Written by Dr. Schubiner on June 15, 2008 5—Modern Medicine's Blind Spot The rapidity of advances in medicine has been staggering over the past 50 years. It has been amazing to see the proliferation of research that has helped us understand how individual cells work, how DNA is translated into proteins that recognize other cells, that repair damaged cells, that create new cells to fight infections, and that communicate with all the cells in the body. We have learned a tremendous amount about how smoking, high cholesterol, and diabetes cause heart disease and about how cancer cells replicate and spread. These advances have created new technologies and medications to fight heart disease, stroke, and cancer by looking at the minute details of cells and proteins. This view of how medicine will advance is now universal; we will find the answers to how the body works and can be healed by looking at the individual areas where the disease is presumed to be. This has worked well so far. But the problem lies in applying this theory to disorders like Mind Body Syndrome (MBS). In MBS, there is no tissue breakdown in the body, so by looking closer and closer at the “problem area”, we are actually missing the problem. In this case, the problem is in the relationship between the mind and the body. Phantom limb syndrome is a situation where real and severe pain can be caused by the connections between the mind and body, yet there is no “disease” in the area where the pain is felt (i.e. the missing arm or leg). In people with Back Pain, if there is a fracture, an infection or a tumor, we are best served by applying the techniques of modern medicine; i.e. find the source of the pain in the painful area and treat it with medications or surgery or physical therapy. However, for those with chronic back pain and no fracture, infection or tumor, trying to treat the source of the pain in the painful area can lead to more harm. Why have back surgery for a problem in the nerve connections between the brain and body? Actually, this has been tried in phantom limb syndrome. They tried amputating the limb at a higher spot to try to decrease the pain, but this didn't work. The definition of what is the problem, what is the source of symptoms is the critical issue. In people with MBS, i.e. with syndromes such as back and neck pain, fibromyalgia, tension and migraine headaches, TMJ pain, irritable bowel and bladder syndromes, tinnitus, insomnia, anxiety, and several other syndrome, what modern medicine actually does is cover up the symptoms as much as possible with pain medications and other medications. However, by missing the underlying cause, we miss an opportunity to understand ourselves better and actually cure the symptoms. The definition of the disease is critical. Ivan Illich wrote in his book, Medical Nemesis, in 1975 that the way we define diseases can actually worsen health in the society. When we define fibromyalgia as a disease with severe pain, but unknown cause and little hope for cure, we are causing people to feel doomed and that can only worsen their physical and emotional pain. When we realize that fibromyalgia is a collection of symptoms caused by MBS, i.e. real, physical pain caused by the triggering of emotions and nerve connections that form a vicious cycle of pain, then we can identify and treat the underlying cause. The treatment of MBS is not alternative medicine, it is simply good medicine: finding the underlying cause of symptoms and treating that in order to cure, rather than cover up the symptoms. Several decades ago, if a woman came to the emergency department with a fracture and a “story” about falling out of bed, most doctors sent her to the orthopedic surgeon to fix the fracture and then home. Now, we ask more carefully about the fracture to make sure that it was not caused by domestic violence. We look for the underlying cause, even if the cause is related to social, rather than medical, factors. It is time for us to look more carefully and clearly at physical symptoms for which there is no clear disease in the body. We will find the underlying cause: Mind Body Syndrome. To your health, Howard Schubiner, MD 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.