The Forgotten Dialect:
Our Body Language

Part 7: Mindbody Research on Pain

Pain Disorders

What is causing all this pain? The answer will vary depending on which professional you ask. But generally the root causes are felt to be due to deconditioning (underuse), overuse (repetitive stress injury, inflammation, strain), aging (arthritis, degeneration or pinched nerves), a previous injury or an irritable nervous system (migraine, fibromyalgia or reflex sympathetic dystrophy). Often, choosing which root cause to blame for someone's pain is not based on the patient's specific symptoms or exam findings. We will all fit into one of those root categories at one point in our life. Whichever one is most prevalent in our life when a chronic pain disorder starts, usually gets blamed for the pain. People with nearly identical types of pain and test results, might receive vastly different diagnoses depending on their age or life circumstances. If they work heavy labor, the pain and MRI results are more likely to be blamed on overuse. If they are elderly and sedentary the same type of pain and MRI results are blamed on aging and deconditioning. How can underuse of the body in one individual cause the same symptoms and findings that overuse of the body causes another? If aging, and the degeneration that comes with it, is the cause of this rising number of pain disorders, then why does back pain become less common above sixty-five years of age, as mentioned earlier in this paper? How can a distant physical trauma lead to lasting pain (which sometimes doesn't even start for months or years after the trauma) when we know that the body heals quickly (usually less than six weeks) after the most invasive and bone breaking surgeries we can perform? When people develop discomfort that has the quality of nerve pain (sharp and electrical), why do we assume the nerve must be physically injured? We know from surgical experience that when a nerve is intentionally cut the patient experiences a loss of function (numbness or weakness), but does not reliably experience pain.

As a doctor that previously made those types of diagnoses, I must admit I did not notice these inconsistencies because I was eager to help explain people's problems and I could not even comprehend that the root cause was more than a physical, structural problem. I did not realize that, although many pain problems begin because of a physical issue, the mind can associate that pain with neutral factors and revive it later in life, long after the tissues have healed.

Just as the mind can induce severe immune dysfunction after associating it with a harmless substance like saccharin, the mind can also induce pain after learning to associate it with other harmless factors. Phantom limb pain is a perfect example of this. People who have had pain in a limb, can experience that pain long after the limb is gone! Studies are showing that those individuals who develop this painful disorder have changes in the wiring of their brain (29). This suggests the pain perception is real, but is a learned phenomenon like a faulty brain program. Researchers have been able to help some individuals recover from this disorder using nothing but a perceptual trick. They use a mirror to convince the brain that the missing limb is actually intact and functioning normally. This takes time and persistence, but eventually the faulty brain program is unlearned and the pain is gone (30).

If we continue to blame neutral factors for our pain, we continue to create more faulty brain programs. And we quickly lose our freedom as our unconscious mind collects more and more pain “triggers”. We will also miss the big picture as we become obsessed with the part of the body that hurts. If we start to look deeper, however, we may be amazed by what is really going on. Dr. Schubiner describes an individual, in his book “Unlearn Your Pain”, who had suffered a leg injury in a traumatic Vietnam War experience. He recovered, but later in life his leg would hurt and he would have to limp for a few minutes “out of the blue”. One day, during an episode, his wife said “Do you hear that helicopter?” He replied, “No, I didn't, but I hear it now.” The next time his leg hurt, he noticed again there was a helicopter overhead. As he began to recognize this association for what it was, his pain and limping were no longer triggered by it (31).

If chronic pain disorders are perpetuated by overzealously learned associations, why is it that some people develop them and others don't? This has to do with our inner turmoil. Faulty brain programs determine when and where we experience pain, but our inner tension, which has no other way out, is the energy that fuels the pain. It may help us to learn about our pain threshold. The pain threshold, or how sensitive we are to perceiving pain, is directly related to our emotional state. Although many of us view the pain threshold as something outside of our control, if we look at our own life experiences, I'm sure we will find that our pain threshold is adjustable. We are more likely to feel physical pain when we are having an emotional melt down. We are less likely to feel pain with a similar injury if we are emotionally stable. We have all observed happy children hurt themselves without complaining. Yet a similar injury would result in inconsolable crying if they were upset at the moment it occurred. Neuroscience has even started mapping out the area of the brain that, when activated by emotional instability, increases our experience of pain. Neuroscience is also showing that there is another area of the brain that is activated by education and emotional balance to decrease our experience of pain. Through learning to activate the correct brain centers we can actually improve our pain threshold!

It is easy to see how chronic pain disorders are a manifestation of unresolved stress being expressed in the body. But why is it that so many of us manifest the same types of chronic pain disorders? And some pain disorders, like fibromyalgia and interstitial cystitis, didn't even exist a couple decades ago. Is it possible that these pain disorders are contagious within our culture? Maybe our unconscious mind is learning to express physical pain in a specific way by learning from our friends, doctors and the news. If that is true, then we would expect pain disorders to differ in different cultures. The unconscious mind would choose the most appropriate type of disorder depending on the expectations fed to it by that society. Do we see that phenomenon? The answer is yes! In the 1990's Norway's socialized health system was being burdened by an epidemic of disability due to whiplash. Investigators decided to look at a similar group of people in Lithuania, a neighboring country where expectations after a car accident were different. They identified 210 people involved in car accidents and 210 people without injuries and followed them over a year. They found that in Lithuania, whiplash did not exist. A car accident did not cause neck pain or headaches any more often then those who had no injury (32).

Another study looked at low back pain in East and West Germany by measuring the rates of disability. Before the Berlin wall was taken down, West Germans had three times more disability due to low back pain. After the Berlin wall came down the rate of back pain in East Germany sky rocketed. The rate of back pain-induced disability between the two countries was nearly the same within just five years. These investigators hypothesized that back pain is a communicable disease and suggested a harmful influence of back-related beliefs and attitudes were transmitted from West to East Germany via mass media and personal contacts, see graph below (33).

For example, someone may have severe low back pain that resolves after a steroid injection. Sometime later they then might develop shoulder pain. This might be diagnosed as a rotator cuff tear and treated with surgery. Now that the shoulder pain is gone, they might notice problems with urinating and find the prostate is enlarged. After this is treated they may discover that they feel anxious for no particular reason. There would be no one physical way to explain all these isolated body problems. And each specialist will believe he/she has fixed the patient's problem. Yet the patient would recall that ever since that first problem started, even though it is gone, they have never gotten better. One part of the body started acting up after another. Despite successfully treating all the symptoms the individual may now have a list of medications to take and a list of doctors they must regularly visit. If we truly intend to understand the root cause of our illnesses, we must first learn to step back and view our lives in a holistic fashion. As we do this we will naturally see how our physical health and emotional health have always been connected. We will also see that modern medicine has powerful treatments to offer, but they are short term fixes at best. If we truly want to experience long lasting health, we must simultaneously recognize the importance of emotional awareness.

28. Martin BI et al; Expenditures and health status among adults with back and neck problems. Journal of the American Medical Association. 2008, 299: 656-664.

29. Flor H; Phantom limb pain: a case of maladaptive CNS plasticity?; Nature Reviews Neuroscience. 2006 November; 873-881.

30. Doidge N; The Brain That Changes Itself; Penguin Books 2007.31. Schubiner H with Michael Betzold; Unlearn Your Pain. Mind Body Publishing, Pleasant Ridge, MI. 2010.

32. Obelieniene D et al; Pain after whiplash: a prospective controlled inception cohort study; J Neurol Neurosurg Psychiatry. 1999 March; 66 (3): 279-83.

33. Raspe et al; Back pain, a communicable disease?; International Journal of Epidemiology 2008; 37 (1): 69-74.