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Chronic Pain

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Have you been living with ongoing back and sciatic pain, neck pain, tension headaches, arm pain, fibromyalgia, or irritable bowel symptoms? Does your pain dictate every aspect of your day and leaves you in constant fear of moving the wrong way while wondering if the pain will ever end? Perhaps you have seen one or several doctors and alternative practitioners who were able to relieve the symptoms on a temporary basis through treatments and medications but it still seems that the root cause of the pain has not yet been identified and addressed. 

Illustration by Isabel Seliger

Neuroscientific advances in the last twenty years have demonstrated beyond doubt that chronic pain and other 'unexplained' chronic symptoms are not solely physical. Rather they reflect how we process our emotions and beliefs and how we deal with different types of stress in life (source).  

In essence, scientists now understand that chronic pain, fatigue, brain fog, anxiety, digestive issues and many 'medically unexplained conditions' such as chronic fatigue syndrome and fibromyalgia, which persist long beyond an injury or infection, are usually in fact learned responses to different emotional or stress triggers. These are caused by the brain and an overactive nervous system and are taking place at a subconscious level, so patients - and practitioners - are not generally aware of it. This is what we call Psychophysiologic Disorders (PPD), Tension Myositis Syndrome (TMS), or mindbody symptoms.  (source). 

In my body-mind approach, I aim to help individuals identify and process the underlying causes of their chronic pain while also developing healthier neural pathways that allow a pain free, healthy life. My goal is to enable individuals to become more stress resilient, emotionally aware, and able to live a healthier, active life moving forward. 

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A False Positive

What can feel even more confusing is when your doctor sends you for an X-Ray or scan and sees wear and tear such as a bulging or ‘slipped’ disc, spinal degeneration, or a joint that shows arthritic changes. You may be told that this is the cause of the pain, yet research has demonstrated that these believed to be abnormalities are in many cases normal signs of aging and usually not the cause of the pain. Numerous studies have shown that a big number of people who received scan results showing disc, joint and arthritic problems did not report any physical pains (https://www.sirpa.org/chronic-pain-research/). On the other hand, you can see very normal looking spines on X-Rays and people reporting to be in excruciating pain. 

DISCLAIMER: Obviously some conditions may have a solely structural cause and in order to diagnose and then safely treat a condition as stress-induced, it is necessary to have these ruled out first by a medical practitioner (e.g. cancer, infection, fracture, autoimmune disorders).

Understanding Pain 

One in three consultations in primary care is concluded without a specific diagnosis and approximately 15-30% of primary care patients suffer from ‘medically unexplained symptoms.’ Pain is usually misunderstood, both in terms of what causes it and why. All pain is generated in the brain and ALL PAIN IS REAL. In fact, the brain is responsible for generating every sensation we feel in our body. When our brain perceives a threat, it alerts us through pain and other uncomfortable sensations. The threat can be physical or psychological. Thus, perceived threats can come from physical tissue damage as well as from overwhelming life situations, chronically high stress levels, fears, and avoidance of unpleasant emotions. 

When feelings of chronic stress or unresolved painful emotions persist over time, our body’s danger alarm mechanism works overtime and does not switch off. Our brain turns into a car alarm that constantly goes off even though there is nothing seemingly wrong with the car. Our bodies become caught in a fight or flight stress response resulting in the sensitization of the nervous system, which in turn causes persistent pain. These stress-induced conditions are called Psychophysiologic Disorders (PPD), Tension Myositis Syndrome (TMS), or mindbody symptoms. 

Research has shown that the severity of tissue damage is not relevant to pain becoming persistent. What is relevant are the following: whether the individual was highly stressed, depressed, or overwhelmed at the time of the injury, whether they had believed early on that their acute pain might become permanent, and also whether they had exposure to traumatic past life events (source). In relation to the ladder, numerous studies have linked stress and trauma with chronic pain, including Adverse Childhood Experiences (ACES).

The misunderstanding that persistent pain must have a structural explanation has led to hundreds of millions of chronic pain patients being misdiagnosed and thus receiving treatment that tries to manage the symptom while completely ignoring the underlying causes.

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How do I know if my pain might be stress-induced?

Once your doctor has ruled out any medical conditions and your pain could not be explained or it was explained but not relieved, then it is quite possible that your pain is mind-body or emotionally-caused.

Let’s start exploring the relationship between your pain and your chronic stress or unresolved painful emotions. The more questions you answer with a ‘yes,’ the more likely it is that you have a Psychophysiologic Disorder (PPD).

  • Does your pain increase when your stress, anxiety, or depression levels increase or in anticipation of stress?

  • Do you find that your pain is inconsistent? Does your pain appear to come on for no reason at all and can spread or move around? Does it seem to go away when you are distracted?

  • Do you have more than one pain symptom?

  • If the symptom began after an injury, has it persisted long after the injury should have healed?
    (healing of most physical injuries is complete in 6 weeks or less)

  • Do your symptoms occur after, but not during, activity or exercise?

  • Are you very critical of yourself or do you tend to push away your emotions?

  • Is it highly important to you to please others or be seen as good by others?
     

Here you can find an extensive list of questions that could help further explore the origins of your pain symptoms: https://ppdassociation.org/symptoms 

Listed below are some of the diagnoses that are commonly found to be stress-induced:

Musculoskeletal:

Back pain, neck pain, hip pain, shoulder pain and other aches and pains throughout the joints or limbs, Tension headache, Fibromyalgia, Sciatica, Whiplash, Repetitive Strain Injury (RSI), Complex Regional Pain Disorder (CRPD), Temperomandibular Joint Syndrome (TMJ), Chronic Tendonitis, Carpal Tunnel Syndrome, Piriformis Syndrome, Plantar Fasciitis, Iliotibial Band Syndrome, Trigeminal Neuralgia, Thoracic Outlet Syndrome, Bursitis, Tendonitis, Sacro-Iliac joint dysfunction. N.B. When Muscles, Ligaments and Tendons are targeted this can cause pain wherever the soft tissue is in the body.

Nerve symptoms may include; numbness, itching, burning, tingling, pins and needles, plus muscle weakness, muscle spasms and involuntary movements, restless leg syndrome etc.

Bladder and genitals:

Spastic bladder, bladder frequency, testicular pain, penile pain, Interstitial Cystitis, chronic prostatitis, undiagnosed pelvic pain, erectile dysfunction, infertility, impotence, vaginitis, vaginismus .

Skin:

Eczema, acne, psoriasis, hives, rashes etc

Mental health:

Obsessive compulsive thoughts, Eating disorders, Depression, Anxiety, panic attacks, Body dysmorphic disorder (BDD), Self mutilation

Gastrointestinal:

Abdominal pain, Ulcer symptoms, stomach pain, nausea, vomiting, IBS, colitis, spastic colon, Hiatus hernia, heartburn, acid reflux, Constipation, diarrhoea.

Immune system:

‘Wind up’ – allergies, hay fever, food intolerances
‘Wind down’ – frequent infections, such as ear, chest, bladder, thrush, cystitis, etc. Veruccas, warts

Heart and Lungs:

(Clearly, as with any other organic symptom, all tests must rule out any other cause first) Repetitive cough, shortness of breath, undiagnosed chest pain, palpitations, high or low blood pressure, hyperventilation or shortness of breath, irregular heartbeats, arrythmias.

Others:

Medically Unexplained Symptoms, Functional Neurological Disorders, difficulty swallowing or gagging, chronic fatigue/tiredness, Migraines, Bell’s palsy, facial paralysis, Vertigo/dizziness, blurred vision, Tinnitus, changes in voice, dental pain etc.