Written by on October 15, 2008 Have you ever noticed that musicians are more likely to have repetitive stress injuries? Of course you have. But are you sure that the cause is actually overuse? What about headaches, back aches, neck aches, abdominal pain, fibromyalgia and TMJ pain? Do musicians have more than their share of these as well? Consider the situation of Jill, a 35 year old cellist who suffered from chronic and recurring wrist pain that for year she attributed to overuse. Here is her story in her own words: ”I have been an active freelancer in a major city for years. Since graduate school days, I have played in many orchestras and chamber groups, driven long distances, taught in various schools, and presented at conferences.Like many of us, I had lived with various aches and pains for years. One fall, preparing for some particularly demanding concerts, my whole upper body seemed to just shut down. I experienced overwhelming fatigue, pain, and various other symptoms. Somehow I kept performing through the 3 month wait for appointments, tests, and results. I was horrified when the specialist told me in all of 5 minutes that I needed 3 surgeries. I was incensed at his bluntness and his unwillingness to come up with anything more than that. I made up my mind then and there that I would find my own way out of this, and consider surgery the absolute last resort. For the next several years I went from one medical professional to the next, with discouraging results. I did exactly as I was told, paying large sums of money to see people not covered on my insurance, and yet nothing was improving. Playing caused symptoms – sometimes predictably and other times with no recognizable cause. I was also unable to do many other things I loved to do. I became very discouraged and ready to give up. What kept me going throughout this dismal period was a deep sense that I was missing a vital piece of this puzzle. Why did the symptoms seem so erratic? Were they really? Why did they bother me more on the day I had to give a badly paid workshop? Why did they diminish to nothing when the workshop turned out to be enjoyable? Why did I feel so much better after being encouraged by a physical therapist? Why was it that my worst flareup began when I saw the most discouraging doctor? Obviously, there was an emotional component to this whole thing – when I calmed down, it calmed down - but when I mentioned this to medical professionals, they responded with shrugged shoulders or polite silence. Sometimes they even laughed at me. I decided to observe myself closely and find my own answers. Soon I found that the onset of pain often came seconds after a painful thought or feeling, usually frustration or fear. Gradually a pattern began to emerge. At one point I spent a long weekend alone, walking in nature, doing yoga, meditating. My symptoms diminished to almost nothing. Yet on all 3 days, when I had to call a difficult coworker, the pain in a particular spot on my arm returned with a vengeance. Finally I discovered Dr. Schubiner's website, yourpainisreal.com, and participated in his fascinating teleconferences. I instantly recognized Mind Body Syndrome in myself and knew I had finally found help. After registering for his online Mind Body Program, I learned to not just relax my body, but to establish an ongoing dialogue with it, or with my instrument, or with the pain, or my frustration, or my deeper self, or whatever needed exploring. I learned to listen for valuable messages from my inner mind – I saw that I had been driving myself ridiculously hard, both physically and emotionally, for years. Perhaps the memory of that strain was an inner barrier to my going back to frequent performing. I also learned to recognize pain that was a conditioned response to certain life situations. The program taught my to take control and stop that pain from escalating. This process, though long and at times frustrating, became a fascinating series of valuable life lessons, with profound rewards. I am now able to play longer and am taking more work. With my body's feedback, I am learning to play in a more relaxed way. I have much to learn in that area, but the things I am learning are equally valuable for my students. Dr. Schubiner's warm and encouraging responses to my emailed questions have given me comfort, strength, and valuable insight. I have an array of skills and tools to use if things get stressful. And best of all – no drugs and no surgery! Today I am playing virtually pain free, with more joy than ever. I am deeply grateful every day for these valuable lessons, for the gift and privilege of music making, and to Dr. Schubiner for his exceptional help.” There have been a tremendous amount of advances in understanding chronic pain in the past two decades. It is important to realize that an injury or an overuse situation can cause acute pain. But with a bit of rest, ice and Motrin, this pain will typically resolve within a week or so. But when the pain doesn't resolve, it is usually NOT because there is an ongoing injury, but because a series of nerve connections have become sensitized and have created a vicious cycle of nerve pathways which are continuing to cause pain, even though the original injury has actually healed. Can this really occur? The answer is clearly “yes.” We now understand that this situation is common and it is similar to what occurs in people with phantom limb syndrome. In this syndrome, people who have had an amputation often feel pain, which can be severe, in the area that was amputated; they feel pain in the foot or arm, which is missing. Obviously, there is no ongoing injury or tissue breakdown in that area; it is gone. Medical researchers have figured out that an alteration of the brain and nerve pathways are the actual cause of this pain. And we now are beginning to realize that this situation also occurs in people with pain in areas which have also healed, such as was the situation with the types of pain seen in chronictendonitis, so called repetitive stress injury and the other syndromes listed above. The name given to this syndrome varies. It is called central sensitization syndrome by researchers, but I call it the Mind Body Syndrome because it is caused simply by connections between the mind and the body. The next important question to consider is this: What triggers the nerve to get sensitized and produce the vicious cycle of pain? To answer this question, we must look at what factors in the brain cause pain to become exacerbated or attenuated. The anterior cingulated cortex (ACC) area of the lower part of the brain causes pain to be increased and the things that cause the ACC to be activated are thoughts and feelings of being afraid, guilty, worried, trapped, overwhelmed or angry. Of course, these thoughts and emotions happen to everyone. In addition, certain types of individuals tend to put extra pressure on themselves, have a tendency to be perfectionists and are often sensitive to criticism. It isn't difficult to see that musicians tend to fit this personality profile. The area of the brain that reduces pain is the dorsolateral prefrontal cortex (DLPFC) and this part of the brain is activated by clear thinking, understanding, being in control, processing thoughts to avoid worrying or guilt, and dealing with emotions by rationalizing, reappraising and letting go. So what does all this mean for musicians with chronic pain that hasn't been helped by rest, ice, massage, pain medications, and other remedies? Can this syndrome be cured? What can be done? The answer is surprising easy. Once you understand what is actually going on, once you realize that the body is not diseased, injured or damaged, you can quickly get better. You can learn to activate the DLPFC by changing your thinking about the pain, about your situation, about your stresses, about your life situation. You can actually change the brain and the nerve pathways by thinking differently, by coping with difficult situations, and by doing things like self-affirmations and meditation. Taking good care of yourself, facing situations that you may have avoided, doing things that nourish you and that are fun. All of these things will activate the DLPFC and diminish activity in the ACC. For those who need more information, read the Mindbody Prescription by Dr. John Sarno or see the web site: www.yourpainisreal.com This approach worked for Jill and it has worked for thousands of people over the past 30 years since this syndrome was described by Dr. Sarno. And it can work for you. If you have tried many other treatments for chronic pain, you may have been looking in the wrong place. Disclaimer: It is important to recognize that the information contained in this blog, whether posted by me or anyone else, cannot be considered to be specific medical diagnoses, medical treatment, or medical advice. General information about MBS/TMS will be posted in response to questions, but you will need to decide if this information is relevant to your situation and, as always, you should consult with your physicians and counselors regarding new symptoms and any changes that you might make in medications or activities.