We understand that you can catch a cold from someone who sneezes near you or a child who comes home from school with a runny nose or sore throat. How much are we influenced by our social situation? Nicholas Christakis and James Fowler and have analyzed data demonstrating that obesity, smoking and happiness are more likely when we are exposed to others with these disorders. Although there is debate about how powerful these factors are, the concept makes intuitive sense. There is a great deal of evidence showing that many of our actions are strongly influenced by factors of which we are not aware, i.e., the subconscious mind. I highly recommend the books by Daniel Wegner and Timothy Wilson for more on this.
What about the role of the brain in the production of pain and other physical illnesses? In the 1980’s, there was an epidemic of hand and wrist pain in Australia, which was diagnosed as repetitive stress injury. Over several years, the number of people diagnosed with repetitive stress injury (RSI) grew exponentially even though there was no change in workplace conditions, such as typing speed or number of keystrokes, which was the presumed mechanism of injury. A recent study has shown that the amount of keyboarding does NOT correlate with the development of hand pain or carpal tunnel syndrome. There are many other situations where physical ailments have been known to be contagious.
A study from Germany tracked the number of people diagnosed with back pain over two decades. The prevalence of back pain was much higher in West Germany than in East Germany just after the fall of the Berlin Wall. Over time, the number of people with back pain in East Germany rose to reach the levels of pain in West Germany. The authors concluded that this was a case of the contagious nature of back pain. There may be other explanations for this phenomenon. However, other studies demonstrate that back pain frequently occurs in those who have no clear injury or disorder in the back.
I have seen several people who woke up with back or neck or wrist pain. They assume that they just “slept in a bad position.” However, I have also seen several people who developed pain after reading a magazine article about that specific type of pain. We have brains that can produce pain. And when we are in a state of heightened stress, we are more susceptible to developing symptoms that are caused by the brain. These symptoms are very real, and they are easily explained by the fact that the brain develops neural networks or pathways of pain. Usually these pains resolve in a few days, but at times they can persist and even become chronic.
Studies from California and Denmark have shown that workers who develop back pain are likely to have psychological stressors that appear to explain the pain. These studies also found that neither MRI scans nor the amount of physical work were correlated with the development of pain. Despite this, there is a very strong inclination in our society to view back pain (and other pains) as always being caused by an injury or other disease process in the body. We know that there are diseases such as fractures or infections that cause back pain and require specific medical treatment. However, unless you are familiar with the writings of Dr. John Sarno, to whom I am indebted for introducing me to this topic, you are unlikely to think that back pain could be caused by stress-related psychological factors. If you are not familiar with Dr. Sarno’s books, such as The Mindbody Prescription, Healing Back Pain or The Divided Mind, you owe it to yourself to read at least one of these.
Once you understand that neural pathways learned by the brain can cause back pain, you will begin to see how back pain can be contagious. Being around others who have back pain (or having a family member with back pain) plants a seed in the subconscious portion of the mind. The mind is now more prepared to create back pain when it is under significant stress. Just as with the common cold, the virus requires a host who is susceptible to it. In the case of back pain, a susceptible host is someone who is under a great deal of stress. It is very unlikely that just seeing someone with back pain will cause it in a random sample of people. Stress primes the brain to produce pain.
Of course, the mind can create pain in almost any area of the body, just as it can create a myriad of other symptoms, such as dizziness, urinary frequency, anxiety, or numbness/tingling sensations. And under stressful circumstances, the subconscious brain must “choose” which (if any) symptom to produce. If the mind has been primed to have back pain by being around others with back pain, then that becomes a more likely outcome. There are several other mechanisms that can influence the brain’s choice of stress-related symptoms and I will discuss more of these in upcoming blogs.
It may be not be possible or desirable to avoid all people with back pain, since it is ubiquitous in our society (although it is much less common in some societies in the world; again the topic of an upcoming blog). However, if you are “exposed” to others with back pain, especially if you are under a significant amount of stress, it might be a good idea to remind yourself that your back is fine to prevent this phenomenon from occurring. If you have a relative, friend or client who develops pain without any clear underlying cause, it can be helpful to consider this possibility. You might find a clue to the identification of stress-related back pain. And this type of back pain requires very different treatment from structurally induced back pain.
To your health,
Howard Schubiner, MD