Chronic Pain?

I have a problem, but my doctor can’t find out what’s wrong and tells me it is stress – can this be true?

Symptoms of Stress Illness are essentially an escape mechanism for the build-up of internal turmoil and just as with steam from a pressure cooker, the symptoms become the manifestation of the build-up of internal emotional ‘pressure’. These turmoils are numerous. They could be due to current stresses and our inability to ‘self-care’ and allow time to feel and process our emotions; or depression and anxiety; or childhood stresses such as abuse, neglect, parental illness or alcoholism; or traumatic events such as bereavement, an accident, witnessing a violent altercation. Certain personality traits, eg being a people pleaser, over conscientious or perfectionist can also exacerbate the existing stress by putting more demands on ourselves or others.

Unfortunately where psychological stress is involved and where there is no outlet, symptoms manifest. In fact the bigger the pressure, the more dramatic the result when an outlet is found, which is often the case with symptoms too.  Some people find that going for a run, thumping a punch bag or doing another physical activity does help them ‘let off steam’ and you can see how this could help dissipate the build-up of some psychological stress.

spinechartSadly as our lives have become more sedentary this happens less often and to make it worse, the constant external distractions in our lives mean we tend not to even notice how we feel inside.  We are so used to the pace of life these days and the constant overloading of information that we often don’t realise this is a problem until we have a symptom.

The symptoms themselves are caused by emotions triggering a response in the Amygdala, the emotional part of the brain.  Just below this area in the brain is the Hypothalamus, which regulates everything in the body, including the autonomic nervous system, which is the unconscious/automatic part of the nervous system.  This includes maintaining all the systems in your body, therefore it regulates; your heart rate, breathing, hormones, temperature, bladder and bowel function etc.

An emotion causes the production of neurotransmitters, or chemical ‘messengers’, throughout the body and the brain and once the emotional part of the brain is stimulated it causes a chain of reactions in the body via this autonomic nervous system.

One example of a common response to an emotion is blushing when embarrassed.  Another example which demonstrates how real physical responses can occur purely due to an emotion, is a man’s penile erection when sexually aroused. Both these examples also demonstrate how the brain can move blood around the body, depending on requirements.  One theory is that lack of oxygen, or hypoxia, is the cause of the pain in soft tissues and these examples indicate how this could happen.  When you understand that the pain from angina, and even a ‘stitch’ when running, are both caused by hypoxia, it is also clear that lack of oxygen to tissues can cause pain, so this theory might well be correct in some instances of musculoskeletal pain.

What other symptoms might I expect?

autonomic-nervous-system-diagramManifestations can vary depending on which area of the body is affected – central nervous system, peripheral nervous system, autonomic nervous system, and where in these systems is affected.

Musculo-skeletal

Back pain, neck pain, joint pain, tension headache, chronic tendonitis, bursitis, frozen shoulder, rotator cuff pain, thoracic outlet syndrome, impingement in the shoulder, osteoarthritis, tennis elbow, iliotibial band syndrome, chondromalacia patellae, piriformis syndrome, plantar fasciitis, shin splints, sciatica, whiplash, RSI, temporomandibular joint syndrome, carpal tunnel, trigeminal neuralgia, fibromyalgia, reflex sympathetic disorder/complex regional pain disorder.

Nerves

Numbness, tingling, itching, burning, pins and needles, muscle weakness, muscle spasms, involuntary movements.

Gastrointestinal

Abdominal pain, ulcer symptoms, nausea, vomiting, IBS, colitis, spastic colon, hiatus hernia, acid reflux, heartburn, constipation, diarrhoea.

Urogenital

Bladder frequency, spastic bladder, testicular pain, interstitial cystitis, prostate problems, impotence, infertility, undiagnosed pelvic pain, dysmenorrhoea, vulvodynia, vaginismus.

Cardiovascular

High or low blood pressure, palpitations, hyperventilation or shortness of breath, repetitive cough, undiagnosed chest pain, Raynauds disease.

Skin

Eczema, psoriasis, hives, rash, etc.

Mental health

OCD, eating disorders, depression, anxiety, panic attacks, body dysmorphic disorder, self harm, phobias, PTSD, trichotillomania

Miscellaneous

Difficulty swallowing/gagging, fatigue/tiredness, migraine, Bell’s palsy, facial paralysis, vertigo/dizziness, tinnitus, floaters in the eye, change in voice/loss of voice.

All serious medical explanations must be ruled out before a stress illness may be safely diagnosed. Stress illness can be diagnosed when the condition is recognised to be medically unexplained. However beware diagnostic tests – much research shows no pain in the presence of structural abnormalities.

What is actually happening? (neurophysiology)

brain-basic_and_limbicThe nerve pathways can begin due to an injury or stressful event that produces strong emotions. Emotional memories are registered and stored in the amygdala, the unconscious brain. Once the pain begins, nerves that send pain signals to the brain become sensitised over time and send repeated signals even when there is no tissue damage in the area where the pain is felt. These signals go to the amygdala and then get amplified by both conscious and sub-conscious emotions, which trigger activation of the anterior cingulate cortex (ACC). The ACC mediates pain. Emotions increase the activity here, such as fear of the pain itself, resentment you can’t do what you want to do etc. The amygdala is closely connected to the hypothalamus which regulates all internal functions via the autonomic nervous system (ANS), all of which is unconscious. The ANS activates the fight, flight, freeze or submit mechanism, which produces nerve activation, muscle tension, GI/GU spasm, and/or CV activation that worsens the physical symptoms. These pathways get reinforced over time, and this creates a vicious cycle of pain and increase emotional responses. A variety of triggers (such as certain physical movements or positions, places, weather changes, foods or situations) can act as conditioned responses and add to the neurologic pathways that perpetuate pain. In the conscious portion of the brain, the dorsolateral prefrontal cortex (DLPFC) area can act to diminish and break the cycle by overriding the activity of the ANS and by deactivating the ACC. All conscious activities in the SIRPA program stimulate the DLPFC and therefore help reduce the pain.

What can I do?

Treatment takes the form of recognising and expressing the unprocessed emotion, gaining perspective on it, and moving forward. However it is not enough to engage with the therapeutic tools such as mindfulness, expressive writing, affirmation, counselling, without the understanding about stress illness. People need to understand that they have stress illness rather than a medical disease and that they can recover. Many people find it very difficult to believe that stress illness can cause such severe pain or such varied symptoms, but it is a critical element of recovery. When people doubt the diagnosis and continue to worry that they have a physical problem, it impedes their recovery because doubt leads to fear and fear leads to persistent pain by activating the ACC. It is common to be sceptical that the program will work, but usually people begin to see responses when they start it, and that helps convince them. Since the mind controls stress illness, it is helpful to believe that you have stress illness, that you are capable of getting better, and that you can cure yourself. A positive attitude activates the part of your brain that decreases pain, the DLPFC.

Goals of treatment

  • To acknowledge, express, gain perspective and let go of the repressed emotions
  • Remove fear of the diagnosis, the future/ever recovering, pain, an activity, letting go
  • Gain day to day life skills, learning to reappraise stress and respond appropriately rather than react inappropriately
  • Gain awareness of learned beliefs, behaviours, and judgements, and when these are not helpful – reduce self-induced stressors
  • Take responsibility/choice – move from victim to self-empowerment
  • Be allowing of self, others, and situations
  • Achieve balance

This requires repetition, persistence and commitment

What can I do now?

I suggest you read a book which will explain in far more details the concept and treatment, and also includes excellent case studies which you may find relevant to your particular situation. If after reading this you are keen to proceed, I will send you forms to complete. One I have received these back and reviewed them, we will book a consultation. This lasts about an hour and a half. After this appointment I will provide you with a program to begin to work through.

Suggested reading

“They Can’t Find Anything Wrong!” by David Clarke

“Chronic Pain” by Georgie Oldfield

“The Divided Mind” by John Sarno

“The Mind-Body Prescription” by John Sarno

Some text used with grateful thanks from www.sirpauk.com

SIRPA-logo