Crisis Knocks

Insights from a therapist who counsels people in their lowest moments.

Mind-Body MD Looks for Emotion Behind Chronic Pain

A different approach to chronic illness.

Dr. David Schechter is a genial, talkative MD who works out of a Beverly Hills office that looks more-or-less like any other doctor's office you've been to. But on Dr. Schechter's shelves is a row of books that indicates there's something different about how he thinks about his patients' pain. They are titles by Dr. John Sarno (The Mindbody Prescription, Healing Back Pain), and describe what Dr. Sarno called Tension Myositis Syndrome (TMS). Sarno's central insight was simple: Much chronic pain has its origins in the mind--particularly in unexpressed anger, sadness, and stress.

Most people have no trouble identifying a "tension headache." But what about other aches and pains? Especially the kind that won't go away despite continued medical attention--things like chronic back pain, Irritable Bowel Syndrome, Fibromyalgia. Dr. Schechter is one of a small, growing number of doctors who, after ruling all else out, look to the possibility that stress and tension are behind physical symptoms, and giving a diagnosis of TMS (also known as Distraction Pain Syndrome, Mind-Body Syndrome, and, most simply, as Stress Illness).

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Treatment of TMS is also simple and radical: Patients are asked to rethink their pain and how they handle it, looking for its source in uncomfortable, unwanted emotion. For many (including a patient described below), relief from chronic pain and illness begins by reapproaching the pain as psychological in origin--not just an ache requiring a pill or surgery, but a mind-body problem, requiring a mind-body solution.

How did you get interested in mind-body medicine?

I was influenced by the seminal work of George Engel, MD, from Rochester, who published his Biopsychosocial Model in an article in Science in 1977, and by a family physician I had as a teenager who told me that my physical symptoms might be due to stress.

I was "ripe," so to speak when I walked into John Sarno's office as a first year medical student at NYU and told him about my knee pain, requesting physical therapy advice. Instead, I got an earful and a career inspiration. He said to me that "95% of chronic pain is psychosomatic" and challenged me if I believed he might be right. I figured it was worth attending one of his evening lectures to find out...later to be examined by him...and cured of my knee pain!

The following year, I was a research assistant in his office and soaked up his clinical approach, sitting in on many patient visits. Somehow, this interest all flowed from my unique childhood and family experiences and the willingness to look at health and life experience as being intertwined in a more complex way than the reductionistic approaches popular in biochemistry and medicine.

How does the day-to-day practice of mind-body medicine work?

The day-to-day practice is about looking and listening to patients...and trying to see beyond the superficial. People have pain and other conditions that have persisted, that other doctors have failed to relieve, or of recent onset in a time of emotional turmoil and pressure.

As a practitioner of mind-body medicine, I do the medical "due diligence" to ensure no structural or biochemical problem is missed. I review prior testing, or order my own. I carefully examine the patient. In addition, I take a detailed psychosocial history and I listen to the pattern of symptoms and probe about the psychosocial context and timing of the symptoms.

A mind-body practitioner takes a broader perspective than ordinary medicine in looking at the person and their emotional life as being crucially important to understanding the cause and perpetuation of the condition. Stress and tension, pressure, and personality are all factors that I take into account in making a diagnosis and formulating a treatment plan.

What do you do when you find that stress, tension, personality, and pressure are at the root of someone's symptoms?

There have been so many remarkable case histories to relate. Here is a recent, dramatic one: A woman in her late-40's came in with over twenty years of mid-back, hip, and sacral pain. She reported that a fall triggered the initial pain problem, and that an auto accident 15 years ago made it worse. She had another fall a number of years later, and became bedridden for over five years. This ruined her marriage and left her with constant pain. Doctors had told her that x-rays indicated "nothing wrong" in the back, and "mild changes" in the hip. She slept, at home with her parents, in an adjustable bed with her head up.

When she came to see me, she had a cushion, was wearing a lumbar and sacral support, and walking with a cane. She admitted to being a people-pleaser, a perfectionist, a good-deed doer, and a peacemaker who was hard on herself. She had always been easily offended, since childhood.

Later she presented me with a list of feared activities including fear of sitting on the floor, fear of sitting in anyone else's car, fear of not using a special seat cushion, fear or lying on her side, fear of sleeping in any bed other than her adjustable bed, on and on.

I diagnosed her as suffering from the TMS/Distraction Pain Syndrome. She left with home educational materials and returned in about three weeks.

This time she walked in without a cane and without a cushion! She told me it had been "quite a journey." She had been weaning herself off her sacral support and back brace. Her pain was 35-40% less than before I saw her and her functionality and mobility had already improved 20%. In reviewing her twenty-plus years of pain, she reported that she had spent over a quarter of a million dollars of her own money, out of pocket expenses for Rolfing, chiropractors, beds, massage, etc.

When I saw this patient again a few weeks later, her pain had gone from a nine out of ten to a zero to one out of ten. She was making plans for future vacations, hotel beds, school, and other activities she had long denied herself due to pain--all after only two months.

This kind of patient and this kind of response is what keeps me motivated. I only wish I could have reached this patient much earlier and saved her years of suffering and so much money.

Do people often get better just from receiving the diagnosis and reading up on it?

People sometimes improve rapidly even just from reading about the diagnosis and the possibility that their problem is not something they'll have to "suffer from" or "live with" the rest of their lives. Seeing a medical doctor who can make a reassuring, clear diagnosis is a huge added bonus. For some, studying the materials at home, after a diagnosis, is all they need. For others, psychotherapy with a therapist familiar with this work is an important component of healing.

Find more about Dr. Schechter and Mind-Body Medicine at Dr. Schechter's website, mindbodymedicine.com. Included there, Dr. Schechter's TMS Screening Questionnaire, his Mind-Body Workbook, and the home education program he has developed.

 

 

Will Baum, LCSW, is a private practice psychotherapist in Los Angeles.

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