Sarno, John - How to cure back pain. People must know the truth! John E

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John Sarno

Attention! This book does not describe a “new approach” to back treatment, but a new diagnosis that requires adequate treatment. Every year, millions of people learn from doctors that the cause of their suffering is osteochondrosis, “pinched nerves,” arthritis, spinal stenosis, intervertebral disc herniation, and so on. But if all these diagnoses are true, then why is medicine not coping with its responsibilities? Why hasn’t a neuropathologist been born yet who would cure at least one of his patients once and for all? Dr. Sarno challenges dogma. He claims: people are not being treated for what they need to be treated for and gives his patients a diagnosis unknown to orthodox medicine - muscle tension syndrome (MSS). Is his theory correct? Let's leave this debate to scientists. What is much more important for us is practice - that thanks to Dr. Sarno, thousands of people have already recovered! Quotes from the book: By ignoring pain or laughing at it, you teach your brain to send new messages to your muscles.

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JOHN S A R N O How to cure a pain in your back PEOPLE SHOULD KNOW THE TRUTH! JOHN E. SARNO Healing BACK PAIN THE MIND-BODY CONNECTION UDC 615.851 BBK 53.57 C20 Translation from English by N. Bolkhovetskaya C20 John Sarno How to cure back pain: People need to know the truth! / Transl. from English - M.: LLC Publishing House "Sofia", 2010. - 224 p. ISBN 978-5-399-00148-7 Attention! This book does not describe a “new approach” to back treatment, but a new DIAGNOSIS that requires adequate treatment. Every year, millions of people learn from doctors that the cause of their suffering is osteochondrosis, “pinched nerves,” arthritis, spinal stenosis, intervertebral disc herniation, and so on. But if all these diagnoses are true, then why is medicine not coping with its responsibilities? Why hasn’t a neuropathologist been born yet who would cure at least one of his patients once and for all? Dr. Sarno challenges dogma. He claims that people are not being treated for what they need to be treated for, and he gives his patients a diagnosis unknown to orthodox medicine - muscle tension syndrome (MSS). Is his theory correct? Let's leave this debate to scientists. What is much more important for us is practice - that thanks to Dr. Sarno, thousands of people have already recovered! UDC 615.851 BBK 53.57 Copyright © 1991 by John E. Sarno, M.D. Healing Back Pain. The Mind-Body Connection This edition published with arrangement with Grand Central Publishing, New York, New York, USA. All rights reserved. All rights reserved, including the right of reproduction in whole or in part in any form. ISBN 978-5-399-00148-7 © “Sofia”, 2010 © LLC Publishing House “Sofia”, 2010 CONTENTS Introduction 7 Chapter 1. Manifestations of muscle tension syndrome 14 Chapter 2. Psychology of muscle tension syndrome 47 Chapter 3. Physiology of muscle tension syndrome 81 Chapter 4. Treatment of SMN 92 Chapter 5. Traditional (standard) diagnoses 123 Chapter 6. Traditional methods of treating the back 150 Chapter 7. Mind and body 164 Appendix. Letters from Patients 209 WARNING Keep in mind: this book, like any other, is not a substitute for a doctor. It was not written to use it to diagnose yourself. If you are experiencing pain, be sure to get a medical examination to rule out a serious illness. INTRODUCTION In my opinion, the main cause of pain in the neck, shoulders, back, lower back and joints is the so-called muscle tension syndrome (MSS). This syndrome presents a major medical challenge. According to statistics, eighty percent of US citizens suffer from back pain to one degree or another. An article published in 1986 in the August issue of Forbes magazine provides the following figures: about fifty-six billion dollars are spent annually on treating the pathologies behind these pains! Back pain ranks first among the reasons people are absent from work due to illness and second in the number of visits to the doctor. Moreover, it is obvious that over the past thirty years the situation has worsened significantly. But why? Really, after millions of years of evolution, the backs of Americans have ceased to cope with their functions? Where did so many patients come from? And why did doctors suddenly find themselves powerless in the face of the disease? The purpose of my book is to answer these and many other questions regarding this widespread problem. I believe that the topic I have raised needs to be looked at more broadly than it is usually looked at, since the reason for the epidemic being described (yes, an epidemic!) lies in the actual inability of medicine to recognize the true nature of the disease, that is, to make an accurate diagnosis. Likewise, while people knew nothing about bacteriology and epidemiology, the plague devastated entire countries. Of course, it is quite difficult to believe in such incompetence of representatives of modern high-tech medicine. Nevertheless, this is a fact. After all, doctors are people too, which means they are by no means omniscient and may well be mistaken. Here is one of the most common erroneous stereotypes that guide doctors: back pain must necessarily be the result of structural disorders in the spine or muscle damage. Another medical misconception: emotions cannot cause physiological changes in the body. My experience with SCI refutes both of these stereotypes. The disorders in question are accompanied by minor (albeit very painful) changes in the soft tissues of the body (not the spine) and are of a psycho-emotional nature. I first became aware of this problem in 1965, when I headed the outpatient department of the Howard Rusk Institute of Rehabilitation Medicine at New York University Medical Center. It was there that I encountered a huge number of patients suffering from neck, shoulder, back and lower back pain. From the point of view of traditional medicine, the causes of their suffering were various kinds of structural disorders - arthritis of displaced intervertebral discs and so on, as well as muscle pathologies associated with incorrect posture, overexertion and insufficient physical activity. Pain in the legs and arms was due to pinched nerves. INTRODUCTION 9 However, the mechanism of pain remained unclear. In such a situation, is it possible to talk about the meaningfulness of the prescribed treatment - all kinds of injections, deep heating with ultrasound, massage and special exercises? Of course not. No one really understood how exactly such procedures affected the body. Doctors were content with primitive ideas - they say that exercise prevents pain because it helps stretch and strengthen the abdominal and back muscles that support the spinal column. As a result, the treatment of such patients could not be called truly successful. The situation was further complicated by the fact that as a result of examinations it was not always possible to establish a direct connection between the pain and its supposed causes. For example, according to the diagnosis, there are degenerative arthritic changes in the patient’s lumbar spine, but the problem is that completely different parts of the body hurt. Or the patient’s intervertebral disc in the lumbar spine is displaced to the left, and for some reason he feels pain in his right leg. But the most important observation was this: in eighty-eight percent of patients with problems such as migraines, heartburn, hiatal hernia, stomach ulcers, colitis, irritable bowel syndrome, hay fever, asthma, eczema and so on, exacerbations of the disease are provoked by the nervous system. tension. But then it is logical to assume that the painful state of the muscles is also associated with nervous tension. More precisely, with muscle tension syndrome (MSS). 10 HOW TO CURE BACK PAIN When we put this assumption to the test and started treating people accordingly, the results were very positive. This was the beginning of the diagnostic and therapeutic Program that will be discussed in this book. It is necessary to clarify that the book does not describe a “new approach” to treating the back, but a new diagnosis - SMN, which requires appropriate diagnosis and treatment. When doctors learned that bacteria were the cause of many infections, they began to look for weapons against them - this is how antibiotics appeared. Likewise, if it turns out that the cause of back pain is psycho-emotional factors, an appropriate new therapeutic technique must be applied. Obviously, traditional psychotherapeutic methods are not applicable in this case. Nevertheless, experience shows that in order for treatment to be successful, it is necessary to explain to the patient what is really happening to him. Are we talking about holistic medicine now? Unfortunately, what lies behind this term is a mixture of science, pseudoscience and folklore. However, the basis of a holistic approach to healing the sick is a wise principle: a person must be perceived and treated as a whole! Unfortunately, this principle is ignored by certified doctors. Perhaps “holistic” should be called healing methods that take into account both the physical and psycho-emotional components of health and illness. And at the same time, in no case should we abandon the scientific approach to the treatment of diseases. That is, I am not talking about “official” or “holistic” INTRODUCTION 11 but simply about good medicine. Although the cause of MSI is nervous tension, it is diagnosed in the traditional way of clinical neurology - based on the physical, rather than psychological, state of the person. Doctors who deal with such things would do well to learn to see the relationship between body and mind and get, so to speak, a diploma in “holistic sciences.” Because medicine that ignores the influence of emotions on people’s health is worthless. Please do not forget: SMN is a physical ailment, the “trigger” for the development of which is emotions. This ailment must be diagnosed by a comprehensively trained doctor, whose qualifications allow him to determine both the physiological and psycho-emotional components of the problem that has arisen. Psychologists, unlike neurologists, are able to discern the cause of muscle pain in the mental discord of the patient. But because they do not have the necessary training in neurology, they cannot make a diagnosis of MIS with complete confidence. And vice versa - it is difficult to find a neurologist who is able to competently recognize the psycho-emotional roots of certain physiological disorders. As a result, the SMN falls, so to speak, “between two stools” and patients leave with the wrong diagnosis. What do doctors think about SMN? It is unlikely that they understand well what is at stake. Judging by the reaction of the doctors I know when it comes to SMN, most doctors either completely deny this diagnosis or ignore it. Some of my colleagues admit that they simply do not know how to treat such patients. I have written several medical articles and special manuals about SMN, but they are available only to a narrow circle of specialists, mainly physiotherapists and rehabilitation specialists. Moreover, in recent years it has become almost impossible to publish work on the topic of MSI, since this diagnosis contradicts medical dogma. So I want to appeal to the doctors who will read my book: it contains much more comprehensive information than any of the articles I have previously published, so it would be nice if you took it seriously, even though I addressed it to the general public. audience. What about readers who have pain in the neck, shoulders, back, or buttocks and think they have MSI? Keep in mind that this book, like any other, cannot replace a doctor; it was not written to use it to diagnose yourself. I think it is at least unethical to instill in people the hope that they can acquire proper medical qualifications by reading popular literature or watching DVDs. If a person experiences recurring pain in any part of the body, it should be carefully examined to rule out serious diseases such as cancer, all kinds of tumors, bone diseases and other pathologies. In other words, he definitely needs to consult a doctor and undergo an examination. The scientific approach requires that any new idea be reliably confirmed. A new concept can be adopted only after unconditional evidence of its truth is obtained. That is why it is extremely important that all the thoughts voiced here become the object of close attention of specialists. I encourage my colleagues to either confirm my conclusions based on their own experience, or argue with me in a reasoned manner. The only thing they should not do is remain indifferent because the problem of back pain is too serious and urgently needs an effective solution. Chapter 1 MANIFESTATIONS OF MUSCLE TENSION SYNDROME I have never seen a patient complaining of pain in the neck, shoulders, back or buttocks who was not convinced that their problems were caused by an accidental injury or excessive physical exertion during sports training. “I injured my leg while running (playing basketball, tennis, bowling).” “I felt pain when I picked up my daughter,” “... when I tried to open a jammed window.” “Ten years ago I was in an accident and since then I have constantly felt pain in my back.” The idea that the causes of pain can only be injuries or other types of external or internal damage is firmly ingrained in the minds of Americans. Of course, if pain occurs during or after CHAPTER 1. MANIFESTATIONS OF MUSCULAR STRAINS 15 physical activity, it is easy to assume that there is a direct line between one and the other connection (although, as you will later learn, such assumptions are often wrong). The widespread belief that the back is vulnerable is nothing less than a medical disaster in American society, which has become a collection of semi-disabled people who are afraid of recurrence of pain and therefore move extremely carefully. For decades, both traditional doctors and various types of healers have been guided by this idea. They tell their patients that pain in the neck, shoulders, back and buttocks arises from injury or disease of the spine and related structures, or from dysfunction of muscles and other joints, without, however, providing any convincing arguments in favor of their diagnoses. As for me, I have successfully treated such disorders for seventeen years and have come to the following conclusion: such pain arises from chronic tension of muscles, nerves, tendons and fascia. The proof of the correctness of my point of view is the high percentage of healings after applying the simple and fast-acting Program described in this book. Doctors' misconceptions about the spine are rooted in the very system of their training and are determined by the philosophy of medicine. The fact is that modern health science is concerned with mechanisms and structures. The body is seen, either explicitly or implicitly, as an extremely complex machine, and disease as its breakdown as a result of infection, trauma, hereditary pathologies, tissue degeneration and, of course, cancer. Medicine 16 HOW TO CURE BACK PAIN cannot live without laboratory tests, believing that they are the only ones worth attention. I'm not going to downplay the role that research played in its development (the invention of penicillin, insulin, and the like). But, unfortunately, when it comes to a person, not everything can be measured with instruments and described using numbers. First of all, this concerns the human mind and the brain responsible for it. It is impossible to place emotions in a test tube and weigh or measure them, so for modern medical science they seem to not exist. And if so, it means that they are in no way connected with health or illness. As a result, most medical practitioners ignore the fact that emotions can cause physiological disorders, although many of them recognize that the patient’s experiences often aggravate his illness. Generally speaking, traditional doctors feel extremely uncomfortable dealing with emotions. They draw a clear line between problems of the “mind” and “body” and know much better how to deal with bodily dysfunctions. A good example of the above is the treatment of stomach and duodenal ulcers. Although it has long been known that the cause of this disease is psycho-emotional stress, most therapists, contrary to all logic, prefer to prescribe exclusively drug treatment, prescribing drugs that reduce stomach acidity, and openly ignore psychotherapy. In other words, they do not care about the cause of the disease and offer exclusively symptomatic treatment - exactly as they were taught in medical institutes. CHAPTER 1 . MANIFESTATIONS OF S I N D R O M A M M U S C H O L S T E R S 17 Since doctors focus primarily on healing the body, the psycho-emotional side of the disease is not is considered by them at all, even if it is the main cause of the patient’s suffering. That is why it is doctors who bear the main share of responsibility for such a widespread, one might say epidemic, disease of this type. Although, in fairness, it should be noted that some doctors still talk about nervous tension, but somehow casually: “You need to relax and rest, you are working too much.” The purpose of this book is to correct this situation. In the first chapter, we'll talk about who is affected by MSI, what parts of the body it affects, how much pain can vary, and how it affects a person's overall health and daily life. Subsequent chapters are devoted to the psycho-emotional side of SCI (with which, in fact, it all begins), its physiology and how to deal with this syndrome. In addition, I devoted a separate chapter to describing the connections that exist between the mind and body and how they affect health. WHO IS AFFECTED BY SMN? Some may say that SMN is a disease without age, since this syndrome can manifest itself not only in adults, but also in children from five to six years of age. Although, of course, the symptoms of a child differ from the symptoms of an adult. I am sure that the “neuralgic pain” so often observed in childhood has never been properly studied, especially since doctors do not have to work very hard to convince mothers of the prevalence of this problem and that In general, it does not pose a threat to the health of the child. One day, during a conversation with a young mother who complained that her daughter was experiencing severe pain in her leg at night, it dawned on me: what the child was feeling was very similar to sciatica in adults, which is one of the most common manifestations of SCI. This means that this syndrome may well occur in children. It is not surprising that no one is able to explain the nature of the so-called “neuralgic pain”, because SMN does not leave obvious physical traces of its presence. You can track a temporary spasm of the blood vessels, causing characteristic symptoms, but then everything returns to normal. The emotional stimulus that provokes a painful attack in children and adults is the same - anxiety. Some believe that in this way the child experiences a kind of replacement of the nightmare with a painful physiological reaction - instead of painful experiences that are unbearable for him, he experiences physical pain. In adults, essentially the same thing happens. I have seen SMN manifest even in octogenarians. That is, this condition has no age and potentially threatens any person capable of experiencing emotions. And yet, at what age does SCI appear most often and what lessons can we learn from this kind of statistics? Our studies, conducted in 1982, included 177 patients treated for SCI. Seventy-seven percent of them were in the age group of thirty to sixty C H A P T E R 1 . MANIFESTATIONS OF S I N D R O M A M M U S E C H O N A S T E R S 19 years old, nine percent - from twenty to thirty years old, two percent - teenagers, seven percent - people from sixty to seventy years old and four percent - over seventy. These statistics confirm that the causes of back pain are primarily of an emotional nature, because the period of a person’s life from thirty to sixty are the years of his greatest responsibility. At this age, we strive to achieve success, to achieve material well-being, and it is then that SMN most often develops. If the primary cause of back pain were degenerative changes in the spine (eg, osteoarthritis, slipped discs, herniated discs, arthrosis, spinal stenosis), these statistics would look different, since SSI would primarily affect older adults. So, to answer the question “Who is affected by MSI?” You can safely answer: “Anyone.” And I can definitely say this: this syndrome most often occurs in the middle of a person’s life - during the years of highest responsibility. Let's look at the main signs of SCI. WHERE DOES SMN APPEAR? Muscles First of all, the syndrome described here affects the muscles (hence its name). The muscles affected by SCI are located in the back of the neck, back, buttocks and are called tonic or postural muscles. They are responsible for the correct position of the head and torso and ensure effective work of the hands. 20 HOW TO CURE BACK PAIN According to statistics, SMN most often manifests itself in the lumbar-gluteal region - in approximately two thirds of patients. Sometimes the gluteal and lumbar muscles are affected separately. The second most common area affected is the muscles of the neck and shoulders. Typically, pain is felt in the side of the neck and upper shoulder, as well as in the trapezius muscle. SMN can appear in any part of the back - from the shoulders to the lower back, but much less frequently than in the two above areas. Most often, the patient complains of pain in one of the body parts listed above, such as the left buttock or right shoulder, but a medical examination reveals something very interesting. Almost every patient with SMN, upon palpation, experiences increased sensitivity or soreness in the muscles of the outer region of both buttocks (sometimes in the entire buttock), the lumbar region and both trapezius muscles. This provides one piece of evidence for the hypothesis that in SCI, pain is not due to a specific spinal pathology or muscle deficiency, but is actually generated by the brain. Nerves The second substrate on which SMN manifests itself is nerves, especially peripheral ones. And most often it affects those nerves that are located in close proximity to the muscles. The sciatic nerves are located deep in the gluteal muscles (one on each side), the lumbar nerves are located under the paraspinal muscles in the waist area - CHAPTER 1. MANIFESTATIONS OF S I N D R O M A M M U S C H O L S T R E N S 21 nits, occipital nerves, also nerves of the brachial plexus - under the upper part trapezius muscles. It is these nerves that are most often affected by SCI. As a rule, SMN covers a fairly large area of ​​the back, not limited to one local area. All tissues in this area suffer from a lack of oxygen, so a person may experience pain in the muscles and along the nerve trunks. When muscles and/or nerves are affected, different types of pain occur. The pain can be sharp, burning, cutting, aching, pressing. In addition, if the syndrome affects the nerves, there is often a feeling of tingling or numbness, sometimes spreading to the muscles of the arms or legs. In some cases, muscle weakness is observed, which can be recorded using electromyography. When SMN affects the lumbar and sciatic nerves, leg pain occurs. If the occipital and brachial nerves are affected, pain appears in the arm. The traditional diagnosis for leg pain is usually “herniated disc,” and for arm pain it is “pinched nerve” (see Chapter 5). SSI can affect any of the nerves in the neck, shoulders, back, and buttocks, causing unusual pain. One of its most frightening symptoms is chest pain. An alarmed person immediately decides: “Heart!” - and for peace of mind, he absolutely needs to know that his heart is all right. Having convinced himself of this, he must be aware that the cause of sharp pain in the chest area may be oxygen starvation of the nerves serving the upper back and front of the body, caused by SCI. 22 HOW TO CURE BACK PAIN In this case, a person may complain of strange accompanying sensations and weakness. Remember: in order not to miss a serious illness, be sure to consult a therapist! This book is not a “how-to” book for those who want to make diagnoses on their own. Its purpose is to describe the clinical phenomenon called MSI. During a medical examination, it is necessary to check tendon reflexes and muscle strength to find out how much oxygen deprivation has affected the nerves - whether it has affected motor skills and the speed of transmission of nerve impulses. In addition, sensory tests (such as a pinprick test) should be performed to ensure that the affected SMN nerve is not damaged. The main purpose of diagnosing and documenting sensory or motor disturbances is to enable them to be discussed with patients, who need to be reassured that the weakness, numbness or tingling they experience is not dangerous. During the examination, a leg lift test is required. There may be several reasons for this test. If the patient feels severe pain in the buttock, he will not be able to raise his straightened leg high. The reason for this state of affairs lies in the muscle or the nerve, or both. However, in most cases, this does not mean that “a displaced intervertebral disc is pressing on the sciatic nerve,” as patients are often told. CHAPTER 1 . MANIFESTATIONS OF MUSCULAR STRAINS 23 When pain occurs in the shoulder or arm, the arm is checked in the same way. Sometimes patients have bilateral pain. People also often report that in addition to pain, for example in the right buttock or leg, they feel periodic soreness in the neck or in one of the shoulders. There is nothing unusual in such situations, since the media can affect any muscle or all muscles of the torso at the same time. Ligaments and tendons Various pains in ligaments and tendons are also part of muscle tension syndrome (TSMS). The term "myositis" is quickly becoming outdated; it was coined many years before it was discovered that nerves were also affected by MSI. Then I realized that in addition to muscles and nerves, this syndrome can also affect other tissues of the body, and over time I became more and more convinced of the correctness of my conclusions. First of all, I paid attention to how my patients described their condition: when the back pain subsided, often Painful sensations in the tendons also disappeared (for example, the symptoms of radiobrachial bursitis disappeared). Inflammation around or in the tendon is called tendinitis. It is believed that painful tendons are inflamed most often due to their overexertion. In such cases, anti-inflammatory therapy and restriction of physical activity are prescribed. Assuming that tendon soreness could be a manifestation of MSI, I began to explain to patients that their tendinitis was most likely associated with back pain and would go away with it. The results of this approach were 24 HOW TO CURE BACK PAIN quite impressive, and over time my confidence that such diagnoses were correct grew. Now I am ready to say that tendonitis is often part of SMI, and in some cases - a direct manifestation of it. So-called “tennis elbow” is one of the most common types of tendinitis. In my experience, the same thing happens with the knee. The most common diagnoses for knee pain are chondromalacia patella and knee injury. However, while the examination will reveal tenderness in the tendons and ligaments surrounding the knee joint, pain in the knee area usually disappears when the back pain stops. Another weak point is the ankle, foot (upper and lower parts) and Achilles tendon. Common diagnoses for pain in this area are neuroma, bone spur, plantar fasciitis, flat feet and injuries due to excessive physical activity. The next area where tendonitis occurs in SMN is the shoulder; the most common diagnoses are bursitis and rotator cuff injury. As a rule, the sensitivity of this area is easily checked by palpating the tendons of the shoulder girdle. The tendons of the hand are usually not affected by SMN. It is possible that what is known as carpal tunnel syndrome is also a type of MTS, but further observation and research is needed to prove this. I recently spoke with a long-time patient of mine who, after a minor injury, began to experience pain in her hip area. An X-ray showed the presence of arthritis in the hip joint. CHAPTER 1 . MANIFESTATIONS OF S I N D R O M A M U C U R L STRAINS 25 Naturally, the doctor decided that this arthritis was the cause of the pain. Since she had suffered from MSI in the past, I suggested that she be examined further. Judging by the x-ray, arthritic changes in the hip joint were quite typical for her age. The joint remained mobile, and the woman did not experience any discomfort while walking. When I asked her to point her finger at the place where it hurt, she pointed to a small area where the tendon attaches to the bone, noticeably above the hip joint - the pain arose when pressing in this place. I said she had tendonitis caused by SMN. After a few days the pain really went away. Tendinitis most often accompanies acetabular bursitis. But in this case, such a diagnosis would be incorrect, since the location of the pain turned out to be above the trochanter of the femur, which can be felt by palpation of the upper thigh. MSD appears in different places and often moves around, especially if the disorder is treated symptomatically. Patients talk about how pain, after passing in one place, appears in another. It seems that the brain does not want to give up its convenient strategy that allows it to divert attention from emotions. Therefore, it is very important that a person knows exactly where the pain is localized. I ask my patients to call immediately and tell me if the pain has moved somewhere else, then we can definitely conclude whether this symptom is part of the MSI. So, three different types of tissue can be affected by SCI: muscles, nerves and tendon ligaments. Let's take a closer look at how SMN manifests itself. 26 HOW TO CURE BACK PAIN PATIENTS’ PERSPECTIVES ABOUT THE CAUSES AND TYPES OF PAIN ATTACKS At first glance at many of my patients, one can assume that they are suffering from the consequences of long-term severe injuries, tissue degeneration, congenital pathologies of the musculoskeletal system or muscle weakness. Most often, the version of trauma wins, since people manage to build a cause-and-effect relationship between their suffering and certain circumstances under which the disease manifested itself. According to a study we conducted several years ago, forty percent of patients say that the pain began after stress, injury, or physical work. For some, it was a car accident - usually a rear-end collision. Someone fell down the stairs or slipped on the ice. Others lifted weights, played tennis, basketball or ran. But since pain appears both within a minute and several hours or days after the corresponding incident, the question arises about its nature. Some say that there was nothing unusual in the incident itself - for example, a person bent down to pick up a toothbrush from the floor, or stretched to get a cup from a cupboard, and the same pain can be felt by a hero who tried to lift a refrigerator on his own. I remember one young man. He was sitting quietly at the table in his office and suddenly experienced such a “lumbago” in his back that they had to call an ambulance and send him home. The next two days were painful for him, with the slightest movement a wave of pain rolled over him. CHAPTER 1 . MANIFESTATIONS OF MUSCULAR STRAINS 27 Why do completely different types of physical activity provoke equally severe pain? Considering the varying degrees of muscle tension and the huge variety of situations after which a person’s condition changes dramatically, it remains to conclude that the incident that occurred is by no means the cause of the problem; it acts only as a trigger. Moreover, many patients do without such triggers at all - the pain they experience simply gradually increases, or they wake up with it one morning. And judging by the studies mentioned above, this happens in sixty percent of cases. The assumption that incidents purported to be the cause of the disease are in fact nothing more than triggers is proven by the following fact: it is almost impossible to distinguish pain that develops gradually from pain that occurs abruptly, as well as to accurately predict the severity and duration of such painful attacks. . This once again confirms that in such cases we are dealing with SMN. Despite the temptation to attribute everything to injury, one must admit that there are no injuries in such cases - the person’s brain simply found a reason to attack the body through SMN. There is another reason to doubt the dominant role of injuries during pain attacks. The biological ability to self-heal is one of the most powerful mechanisms for preserving the species, which has evolved over millions of years of life on Earth. Thanks to this ability, our bodies recover quite quickly from injury. 28 HOW TO CURE BACK PAIN Even the largest bone in the human body - the femur - when broken, heals in six weeks, and the person only experiences pain for a short time. This is why it seems strange that an injury can still cause pain after two months, let alone two or ten years. Nevertheless; Most people are absolutely sure that injuries are the cause of their pain, and unconditionally agree with the same doctors’ diagnoses. So, almost all patients who experience attacks of back pain try to find a connection between their current condition and some incident in the past, perhaps even something that happened several years ago - for example, a car accident or a fall while skiing. In their opinion, trauma must be present. This belief is one of the biggest obstacles to recovery. It is necessary to remove this obstacle from the patient’s consciousness, otherwise the pain will recur. A person needs to start looking for a psychological explanation for his illness. And indeed, having learned the diagnosis - muscle tension syndrome (MSS), he begins to remember the psychological problems that he had to face in those periods of his life when he was plagued by attacks of pain: for example, when moving to a new job or when getting married; these difficulties could also be associated with the illness of one of the family members, a financial crisis, and so on. Or the person admits that he has always been anxious, hyper-responsible and too conscientious - in a word, a real perfectionist. Awareness of psi CHAPTER 1 . MANIFESTATIONS OF S I N D R O M A M U S C H E R S T E R S 29 chological background of physical pain is the first step to recovery. To avoid such awareness means to condemn oneself to long-term illness and disability. THE NATURE OF PAIN ATTACKS Acute pain Probably the most common and most frightening manifestation of SCI is acute pain. It is sudden and painful, as in the case described above with the young man. Most often, such pain is localized in the lower back and affects the lumbar and/or gluteal muscles. Each movement brings a new wave of pain, which makes the patient’s condition very unenviable. The spasm freezes the muscles. A spasm is a sharp contraction (tension) of muscles, a pathological condition that can cause unbearable suffering. Almost everyone knows what a cramp in the leg or foot is, but the cramp passes quickly. An attack of MSI does not stop so easily - as soon as the pain subsides, any movement provokes it again. I believe that spasm, like other manifestations of MSI, develops as a result of oxygen deficiency. Most likely, shin cramp is also a consequence of lack of oxygen in the muscles, which often occurs in bed when blood circulation is slow. People often report that at the moment the attack begins, they seem to hear some kind of noise - a clicking or crackling sound. Remembering him, patients say: “The back is out of order.” And although in fact nothing is broken in their back, they are convinced that it is a breakdown. It is difficult to find an explanation for this noise. Perhaps it is 30 HOW TO CURE BACK PAIN similar to the sound felt during manipulation of the spine - “vertebral clicks”. One thing is clear - it is not a sign of something dangerous. Although attacks of acute pain most often occur in the lower back, they can also occur in the neck, shoulders and upper back. But wherever this acute, almost unbearable pain appears, the most amazing thing is that it, in fact, does not threaten your health. Quite often during such attacks the body becomes distorted. It can lean forward or to the side, or perhaps forward and to the side at once. No one has yet given an exact explanation for this. Of course, this body position is very uncomfortable, but does not cause serious harm. The described attacks of acute pain can be of varying duration, and after them the person remains in a state of anxiety and fear for a long time. It seems that something terrible has happened and you need to be very careful not to make the wrong move that will lead to a new attack. If pain in the lower back is accompanied by pain in the leg, anxiety grows as the threat of a herniated disc and, accordingly, surgery begins to loom on the horizon. Most middle-aged people have heard about such hernias and are afraid of them. Such fear increases the pain. If during a medical examination a disc herniation is actually discovered, fear increases. A person feels numbness or tingling in the lower leg or foot, or weakness in the leg (these sensations accompany MSI and are actually a consequence of increasing fear). Next we'll talk more about CHAPTER 1. MANIFESTATIONS OF MUSCULAR STRAINS 31 that a herniated disc rarely causes pain. Unfortunately, there are not many remedies to get rid of such pain. If, fortunately, a person understands that this is just a muscle spasm and nothing terrible is happening at the physiological level, the attack will soon pass. But this happens extremely rarely. I advise my patients not to panic about what is happening, to go to bed and perhaps take a strong pain reliever. Next, they should test their motor abilities little by little, without trying to remain motionless for many days or weeks. If a person can overcome his own prejudices, the duration of a painful attack will be significantly reduced. Chronic pain However, most often pain with SCI develops gradually - without acute attacks. In some cases, it is impossible to explain the appearance of pain at all. In other cases, unpleasant sensations appeared and increased hours, days and even weeks after any incidents. It could be an accident where your car is rear-ended by another car and your head snaps back. The x-ray shows no fractures or displacement of the cervical vertebrae, but for some reason pain appears over time - usually in the neck and shoulders, and sometimes in the middle or lower back. Sometimes the pain starts in the neck and shoulders, and then goes down, covering the back. If you realize that it is MSI, the pain will likely go away fairly quickly. If doctors take care of you, pain symptoms may persist for many months. 32 HOW TO CURE BACK PAIN DURATION OF ATTACK Is it an acute attack or a gradual increase in pain - where does it all come from? Remember: an incident, no matter how dramatic, is likely just a trigger. The true cause of pain should be sought in the psychological state of the patient. Sometimes the reason is obvious - for example, a financial crisis or an event that is usually considered joyful - a wedding or the birth of a child. I know many professional athletes who suddenly begin to feel pain during competition, such as a tennis tournament. Naturally, they were sure that the cause of the pain was injury. However, upon learning that they had SLI, these people recalled how much they were worried about the outcome of the match. Apparently, the real cause of MSI should be considered not so much the source of anxiety that overcomes a person, but rather a hidden psycho-emotional reaction to it - anxiety or anger. The strength of the manifestation of pain symptoms depends on its intensity. In other words, SMN is caused by suppressed emotions. We prefer not to let out our unpleasant and painful experiences. It’s as if we have a program built into us that keeps them in the back of our subconscious. Finding no way out, they make themselves known in the form of SMN. We will talk about this topic in more detail in the chapter on psychology. But it also happens that a person says: “When this started, nothing special was happening in my life.” As a result, it usually turns out that he is constantly in a state of anxiety. It seems to me that such people experience a gradual accumulation of CHAPTER 1 . MANIFESTATIONS OF MUSCULAR STRAINS 33 internal “garbage” and when the “container” overflows, physical symptoms appear. It is worth paying attention to this by patients; he quickly recognizes his perfectionism, which forces him to respond to daily stress with suppressed anger and anxiety. Delayed attack There is another fairly common variant of SMN. In such cases, patients experience a rather long period of nervous tension - for example, during a serious and prolonged illness of one of the family members. They themselves seem to be quite healthy, but after one or two weeks after the “dark streak” in their life ends, suddenly an attack of back pain occurs - acute or gradually increasing. While these people had to act, they, one might say, controlled themselves, but as soon as the danger passed, the accumulated anxiety spilled out, provoking pain. The same situation can be explained this way: a stressful situation provokes a surge of emotional pain and despair of such strength that physical pain is simply not needed. In other words, the function of pain is to distract a person's attention from suppressed unwanted emotions such as anxiety and anger. And when a person is going through a crisis, there is no point in being distracted from it. Whatever the psycho-emotional component of SMN, it is a pattern that must be taken into account if we want to make a correct diagnosis for back pain. 34 HOW TO CURE BACK PAIN Vacation or weekend syndrome How anxiety manifests in a person mainly depends on his character. Often, patients report that during each vacation they have a painful attack or that the chronic mild pain that bothers them gets worse on weekends. The reasons for such problems are quite obvious - these people are extremely worried about work or business when they are not working. There is a kind of delayed reaction here: while they are at work, their anxiety can be said to “burn out,” and during rest, anxiety and fear increase. A tense, repressed person often hears the advice: “Relax,” as if he could do it arbitrarily, of his own free will. There are many relaxation techniques, including meditation, but until a person learns to get rid of repressed anger and anxiety, no amount of relaxation will help him - he will suffer from MSI and spasmodic headaches. Some people don’t even know how to disconnect from everyday worries and think about something pleasant. I remember a patient who always had back pain when she sat down at the table and poured herself something to drink, hoping to relax. I recently spoke with a young man whose example could serve as a perfect illustration of “vacation” muscle tension syndrome (TSMS). He told me that he had been in a state of extreme nervous tension for a long time and did not feel any pain in his back. Until he went on his honeymoon. And then one day CHAPTER 1. MANIFESTATIONS OF MUSCULAR STRAINS 35 he woke up from a nightmare and immediately felt a strong spasm in his back. This case could be explained by the experiences, albeit pleasant ones, associated with marriage, but given that my patient belonged to the category of extremely obligatory people, I associated his illness with his attitude to work. I met this young man again three months after we met. His back still hurt, especially since magnetic resonance imaging showed a displaced intervertebral disc in the lumbar spine and doctors insisted on surgery. (Magnetic resonance imaging is a diagnostic test that can take pictures of soft tissue, which means it can see problems such as slipped discs or tumors.) It turned out that he came to see me after reading my article about SMN. After examining him, I came to the conclusion that his symptoms could not have developed as a result of an existing intervertebral disc displacement. Such a neurological picture could only occur with inflammation of the sciatic nerve, a typical manifestation of SMN. Be that as it may, upon learning that the cause of his suffering was SMN, the young man was happy and quickly recovered. Another fact that many people find extremely difficult to accept is that very often the source of their suppressed anger and anxiety, and therefore their SMI, is their personal life - an unhappy marriage, problems with children, or the need to care for elderly parents. I could give a lot of examples confirming this: women bound by the bonds of a hateful marriage, which they are unable to break due to emotional or financial dependence on their husbands; people who are competent and successful in business, but are completely unable to solve problems with their spouses or children. I remember one woman who suffered from back pain. She lived with her brother, who had a very difficult character. Despite treatment, the pain that tormented her only intensified. And then one day she did something absolutely out of the ordinary - she splashed out her accumulated rage on her brother. The woman screamed and swore, and then ran out of the house. And - oh, miracle! - the pain disappeared. Unfortunately, my patient was unable to maintain her fortitude and soon the pain returned. Holiday Syndrome It is not uncommon to hear or read about the stress that people experience during holiday events. What should be fun and relaxation turns into torture. I have repeatedly encountered situations where patients experienced attacks of pain accompanying SCI before, during or immediately after major holidays. The reason for such attacks is obvious: significant events require considerable effort, especially from women, who traditionally take on the responsibilities of preparing and holding festive events. In addition, the general consensus is that such events should be fun and relaxed. Usually in such cases, women do not even realize how strong their internal tension is, so a sudden attack of pain comes as a complete surprise to them. CHAPTER 1 . MANIFESTATIONS OF SIN DROMA OF MUSCULAR STRAINS 37 NATURAL HISTORY OF SMN What are the characteristic manifestations of SMN? And what happens when a person remains in the grip of this syndrome for a long time? Conditioning One of the most important concepts necessary for understanding the topic discussed here is the so-called conditioning. Conditioning also has a new and more popular synonym: programmedness. We can say that all living beings, including people, have their own built-in programs. This phenomenon was discovered and further studied by the Russian scientist Ivan Pavlov. His experiments showed that, in response to certain stimuli, animals form associations that cause repeated physical reactions. For example, Pavlov rang the bell every time he fed his experimental dogs. After several repetitions of this procedure, the dogs began to salivate after a familiar bell, even if there was no food. That is, salivation turned out to be caused not only by food, as it was before, but also by the bell - in response to a certain sound, the expected physiological reaction arose. It appears that the process of conditioning or programming comes first when a person experiences a pain episode associated with SCI. Interestingly, people suffering from MSI most often begin to experience pain while sitting. It's surprising that such a gentle posture can provoke pain. Conditioning occurs when two things 38 HOW TO CURE BACK PAIN happen at the same time, and it is logical to assume that at some point the person with SCI felt pain while sitting. His brain associated this body position with painful sensations, and the program was born: “it hurts when I sit.” Subsequently, pain appears due to a subconscious association with sitting, and not because such a position is harmful to the back. This is one way of conditioning, there are probably others that I don’t know about yet, since most people with “problematic” lower backs complain specifically about pain when sitting. Car seats have a bad reputation, so when you get into a car, you automatically prepare yourself for pain. Often people are programmed to experience pain because someone told them about it. You hear: “Try not to bend at the waist” - and some time later you feel pain when bending, although nothing like this has happened before. Another authority tells you that sitting increases pressure on the lower back - obviously you are bound to experience pain when you sit. Standing in one place, lifting and carrying weights - all these supposedly dangerous actions can serve as the basis for the formation of more and more new conditionings. Some people say that when walking the pain that torments them goes away, others say that it intensifies. Some people feel worse during the day, while others feel worse at night. One man lifted weights all day long without even thinking about his back. But at night (at about three o'clock) he woke up from a severe attack of pain, forcing him to get out of bed. A clear example of formed conditioning. CHAPTER 1 . APPEARANCES OF SIN DROMA OF MUSCULOUS STRAINS 39 And someone complains that as soon as he wakes up and gets out of bed when his back starts to hurt. In such people, the pain usually intensifies in the evening. Judging by the stories of all these people and the results of the examinations, I confidently tell them that they have MSI, but their internal programs make them believe that the cause of the tormenting pain is different. However, a few weeks after they finish my treatment program, the pain goes away, which proves that the pain attacks were conditioned. Agree, if the pain was caused by tissue damage, it would not disappear after rehabilitation, consisting mainly of lectures and seminars. And so it turns out that previous subconscious programs are destroyed thanks to new knowledge. In MSI, the importance of conditioning cannot be underestimated, since it is precisely this that provokes reactions that remain incomprehensible to patients. When someone says: “I can only lift light objects, their weight should not exceed three kilograms, otherwise my back starts to hurt,” this means; that the pain is psychosomatic in nature. Another similar example: a woman complains that she experiences pain when bending over to fasten her shoes, while she can easily bend at the waist and touch her palms to the floor. The reason for many of these conditioned reactions is the fear that appears in people who feel pain in the back, especially in the lower part. These people have often heard and read a lot about how fragile and vulnerable part of the body their back is, how easy it is to injure it under such heavy loads as running, swimming or cleaning the apartment with a vacuum cleaner. And they are accustomed to associating physical activity with pain, which will definitely appear if they wait for it. That's what conditioning is. Neither a specific posture nor the type of activity is particularly important when it comes to pain from MSI. It is important to remember about the subconscious program that triggers a pain attack, that is, the psycho-emotional, and not the physiological, component of pain plays the main role. Patterns of MSI Probably the most common pattern of MSI is the recurrent pain attacks discussed earlier. They can last for days, weeks and even months, and then the pain begins to subside little by little. Typically, medical treatment includes bed rest, painkillers and anti-inflammatory drugs in the form of tablets or injections. I do not instruct my patients on what to do during an acute pain attack because the goal of my program is not to treat attacks, but to prevent them. But sometimes people call me and ask for advice on what to do in case of an acute attack. As I said earlier in this chapter, it is extremely important to wait until the pain subsides. I can prescribe a strong painkiller, but in no case an anti-inflammatory, because there is no inflammation. The irony is that during the painful attacks of MSI, it would be better not to seek advice from a doctor at all. But this behavior cannot be called absolutely correct either, since in some cases the pain may be associated with real pathologies. MANIFESTATIONS OF S I N D R O M A M U S C U R L STRAINS 41 logical and then a consultation with a therapist is necessary. But, even if we are not talking about any truly serious pathology, the diagnoses that doctors make sound ominous: degenerative changes in the intervertebral discs, arthritis, spinal stenosis, traumatic arthritis, and so on. Combined with dire warnings about what will happen if the patient does not begin to comply with the prescribed bed rest or at any time in his life tries to run, vacuum the apartment and play tennis and bowling - an ideal combination for further regularly recurring pain attacks. But the human spirit is not so easily broken, and in the end the pains subside. The person feels relief, the physical pain goes away, but the fear remains. With the exception of the rare daredevil, most people who experience acute pain never attempt any of the above-mentioned hazardous activities again. People become extremely attentive to their feelings and are constantly in a state of anxiety. They are afraid of a new attack, and it inevitably comes. It may take six months or a year, but eventually the prophecy comes true and a terrible event occurs. As before, a person associates pain with some incident. This time, along with the back, the leg may hurt, and then frightening conversations begin about the prospect of surgical intervention if computed tomography or magnetic resonance imaging (MRI) shows an intervertebral hernia (computed tomography, like MRI, provides information about the condition of bones and soft tissues) . As a result, anxiety increases and pain intensifies. 42 HOW TO CURE BACK PAIN This pattern of recurring acute pain attacks is quite common. Over time, painful attacks occur more often, become stronger and last longer. And with each new attack, fear grows, which forces people to avoid physical activity. Some patients gradually bring themselves to a state of complete immobility. In my opinion, fear-based movement restrictions are the worst part of the pain syndrome. Despite attempts to give up “extra movements,” the pain will still come and go, affecting all aspects of a person’s life - his work, family relationships and leisure. I have seen patients with SCI seem more disabled than people who were paralyzed in both legs. The latter lived a full life, raised children and worked, while moving in a chair on wheels. Some patients with severe manifestations of MSI spend most of their lives in bed due to pain. Over time, for many people, MSI becomes chronic. Now they feel pain not periodically and paroxysmally, but constantly, usually not very strong, but worsening with certain types of physical activity or in certain positions, which, as we remember, indicates its conditioning: “I can only lie on my left side”; “When I lie down, I definitely need to put a pillow between my knees”; “I never go anywhere without my little back cushion”; “If I sit for more than five minutes, my back will hurt”; “I can only sit on hard chairs with a straight back” and the like. CHAPTER 1 . MANIFESTATIONS OF MUSCULAR STRAINS 43 For some, pain becomes the central theme of their entire lives. It’s not uncommon to hear people say, “Back pain is the first thing I think about when I wake up in the morning and the last thing I think about when I go to sleep.” It becomes an obsession. MSI has many different manifestations. Some people experience mild pain all the time and try to avoid physical exertion. Others, despite periodic acute attacks, live their lives as usual with few or no restrictions. I have already spoken quite a lot about both relatively mild and more severe manifestations of SCI, when pain is felt in the lower back and leg. But sensations in the neck, shoulders and arms can also be very painful and interfere with normal life. Let me give you a typical example. My patient is a middle-aged man who has been suffering from pain attacks in the neck and shoulders for three years, accompanied by numbness and tingling in the arms. He came to see me after he felt pain in his left arm eight months ago. Previously, this man had seen two neurologists, undergone several examinations, and as a result he was told that the pain was due to a “problem in the intervertebral discs of the cervical region.” He was faced with a dilemma - whether he should undergo surgery immediately or whether he could wait for a while. He was warned that without surgery he was at risk of paralysis. It is not surprising that after this diagnosis, the pain spread from his neck and shoulders to his entire back - he could no longer play his favorite sports - playing tennis and skiing. The man was very scared. 44 HOW TO CURE BACK PAIN After examining him, I discovered that he has SMN and there are no pathologies in the cervical spine. Fortunately, the third neurologist he consulted confirmed that his spine was completely fine. As a result, the man accepted my diagnosis with a light heart - muscle tension syndrome (MSS). After completing my program, within a few weeks he was pain-free and able to return to his favorite activities. The attacks did not recur. Sometimes, he said, he could only feel “a little” in his shoulder or knee. For anyone who actively plays sports, knee pain is an extremely annoying factor. I have seen this from my own experience and can confirm that it gets on my nerves, worries me and generally interferes with my normal life. And here we must remember that any ligament or tendon in the arms and legs, any muscle or nerve in the neck, shoulder, back and buttocks can be affected by SCI. Although an attempt should be made with each new patient to clearly identify the areas of the body affected by SSI, this part of the consultation is the least significant. A conversation with a person about the pain he is experiencing is essentially an excursion into his personal life. Once we understand where he feels pain, this information can be put aside, since we are not working directly with the muscles, nerves and ligaments. The main thing is to find out which episode in the patient’s emotional life played a fatal role and caused the appearance of pain symptoms. I remember the case of one man who decided that he was financially secure enough to leave his business to the care of his children at a young enough age. Soon he began to experience back pain, CHAPTER 1. APPEARANCES OF MUSCULAR STRAINS 45 because of which, in fact, we met. During the conversation, it became obvious that, having retired, he was so preoccupied with numerous family problems (caused by the death of several relatives) that he began to seriously worry about the business he left behind. In addition, he began to be afraid of the prospect of supposedly approaching old age and death. All these experiences at the conscious and subconscious levels caused increased anxiety (and anger), which led to the emergence of MSI. Traditional medicine attributed his condition to early aging of the spine. It is clear that the treatment prescribed on the basis of such a diagnosis did not bring any results - after all, in reality the problem was not in the back, but in one’s attitude to life. SCI can affect the muscles, the nerves surrounding them and the nerves that run through them, as well as the ligaments and tendons of the arms and legs. In this case, a person feels pain, tingling, weakness or numbness in various parts of the body, and the intensity of the sensations he experiences also varies - from minor discomfort to excruciating pain, which actually makes him disabled. Repeated painful attacks, accompanied by fear of them and their intensification during physical activity, are the main characteristics of SMN. Pain, numbness, tingling and weakness are nothing more than ways to attract your attention. This is how the brain tries to tell you that something is wrong. For most people - both doctors and their patients - this “out of order” means pathology and the resulting injury - individually or in combination. And the deeper this belief, the more pain is associated with physical activity. The patient cannot resist the conclusion that he was injured somewhere or that some kind of disorder arose in his body. Then he begins to be guided by a program based on fear of such simple poses and movements as sitting, standing, bending or lifting heavy objects. The complex of symptoms of MMN, fears and limitations in mobility attracts increased attention from a person to his body. As we will see in the following chapters, this is precisely the main purpose of muscle tension syndrome (TSS) - to create physical discomfort that distracts attention from unwanted emotions. It seems that such a price is too high, but no one knows exactly how the inner workings of the mind occur, we only assume that fear and painful sensations are undesirable for it. Chapter 2 PSYCHOLOGY OF SMN Pain in the neck, shoulders and back is usually not the result of mechanical disorders, so they cannot be cured by mechanical means. They are associated with human emotions, personal fulfillment and the vicissitudes of life. Attempts by traditional medicine to cope with such pain resemble a parody of treatment. Doctors diagnose various structural pathologies, when in fact the problem lies in what makes the body's structures work, namely the mind. SMS is expressed in the form of physical pain, but it is provoked by psychological difficulties, not physical pathologies. This is an extremely important aspect of the syndrome described, which we will talk about on the following pages. But first of all, I want to give a few definitions so that there is no confusion in words. TENSION Tension is a widely used term that has different meanings to different people; in my work and in 48 HOW TO CURE BACK PAIN in this book, this word is included in the name MTS - muscle tension syndrome. I use it to describe a state that occurs involuntarily in response to certain experiences, so it will continue to be common. It can be said that experiences are the result of a complex interaction between different areas of the mind, as well as between the mind and the external world. Some of them are accompanied by discomfort, provoke mental pain, or simply cause embarrassment. Such experiences are not accepted in society and are considered unacceptable. That's why we suppress them. I'm talking primarily about anxiety, anger and low self-esteem (inferiority complex). These experiences are driven deeper, because our mind does not want us to experience them and demonstrate them to the world around us. Probably, if people had a choice, most would prefer to become aware of their own negative experiences and deal with them, but the human mind functions in such a way that they are instantly and automatically suppressed - so there is no choice. Such suppression is inevitably accompanied by tension. So, when we use the word “tension” here, we will be talking about suppressed, unwanted experiences. STRESS The concept of “stress” is often confused with the concept of “tension” and is assessed negatively. I prefer to use it to refer to any factor that puts any kind of pressure on a person. We may be in a state of physical or CHAPTER 2. PSYCHOLOGY OF SMN 49 emotional stress. Heat and cold are types of physical stress, while responsible work or family problems are types of emotional stress. Stress associated with MSI leads to emotional reactions and suppression of experiences. Hans Selye was the first to draw attention to how stress affects the body, and his in-depth research on this problem became one of the brightest achievements of medical science of the twentieth century. Selye gave the following definition of stress: “a nonspecific response of the body to any challenge addressed to it.” Stress can be both external and internal. Examples of external stress are responsibility at work, financial problems, change of profession or place of residence, worries about children and parents. But the significance of internal stress in terms of creating tension is much greater. In this case, we are talking about all kinds of perfectionism, the need to surpass others at any cost, and similar things. People often say that they are stressed at work, which is where tension comes from. But if they did not feel a certain sense of hyper-responsibility in relation to their work, they would not feel the tension. Typically, such individuals are prone to competition and strive to get ahead at any cost. As a rule, they are extremely self-critical and place increased demands on themselves. A housewife and mother with a similar character puts pressure on herself no less than any manager, although the center of her worries and worries is not work, but family. She worries about her children, husband, parents, wants her family to have the best, and spends all her energy on this. A woman of this type 50 HOW TO CURE BACK PAIN will be very upset if she feels that one of the family members is dissatisfied with her (the desire to please loved ones is not only characteristic of women, recently one of my patients - a middle-aged man - sitting in my office, admitted to same). Thus, stress is the outer shell of a certain emotional structure consisting of experiences of everyday life that are imposed on a person’s character. Stress causes tension (a consequence of suppressing unacceptable experiences). Now let's take a closer look at what a person is. CONSCIOUS MIND The conscious mind is that part of your personality that you are aware of. With this part of yourself, you can definitely tell what feelings you are currently experiencing, such as joy or sadness, and you are confident that you know yourself. You know that you are a conscientious, hardworking and, perhaps, suspicious person, and perhaps even a perfectionist. It seems to you that it is these personal qualities that determine your behavior. But is this really so? Often there are subconscious motives behind our actions that we are not aware of. That's why it's important to look into your subconscious, which we'll do shortly. Many people with SLI admit that they are overly conscientious. We can say that they themselves classify themselves as “type A” people, according to the classification of physicians Meyer Friedman and Ray Rosenman, presented in their book “Core Behavior Types.” CHAPTER 2. PSYCHOLOGY OF SMN 51 A person of this type is a workaholic. He can work eighteen hours a day without noticing fatigue. But even the most hardworking people should remember that human strength is not limitless and prolonged overexertion is fraught with cardiovascular diseases, as well as other diseases. In addition, such people should pay attention to their own feelings. Most often, a “type A” person tries not to pay attention to his experiences, since they seem to him to be a manifestation of weakness. However, according to my observations, there is a certain difference between patients suffering from SMN and “type A” people, because coronary artery disease is quite rare in SMN. Yes, I have observed several similar cases, but their number cannot be compared with the number of patients with such accompanying diagnoses as colitis, hay fever, migraine, acne, urticaria, and so on. It appears that these conditions, in addition to back pain, are the most common and characteristic manifestations of MSI, reflecting a lower level of impulsivity than in Type A people. Be that as it may, our own personal characteristics that we are aware of and everything connected with them are just a drop in the bucket compared to what is hidden in our subconscious. SUBCONSCIOUS In psychological literature, the term “subconscious” indicates that part of a person’s mental activity that he is not aware of. This is the sense in which we use it when discussing emotions. 52 HOW TO CURE BACK PAIN The subconscious is a deep, mystical and unsolved area of ​​the human psyche, a place where a wide variety of feelings live, not always pleasant, not subject to logic and sometimes downright frightening. We gain some insight into what is going on in our subconscious when we recall and evaluate our dreams, which manifest themselves without any supervision from the waking conscious mind. The subconscious mind is the repository of all our experiences, no matter how pleasant or socially acceptable they are. Knowing what is happening in our subconscious is extremely important, since it is precisely this that often dictates our behavior after waking up. And it is in the subconscious that the roots of SMN are hidden. Interesting fact: the predominant part of the emotional and mental activity of the human psyche takes place below the level of consciousness. Our mind is like an iceberg - its conscious tip is much smaller than what we are not aware of. And it is in the subconscious that complex processes take place that allow us to think, remember, write, speak and think logically, that is, do everything that allows a person to consider himself a rational being. Our ability to make sense of what we see, recognize faces, and perform dozens of different actions that we take for granted is also the result of subconscious brain activity. Most emotional reactions probably originate in the subconscious. Experiences that do not find a way out remain there in a suppressed state and provide conditions favorable for the occurrence of SMN. The structures described here CHAPTER 2. PSYCHOLOGY OF SMN 53 of the human psyche, divided into consciousness and subconscious, as well as the unconscious content of its “lower floors” (which, under certain conditions, can be raised upward and conscious) were discovered more than a hundred years ago by Sigmund Freud. To better understand where muscle tension syndrome (MSS) comes from, it is necessary to understand the processes occurring in the subconscious. Low Self-Esteem It was a shocking revelation to me to realize how many people live with low self-esteem. For this, there must be some cultural prerequisites and general trends in raising children that determine this phenomenon. The feeling of one’s own inferiority is deeply hidden, but it still manifests itself in one way or another in a person’s behavior. As a rule, we strive to compensate for unpleasant experiences, therefore, when we feel weak, we demonstrate strength. Many years ago, in my practice, there was a case that served as the clearest illustration of this statement: a sort of macho man who was overcome by lower back pain came to me for treatment. The nurses said that he boasted to them of his toughness in fights, business and amorous affairs. In my office, he complained inconsolably of unbearable pain. Emotionally, this man was a little boy desperately trying to prove to himself and the world how big he was. Most likely, the obsessive need to achieve success, reach the goal and win, inherent in most of us, is a reflection of a deeply hidden inferiority complex. Wherever the desire 54 HOW TO CURE BACK PAIN to live in accordance with a certain ideal - to be the best parent, the best student or the best employee - comes from, it is characteristic of people with SLI. A typical example is a man who has worked selflessly for many years, created a very successful business and is surrounded by children and grandchildren whom he patronizes. He always liked this role, but the responsibility on him was always extremely high. For many years he suffered from lower back pain, despite having tried a variety of therapies. By the time I met him, pain had long been a part of his life. He accepted the concept of tension as the cause of pain, but could not get rid of the internal patterns that caused it. Our hero considered himself too old to resort to psychotherapy, which is often necessary in such cases. However, it was now clear to him that there were no pathologies behind the pain he was experiencing, and this was the main result of our treatment. My next patient is a young man in his twenties who had his first child shortly after starting a branch of the family business. New areas of responsibility simultaneously appeared in his life, and he, as an extremely conscientious person, took them seriously. This young man soon developed lower back pain as a result of MSI. As soon as he realized that the source of pain symptoms was internal tension, the pain disappeared. Later we will talk about the fact that such awareness is a key factor in the treatment of SCI. These two men - the old one and the young one - had one common quality, namely: a heightened sense of responsibility and a strong internal motivation to achieve success in business and in family life. Such people do not need to be controlled and forced to work; they are already over-disciplined and over-responsible. Those who develop MCI tend to be extremely goal-oriented. They strive to achieve results at all costs and set themselves difficult tasks. In our culture, success is won through competition, and these people have the necessary fighting qualities. They are used to placing higher demands on themselves; they always feel like they could have done more than was done. Often their perfectionism manifests itself in unexpected ways. I remember one young man, who grew up on a farm, confessing to me that after he learned what SMF was, he understood why during haymaking he had an irresistible desire to stack the hay in perfectly even stacks. Now you are probably wondering why such excellent qualities as hard work, responsibility, passion for work and the desire for excellence often become the cause of SMI. It is quite obvious that there is a direct connection between such personality characteristics and SMN, but how does it arise? To understand this, you need to remember anger and anxiety. Anger and anxiety I do not have a special psychological or psychiatric education, and I am aware that my descriptions of psychophysiological processes in the human body are simplified and may seem naive to professionals. But since this book is intended for a general audience, a minimum of specific words and complex concepts is just right here. Be that as it may, we are dealing with an almost unexplored border territory located between the psyche and physicality of a person. Alas, modern medical science actually ignores this territory (with rare exceptions). The reasons for such inattention are discussed in chapter seven, “Mind and Body.” For me, my experience diagnosing and treating MIS sheds some light on what happens in the unknown realm where emotions and physiology meet. We will talk about anger and anxiety in one section, because I believe these feelings are related and most often suppressed, and therefore trigger the development of MSD. Even at the very beginning of my work with SUD, it became clear to me that most people suffering from this syndrome suppress anger and anxiety. Even those who at first deny it eventually agree that it is still inherent in them, they just “tried not to think about anything like that.” Considering the personality characteristics listed above that are characteristic of SMI, it is not difficult to conclude: it is anxiety that becomes the cause of this syndrome in the first place, since a person is always in a state of worry: “What will happen next?” Anxiety is an exclusively human phenomenon, standing somewhere next to fear, but on a higher level, since it is caused by a quality that animals do not possess, namely the ability to expect and anticipate. Anxiety arises in response to the assumption of danger and carries a certain logic, unless the expectation of danger itself is illogical, as is often the case. An anxious person sees a threat in everything, even where there is none. This is the nature of homo sapiens. But it often happens that the individual himself is unaware of his anxiety, since it remains hidden in his subconscious as a result of the suppression mechanism. As we will see later, the SMN takes an active part in the process of such suppression. Narcissism We have already talked about the role of low self-esteem. Next to this feeling hidden in the subconscious there is another, no less interesting phenomenon - narcissism, which implies excessive concentration on one’s own person. It originates in a person's tendency to love himself. The evolution of society in the United States of America has led to the emergence of an “I”-oriented society that excludes any collectivism. It is said that in many Indian dialects the pronouns “I”, “me” and “me” simply do not exist, because the Indians associate themselves with something greater than a certain individual, and feel like an integral part of the tribe. Today's white Americans, on the contrary, profess extreme individualism and admire those who “made themselves.” This coin has a second side - a person who is entirely focused on his own selfish interests and does not have true ideals inevitably becomes greedy. We are periodically shocked by the news that respected members of the American business community or government officials are convicted of crimes, but in fact there is nothing to be surprised at, such a trend is just a logical extension of society's favorable attitude towards narcissistic selfishness. Anger Narcissism is present to some degree in all people. When this personality characteristic is hypertrophied, a person may have problems with social adaptation, since he tends to get irritated over trifles, especially when communicating with people who do not want to obey his will. As a result, anger is born, and if the degree of narcissism of an individual goes off scale, he can be in an angry state almost constantly, without even realizing it, since anger, like anxiety, is suppressed in the subconscious. This may seem paradoxical: on the one hand, we suffer from low self-esteem, and on the other, our narcissism provokes us to pretend to be royalty. Remember the fairy tale about the prince and the pauper? These diametrically opposed feelings are two sides of the same coin, and although this sounds strange, we usually experience them simultaneously. This situation is quite typical for the human psyche. She harbors many conflicting emotions, most of which we are not even aware of. Why do people feel angry? As a matter of fact, everything that causes anxiety in a person (unconsciously) makes him angry. You try to do your best job and hope that everything will be okay (anxiety), but you are afraid of problems that will arise when dealing with colleagues (anger). CHAPTER 2. PSYCHOLOGY OF SMN 59 Although work is most often the cause of anxiety and anger, personal relationships are also a common source of suppressed negative emotions. In family life, quite serious problems often arise that remain unattended because they seem insignificant. One of my patients was a forty-eight-year-old woman who grew up in an orphanage. She got married early and devoted herself entirely to her family and home. This woman coped well with her household responsibilities because she was smart, diligent and conscientious. But the moment came when she began to feel burdened by the fact that she had not received a decent education and did not even have a driver’s license - after all, her life was dominated by the interests of her family. She was not aware of this internal resentment, and gradually she developed back pain, for which she was treated for a long time and unsuccessfully, including surgical methods. When this woman came to me, it was difficult for her to perform even the simplest actions, since her back pain had become constant. My program helped her become aware of her repressed feelings, and as a result, the pain that tormented her disappeared. The healing process was not easy, and she had to endure a lot of emotional pain. But this is quite natural in such a situation, and, of course, much better than the unbearable physical pain that turned her into a helpless victim. An important source of anger and resentment that we are usually unaware of is our sense of responsibility to loved ones - parents, spouses and children. Although we sincerely love them, they often complicate our lives, and gradually inner anger grows in us. But is it possible to consciously be angry with an elderly parent or a young child? Here's a good example: a man in his forties went to another city to visit his elderly parents. The weekend was not over yet, and our hero developed back pain for the first time a year after the successful completion of the SMN therapy program. When we met, I assumed that the pain had returned due to some subconscious anxiety, but the man insisted that the weekend had been wonderful. True, he later admitted that his mother was very weak and he had to look after her all this time, and in general he was worried about his elderly parents. The situation was aggravated by the fact that they lived far away and, in order to visit them, he needed to fly to them by plane. My patient is a good, decent person, and, of course, he would in no way blame his parents for getting old. Therefore, he subconsciously suppressed the irritation that had accumulated in him, which, for reasons that we will talk about a little later, caused a new attack of pain. Now let's look at another case. My patient, a young father whose firstborn son barely slept, suffered from sleep deprivation, as did his wife. In his free time from work, he tried to help her care for the child, and if earlier their life together resembled a continuous honeymoon, now only memories remained from that time. Soon the young father began to have back pain due to suppressed anger at his own child (ridiculous, right) and at his wife, since she could no longer meet his emotional and physical needs as before (agree, absurd). Since the emotions he experienced CHAPTER 2. PSYCHOLOGY OF SMN 61 were unacceptable to him, he developed SMN. Many doctors would interpret the situation described differently. They would say that his back hurt due to the fact that he often carried the child in his arms, slept little, and also did unusual housework. A familiar explanation, isn't it? Another common explanation for such cases is the so-called “secondary gain”, beloved by behavioral psychologists - supposedly there are often cases when a person gets sick in order to gain some advantage. However, in this case, both of these explanations should be considered untenable. On the one hand, our young father was in excellent physical shape, having played college football in high school and college. It is hard to believe that under any circumstances it was contraindicated for him to pick up a small child in his arms. On the other hand, the concept of a benefit accruing to a person due to illness is also very dubious - I find it difficult to believe that such a benefit exists in nature. However, behavioral psychologists like this concept because it is simple and the weight of what you need to do to correct the situation is to reward yourself for behavior that excludes "secondary gain" and punish for the opposite. And no fuss with such unpleasant subconscious feelings as anxiety and anger. Many years ago, before I knew about SMN, I tried this approach and found it ineffective. All family relationships are emotionally burdened to one degree or another. This is what you need to remember 62 HOW TO CURE BACK PAIN first of all, when a person suddenly and for no apparent reason begins an attack of SMN. The combination of anxiety, love for a loved one, and internal resistance to the responsibilities associated with close relationships represents the source of deep conflict from which SMI grows. Here is another, one might say classic, case of manifestation of SMN. My patient was a thirty-nine-year-old married man who ran the family business that his father had started. He told me that his father was still actively involved in the business, but lately he had become more of a hindrance than a help. The man admitted that he had a conflict with his father on this basis and he felt guilty. The pain started about two and a half years ago, and four months after it started, he came across information about SMN. He decided that this was complete nonsense and that it was better to trust traditional medicine. He consulted many doctors, tried all possible methods of treatment, but to no avail. Two years later, the man still suffered from pain, the thought of which haunted him constantly, and could no longer move as freely as before. He was afraid of any physical activity and did not even dare to bend over. He eventually completed my program successfully and was soon pain free. During the next consultation, I saw a cooperative person, ready to accept any information, and I simply could not believe that at first he completely rejected the obvious diagnosis. This incident became a lesson for me: when working with SMN, you have to admit an unpleasant fact: people tend to deny in every possible way the very idea of ​​SMN until their situation becomes critical. It is quite obvious that the cause of this man’s pain syndrome was hidden in his relationship with his father. I will give another clear example of the role of family relationships in the development of SMI. One day, a woman who had gotten rid of lower back pain thanks to my program two years earlier called me and said that she now had pain in her neck, shoulder and arm. She was sure that the cause of the pain was her relationship with her husband and teenage stepdaughter. I advised her to try to avoid traditional medical treatment, but the pain progressed. The woman had difficulty moving both shoulders, a common manifestation of SCI in the neck and shoulders. And then one day she decided to face the problem and told her husband everything she thought. As a result, as soon as they managed to unravel the tangle of family problems, the pain disappeared. After all, its cause was suppressed resentment. In the chapter on treating SCI, I will go into more detail about how to deal with such situations. One of the main conflicts between the subconscious and consciousness is the battle between the negative feelings we experience and the desires generated by narcissism with that part of our mind that is concerned with issues of decency and the compliance of our actions with social norms. Renowned psychoanalyst Karen Horney described the so-called “tyranny of debt” that often dominates a person’s life. Patients often report that they are rigidly guided by certain behavioral imperatives. One woman who refused to admit her perfectionism told me that she was born into a family with a cult of strong character and inflexibility. Obviously, since she herself was by nature a rather gentle person, the dominant attitudes in her family gave rise to internal conflict in her. Often it is the pressure of cultural traditions that forces us to behave in one way or another. I remember one of my patients - a very beautiful woman, a member of a religious group that welcomed large families - six to eight children were common among them. I suggested that her pain was caused by an internal resistance to the responsibility of raising so many children. For a long time she did not want to agree with this, insisting that she did not feel any resistance. In the end, I was able to explain to her that it is very difficult to realize such feelings, since they are suppressed and locked in the subconscious. As a result, she admitted that somewhere deep inside her, resistance still existed, and soon the painful symptoms began to subside. The longer I work with SMI, the more impressed I become by the impact anger has on the human body. We have all learned to suppress it so well that in most situations we are completely unaware of its existence. I came up with the following idea: compared to anxiety, anger plays a more important role in the development of symptoms of MSI; Perhaps anxiety is a reaction to suppressed anger. The following story made a very strong impression on me. A man between forty-five and fifty years old suffered from panic attacks, among many other health problems. After an examination, I diagnosed him with SMN and told him that the cause of his panic was most likely not increased anxiety, but suppressed anger. Then he told me about one incident in his life that confirmed my assumption. One day he got very angry with someone and was ready to get into an argument, but he remembered that this was indecent and chose to restrain himself. A moment later he had a panic attack! My patient was probably not only angry at that moment, he was beside himself with anger, and the need to suppress such strong emotions turned into panic for him. We will soon see that situations like this often cause MSI. But first, let's understand the phenomenon of suppression. Where does it come from? Suppression I remember a woman proudly telling me how she was able to overcome her fifteen-month-old baby's temper tantrums. A “smart” family doctor advised her to splash ice water in the child’s face when he began to get angry. The effect was amazing - the baby was no longer angry. At such a tender age, he learned to suppress his emotions. He was programmed to suppress anger, and now he will be guided by this subconscious program throughout his life. Faced with the many annoying, upsetting and infuriating situations that happen every day in the lives of any of us, he will automatically begin to suppress the natural reaction of anger, and when the level of accumulated anger crosses a critical line, he will develop SMN. This story serves as an excellent illustration of one source of the need for suppression: well-intentioned parental influence. This is perhaps the most common reason why we learn to suppress emotions. Trying to raise their children, parents unknowingly create psychological problems for them that will make themselves felt in adulthood. Just imagine how many reasons there are for suppressing anger - both logically justified and unconscious. Everyone wants to be loved, and no one likes disapproval from other people. Therefore, we suppress the urge to engage in antisocial behavior. We are afraid of punishment, although we do not want to admit it to ourselves. According to society, expressing anger is an unacceptable behavior. We learn this in early childhood and know that being angry is not good (especially when this feeling arises in response to an external stimulus to which we should not react negatively), and therefore we suppress our own anger. At the same time, we are not even aware of our own need to suppress anger. As a result, out of nowhere we have SCI or some problems in gastroenterology. Personally, I already know: if I get heartburn, it means I’m angry about something, although I don’t know what. Then I start thinking about the possible source of my heartburn, and when I find it, it goes away. After seventeen years of working with SUDs, it is clear to me that we all get angry and anxious, regardless of cultural traditions or upbringing, and we all suppress our negative emotions. On the other hand, the psychological conditions leading to psychophysiological reactions like SMN, gastric ulcers and colitis, CHAPTER 2. PSYCHOLOGY of SMN 67 are universal and differ only in the degree of manifestation. In serious cases we call these reactions neurotic, but in fact we are all neurotic to one degree or another, so this definition becomes meaningless. The concept of repression is closely related to the concept of the unconscious. Both of these concepts were first expressed in the language of science by Sigmund Freud. Peter Gay's excellent biography of Freud, Freud: A Life in Our Time, provides a wonderful metaphor for the unconscious: “The unconscious is like a maximum-security prison for antisocial elements, whether languishing there for years or newly arrived; The prisoners are treated harshly and vigilantly guarded, but they cannot be completely controlled, and they are constantly trying to escape.” It is these “antisocial elements” imprisoned in the subconscious that are described in this chapter. They strive to break out of captivity into our consciousness, but the subconscious mind resists and surrounds them with walls of oblivion. Recently I heard a most interesting story from a patient. After examining her, I diagnosed her with MSD and explained what it meant. The patient said that the pain began after she invited her older sister on a trip to Europe. From that moment on, she was constantly worried: would her sister like the trip? Then she began to be angry with herself for such experiences. Soon she began to dream about her sister and mother and long-standing teenage grievances against them surfaced, which became especially painful after her father died (the girl was eleven years old). This set of emotions: anxiety, anger and grievances rooted in childhood is fertile ground for 68 HOW TO CURE BACK PAIN SMN. I was amazed when, after my little prompting, the woman was able to bring such important psychological material to the surface of her consciousness. Interestingly, more than eighty percent of Americans suffer from pain, which I consider to be symptoms of tension muscle syndrome (TSMS), and the number has been growing exponentially over the past thirty years. Back and neck pain is the number one cause of absenteeism in the United States, according to the number of sick days. And about fifty-six billion dollars are spent annually on the fight against these pains. In other words, we are talking about a real epidemic! PHYSICAL DEFENSE AGAINST SUPPRESSED EMOTIONS For many years I was sure that SMN is, so to speak, a physiological outburst of suppressed negative emotions. But in the early 1970s, it became clear to me that the back and neck pain that afflicts a large portion of our population was a result of their suppression. This is evidenced by the following fact: eighty-eight percent of people with SCI suffer from the obvious consequences of chronic nervous tension - colitis, stomach ulcers, asthma or migraines. The idea that pain does not express repressed emotions, but, on the contrary, prevents them from moving into consciousness, was suggested to me by my colleague Dr. Stanley Cohen during our joint work on an article. He said that in psychological language this is called protection. That is, pain with SMN (or with stomach ulcers, colitis and migraines), as well as asthmatic attacks CHAPTER 2. PSYCHOLOGY of SMN 69 arise in order to distract a person from the real source of his suffering, hidden in the sphere of emotions. At the same time, attention willy-nilly switches to physical sensations. This means that SMN is not a physiological pathology at all, but part of a psycho-emotional process. Pain syndromes in the neck, shoulders and back have become epidemic over the past thirty years precisely because they have become the most common type of protection against repressed emotions. The sign of a good disguise: no one knows what she is hiding. As a result, not a single person suffering from back pain even tries to associate it with emotional factors. On the contrary, almost everyone begins to look for the cause in some kind of injury or degenerative tissue changes. Yes, there are diagnoses that indicate actual pathologies - fibromyalgia, fibrositis, myofasciitis, and the like. These pathologies can indeed occur as a result of injuries and muscle failure, but they also represent an excellent disguise for psycho-emotional problems. As long as a person's attention is focused on physical pain, suppressed emotions will not be able to get into consciousness. I have repeatedly noticed: the more painful the hidden emotion, the stronger the SMN. For example, in a patient who has suppressed rage caused by bullying as a child, the pain usually becomes unbearable. They literally immobilize him and disappear only when he has the opportunity to throw out the terrible, painful anger that has been languishing in the subconscious for years - this is another example of how anger becomes the cause of SMI. 70 HOW TO CURE BACK PAIN EQUIVALENTS OF SMN As I said, there are other diseases that perform the same task as SMN. Here is a list of the most common ones: Pre-ulcerative conditions Stomach ulcer Hiatal hernia Irritable bowel syndrome (mucosal colitis) Hay fever Asthma Prostatitis Tension headache Migraine Eczema Psoriasis Acne, urticaria Dizziness Tinnitus Frequent urination All of these diseases can serve one purpose - to suppress emotions. And the longer a person remains in delusion, considering them “only diseases,” the more he suffers from them. As long as these diseases have something to suppress, they will not go away. In addition, some symptoms may be replaced by others. For example, new generation medications for the treatment of stomach ulcers help get rid of it, but some other disease comes to replace it. One forty-year-old man told me that ten years CHAPTER 2. PSYCHOLOGY OF SMN 71 ago he developed pain in the lower back and had surgery on his spine. Five months after this operation, he developed a stomach ulcer, which tormented him for almost two years. The doctor prescribed him various medications, but they did not help. Then the ulcer stopped making itself felt, but instead his shoulders and neck ached. The operation and treatment of the ulcer did not relieve him of the problem, but simply displaced some of its symptoms, giving way to others. History of treatment of stomach ulcers The history of treatment of stomach ulcers is quite interesting. The decline in the number of cases of this disease in the United States of America and Canada over the past twenty years is attributed to the emergence of new highly effective drugs. Thanks to journalist Russell Baker, I have a better explanation. In one of his Sunday articles in the New York Times magazine (August 16, 1981), he raised the question: “Where have the stomach ulcers gone?” Mr. Baker drew readers' attention to the fact that people began to suffer from this disease less often. This article gave me an idea: since everyone - both doctors and their patients - understood that an ulcer is associated with stress, it means that it has ceased to be a good means of masking suppressed emotions. This is why the incidence of stomach ulcers is decreasing. And maybe this explains where so many sore backs, shoulders and necks come from? MIND AND BODY I believe that almost any organ in the body can be used to mask repressed emotions. As examples, I will give hay fever, frequent respiratory diseases and urogenital problems. One of my acquaintances, a urologist with an academic degree, told me that in more than ninety percent of cases, prostatitis occurs due to nervous tension. I have a patient who suffers from constant dry mouth due to a reflex contraction of the salivary ducts caused by nervous tension. Suppressed emotions can trigger laryngitis. Ophthalmologists talk about common visual impairments associated with nervous tension, and so on. However, I remind you that the above in no way replaces the medical examinations that are necessary to exclude degenerative, infectious and neoplastic diseases as the causes of symptoms (we will talk more about this topic in the chapter on the mind and body). The final verdict of the specialist should be in the affirmative. Vague diagnoses like “I don’t know exactly what it is, so most likely psychosomatics are to blame” are unacceptable. The doctor should say, for example, the following: “Now that we have ruled out the possibility of a tumor, I can confidently continue treatment, knowing that the cause of the disease is psychological.” Rarely does anyone do this, since most medical practitioners either know nothing about the psychosomatic nature of many common diseases, or prefer not to think about such topics and continue to treat the symptoms.

Ecology of health: A psychophysiological disease is any disease in which physical symptoms...

A psychophysiological disease is any disease in which the physical symptoms are believed to be a direct result of psychological or emotional factors. This diagnosis means that psychological factors either initiated or are contributing to the back pain, or both.

It should be emphasized that although psychological factors may be the cause of physical symptoms, the symptoms are not substantiated by imaging techniques. However, actual physical problems (such as back pain) can be triggered by emotional factors.

The history of “stress back pain”

Dr. John Sarno, MD, a professor in the Department of Physical Medicine and Rehabilitation at New York University, recently popularized the idea of ​​"stress-induced back pain," which he calls "Tension Muscle Syndrome" (TSMS), although the concept dates back to 1820. year.

Dr. Edward Shorter's book From Paralysis to Fatigue details the history of psychosomatic illnesses. And back in the 1820s, the diagnosis of “irritable spine” was made and this is essentially equivalent to the modern idea of ​​stress back pain. The diagnosis of “irritable spine” was quite popular and spread throughout the world at that time.

Interestingly, Dr. Shorter opined that many doctors and patients of the era began to firmly believe in this diagnosis, even though there was no obvious pathology. Dr. Shorter noted that doctors put this diagnosis in the patient's head, increasing fears that a serious illness existed and recommending bed rest to patients.

The diagnosis of "irritation of the spine" remained quite common until the early 1900s. Dr. Shorter believes that the diagnosis served "the need to remain competitive with other medical clinics in "medicalizing" patients with certain subjective complaints. It also served the needs of patients by providing an opportunity to "save face" and have a medical diagnosis, rather than paying attention to possible psychological and emotional factors, since most patients did not want to admit the presence of psychological problems.

The history of the diagnosis of "spine irritation" is useful for understanding current medical approaches to back pain. Even today, some doctors pay attention primarily to structural “explanations” for back pain, and convince their patient that “diagnostic findings” are the cause of the pain, thereby instilling fear in the patient, and then advise “justified” treatment. However, if the true cause of back pain is stress, then active treatment using physical methods may not be effective and cause even more stress in the patient.

And if we return to Dr. John Sarno's conceptualization of “stress-related pain,” we can see similarities with the concept of “spine irritation.” The most important difference is that Dr. Sarno places the primary causative factors (psychological and emotional) at the forefront of his treatment plan; while some doctors continue to use only “physical” treatments.

Specifically, Dr. Sarno's theory holds that most cases of back pain that are treated by the medical community using "organic" approaches are actually stress-related. It is important to note that this theory and treatment approaches have received mixed reception in the medical and psychological community and have not yet been clearly supported by scientific research.

How does stress cause back pain?

There are many theories about the causes of stress-related back pain. It is important to note that the overriding principle of all these theories is that psychological and emotional factors cause certain physical changes and the result is back pain.

In most theories of stress back pain, the cyclic pain gets worse as it continues, leading the patient to become restless and have trouble performing daily activities.

Cyclic pain is characterized by:

• The patient becomes unnecessarily limited in performing many functions of daily life.
• This decrease in activity is due to the patient's fear of pain or injury.
• This fear may be exacerbated by the doctor's (loved ones) recommendations to calm down due to the presence of diagnosed small structural changes (which in fact may have nothing to do with back pain).
• Restrictions in movement and activity contribute to impaired physical condition and weakening of muscles, which in turn leads to increased back pain.

​

Of course, such a cycle provokes increased pain, increased fear, and even greater physical maladjustment, along with other reactions such as social isolation, depression and anxiety.

Dr. Sarno's theory

In Dr. Sarno's formulation of SNM, back pain is not related to mechanical or physical factors, but is caused by the patient's feelings, personality and subconscious problems. Key emotions include unconscious anger and rage. Additionally, he describes people who may develop strained muscle syndrome as personality type with the following characteristics:

• Has strong internal motivation to achieve success.
• Has a great sense of responsibility.
• Purposeful and disciplined.
• Self-critical.
• Perfectionist and compulsive.

Dr. Sarno's theory suggests that these personality characteristics interact with stressful life situations to lead to back pain. It is also noted that the source of psychological and emotional stress is not always obvious.

Dr. Sarno's theory of TMS describes the mechanism by which emotional stress is pushed from awareness by the mind into the unconscious. This unconscious tension causes changes in the nervous system. The changes cause blood vessels to narrow and reduce blood flow to various soft tissues, including the muscles, tendons, ligaments and nerves of the spine. This leads to a decrease in oxygen supply, as well as the accumulation of biochemical waste in the muscles. This in turn leads to muscle tension, spasms and back pain experienced by the patient.

Diagnosis of “stress pain” in the back

The diagnosis of stress back pain is often made based on a thorough medical history and physical examination. But patients should be careful when attempting to self-diagnose stress-related back pain, as the pain may be caused by a serious medical condition (such as a spinal tumor or infection). A thorough physical examination using imaging techniques can usually rule out more serious structural causes of back pain in most patients.

In cases where back pain is related to stress, the history of back pain is often quite variable. The pain may occur after a specific incident or appear suddenly. For example, pain often begins with an incident of muscle and ligament sprain, but does not disappear due to the influence of emotional factors, although the muscles and ligaments have already recovered from the injury.

In many cases, an MRI scan may reveal disc protrusion or osteochondrosis, although stress is actually the cause of back pain. In these cases, the MRI findings are not clinically significant and ultimately these changes are not considered the cause of the pain.

Common characteristics of stress back pain include symptoms such as:

• Back pain and/or neck pain
• Diffuse muscle pain
• Painful spots in the muscles
• Sleep disturbance and fatigue
• In many cases, with stress back pain, patients complain of migration of pain

In general, the symptoms of stress back pain are similar to those seen with fibromyalgia.

According to Dr. Sarno, the diagnosis of SUI is made only when organic causes of pain have been completely excluded, and at the same time, the characteristic features of SUI are present.

Treating stress-related back pain

Just as there are many theories about how stress and other emotional or psychological factors can cause back pain, there are many treatment approaches. But we can highlight the main approach - complex.

With an integrated approach, the treatment of stress back pain is carried out in a more extensive manner than defined by Dr. Sarno’s concept of SNM.

With a holistic approach, doctors do not always see clear personality characteristics, which Dr. Sarno said is important, and do not focus on unconscious anger as the focal psychological problem.

An integrated approach to treatment takes into account various factors: physical, emotional, cognitive and environmental factors, and aims to impact all aspects. Thus, The impact of treatment is carried out on the following aspects:

• Physical, including weakened muscles, irritated nerves, etc.
• Emotional, including depression, anxiety, anger, etc.
• Cognitive, such as negative thoughts, pessimism, despair, etc.
• Environmental factors such as job loss, financial problems, etc.

A comprehensive treatment program may include procedures such as:

• Treatment of physical factors with physiotherapy, analgesics and exercise therapy.
• Treatment of physical and emotional factors through the use of appropriate medications (antidepressants or muscle relaxants).
• Treatment of emotional and cognitive factors using psychological pain management techniques and biofeedback.
• Treatment of environmental factors through consultation.

Such complex therapy for the treatment of back pain has been used for more than 25 years and has proven its effectiveness, although the key factor in the outcome of treatment is the patient’s motivation to undergo the full course of treatment and rehabilitation. published