When Stress Hurts, by Barbara Kline, LCSWC
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Circa 1964. Don Draper is doubled over with stomach pain. His heart is racing, his hands are shaking. Beads of sweat cover his brow. He lunges toward his office waste basket and vomits as he reacts to the recent discovery that he is being investigated by the government (Mad Men 2010).
Circa 2011. Carol Bateman (not her real name) bends over to pick up the bag of groceries she is taking to her mother. She feels a sharp twinge in her lower back. She straightens with difficulty. She has too much to do to pay attention to the pain. After working at the office all day, she stops at the supermarket for the groceries, picks up the kids from soccer practice, drops them off at home and makes her way to her Mom’s. Later that evening she will fix dinner for the family, go over homework assignments, pay some bills, balance the checkbook, fold the clothes she left in the dryer that morning, and fall into bed exhausted but unable to sleep. The pain in her back that began as a twinge has now escalated to near-agony. She takes some over the counter pain pills and makes a mental note to call the doctor.
What Carol doesn’t realize is that she, like Don, is having a physiological reaction to emotional distress (Clarke 2011).
Although it is more readily accepted that stress can cause ulcers and other gastrological ills, it is less accepted by patients and doctors alike, that chronic back pain often shares the same etiology. In fact, there is no bodily system that is immune. Degenerative Disk Disease, Stenosis, Carpal Tunnel Syndrome, Rotator Cuff Tears, Plantar Fascitis, GERD, IBS, Tinnitis, Dizziness, Fibromyalgia, TMJ, etc. are just a few of the diagnoses given to physical symptoms of stress.
In his book, Healing Back Pain: The Mind Body Connection, Dr John Sarno (1991) suggests that 98% of the people in the United States who have chronic back and neck pain. actually have what he termed TMS (Tension Myositis Syndrome). Furthermore, he believes that herniated disks that show up on MRIs or other imaging studies, are incidental and not the cause of the severe pain that the patient is experiencing. He believes that physical pain (and other symptoms) can be the mind’s way of distracting us from emotional pain that is too difficult to express.
In the November 2009 issue of Reader's Digest was an article entitled, "Is Your Doctor Out of Date?" One of the topics was that of low back pain. The article stated that using MRIs to figure out the cause of back pain is not feasible as research has shown that herniated disks, arthritis, etc. found on the images are not what is causing the pain. .Furthermore, it was found that surgery to fix the findings does not (in most cases) eliminate the pain. The article also noted the use of epidural steroids as being overprescribed with little, if any, improvement (Landau 2009).
So, if physical interventions such as the above don’t help, what does? Although it seems too simplistic, Dr. Sarno has found that just knowing that the pain is not being caused by something structural is sometimes all it takes to get rid of it. Dr. Sarno advocates talking to your brain. He posits that getting angry with your brain and telling it you know what is going on will release the power of the mind to create the pain (Sarno 1991). Educating yourself about the mind/body relationship and reading books by experts on the subject will help you understand this connection and give you the tools to cure yourself.
For example: Being a good person, Carol is carrying on her daily responsibilities without complaint. However, she may be repressing an enormous amount of rage and resentment at having to care for everyone else’s needs with little time for her own. Being the kind person that she is, she doesn’t allow herself to recognize those negative emotions so she continues to stuff them until they overflow. If Carol doesn’t express these feelings through words or tears, she may develop physical symptoms (Clarke 2011).
It is very important to first see a medical doctor to rule out anything serious such as cancer or infection, and to ask him/her, “Do you have any evidence that being physically active will harm my back/neck/etc.” If the answer is “no” it will be in the patient’s best interest to not restrict normal activities as fear of activities can help perpetuate the pain cycle.
If simply acknowledging the etiology of the pain doesn’t get rid of it, the patient is urged to look at any imbalance in their lives. One tool patients can use to help identify their energy usage is the ecogram. They would draw a circle with their name in the center then draw other circles extending out from it, connected with straight lines. In each of these extended circles they would put the names of the activities or people in their lives that represent where they are giving or receiving energy. Arrows would be placed on the lines to show in which direction energy is going. In this way they can see if there is a balance between energy out and energy in.
The next step would be to use problem solving to break things down so they are not so overwhelming. Can Carole delegate some of her duties to other family members? Can she change the way she thinks about her role in creating the problem? Asking herself, “why is what they want more important than what I want?” can give her a different perspective on the situation. Setting boundaries and limits will enable her to feel more in control and less stressed. Learning that it is ok to say “no” when asked to do something she doesn’t want to do will also help her gain control.
Identifying cognitive distortions and reframing will also help chronic pain sufferers learn to be more accepting of their right to take care of her own needs. Challenging their irrational thoughts (cognitive distortions) “I must be perfect or no one will like me” or “If I don’t take care of everyone, I am a bad person” will help them see that taking care of themselves is not being selfish. Reframing using “want to/could” instead of “have to/should” and telling themselves, “this is disappointing” instead of “this is terrible” can help them tone down their response to daily stressors.
If the above doesn’t get rid of the pain, the patient may need psychotherapy to help them identify repressed negative emotions that may be maintaining their discomfort. Knowing that stress (tension) and/or repressed emotions are what is causing the pain and accepting this both consciously and unconsciously may bring an end to it. Once the charade is exposed, the brain will no longer be able to use the pain as a distraction from emotional issues and it will disappear. The patient is taught to think psychologically, not physically and to be aware of what is happening. Then there will be no more reason for the pain (Sarno, 1991).
- Clarke, David M.D. ( 2011) Teleconference
- Landau, Meryl (2009). November 2009 Reader’s Digest.
- Mad Men (2010). Season Four.
- Sarno, John. (1991). Healing Back Pain: The Mind-Body Connection. New York: Time Warner Books.
About Barbara Kline
Barbara Kline is a LCSWC who cured her own back pain using the above recommendations and has seen others do the same. She went to school to become a therapist so that she could help others cure themselves of their pain and not just manage it (as most pain clinics advocate). She has had extensive training in mind/body techniques and is part of a group of dedicated clinicians across the U.S. who advocate this approach. She was featured in a Hagerstown Magazine article entitled, “No Pain, Big Gain” (July/August 2010). Barbara practices psychotherapy at Prospect Cottage in Hagerstown, MD and can be reached at (301)745-1900 or her website. www.prospectcottagetherapies.com.