Dr. Schubiner's Blog Cause and effect: The controversy about vaso-constriction and persistent soft tissue injury in MBS

Written by Dr. Schubiner on November 26, 2009


One of the great books of the twentieth century is Victor Frankel’s, Man’s Search for Meaning. In the book, he describes the need we have to understand why things happen. When someone gets sick, one of the first questions asked is, “Why did this happen?” One of the more frustrating aspects of being a physician is trying to answer this question for people with cancer and other serious physical diseases. For most people, we are forced to say, “I don’t know.” No one is ever happy with this answer.

Fortunately for Mind Body Syndrome, we do know what is causing the symptoms: stress and emotional reactions that were typically primed in childhood and emerge later in life in response to new stressors which are linked to the earlier emotions (“emotional speed dial”), which is coupled with limited awareness or suppression of emotions and body reactions which alert us to a perceived danger. I am currently finishing a book, entitled Unlearn Your Pain, which attempts to detail these processes from a psychological and neurological perspective. It is axiomatic that the greater awareness and understanding of the cause of Mind Body Syndrome, the better we will be able to resolve the underlying emotional conflicts and eliminate the resulting physical or psychological symptoms.

For many people, the explanation above is sufficient to get them on the path towards healing. However, for the more scientifically inclined, the question of “why is this happening?” goes deeper. What is happening on a physical level in the body to create these symptoms?

There is clear scientific data to show that the pain and other symptoms experienced are real. Studies by Dan Clauw, M.D. and colleagues at the University of Michigan clearly document that the pain of fibromyalgia (for which there is no evidence of physical tissue damage in the areas where the pain is being felt) activates the same brain structures as pain caused by tissue damage in the body. However, a process known as central sensitization is present, which suggests that the nervous system and brain have developed pathways that create and activate pain. These processes are learned and malleable since the pain often moves from place to place in the body and is greatly affected by stress and emotions. Dr. Clauw has also shown that people with chronic back pain also have central sensitization. (This effect is demonstrated by increased amount of pain reported after pressure is exerted to the thumb.) Derbyshire and colleagues at the University of Pittsburgh have also shown that pain induced by hypnosis activates the same areas in the brain as does pain caused by heat applied to one’s hand. In short, the brain can create real pain.

Despite these data suggesting that the most important place to look for the cause of chronic pain in MBS is the brain, it is clear that effects in the body do occur. When MBS causes diarrhea, the colon is activated to increased peristalsis (stool propelling motion); while when MBS causes constipation, the colon shows decreased activity. When we get embarrassed, our face may turn red, obviously a sign of vaso-dilation of blood vessels; while stress can also cause our hands to get cold and clammy, which is caused by vaso-constriction of blood vessels.

There are scientific articles that document changes in tissues due to stress. Studies of how quickly wounds heal in people with more or less stress show that healing is delayed and there is evidence of vaso-constriction and release of inflammatory cytokines, which cause slower return of these tissues to normal. However, since this delay in healing is small (on the order of a few days) and the tissues do heal after wounds, I don’t think that these mechanisms of vaso-constriction and changes in the tissues persist long enough to explain pain that lasts for months, years, or decades.

In order to fully explain Mind Body Syndrome, it is necessary to explain symptoms that last for years and symptoms that are remarkably varied and complex. Would vaso-constriction and tissue changes explain ringing in the ears, fatigue, anxiety, frequent urination, diarrhea, and constipation? I don’t think so. The only way to explain the varied manifestations of MBS is to understand that nervous system activation, probably of the autonomic nervous system (ANS), which becomes learned or wired into the brain is the likely culprit. The ANS can cause increases or decreases in GI motility (for example, irritable bowel syndrome), urinary contractions (irritable bladder or interstitial cystitis), blood vessel constriction or dilation (migraine headaches, fainting, or flushing), rapid or slow heart beat, and activation (anxiety) or deactivation (fatigue and depression) of general nervous system activity.

It seems to me that attempts to explain MBS by focusing on what is going on in the peripheral tissues are misleading. They tend to make people about a physical problem such as not getting enough oxygen to the body or persistence of soft tissue injuries that are not present. Therefore, they may not be focusing on the real problem: learned pathways in the brain that need to be reprogrammed. I believe that this concept better explains MBS in all of its manifestations and affirms that there is no significant physical problem that requires intervention. When therapeutic energies are focused on changing the brain in order to change the symptoms, successful outcomes are more likely.

To your health,

Howard Schubiner, MD

 

I love this summary of MBS explained in one sentence in the above blog:

"Fortunately for Mind Body Syndrome, we do know what is causing the symptoms: stress and emotional reactions that were typically primed in childhood and emerge later in life in response to new stressors which are linked to the earlier emotions (“emotional speed dial”), which is coupled with limited awareness or suppression of emotions and body reactions which alert us to a perceived danger"

One question I have about the learned neural pathways mechanism as a cause of TMS--how does this explain the phenomenon of symptom substitution? For example, if my TMS shifts from pain to allergies (or any other unrelated condition) within a few hours, how has my brain so quickly developed a new neural pathway?

 

In my very limited understanding, I am not sure the unconscious deals in neural pathways. It is like an off-road vehicle, it goes wherever it wants. You block one gateway, and it finds another one, so pain then becomes allergies, etc.
The conscious brain is like a train, it runs on tracks. You can lay down new ones for it.
Maybe someone who has studied NLP can shed some light.