A Goal of Learning is to understand, at a very deep level, that pain is a creation of the brain and that chronic pain involves a brain problem, sensitization, that must be overcome.
For example, for patients who believe their back pain cannot go away because it is due to disk degeneration, it is very helpful to learn that disk degeneration is normal in people over 30 without pain:
Age-specific prevalence estimates of degenerative spine imaging findings in asymptomatic patients [Brinjikji]
| Age (yr)
|
|||||||
|---|---|---|---|---|---|---|---|
| Imaging Finding | 20 | 30 | 40 | 50 | 60 | 70 | 80 |
| Disk degeneration | 37% | 52% | 68% | 80% | 88% | 93% | 96% |
| Disk signal loss | 17% | 33% | 54% | 73% | 86% | 94% | 97% |
| Disk height loss | 24% | 34% | 45% | 56% | 67% | 76% | 84% |
| Disk bulge | 30% | 40% | 50% | 60% | 69% | 77% | 84% |
| Disk protrusion | 29% | 31% | 33% | 36% | 38% | 40% | 43% |
| Annular fissure | 19% | 20% | 22% | 23% | 25% | 27% | 29% |
| Facet degeneration | 4% | 9% | 18% | 32% | 50% | 69% | 83% |
| Spondylolisthesis | 3% | 5% | 8% | 14% | 23% | 35% | 50% |
These are the books that helped me understand, at a very deep level, that pain is a creation of the brain and that chronic pain involves a brain problem, sensitization, that must be overcome.
My own breakthrough from my five years of chronic pain came from watching YouTube videos and then reading books, starting with “The Mindbody Prescription: Healing the Body, Healing the Pain” by John Sarno, M.D. He advises patients who cannot visit him in person for his three hour healing lecture to just read his books over and over again until their pain goes away. The basic message of the videos and books is that the brain creates pain and therefore also possesses the ability to turn it off.
Dr. Howard Schubiner was trained by Dr. Sarno and has established a wonderfully successful mind body program, using Dr. Sarno’s ideas to help patients overcome their chronic pain now that Dr. Sarno has retired. I highly recommend watching his videos and deciding if you want to spend the $100 to enroll in his mind body program online or contact him about joining one of his groups in person. Most of the success stories on his site mention personal contact with Dr. Schubiner.
Dr. David Schechter was also trained by Dr. Sarno and has a practice in Los Angeles. He wrote the book Think Away Your Pain and has a great website http://www.mindbodymedicine.com with information about how to overcome chronic pain and resources. He also has success stories and videos on the website. Some of the success stories come from people who have not worked personally with Dr. Schechter, but just used the materials that you can find on his website:
“I just wanted to thank you for you tapes and workbook-they are excellent! I read Healing Back Pain, and lost 90% of my pain, but still had occasional flareups, and some fear. The workbook really helped me stop the flareups, pin point a couple of things at work and while driving (road rage) that caused the flareups. Thanks again, A.J.”
“Over the past few days I have watched your DVD and listened to your CDs and I have been CRYING AND WALKING at the same time. IT HAS WORKED!!! E.C. “
In addition to the success stories from Drs. Schubiner and Schechter, there is peer-reviewed evidence for the usefulness of Dr. Sarno’s approach on the tmswiki: tmswiki.org/ppd/An_Introduction_to_Tension_Myositis_Syndrome_(TMS):
“During his time in practice, Dr. Sarno conducted two follow-up surveys of his patients to gauge the effectiveness of his treatment approach. The first, conducted in 1982, selected 177 patients at random, of which 76% reported being pain free. The second study was done in 1987 and focused on 109 patients who experienced back pain. In this survey 88% reported being pain free. Dr. David Schechter also conducted similar follow-up surveys on his patients, and reported a 57% success rate among 85 patients.
In 2010, Howard Schubiner, MD, conducted a Randomized Control Trial on the effectiveness of the Tension Myositis Syndrome (TMS) approach in treating fibromyalgia patients. This study was the first TMS-specific research study to use a RCT, the gold standard of the medical community. The study was conducted on 45 randomly chosen women who had fibromyalgia. The treatment consisted of a one-time consultation followed by 3 weekly, 2 hour group lecture sessions explaining TMS. After a 6 month follow up, 46% of the participants reported a pain reduction of at least 30%. After these promising results, Howard Schubiner received a research grant from the National Institutes of Health to further explore the effectiveness of this approach.”
There is also very useful information in the Wikipedia entry: Tension myositis syndrome. This is a method based in the complex, and growing, field of psychological influences on chronic pain [Hoffman].
Learning with Operant and Cognitive Behavioral Treatments (OBT and CBT)
Learning about yourself and your mental processes with psychotherapy can be especially effective if you can find a psychotherapist with experience in treating chronic pain [Jensen, MP] [Hoffman, BM] [Thieme et al.]. Multimodal treatment of chronic pain often includes operant and cognitive behavioural treatments.
In Operant Behavioural Treatment (OBT), patients are retrained with multiple sessions (of order 15) by a clinician, usually a psychologist or psychiatrist, to decrease observable pain behaviors. Pain behaviours have been defined as verbal and nonverbal behaviours that are used to communicate a problem to the environment [Fordyce, W]. They might include such behaviours as vocal responses like moans and gasps, motor behaviour such as hunched body postures, hand rubbing, grimacing, and limping, and avoidance behaviour such as avoiding work or social interactions [Mazzucchelli and Da Silva].
In Cognitive Behavioural Treatment (CBT), patients are retrained with multiple sessions (of order 15) by a clinician, usually a psychologist or psychiatrist, to decrease maladaptive thoughts and attitudes, such as catastrophizing (telling yourself that things are much worse than they actually are) [Thieme et al.]. CBT can deal with “thought viruses” that perpetuate pain such as a patient’s belief that pain always equates to harm, resulting in reluctance to engage in activity or therapy [Peter, I., et al.].
OBT and CBT have been demonstrated to be more effective in long term reduction of chronic pain than passive treatments such as infrared heat therapy [Thieme et al.]. Though OBT and CBT both require a clinician, their focus is on active self-management of pain. This fits with the basic message of this document – move from passive to proactive! This document and most of its resources can help you do the work of recovering from chronic pain by retraining your brain in your own home. If, however, you are lucky enough to be able to find pain management specialists in your area and within your budget that use a multimodal approach including OBT or CBT, this may be a great alternative.
A systematic review and meta-analysis of randomized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache, found effect sizes of 0.33 for cognitive behavioral therapy and 0.32 for behavior therapy [Morley]. Several non-pharmacological interventions, particularly exercise and cognitive-behavioural therapy (CBT), have garnered good evidence of effectiveness as stand-alone, adjunctive treatments for patients with chronic pain [Hassett].