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Psychology of Back Pain from The Cleveland Clinic

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[quote][i]Originally posted by Northerner[/i]
[br]The following are excerpts from a back pain page on The Cleveland Clinic's web site.

These don't line up exactly with Dr. Sarno's theory, but they aren't far off.  For those of you unfamiliar with the Cleveland Clinic, it is highly prestigious, and perhaps one of the top ten research medical institutions in the country.

Among other things, one of these excerpts reminds us that out of every 100 people walking on the street who have never had back pain, 40 of them have ruptured disks, pinched nerves, cracked vertebrae and other nasty-sounding things that should be causing excruciating pain.  And they are pain free.

from the first link:

"Why is psychological treatment often recommended for a physical problem such as back pain?

There is a difference between mechanical or structural problems in the back and back pain. Some people have a high level of structural damage and feel very little pain, others have little structural damage and feel lots of pain. The reason for this difference relates to the biochemical processes in our bodies that determine our pain levels. These biochemical processes are influenced by psychological processes.

When we are experiencing stress, including the stress of having back pain, a variety of biochemical changes occur in the body that can alter our perception of pain. Our blood vessels constrict, which lessens the supply of nutrients to the damaged area. Our muscles tense, leading to increased muscle pain around the damaged area. Stress-related hormones also enhance the body's inflammatory response. As a result, we produce more of the hormones responsible for inflammation in the body.

We also produce less serotonin, another brain chemical. High levels of serotonin are associated with feelings of pleasure and contentment, and with good sleep. Low levels are associated with irritability, lack of sleep and increased pain perception."

Here's the link:

http://my.clevelandclinic.org/disorders/Back_Pain/hic_Psychological_Aspects_of_Coping_With_Back_Pain.aspx

From the second link:

"The Mind-body issue

Most people think that the mind and the body are separate and function independently. Instead, these two usually work together in shaping our experiences. Sometimes psychological factors can reduce or eliminate the effects of physical problems. For example, one line of research asked normal volunteers (that is, people who have never complained of chronic back pain) to undergo imaging procedures such as CT scans or MRI scans. Surprisingly, about 40% of these subjects had ruptured disks, pinched nerves, cracked vertebrae, or some other form of physical problem that should have produced significant back pain, but didn't. On the other end of the spectrum, there are some rare cases of conversion disorder: a psychiatric condition where the person feels chronic back pain, but there is no identifiable physical problem at all. In most cases, though, chronic back pain is a psychosomatic (literally, "mind-body") condition, where a real physical problem exists, but psychological factors play a large role in determining the person's experience of that problem. In some cases, mental processes such as dependence, depression, or frustration may make the pain worse; in other cases, a positive attitude and a sense of independence may lessen the pain."

http://my.clevelandclinic.org/disorders/Back_Pain/hic_Psychological_Factors_of_Chronic_Back_Pain.aspx

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T O P I C R E V I E W
Northerner	Posted - 12/28/2008 : 09:53:06 The following are excerpts from a back pain page on The Cleveland Clinic's web site. These don't line up exactly with Dr. Sarno's theory, but they aren't far off. For those of you unfamiliar with the Cleveland Clinic, it is highly prestigious, and perhaps one of the top ten research medical institutions in the country. Among other things, one of these excerpts reminds us that out of every 100 people walking on the street who have never had back pain, 40 of them have ruptured disks, pinched nerves, cracked vertebrae and other nasty-sounding things that should be causing excruciating pain. And they are pain free. from the first link: "Why is psychological treatment often recommended for a physical problem such as back pain? There is a difference between mechanical or structural problems in the back and back pain. Some people have a high level of structural damage and feel very little pain, others have little structural damage and feel lots of pain. The reason for this difference relates to the biochemical processes in our bodies that determine our pain levels. These biochemical processes are influenced by psychological processes. When we are experiencing stress, including the stress of having back pain, a variety of biochemical changes occur in the body that can alter our perception of pain. Our blood vessels constrict, which lessens the supply of nutrients to the damaged area. Our muscles tense, leading to increased muscle pain around the damaged area. Stress-related hormones also enhance the body's inflammatory response. As a result, we produce more of the hormones responsible for inflammation in the body. We also produce less serotonin, another brain chemical. High levels of serotonin are associated with feelings of pleasure and contentment, and with good sleep. Low levels are associated with irritability, lack of sleep and increased pain perception." Here's the link: http://my.clevelandclinic.org/disorders/Back_Pain/hic_Psychological_Aspects_of_Coping_With_Back_Pain.aspx From the second link: "The Mind-body issue Most people think that the mind and the body are separate and function independently. Instead, these two usually work together in shaping our experiences. Sometimes psychological factors can reduce or eliminate the effects of physical problems. For example, one line of research asked normal volunteers (that is, people who have never complained of chronic back pain) to undergo imaging procedures such as CT scans or MRI scans. Surprisingly, about 40% of these subjects had ruptured disks, pinched nerves, cracked vertebrae, or some other form of physical problem that should have produced significant back pain, but didn't. On the other end of the spectrum, there are some rare cases of conversion disorder: a psychiatric condition where the person feels chronic back pain, but there is no identifiable physical problem at all. In most cases, though, chronic back pain is a psychosomatic (literally, "mind-body") condition, where a real physical problem exists, but psychological factors play a large role in determining the person's experience of that problem. In some cases, mental processes such as dependence, depression, or frustration may make the pain worse; in other cases, a positive attitude and a sense of independence may lessen the pain." http://my.clevelandclinic.org/disorders/Back_Pain/hic_Psychological_Factors_of_Chronic_Back_Pain.aspx
3 L A T E S T R E P L I E S (Newest First)
stanfr	Posted - 12/30/2008 : 06:57:54 S Grace, I havent conquered my myriad of health issues that are mind-body, Sarno's approach has gotten me far but it's not a magic bullet. Im not sure how you can say "psychological factors causepain" and then say they are responsible for us "experiencing pain differently than others". Those are contradictory statements and i hope you can see the important difference, as the second implies that the pain comes from another (possibly physical) source. This latter confusion is what keeps many of us (including myself) from conquering TMS completely--it's an everpresent, maybe even subconcious, doubt The simple stress/psychology=pain formula isn't enough to explain this, there has to be a repressed or subconcious component for it to operate. In my case, there is way more than "pain" involved, there's dermatologic issues, circulatory issues, immune system issues, physical issues (eyesight, for example), all of which are way more involved than a simple derailment of how my mind processes "pain". CBT will definitely help, but you have to attack the route cause IMO for it to be successful, not just deal with the resultant anxiety etc.
skizzik	Posted - 12/29/2008 : 19:48:46 quote: Originally posted by Southern Grace She has been trying to get me to accept basically the same things that this article is describing. That it is my personality, depression tendencies, anxiety disorder and cognitive thinking that has caused me to feel the pain with the intensity that others without these things otherwise would'nt. No more looking for repressed emotions...but to focus on my emotional makeup and what I am dealing with in the here and now. To find a different way (yes, cbt)to solve/accept these issues which in turn would ease the way my mind processes physical pain. my thoughts.....anyone want to share theirs? S.G. I think thats pretty much in line w/ what others conclusions have come to here. That would sum up "la kevin"'s recovery. Also, in the "MBP" The guy who writes to Sarno and explains his recovery (I think his last name was campobello) says over a period of 3 months he worked to fix what could be fixed in his life and accept what couldn't be fixed in his life and walla, no more pain. That seems to be more on par w/ "now" than repressed emotions. Of course mzlorinj always brings up the 3 beakers of stress straight from the mouth of sarno. 1/3 stress from past, 1/3 from current, and 1/3 anxiety from future (i think). Ok, nuff outta me, I havent posted in a month, and have exploded today, later.
drziggles	Posted - 12/29/2008 : 07:36:01 thanks for the great links. i wish they had not lumped in secondary gain and pain as a "ticket out"--skeptical patients reading this for the first time will home in on those aspects and get very annoyed, I can guarantee...

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