By Mark H. Musicant, MD, Medical Director, Sansum Medical
Clinic Occupational Medicine
I occasionally use stories and anecdotes to help patients resolve pain issues. These successful pain resolution stories, are of previous patients and often illustrate the importance of mind-body awareness. The following case occurred several years ago.
Joe, a fifty-five-year-old maintenance worker/gardener for a local school system, developed back pain on the job and was seen for an evaluation. Other than age, there were no red flags. X-rays showed moderate degenerative changes. His exam showed decreased motion, but no evidence of weakness or other signs of radiculopathy.
Joe was treated initially with NSAIDS, and referred for physical therapy. He was placed on light duty with limited lifting. After two weeks, he was no better and complained of increased pain, requesting stronger pain medication. He was given Tylenol with 1⁄2 grain codeine in addition to the NSAIDS. He continued with physical therapy. Six weeks after the initial visit, his MRI scan showed only typical narrowing of several disc spaces and degenerative changes.
At this point in treatment, I often refer to a spine specialist for a second opinion, or to pain management, if there seem to be symptoms that may be amenable to a facet injection or an epidural. But before referring, I wanted to gauge Joe’s willingness to consider mind-body relationships that might contribute to pain. I shared several anecdotes about my own personal pain issues and how they were resolved. John appeared interested, so I continued to describe the theory and work of Dr. John Sarno.
Dr. Sarno wrote The Mindbody Prescription. He was a professor of Clinical Rehabilitation Medicine at New York University School of Medicine and an attending physician at the Howard A. Rusk Institute of Rehabilitative Medicine at New York University Medical Center. His theory is that much of chronic
pain is caused by internalized emotions, especially rage. Rage (“going postal”) is so powerful that we will not generally bring it to consciousness, and we will repress the feeling. His theory is that muscle tension and pain are expressions of the underlying unexpressed emotions.
After he evaluated his patients to rule out any objective tissue damage, Dr. Sarno described to the patient the relationship of rage and fear to physical pain. He then gave patients the following homework: make a list of anger, rage, stresses, fears, and unresolved childhood issues, and do a daily reflection on these
issues. I described to Joe how this worked for me with my eight weeks of unresolved low back pain; and how three old issues—old angers—came to mind. I wrote them down and reflected on them. The next
morning, my lower back pain and right leg dysesthesia were gone. Joe stopped me at this point and said:
“That’s step 10.” Step 10, he explained, was similar to what I had described.
It involved taking inventory and doing a daily reflection. He revealed that he was an alcoholic, though he had not had any alcohol for several years. But, he had stopped going to meetings and had stopped contacting his sponsor. Codeine, He acknowledged, was a substitute for alcohol. He did not ask for more medication at this visit.
Joe continued on light duty for one more week. At the follow-up visit, he said that he was off all medication. He had contacted his sponsor and he had attended several AA meetings. His pain score went from “5-6” to “1” and he felt ready for regular work. A phone follow-up several weeks later confirmed that he was pain-free and not taking medications. He was back in his AA program and in contact with his sponsor.
Joe’s story is now one that I share when a patient shows a glimmer of interest in the way their emotional life and their stressors might contribute to their pain. Patients often have an intuitive knowing that their pain has something to do with a difficult relationship or situation.
