Common links to all chronic illnesses

Chronic mental and physical diseases are caused by common problems occurring at the genomic (DNA) and mitochondrial level (energy generators in each cell). These are the most basic components of evolution and maintaining life. Basic science research has brought this to light in numerous papers. The problem is the lack of communication between these silos of knowledge and clinicians to bring these critical concepts into the clinical domain.

This is short list of symptoms, illnesses, and disease states caused by exposure to chronic stress (threat), which is catabolic (consuming fuel) and inflammatory (attacking tissues). It is the reason that “stress kills.”¹ The variables are the intensity and duration. The sources of threat come in an infinite number of forms and can be real or perceived.

Symptoms

• Anxiety
• Obsessive thought patterns
• Carpal tunnel syndrome
• Migraine headaches
• Tension headaches
• Facial, neck, thoracic, and low back pain
• Pelvic pain
• Irritable bladder syndrome (interstitial nephritis)
• Irritable bowel Syndrome (IBS)
• Migratory skin rashes
• Tingling/burning sensations
• Tinnitus
• Insomnia
• Chronic mental and physical pain

Illnesses

• Fibromyalgia
• Chronic fatigue
• POTS disease (postural orthostatic hypotension)
• Asthma
• Hypertension
• PTSD
• Eating disorders
• Reflex Sympathetic Dystrophy (RSD)
• Temporomandibular joint syndrome (TMJ)

Diseases

• Cardiovascular disease
• Dementia/ Alzheimer’s disease
• Parkinson’s Disease
• Renal failure
• Autoimmune disorders
  • Crohn’s disease, colitis, rheumatoid arthritis, SLE (systemic lupus erythematosus), dermatomyositis, psoriasis, and ankylosing spondylitis
• Early mortality
• AODM
• Metabolic Syndrome
• Obesity (core)
• Major depression/ deaths of despair (suicide)
• Peripheral vascular disease
• Osteoporosis
• Bipolar disorder
• Addiction
• Obsessive compulsive disorder (OCD)
• Schizophrenia
• Cancer – except colon cancer and melnoma

You may be wondering how so many different symptoms and disease states can be linked by a common cause. It is because under sustained heightened threat physiology, each cell and organ system responds in its own unique way and will eventually breakdown.

Each of us is unique

Chronic disease is a complex problem affected and defined by many individual variables. It is not going to be solved by information gained by prospective clinical trials on ill-defined groups of patient. There are several reasons for this problem.

• • Trauma of any sort is connected to a higher chance of experiencing chronic disease.² It is worse when it happens in childhood as it alters the structure of the brain as well as causing long-term elevations of inflammatory markers. However, chronic adult trauma, bullying, or living under societal threats also keeps one in an activated threat state.³

There are at least four patient scenarios that affect one’s capacity to heal.

• Willing to engage – Since the greatest factor predicting a successful outcome is willingness to engage and take responsibility, any clinical study has to begin here. If people can or will engage, will they heal? This seems to consistently play out and we have seen hundreds of patients heal as evidenced by many powerful testimonials. This group must be clearly defined, and then various clinical interventions can be evaluated and refined with ongoing research. The “stages of change” questionnaire is one validated tool to sort this out.⁴
• Emotional inability to engage – This group is one who has suffered so much trauma that they have incurred a significant mental illness and/ or have no capacity to face incredibly unpleasant emotions. They are in a mental survival state. 86% of people in chronic pain referred as an outpatient to a psychiatrist are so frail, they cannot engage.⁵ It is a major reason why traditional psychotherapy is not very effective for treating chronic pain. There are ways to bring this group into a better state.
  • Skilled somatic trauma therapy – training one to feel safe
  • ISTDP – Intermediate Short Term Dynamic Psychotherapy.⁶ This is a specific approach designed to teach people to tolerate unpleasant emotions and also feel safe.
  • Specifically stabilizing their mental health situation.
• Don’t want to engage – Angry/ frustrated – This group is maybe the most challenging in that they are so angry that they will not engage in anything. Anger is a hyper-inflammatory/ metabolic state that causes the neocortex (thinking centers) to be less active and the survival midbrain to become more active. In other words, they cannot think clearly and process new information. They also don’t want to in that anger is destructive, including self-destructive. So, the activated physiology also blocks willingness to engage.
  • There are many approaches to bring them back “online”, but it is unclear what is the best approach for a given person.
• Lack resources – There are other obstacles to learning new skills. They include illiteracy, low educational level, no access to computers or lack skills, low IQ, poor access to care, poverty, chaotic family situation, and anything that causes unrelenting threat (stress).

Treating the individual

• We are not going to be healed from data gleaned from randomized clinical trials on general populations. Each person is “programmed” by their entire past up to this moment and are infinitely unique. It is a little unclear how modern medicine has veered so far away from treating each person individually.
• The complexity of chronic disease, uniqueness of each person and circumstances, and the need to address multiple factors simultaneously makes it impossible to do randomized prospective studies on large ill-defined groups and obtain meaningful data. It simply cannot and will never be done. How can you compare a college professor with someone who is illiterate? The core basis for our “data” is deeply flawed.
• We must think differently, as current approaches are not only ineffective, but they are also making the problem of chronic disease much worse. “Data” has not helped us heal. In fact, physicians, by being more focused on the data (which they may not realize is so flawed) have become more detached from their patients as they continue to administer ineffective care. Many caregivers and patients alike are frustrated by the lack of success and have somewhat given up.
  • Research has shown us solutions for specific symptoms, but it has not helped us deal with the complexity of a person and his or her disease state.
• This quote from Dr. Francis Peabody in 1927⁷ is at the core of the problem.

Disease in man is never exactly the same as disease in an experimental animal, for in man the disease at once affects and is affected by what we call the emotional life. Thus, the physician who attempts to take care of a patient while he neglects this factor is as unscientific as the investigator who neglects to control all the conditions that may affect his experiment.

What we now know is that emotions reflect one’s physiological state and he was well ahead of this time. In 1927, he was concerned with the intrusion of technology into the patient/ physician relationship.

Summary

Big data is harming all of us because it is not granular enough. Not only is the burden of chronic disease continuing to rise, but it is also crippling our society both financially and emotionally. “Mainstream medicine” is not only actively promoting ineffective risky, expensive, and ineffective treatments, we are hurting people that trust us.

Chronic disease is solvable by applying a systematic approach that creates a healing alliance where both the patient and provider can heal. Humans are not data points. The “data-based” foundation of care is deeply flawed. Is it any wonder that the burden of chronic disease continues to crush us financially and emotionally?

It is more important to know what sort of person has a disease than to know what sort of disease a person has. 

              Hippocrates

References

1. Holmes TH, Rahe RH. The Social Readjustment Rating Scale.J Psychosom Res (1967); 11:213–8. doi:1016/0022-3999(67)90010-4
2. Felitti VJ, Anda Rf, Nordenberg D, et al. The relationship of adult health status to childhood abuse and household dysfunction. American Journal of Preventive Medicine (1998); 14:245-258.

3. Takizawa, R, et al. Bullying victimization in childhood predicts inflammation and obesity at mid-life: a five-decade birth cohort study. Psychological Medicine (2015); 45: 2705- 2715.
4. Carr JL, et al. Is the pain stages of change questionnaire (PSOCQ) a useful tool for predicting participation in a self-management programme? BMC Musculoskeletal Disorders (2006); 7:101-108. doi:10.1186/1471-2474-7-101.

5. Abbass Allan. ISTDP in the treatment of chronic pain. Lecture to the Dynamic Healing Discussion Group (4/6/22); from the Halifax ISDTP database. https://drive.google.com/drive/folders/1k9AXx1webG69mKlCGoCU8XeUtNwTTM3q?usp=sharing
6. Abbass Allan, et al. Intensive short-term dynamic psychotherapy to reduce rates of emergency department return visits for patients with medically unexplained symptoms: preliminary evidence from a pre-post intervention study. CJEM (2009); 11:529-34.
7. Peabody FW. The care of the patient. JAMA (1927); 88:877-882.

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There is a growing group of health care professionals who are determined change the current trajectory of medical care. There is an ever-increasing burden of chronic mental and physical disease¹, current approaches are not working, yet we are continuing to embrace them.

The core of chronic disease

Chronic disease is created by your body’s sustained exposure to stress hormones, increased metabolism (fuel consumption), and inflammation. The term is for this situation is, “threat physiology.” The solution lies in learning methods to bring your body into safety physiology, which is necessary for regeneration and healing.

An informal workgroup was created in early 2020 consisting of research scientists and clinicians. We meet twice a month for an hour and have discovered that there is deep research documenting the effects of chronic stress on your body.^2,3,4 Historically, these scientists have not had a consistent forum to communicate with each other and most of this knowledge has not entered clinical care.

A deeper understanding of the nature of chronic disease, including chronic mental and physical pain, offers possibilities of solutions. Indeed, many clinicians have watched many patients break free from chronic pain as they have learned the principles and tools to alter their body’s physiology from threat to safety.

Is your body a parked car?

A parked car has no “symptoms.” You have to start it so see what is going on and then systematically test it if it is not running well. But what if it is a new car that runs out of gas, or the wrong fuel was put into the tank? What if you drove it in second gear for days at 80 mph? There will be “symptoms” before there are structural changes from it breaking down.

Of note, your body is never “turned off.” In fact, the complexity of interactions happens at around 20-30 million bits of information per second.⁵ It is well-beyond human comprehension about how it all works together although we are gaining some ground. We have no clue about human consciousness. We know rough concepts about what part of the brain lights with what input. One of my more skeptical spine fellows pointed out that current technology is a start, but he likened it to seeing what a person is making for dinner from a plane flying at 35,000 feet without magnification.

The myth of MUS (Medically Unexplained Symptoms)

How would you feel if you tried to run a marathon without any training? What if I decided to play NFL football, even for one play? My body is “normal” (could be better) but I would quickly develop symptoms. Most bodily symptoms, illness, and disease are physiological issues and not structural. Medicine has gone completely the opposite direction, addressing most problems as structural, and if they can’t “find” anything, it must not be “real.” There is even a new term that arose in 2002 called, “MUS” (Medically Unexplained Symptoms).⁶ That could not be farther from the truth. Looked at from the perspective of the body’s function, the correct term would be, “MES” (Medically Explained Symptoms).

This summit brings together pioneers of many disciplines of care who have dedicated their lives and careers to making life better for everyone – providers and patients. You will hear the research and data directly from them. I will warn you that you may not understand some of the deeper data in some of the presentations, but you will definitely get a feel of the concepts.

A letter from some of the presenters

Thank you so much for joining us for this paradigm-shifting two-day virtual Summit about the common basis for chronic disease, including chronic pain.

 Stephen Porges, Les Aria, DR Clawson, and David Hanscom have been working together with an extended community of doctors, scientists, and researchers to better understand each other’s fields of expertise and how they fit into addressing chronic pain. It has been fascinating and exciting to see the evolution of so many concepts and how they fit together in a cohesive model.

The Speakers

This group of speakers has been researching and documenting best practices around solving chronic pain. They include EAET (Emotional Awareness and Expression Therapy), PRT (Pain Reprocessing Therapy), and ISTDP (Intensive Short-Term Dynamic Psychotherapy). They  developed, refined, and documented the effectiveness of these approaches.

• Howard Schubiner, MD – EAET, PRT
• Tor Wager, PhD – Documented the effectiveness of PRT with fMRI’s
• Allan Abbass, MD – ISTDP
• Yoni Ashar, MD – PRT

These speakers are true pioneers in their fields.

• Steven Hayes, PhD – Founder of ACT (Acceptance and Commitment Theory)
• Angelos Halaris, MD – Early pioneer in the field of psychoneuroimmunology
• Richard Gevirtz, PhD – Deep research documenting the role of the autonomic nervous system in the creation of disease.
• Stephen Porges, PhD – Originator of the Polyvagal Theory

Some researchers that have made core contributions are:

• Sue Carter, PhD – International expert on oxytocin/ vasopressin
• Naomi Eisenberger, PhD and Robert Lustig, MD – renowned for linking mental health to physiology, metabolism, and neural circuitry.

Clinicians who are presenting the implementing these ideas include some of the above speakers and:

• David Clawson, MD – physiatrist/ chronic pain/ rehab
• Nicole Sachs, LCSW – leader in mind/ body medicine
• Steve Overman, MD – rheumatology
• Les Aria, PhD – chronic pain/ clinical psychologist
• David Hanscom, MD – orthopedic spine surgeon

Bruce Lipton, PhD is the author of the “Biology of Belief” who was also a pioneer in presenting many of these ideas over 30 years ago.⁵ He is the final speaker. What is fascinating is how modern neuroscience has confirmed many of his concepts. Your belief systems affect the expression of your genetic code (epigenetics), your inflammatory markers, the function of the mitochondria (fuel generators in each cell), and are connected with many chronic disease states.

Mental threats are the bigger problem

This brings us to the second day where we present the data on how mental stress creates sustained threat physiology, and the result is many physical and mental symptoms, including chronic pain.

Bringing so many disciplines together has been deeply rewarding and enriching for all of us and we hope it will be for you too. Pull up a comfortable chair and immerse yourself in the weekend. We are looking forward to exploring these ideas together and setting the foundation for next year’s progression of these concepts.

The Summit is intended to present these emerging ideas to a wide audience and further deepen the cross-fertilization of ideas amongst the participants. Whether you are a doctor, health professional working with chronic pain patients, caregiver, sufferer yourself, or a basic science researcher, you will discover a different way of looking at the source of the issue as well as some innovative solutions.

Best regards,

David Hanscom

Steve Porges

Les Aria

DR Clawson

The Summit

Many of the presenters have educational materials, books, courses, and apps that are useful for both clinicians and patients. They will be organized, and links provided at the course.

You can register here. The Summit will be recorded and with registration the recordings will be available for 30 days after the conference.*

*CME credits are available only for those who attend the live conference.

This is not just another pain summit. It is the coming together and flow of innovative ideas and concepts. Be a part of our efforts to bring medicine closer to practicing and implementing known and documented effective interventions for chronic mental and physical disease.

References:

1. O’Neill Hayes T and S Gillian. Chronic Disease in the US: A Worsening Health and Economic Crisis. AmericanActionForum.org, September 10^th, 2020.
2. Dantzer R, et al. Resilience and immunity. Brain, Behavior, and Immunity (2018); 74:28-42.
3. Cole SW, et al. Social regulation of gene expression in human leukocytes. Genome Biology (2007); R189. doi: 1086/gb-2007-8-9-r189
4. Naviaux R. Perspective: Cell danger response Biology—The new science that connects environmental health with mitochondria and the rising tide of chronic illness. Mitochondrion (2020); 51:40-45.
5. Lipton, Bruce. The Biology of Belief. Hay House, Los Angeles, CA, 2016.
6. Edwards TM, et al. The treatment of patients with medically unexplained symptoms in primary care: A review of the literature. Mental Health and Family Medicine (2010); 7:209-221.

The post Not Just Another Pain Conference – The 2nd Annual Pain Summit first appeared on Back in Control.

The post Not Just Another Pain Conference – The 2nd Annual Pain Summit appeared first on Back in Control.