mindfulness -vs- fascia: vox takes on pain

IS MINDFULNESS REALLY THE ANSWER TO MOST CHRONIC HEALTH ISSUES AND PAIN?

Mindfulness Pain

Brian Resnick recently wrote an article for Vox called 100 Million Americans Have Chronic Pain. Very Few Use One of the Best Tools to Treat it, which contains a variety of information about CHRONIC PAIN in general (BTW, his 100 million stat is correct) as well as specifically on CHRONIC BACK PAIN, FAILED SPINAL SURGERIES, ASYMPTOMATIC DISC HERNIATIONS, the PLACEBO EFFECT, CENTRAL SENSITIZATION, along with numerous others.  He also brought up a number of books, including a couple by Dr. John Sarno.

Sarno and a growing number of others believe that much — maybe even the majority of  — people’s pain is caused by something he’s coined as TMS (Tension Myositis Syndrome).  What is TMS?  In many ways it’s like FIBROMYALGIA in that it’s symptoms are rather diffuse and widespread and frequently includes things like pain, TRIGGER POINTS, PARESTHESIAS (numbness, tingling, and a variety of other abnormal sensations) as well as SCIATICA.  People in Sarno’s camp look for tender points in three areas specifically — on the outer buttocks, the upper traps, and the lumbar errectors / paraspinal muscles of the low back.  They also look for a history of what they refer to as “Mindbody Syndromes“.  What are Mindbody Syndromes you ask?

Mindbody Syndromes involve diseases that are said to be not real (or at least not real in the sense that there are no tests or examinations that create a definitive diagnosis) or dramatically over-diagnosed.  Some that were mentioned by various doctors promoting TMS included INTERSTITAL CYSTITIS, IRRITABLE BOWEL SYNDROME, chronic pelvic pain (vulvodynia), CHRONIC BACK PAIN, CHRONIC NECK PAIN, HEADACHES / MIGRAINES, WHIPLASH, STOMACH ULCERS, or pain caused by disc issues or wearing or worn out joints (ARTHRITIS, SPINAL STENOSIS, DJD), as well as others. 

Chronic pain tends to lead to something known as “catastrophizing” or believing that everything is or will be a catastrophe.  The website Psych Central put it this way.  “Catastrophizing is an irrational thought a lot of us have in believing that something is far worse than it actually is. Catastrophizing can generally can take two different forms: making a catastrophe out of a current situation, and imagining making a catastrophe out of a future situation.”  In English, this means that many people are ruled by both fear and stress; both of which lead to an all-too-common problem I have written about extensively (SYMPATHETIC DOMINANCE).  Resnick had this to say about a person who had been living in a loop of fear, stress, and catatrophizing…….

“Golson had been catastrophizing his pain, thinking of the worst possible outcomes, like losing his job or having to largely start over in life. A similar thing happens to people who suffer from anxiety: Feelings get magnified in a loop of negative rumination.  Research has shown that catastrophizing is associated with worse pain outcomes: more intense pain, and a greater likelihood to develop chronic pain. It’s also associated with higher levels of fatigue.  Neuroimaging studies suggest that if you engage in catastrophizing thoughts, it amplifies pain processing — so you’re unwittingly pouring gasoline on the fire.  But as a chronic pain patient who bounces from specialist to specialist seeking a diagnosis, it’s hard not to catastrophize.  Considering how dangerous and damaging the past decades of treating chronic pain with addicting opioids has been, and how risky and expensive surgery can be, they’re a worthy option, one that’s never sold to doctors by pharmaceutical representatives or advertised directly to consumers on TV. The most common psychological treatment for pain, and the most well-studied, is cognitive behavioral therapy, or CBT. Overall, it’s one of the most rigorously tested and effective tools psychology has to offer. More typically, it’s used to treat anxiety, phobias, and mood disorders like depression. But it can also help some people manage their pain.  Like the somatic tracking exercises described above, the goal of CBT is to come to a new understanding about pain. That it isn’t something that’s physically harmful and that certain thoughts and behaviors can make pain worse.”

I agree with most of what’s in this paragraph.  After all, as a man thinketh in his heart, so is he (HERE).  And face it; opioids are dangerous and ineffective for anything beyond short term use (HERE).  By the way, I’ve mentioned CBT on my site a number of times.  Most of the therapies that fall under this umbrella involve talking things out or writing down past hurts that might be repressing emotions.  Practitioners have patients recognizing characteristics that might be doing a great deal of harm (people pleaser, perfectionist, etc), and then work on figuring out why certain situations cause certain responses.  Many of those teaching various sorts of Mind / Body Therapies also urge those under their care to stop all PHYSICAL THERAPY, CHIROPRACTIC, or massage treatments in addition to gradually returning to normal ADL’s (Activities of Daily Living).  Finally, support groups and in some cases psychotherapy, are needed.  Some of the bigger studies that back Cognitive Behavioral Therapies include……

  • 2014’s study in American Psychologist (Cognitive-Behavioral Therapy for Individuals With Chronic Pain)
  • 2016’s study in JAMA (Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain)
  • This month’s study in JAMA Internal  Medicine (Association Between Psychological Interventions and Chronic Pain Outcomes in Older Adults: A Systematic Review and Meta-analysis)

While I think that mindfulness techniques are unequivocally important for people struggling with certain types of chronic pain, there are some holes in this way of thinking that bear discussion.  For instance, of the Mindbody Syndromes mentioned earlier, Interstitial Cystitis and IBS are both real AUTOIMMUNE DISEASES.  Furthermore, we have a different understanding of ulcers than when Dr. Sarno wrote his original book back in the 1970’s (HERE).  What I really want to bring up, however, are the mechanical issues such as back pain and neck pain.  To do this I want to use whiplash as my example.

Whiplash is not only extremely common (HERE), but is another of the myriad of health-related issues that do not show up with normal imaging (HERE).  But guess what?  That’s not because there is nothing there to see in a whiplash injury, but because current technology does not even remotely approximate what it’s been touted to do (i.e. x-rays only show bones, but MRI shows eeeeeeverything). 

Renowned whiplash researcher Nikolai Bogduk and numerous others have proved this with studies showing extensive post-whiplash microscopic damage via tissue samples taken from autopsies.  It’s no different, really, than what’s currently going on in the NFL with Chronic Traumatic Encephalopathy (CTE).  While there is currently no imaging or blood tests for CTE, thanks to autopsies we now know it not only exists, but on some level affects almost 100% of professional football players (see Will Smith’s excellent movie, Concussion).  And we have not even begun discussing the three main reasons people get headaches / migraines (HERE), one of the biggest being adhesed fascia.

FASCIAL ADHESIONS are so common in CHRONIC PAIN SYNDROMES that they could almost be considered ubiquitous.   And here’s the kicker; you can’t see them with standard medical imaging such as MRI or X-ray either (HERE).  I don’t have to explain what this means to the average sufferer.  Accusations of drug-seeking, malingering, or essentially being labeled a whiner who needs to suck it up and get tougher.  Furthermore, how in the world can any practitioner or physician take care of people’s chronic pain or chronic health issues while their patients continue living a state of perpetual systemic inflammation — inflammation that 100% of the time leads to fibrosis / scar tissue (HERE)?  And in case you weren’t aware, fibrosis is America’s #1 leading cause of death (HERE).  So yes, it is a big deal.

Do you remember earlier where I stated, “They also look for specific tender points on the outer buttocks, the upper traps, and lumbar errectors / paraspinal muscles“?  These are problems that can all easily be explained by fascial adhesions or myofascial trigger points — problems that in most cases can be successfully addressed BIOMECHANICHALLY.  The area of the buttocks mentioned is where CLUNEAL NERVE ENTRAPMENT occurs (be aware that there are any number of other cutaneous nerve entrapment syndromes that are all fairly common as well — HERE).  The lumbar errector muscles are where the THORACOLUMBAR FASCIA lives (a very common area to get adhesions), not to mention the fact that UPPER TRAPS / LEVATOR trigger points are far and away the most common place to get trigger points.

While I think that the medical community grossly under-appreciates the mind in relation to chronic pain or other chronic health issues, I also feel that the brain (IN THE FORM OF CS) can become a convenient scapegoat.  Instead of “gee, I don’t really know why you are struggling with this problem Mrs. Smith, maybe you ought to go see if that whackjob Dr. Schierling could help you in a single visit like he does so many people” (HERE), it’s easier to just tell Mrs. Smith, “it’s all in your head“.   Despite the fact I see these sorts of cases on a daily basis, allow me to share with you the story of a patient who recently flew in for a week of treatment. 

This individual (I’ll call him Ralph) had struggled for years with chronic tightness and restriction in his neck, chest, and abdominal area (he had about 50% normal motion in his neck) despite living a healthy lifestyle.  On day one I spent most of my time in the neck and upper back region making a bit of headway with his ranges of motion but in all honesty, it was not great.  On day two, I worked my way down into the chest and abdomen, which helped a bit as well.  Here’s the crazy part.  Since his lower abdomen had significant scar tissue, I checked his hip flexors.  Not only did they have a lot of buildup of adhesion, but when I broke said adhesion his ROM in his C-spine normalized.  Instantly — an “ANATOMY TRAINS” sort of moment. 

What’s doubly interesting about his case is that the one and only thing that had benefited Ralph up to this point (years of seeking) was meditation and mindfulness.  But he realized after reading my FASCIA PAGE that his problem was not simply all in his head.  Yes, mindfulness helped.  No, he could not meditate away hardcore FASCIAL ADHESIONS.  No one can.  In fact, I would hate to be the person to tell someone like DONNIE T that his problem was all in his head!

If you are interested in seeing a post that addresses multiple aspects of chronic pain, including the mind-body connection, all you need to do is CLICK HERE and start reading.  I’m not selling you anything and am not guaranteeing a “cure”.  What I am suggesting is that there are probably some effective things you could be doing for yourself, but for whatever reason, are not.  Oh; and if you found this post interesting or informative, be sure and get it in front of the people you love and care about most.  The easiest way to accomplish this is by showing us some love on FACEBOOK.

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