experiencelifemag.com Print › | Back › Head Case When the source of your pain escapes you - and your doctor - it could be psychogenic. By Susan Gaines April 2008 Timely Encounter How Mind Creates Matter Translating Pain Window to the Mind How Do I Know If My Pain Is Psychogenic? In the fall of 1990, Robert Post reached into the refrigerator, heard a pop and felt a sharp pain in his right knee. Within six months, his shoulders, hips and back were also aching. The simple act of reaching for the mayo had ignited a chain of physical and psychological events that kept him prisoner in a cycle of pain that would last three years. The 54-year-old professional comedian saw doctors, physical therapists and psychologists. He was twice tested for multiple sclerosis. But tests were negative, x-rays normal. He took medication, did rehab exercises, practiced yoga and meditated. Post did everything he could to fix the problem, but it only became worse. He began compromising his posture to accommodate his shifting but persistent pain. He climbed stairs like a man decades older than he was. Eventually, Post was forced to cut out some of the more demanding physical aspects of his performances. His friends stopped asking him to play golf, one of his favorite pastimes. But that was the least of his worries. “I was no longer thinking much about golf,” he says. “I was thinking, ‘Are they going to put me in a wheelchair?’” Timely Encounter Then, one day in 1991, Post was preparing to board a flight home to Ohio after a performance in Maine, but he was so wracked with pain that a friend suggested he take a later flight and get a massage. The massage therapist suggested he see Craig Williamson, MSOT, a Portland, Maine–based occupational therapist with a reputation for helping people find relief from chronic, mysterious pain. Williamson, author of Muscular Retraining for Pain-Free Living (Trumpeter, 2007), pioneered “somatic integration,” a form of therapy that includes hands-on techniques, corrective movement exercises, kinesthetic retraining, body-alignment education and psychophysical repatterning. Over the next two years, with Post commuting to appointments, the two developed a healing relationship that brought Post lasting pain relief. The success of treatments like somatic integration, Rolfing and ortho-bionomy (see page 80) for treating chronic muscle pain can be traced to the notion that mind and body are connected, or that our emotions have physiological expressions and can “live” in our bodies. Post eventually came to understand his pain as psychogenic, or psychosomatic. In other words, the tangible byproducts of suppressed emotions were causing his pain — and ridding himself of his pain’s tyranny meant learning to release and resolve, rather than ignore, those feelings. How Mind Creates Matter Psychogenic pain does not refer to pain that is imaginary or “all in our head.” In fact, the pain triggered by emotional factors is no less real — or potentially debilitating — than pain caused by a bulging disk or a sprain. All pain has certain psychogenic aspects. “Pain is the mind trying to get your attention. If emotional issues are repressed, they can manifest in the body as pain or illness,” says Deb Shapiro, author of Your Body Speaks Your Mind: Decoding the Emotional, Psychological and Spiritual Messages That Underlie Illness (Sounds True, 2006). There is little argument that thoughts and feelings have physical consequences. Consider how sadness elicits tears. Or how fear or anger gets our heart racing. The ˙ biological and the emotional are closely linked through the autonomic nervous system (ANS), the body’s wiring for survival. This is the system that can inspire you to fight, flee or freeze with a quick infusion of cortisol, adrenaline, peptides and other very real chemicals. Every emotional state or reaction carries its own biochemical and neuromuscular signature. But the ANS does not discriminate between the stress of daily life and that of an imminent physical threat. It sends stress signals throughout the body in either case. Over time, these stress chemicals can overload our systems, flipping on dormant genetic switches, causing illness, anxiety, depression or — you guessed it — physical pain. John Sarno, MD, author of Healing Back Pain: The Mind-Body Connection (Grand Central Publishing, 1991), posits that emotions follow physiological pathways, causing constriction of arteries around muscles, joints and nerves. This constriction deprives specific areas of oxygen and can ignite our body’s pain receptors. But by learning the language of the “body-mind,” says Shapiro, we can begin to decode the underlying messages and release the emotions and the physical pain. Translating Pain Because trauma and chronic stress reside in our bodies, traditional talk therapy does not always help alleviate pain or other physical manifestations of suppressed emotions. “You can talk and talk and talk and still not reach the limbic system,” says Maggie Scarf, author of Secrets, Lies, Betrayals: The Body/Mind Connection (Random House, 2004). The limbic system is the area of the brain where emotions churn. It’s also involved in memory, which could explain why a Vietnam War veteran may feel anxious on a rainy, humid day. Memories of the jungle spark a physical response to something that happened long ago. “The body is always talking to you, but many people don't know how to listen,” says Scarf. The exact mechanism for alleviating psychogenic pain is not well understood, however. “Information enters the limbic system through different senses and experiences — physical, emotional and spiritual,” says Ron Tarrel, DO, director of the Neurocritical Care and Stroke Services Program at Abbott Northwestern Hospital in Minneapolis. “But there’s no one formula for successful treatment, because psychogenic pain’s causes and manifestations are different in each individual. But we do know that certain treatments work for certain people.”   Window to the Mind Williamson combined a variety of therapeutic approaches with Post: helping him identify and shift dysfunctional movement patterns; teaching him slow, mindful movements to help him tune in to the parts of his body that had become “mute”; and drawing his attention to the ways that stress created painful and destructive patterns in his body. “I realized that my pain is a signal to tap in to my emotions,” Post says. By bringing consciousness to both physical and psychological expressions of stress, it’s possible to let go of the dysfunction that causes pain. A growing body of research shows that thought alone can alter the physical structure of the brain. Jon Kabat-Zinn, author of Full Catastrophe Living (Piatkus Books, 2001) and founder of the Center for Mindfulness in Medicine, Health Care and Society at the University of Massachusetts in Worcester, discovered that regular mindfulness meditation reduces both the experience of pain and its inhibition on everyday activities. Post still remembers the relief he felt when his pain began to lift. “It was the most extraordinary feeling: The pain finally began to go away,” says Post. “The first time I swung a golf club again, I felt like I was flying.” Susan Gaines frequently writes about fitness, health and parenting, including a regular fitness column for Twin Cities Metropolitan. How Do I Know If My Pain Is Psychogenic? The following examples suggest a strong possibility that your pain is psychogenic, according to Craig Williamson, author of Muscular Retraining for Pain-Free Living (Trumpeter, 2007): There is no evidence of a structural cause to the pain (that is, scans are negative or show negligible injury), and the pain is not affected by treatments that have been proven effective. Pain began at, or shortly after, a time of significant emotional stress.  Pain occurs bilaterally. (That is, it exists in the same place on both sides of the body. For example, both shoulders, both hips, both elbows.) Your pain level increases and decreases from day to day, but you do not find that the intensity is connected to certain activities. It does not seem to respond to rest.  You feel pain in an area that is habitually tense, even when you’re at rest.

Head Case

When the source of your pain escapes you - and your doctor - it could be psychogenic.

Timely Encounter
How Mind Creates Matter
Translating Pain
Window to the Mind
How Do I Know If My Pain Is Psychogenic?

In the fall of 1990, Robert Post reached into the refrigerator, heard a pop and felt a sharp pain in his right knee. Within six months, his shoulders, hips and back were also aching. The simple act of reaching for the mayo had ignited a chain of physical and psychological events that kept him prisoner in a cycle of pain that would last three years.

The 54-year-old professional comedian saw doctors, physical therapists and psychologists. He was twice tested for multiple sclerosis. But tests were negative, x-rays normal. He took medication, did rehab exercises, practiced yoga and meditated. Post did everything he could to fix the problem, but it only became worse.

He began compromising his posture to accommodate his shifting but persistent pain. He climbed stairs like a man decades older than he was.

Eventually, Post was forced to cut out some of the more demanding physical aspects of his performances. His friends stopped asking him to play golf, one of his favorite pastimes. But that was the least of his worries. “I was no longer thinking much about golf,” he says. “I was thinking, ‘Are they going to put me in a wheelchair?’”

Timely Encounter (Back to Top)
Then, one day in 1991, Post was preparing to board a flight home to Ohio after a performance in Maine, but he was so wracked with pain that a friend suggested he take a later flight and get a massage. The massage therapist suggested he see Craig Williamson, MSOT, a Portland, Maine–based occupational therapist with a reputation for helping people find relief from chronic, mysterious pain.

Williamson, author of Muscular Retraining for Pain-Free Living (Trumpeter, 2007), pioneered “somatic integration,” a form of therapy that includes hands-on techniques, corrective movement exercises, kinesthetic retraining, body-alignment education and psychophysical repatterning. Over the next two years, with Post commuting to appointments, the two developed a healing relationship that brought Post lasting pain relief.

The success of treatments like somatic integration, Rolfing and ortho-bionomy (see page 80) for treating chronic muscle pain can be traced to the notion that mind and body are connected, or that our emotions have physiological expressions and can “live” in our bodies.

Post eventually came to understand his pain as psychogenic, or psychosomatic. In other words, the tangible byproducts of suppressed emotions were causing his pain — and ridding himself of his pain’s tyranny meant learning to release and resolve, rather than ignore, those feelings.

How Mind Creates Matter (Back to Top)
Psychogenic pain does not refer to pain that is imaginary or “all in our head.” In fact, the pain triggered by emotional factors is no less real — or potentially debilitating — than pain caused by a bulging disk or a sprain.

All pain has certain psychogenic aspects. “Pain is the mind trying to get your attention. If emotional issues are repressed, they can manifest in the body as pain or illness,” says Deb Shapiro, author of Your Body Speaks Your Mind: Decoding the Emotional, Psychological and Spiritual Messages That Underlie Illness (Sounds True, 2006).

There is little argument that thoughts and feelings have physical consequences. Consider how sadness elicits tears. Or how fear or anger gets our heart racing. The ˙ biological and the emotional are closely linked through the autonomic nervous system (ANS), the body’s wiring for survival. This is the system that can inspire you to fight, flee or freeze with a quick infusion of cortisol, adrenaline, peptides and other very real chemicals.

Every emotional state or reaction carries its own biochemical and neuromuscular signature. But the ANS does not discriminate between the stress of daily life and that of an imminent physical threat. It sends stress signals throughout the body in either case. Over time, these stress chemicals can overload our systems, flipping on dormant genetic switches, causing illness, anxiety, depression or — you guessed it — physical pain.

John Sarno, MD, author of Healing Back Pain: The Mind-Body Connection (Grand Central Publishing, 1991), posits that emotions follow physiological pathways, causing constriction of arteries around muscles, joints and nerves. This constriction deprives specific areas of oxygen and can ignite our body’s pain receptors.

But by learning the language of the “body-mind,” says Shapiro, we can begin to decode the underlying messages and release the emotions and the physical pain.

Translating Pain (Back to Top)
Because trauma and chronic stress reside in our bodies, traditional talk therapy does not always help alleviate pain or other physical manifestations of suppressed emotions. “You can talk and talk and talk and still not reach the limbic system,” says Maggie Scarf, author of Secrets, Lies, Betrayals: The Body/Mind Connection (Random House, 2004).

The limbic system is the area of the brain where emotions churn. It’s also involved in memory, which could explain why a Vietnam War veteran may feel anxious on a rainy, humid day. Memories of the jungle spark a physical response to something that happened long ago. “The body is always talking to you, but many people don't know how to listen,” says Scarf.

The exact mechanism for alleviating psychogenic pain is not well understood, however. “Information enters the limbic system through different senses and experiences — physical, emotional and spiritual,” says Ron Tarrel, DO, director of the Neurocritical Care and Stroke Services Program at Abbott Northwestern Hospital in Minneapolis. “But there’s no one formula for successful treatment, because psychogenic pain’s causes and manifestations are different in each individual. But we do know that certain treatments work for certain people.”
 

Window to the Mind (Back to Top)
Williamson combined a variety of therapeutic approaches with Post: helping him identify and shift dysfunctional movement patterns; teaching him slow, mindful movements to help him tune in to the parts of his body that had become “mute”; and drawing his attention to the ways that stress created painful and destructive patterns in his body. “I realized that my pain is a signal to tap in to my emotions,” Post says.

By bringing consciousness to both physical and psychological expressions of stress, it’s possible to let go of the dysfunction that causes pain. A growing body of research shows that thought alone can alter the physical structure of the brain. Jon Kabat-Zinn, author of Full Catastrophe Living (Piatkus Books, 2001) and founder of the Center for Mindfulness in Medicine, Health Care and Society at the University of Massachusetts in Worcester, discovered that regular mindfulness meditation reduces both the experience of pain and its inhibition on everyday activities.

Post still remembers the relief he felt when his pain began to lift. “It was the most extraordinary feeling: The pain finally began to go away,” says Post. “The first time I swung a golf club again, I felt like I was flying.”

Susan Gaines frequently writes about fitness, health and parenting, including a regular fitness column for Twin Cities Metropolitan.

How Do I Know If My Pain Is Psychogenic? (Back to Top)
The following examples suggest a strong possibility that your pain is psychogenic, according to Craig Williamson, author of Muscular Retraining for Pain-Free Living (Trumpeter, 2007):

• There is no evidence of a structural cause to the pain (that is, scans are negative or show negligible injury), and the pain is not affected by treatments that have been proven effective.
• Pain began at, or shortly after, a time of significant emotional stress. 
• Pain occurs bilaterally. (That is, it exists in the same place on both sides of the body. For example, both shoulders, both hips, both elbows.)
• Your pain level increases and decreases from day to day, but you do not find that the intensity is connected to certain activities. It does not seem to respond to rest. 
• You feel pain in an area that is habitually tense, even when you’re at rest.

Print | Email | Comment | Subscribe | Give a Gift