Written by: Miriam Gauci Bongiovanni, Executive Contributor
Executive Contributors at Brainz Magazine are handpicked and invited to contribute because of their knowledge and valuable insight within their area of expertise.
Six years ago I discovered what I felt was the world’s best kept secret. Imagine stumbling upon someone who perfectly explains to you the meaning behind a life event that you never understood, and feeling that finally, everything makes sense.
I kind of experienced something similar. I discovered how to heal from chronic pain.
Like the majority of chronic pain sufferers, I went through a succession of conventional ‘treatments’ and tests to try and determine the cause and solution to my symptoms. Sadly, this only led me to being diagnosed with piriformis syndrome, a HAGL lesion in the shoulder, muscle weakness, unexplained nerve pain, and eventually, fibromyalgia, a supposedly incurable condition that involves widespread pain and other symptoms.
Luckily, I came across the work of Dr John Sarno, an American Doctor of Rehabilitation Medicine who is famous for healing hundreds of individuals from back pain and other chronic conditions (at times, through the contents of his books!) Just like every other ‘remedy’ that I came across over the internet, I approached his work and proposed solutions with significant skepticism.
After all, Sarno’s premise was that if I accepted that my body was not really damaged, and if I recognized that certain negative emotions had triggered my symptoms, then my pain would eventually go away. Sounds fantastic, doesn’t it? Most individuals would immediately refute such an explanation without digging further. But since I had exhausted all other options, I decided to give it a try. Today, I shudder to think what would have happened if I hadn’t!
In one month and a half, I overcame ALL of my chronic symptoms. I claimed my old life back, which included resuming my favourite sport, rock climbing. All of this because I was introduced to a couple of different and more accurate perspectives on chronic pain, which boil down to one fact: that chronic pain is maintained and regulated by the brain, the seat of our emotions.
In this article, I’ll briefly introduce you to three interesting and as yet unconventional perspectives on chronic symptoms which could make the difference in your own situation or that of your loved ones.
1. Repressed emotions can lead to psychosomatic symptoms
Dr John Sarno’s approach was based on the theories of Karl Jung and Sigmund Freud, relating to how our unconscious emotions may actually express themselves somatically in the body because they have no other outlet.
The symptoms then serve as a ‘protective’ mechanism, often getting us out of situations that we find threatening or uncomfortable.
For example, if one finds his job to be significantly stressful, and is constantly scared of receiving criticism from his boss or colleagues, one might develop a chronic pain condition that would ‘attempt’ to get him off work, such as intense back pain or a repetitive stress injury that is (mistakenly) blamed on typing or another repetitive activity.
In this way, since the individual refused to consciously address the stressful situation, his unconscious mind came up with another solution to chronic pain. This pain, in turn, takes control of the situation, forcing the individual to take time off work, or perhaps even to quit completely.
Dr Sarno also noted that the onset of unexplained symptoms often correlated to significantly stressful periods in one’s life, such as the birth of a child or a change in career.
He linked this to the sheer amount of pressure involved, as well as to unexpressed rage within the self; in his opinion, it is very likely for a new parent to repress rage towards a newborn, because it is ‘unthinkable’. Yet in reality, there is often significant rage as the parent suddenly has to shift to a completely new way of life, and often ignore his or her own needs in the process.
Given that the unconscious is ‘childlike’ and selfish, this creates internal rage that is often unacknowledged by the more ‘adult’ and logical ego. This rage is expressed as pain in the body: eventually, this pain may also force the individual to take a rest and accept others’ help without feeling the same amount of guilt or shame that he or she would have felt if he’d consciously and ‘selfishly’ decided to take some time off.
So what’s the proposed solution?
In a nutshell, always strive to seek more awareness of your internal situation. Get honest with yourself, and don’t push away or deny your emotions. There’s a difference between acknowledging your emotions but deciding to act responsibly, and denying these emotions in your effort to be the perfect parent, spouse, entrepreneur or employee.
2. The Neuroscience perspective ‒ The brain is the ‘manager’
Research in Pain Neuroscience has continued to build on Sarno’s Work. Sarno himself had explained that when we respond to chronic symptoms with fear or apprehension, we cause these symptoms to amplify or persist.
There is actually a scientific explanation for this. The phrase ‘neurons that fire together, wire together’ explains it pretty well. The more negative attention we give to chronic symptoms, the easier it is for the brain to keep regenerating these symptoms.
This is because when we give our symptoms negative attention and feed it with negative emotions like fear, dread or helplessness, we are essentially interpreting these symptoms and the activities that triggered them as threatening. Let’s say that you get sciatica pain every time that you attempt to go for a run (and I don’t mean the usual soreness here, but intense pain shooting down one or both legs).
When you respond to the pain with fear, frustration and helplessness, you are essentially sending the message to your brain that running is dangerous for your body. To protect you from further danger, the brain will reproduce the same kind of pain each time you go for a run, even though there is no injury present! Sometimes, things get even worse. Giving pain the wrong attention can lead to what we call central sensitization. This is when things that shouldn’t hurt start to hurt. And so, the individual who experienced sciatica after a run may eventually start to experience the same pain even while walking, as the brain starts to mistakenly fire the alarm at the first sign of ‘physical activity’.
The latest clinical trial that backs up the brain’s involvement in all of this is the one conducted by Yoni K. Ashar et al., which showed significant changes in specific brain regions in individuals who underwent pain reprocessing therapy for their chronic back pain (Jama Psychiatry, 2021).
Essentially, pain reprocessing therapy involves teaching the brain to interpret painful sensations as less scary and dangerous. Once the individual changes his or her reaction to pain from a negative one (such as fear) to a more positive one (such as acceptance or curiosity), the pain is more likely to subside. Interestingly, this is accompanied by real structural changes in certain brain regions!
In this particular clinical trial, 66% of participants were pain free or nearly pain free after this psychological ‘treatment’. This was in stark contrast to the 10% who were nearly pain-free after conventional back pain treatment.
So what’s the proposed solution?
Chronic symptoms work differently to acute symptoms, and are often a learnt response. To change this, you need to react differently, by, first and foremost, reducing the ‘threat level’ that your brain associates with these symptoms and the activities or movements that trigger them.
This can be done through various self-talk techniques, the language you use when talking about your pain, and mindbody practices like meditation.
3. The psychological perspective ‒ mental and physical symptoms feed on each other
It’s a well-known fact that chronic pain is often accompanied by other disorders, such as anxiety, panic attacks and depression. Trauma and other adverse childhood events have also been linked to conditions like fibromyalgia and other chronic conditions (Nermin Gündüz et. al, Lucie A. Low et al.) But sadly, most medical practitioners and individuals fail to grasp the importance behind these facts. We often believe that chronic pain leads to depression or negative states of mind. The thing is, very often, it’s the depression and anxiety which are often present due to adverse events or long periods of chronic stress that cause the onset of chronic symptoms in the first place.
Since the two feed each other, this creates what we call a ‘ouroboros effect’; negative feelings can lead to intense pain, and the severity of the pain itself leads to more depressive feelings, which in turn lead to persistent symptoms. And so the cycle continues.
Sadly, depression is often treated independently of the pain. Individuals are not encouraged to explore the links between negative thoughts and their symptoms, because this takes time and requires a certain amount of open mindedness and vulnerability.
And so, chronic pain sufferers often adopt the one-way belief that their symptoms are the principal culprit for their depression.
Luckily, this perspective is starting to shift. As explained on the Mayo Clinic’s website: “In many people, depression causes unexplained physical symptoms such as back pain or headaches. This kind of pain may be the first or the only sign of depression.” (Mayo Clinic)
This ties in with Sarno’s explanation that repressed emotions can cause physical symptoms. Sometimes, the individual cannot exactly pinpoint the reason for his or her depressive state, and that is due to the fact that some of these reasons remain repressed deep in the unconscious mind.
So what’s the proposed solution?
There is no easy ‘way’ out of this predicament. The solution is to accept the fact that negative states of mind and thought patterns make it more likely for the body to keep reproducing chronic symptoms, and to work on gradually changing these thought patterns and shifting to better-feeling states of mind.
This can also entail embarking on a brave journey into one’s inner self, in an attempt to make the unconscious conscious and uncover the original sources of one’s anger or depression.
Last but not least: the above factors are not simply contributing to your symptoms, they are causing them! This means that you need to stop blaming your symptoms on anything else, be it diet, old injuries, repetitive ‘strain’ or any kind of degeneration. It’s a bold and controversial statement to make, but it’s this belief that ultimately leads individuals to complete healing.
So if there really is a solution, why isn’t this all out there?
There are various techniques that can help an individual overcome chronic symptoms that are due to a mindbody process. These include PRT (pain reprocessing therapy), emotional release, increasing one’s self-awareness, habit and lifestyle changes, as well as other relaxation techniques.
Sadly, conflicting explanations that blame pain on purely structural causes, such as normal wear and tear, muscle imbalance as well as degeneration (which is common in both chronic pain sufferers and those who have no chronic pain at all), often prevent individuals from even trying a mindbody approach.
I’ve had a client recently who recovered from very severe chronic symptoms (she couldn’t even put a blanket on her feet due to the pain this created!). She reported her improvement to her pain specialist. The response was sad, but it clearly shows that the majority of the population is not yet ‘ready’ for this approach.
The specialist acknowledged that most pain practitioners are aware of the role of negative emotions and depression in relation to chronic pain, and that a mind-body approach is a solution that does often work.
But he also pointed out the fact that the great majority of individuals do not respond well to this suggestion, and therefore, they refrain from proposing it, for fear of damaging their reputation (imagine Sally getting onto a local Facebook group condemning her doctor for telling her that her emotions are responsible for generating pain - you get the picture!)
But things are starting to change, as more doctors, psychotherapists, and practitioners are working together to increase awareness and educate both medical practitioners and common individuals. I am glad to be one of these practitioners in my role as Chronic Pain Coach, but it’s a huge task that requires a radical change in perspective, which only a few are ready to undertake.
It will take a while before the concept of ‘pain management is shunned in favor of ‘pain recovery’. ‘Recovery’ sounds bold, but it is very possible in the majority of chronic conditions, for as long as the individual is exposed to the correct information and techniques.
If you’re a chronic pain sufferer and are ready to take one step ahead, check out my blog and coaching services here. I will help you determine whether a mind-body approach is right for you, educate you, and help you overcome chronic pain for good.
Miriam Gauci Bongiovanni, Executive Contributor Brainz Magazine
Miriam is a certified Holistic Life Coach and MindBody Practitioner specializing in chronic pain recovery. After having overcome debilitating symptoms herself by working with the mind-body connection, she continued to study the psychology of chronic pain and pain neuroscience. Miriam founded her coaching and educational venture, PainOutsidetheBox, as part of her vision to educate people on the connection between chronic pain and the brain. Miriam now coaches clients internationally, empowering them to eliminate pain, resume physical activity and reclaim their lives. She is also the author of an internationally-accredited MindBody Syndrome Practitioner Course delivered by the MindBodyFood Institute and runs a self-paced Pain Recovery Program for chronic pain sufferers on her website, www.painoutsidethebox.com.
References:
Dr John E. Sarno, M.D., Healing Back Pain: The MindBody Connection, Grand Central Life & Style (1991).
Yoni K. Ashar, PhD; Alan Gordon, LCSW; Howard Schubiner, MD; et al, ‘Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial, JAMA Psychiatry. 2022;79(1):13-23,
Nermin Gündüz, Aslıhan Polat, Erkal Erzincan, Hatice Turan, Ilgın Sade, and Ümit Tural, ‘Psychiatric comorbidity and childhood trauma in fibromyalgia syndrome’, Turk J Phys Med Rehabil. 2018 Jun; 64(2): 91–99.
Lucie A. Low and Petra Schweinhardt, ‘Early Life Adversity as a Risk Factor for Fibromyalgia in Later Life’, Pain Res Treat. 2012; 2012: 140832.
Daniel K. Hall-Flavin, M.D., ‘Pain and Depression: Is there a link?”, Mayo Clinic.
