The Forgotten Dialect:
Our Body Language

Part 1: Medicine's Blind Spot

* By the example we set for ourselves, through our thoughts, words and actions, we determine our happiness. Hence, we are responsibile for our own emotional state.

Definitions: The following terms are used interchangeably in this paper: stress, emotions, turmoil and tension. Although typically people think of stress as something originating from our environment and emotions as something that arises inside of us, in the context of this writing they are both considered internal creations. In my opinion, a person or event would not be stressful if it didn't emotionally upset us.

Disclaimer: The concepts presented in this paper are not meant to substitute a medical evaluation or treatment. Although developing our emotional awareness will lead to substantial improvements in the quality of our life experiences, it will not necessarily lead to the resolution of a particular physical or mental condition.

Medicine's Blind Spot

* A problem in one part of the body is often a reflection of an issue with the person as a whole. To better understand and treat illnesses, we need to think holistically.

After finishing my neurology training in 2005, a problem began revealing itself to me in my clinic. There was a glaring discrepancy between what I was "taught" about human illnesses, and what I was actually "seeing". If I tried sticking to my education, most of my patient's illnesses did not follow the textbook. Many neurological illnesses do not show up any tests, so the story of the patient's symptoms is the most important piece of information. I found myself either having to ignore some of their symptoms or I would ask them to describe their symptoms in a way to fit the textbook. Using leading questions, in essence, I would highjack their story so that it would make sense. I was trying to force a square peg into a round hole. Even when the patient's story was nicely explained by a textbook illness, important questions were still left unanswered. Why did the illness start now? If "problem A (high blood pressure ie.)" was the primary cause of "problem B (a stroke ie.)", then what caused "problem A" to begin with? And why doesn't everyone with "A" get "B"? And why can't we predict how this illness will progress?

Many other doctors are experiencing this same problem. Research confirms that only 10-16% of problems that people go to their primary care doctor for, have an identifiable cause. Not surprisingly, most these problems don't respond to medical treatments well (1,2).

Pain disorders are the perfect example. If we really knew what was going on with pain disorders, doctors would agree on the cause and pain would be easy to treat. However, depending on the type of doctor you go to, you are likely to receive a different diagnosis for your pain. And regardless of how elaborate or expensive the treatments may be, the results are not necessarily predictable, reproducible or long lasting. In fact, most treatments do no better than a placebo (fortunately placebo is pretty powerful).

Epidemics of pain attributed to degeneration of the spine have flooded the medical community. The problem with the explanations and treatments offered to these people is that they don't make sense and they don't reliably work. If degeneration causes the pain, then why do 64% of people without any back or nerve pain have serious spinal disc abnormalities and/or degeneration showing up on their MRI scans? Those MRI abnormalities are not useful in predicting the development of future pain problems in those people either (3,4). Surgically fixing spinal abnormalities is no more effective than conservative treatments at relieving back pain and disability according to major reviews (5,6). We can fix the spinal degeneration, but we cannot guarantee you'll feel better. And, even though spinal degeneration is more common with age, studies show that back pain actually decreases above the age of sixty-five (7).

Knee pain is another good example. X-rays do not correlate with pain. 10% of people with knee pain have normal X-rays. About 50% of people with severe arthritis in the knee, have no pain (8). Treatments are no better than placebo. Doing knee surgery using a scope to either remove arthritis or flush out the knee joint is no more effective than a placebo surgery. In one study, the real surgery and the fake one relieved pain and disability to the same extent (9).

Science and technology are awesome when it comes to solving isolated, specific problems. However, the human system is interconnected. Specific physical problems are often the manifestation bigger issues. When medical treatments suppress symptoms in one part of the body, a new symptom will pop up elsewhere. Medicine has become so focused on our individual body parts it doesn't see that fixing symptoms is not fixing people's lives. If we expect medical technology to fix us, we will eventually find ourselves disappointed and on a dead end road. In the next section, we will step back and take a holistic look at the human condition.

1. Kroenke K, Mangelsdorff AD; Common symptoms in ambulatory care: incidence, evaluation, therapy, and outcome; Am J Med. 1989 Mar;86(3):262-6.

2. Mountainview Consulting Group (2008). Integrating primary care and behavioral health services. American Psychological Association. Bureau of Primary Health Care: Managed Care Technical Assistance Program, p. 8.

3. Jensen MC, et al; Magnetic Resonance Imaging of the lumbar spine in people without back pain; NEJM. 1994 July 14; 331: 69-73.

4. Boos N, et al; Natural history of individuals with asymptomatic disc abnormalities in magnetic resonance imaging: predictors of low back pain-related medical consultation and work capacity. Spine. 2000, 25: 1484-92.

5. Weintstein JN, et al; Surgical vs. nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trail (SPORT): a randomized trail. Journal of the American Medical Association. 2006, 296: 2441-50.

6. Weinstein JN, et al; Surgical vs. nonsurgical treatment for lumbar degenerative spondylolisthesis. New England Journal of Medicine. 2007, 356: 2257-70.

7. Strine TW, Hootman JM; US national prevalence and correlates of low back and neck pain among adults. Arthritis Rheumatology. 2007, 57: 656-65.

8. Creamer P and Hochberg MC; Why does osteoarthritis of the knee hurt- sometimes? British Journal of Rheumatology. 1997, 36: 726-728.

9. Moseley et al; A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee. New England Journal of Medicine. 2002, 347: 81-88.