  this person has correctly identified that this is the shadow side of anger. However, the terminology is tricky in that anger is also the sensation generated by threat physiology. Anger and the pain are the same entity. The better term for anger is “hyper activated threat physiology.” It is not a psychological problem. The key to treating both of them is learning methods to lower your stress chemistry. It is one of the main focuses of The DOC Journey. It requires a multi-pronged self-directed approach that is not difficult but requires commitment to develop the expertise to regulate your physiology.

Connecting to the pain

What is unusual about this story is the degree to which these symptoms are being embraced and being a source of learning to move to a higher place. Most of us want to fight or run from them, which unfortunately reinforces the pain circuits. Being with your pain, mental or physical, is a major aspect of healing. There is a saying, “what you resist will persist.” It is similar to trying to escape from a finger trap. The harder you pull, the tighter the trap becomes and the key is letting it loosen first and gently remove it.

What I am concerned about is that this is intense pain and unless there are other approaches being used to move forward, you’ll eventually become worn down. White knuckling alone can’t and won’t work. Combined with other tools, this is a remarkably powerful step. In the “C” quence of healing, connecting with your pain is a foundational step, but not the final solution.

Anger – the tipping point

The most significant tipping point in healing is learning to process anger and move forward. This is challenging in that when you are suffering from chronic pain, you have a legitimate reason to be extremely angry. These symptoms are intense and it is hard to “make space” in order to heal. I have always been in favour of doing whatever is needed in order to provide symptomatic relief. Some options include medications, biofeedback, local measures, vagal stimulation, and possibly spinal cord stimulation. None of this are definitive solutions, but in the context of a healing journey, can be very helpful.

Scottish Fold Cat – koldunova/AdobeStock

Ants under the skin

I have a close friend of mine who developed sensations of ants crawling under his skin throughout his whole body. He was more than miserable. I talked him through the concepts behind solving these symptoms. One way of lowering inflammation is by stimulating the vagus nerve. It is the 10th cranial nerve that originates in the middle part of the brain and connects to every internal organ and the immune system. It is highly anti-inflammatory. He re-engaged in the expressive writing, active meditation, and then used various breath techniques that stimulate the vagus nerve. He used them with a vengeance. Within a couple of weeks, the sensations resolved, and have been gone for over 6 months. There are still other things he can do to keep moving forward, but his remarkable focus on one set of techniques to jump start the process was remarkable. The other factor was him taking charge of his situation.

My story

My personal experience included severe burning sensations that enveloped both of my feet for over 20 years. During the worst period of my ordeal, I felt like they were in toaster ovens, especially at night. I took off my shoes whenever possible. I underwent many tests to find the cause and nothing was found. These symptoms have been gone for over 19 years with just occasional tingling. I also had skin rashes that would randomly appear on my arms, wrists, and legs. They were preceded by severe burning for 10-15 minutes, would last for several hours, and then disappear. Those have also resolved unless I quit using the tools I teach everyone else. If I stop doing expressive writing for a few weeks, the first symptoms to show up are skin rashes on the backs of my wrists.

Summary

This story represents the major paradox in treating chronic pain. The tipping point is processing the legitimate anger about having it, but how do you not be angry when suffering at this level? It happened for me and also for hundreds of other patients I have witnessed breaking free. I can’t completely explain how I broke free or how I got there. The common theme is persistence in using the tools and layering on others. Jumping around for a solution doesn’t work and it is counterproductive. In the depths of my frustration, I remember the deep sensation of being fed up with it all and moving on. Although I been trying to use many tools with quite a bit of success, it marked the tipping point of my symptoms resolving over the next six months. Your body knows how to heal.

The post Fierce Pain – Medically Explainable Symptoms (MES) first appeared on Back in Control.

The post Fierce Pain – Medically Explainable Symptoms (MES) 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.