20 Oct Painfully Painful Pain

Pain.

In addition to the Donor doc and the Battle for Brooklyn (not to mention the Broken Angel doc) we have also been struggling to pull together a documentary about Dr. John Sarno. Dr. Sarno, who is 86, practices as the Rusk Center for Rehabilitative Medicine at NYU Medical Center. When he started practicing over 50 years ago he didn’t have any experiences treating people with chronic pain. At some point he started to see patients with problems like tennis elbow and lower back pain that wouldn’t go away. In examining the patients he noticed that they shared a lot of qualities. They were mostly in their 30’s and 40’s, they tended to be the type of people whom he termed “goodists” that took on a lot of responsibilities, and the often had a history of other ailments like allergic reactions and ulcers. In short order, he realized that a lot of these pain syndromes were psychosomatic. This is not to say that the pain was not real, but that it was being initiated by a process in the brain. He wasn’t sure exactly how the syndrome was working, but he found that when he simply talked to his patients about it, pointed out that there was nothing physically wrong, and instructed them to continue physical exercise while thinking about the stress basis of the pain- that the vast majority of them improved drastically.

He continued to focus his treatment methods and published a book called, “Healing Back Pain”. That book, which was published in the 70’s, was given to my father in the early 80’s when he was battling very bad back pain. As a psychologist my father understood and believed in Sarno’s methods. At the same time he continued to battle pain until he died.

When I was in the 2nd, 3rd, or 4th grade (I can’t remember exactly) my father nearly died from a bleeding ulcer. I remember waking up for school and seeing him looking pale, and in pain as he shuffled to the bathroom with (I apologize for these next few words but they are true) sagging bloody underwear. My mother did her best to hide her hysteria but it was in full bloom as she hustled us off to the school bus while calling an ambulance to come get him. My memories are very vague but I have a distinct recollection of the ambulance coming down our street very slowly as it searched for our house. One part of me remembers stopping him to point out our house, but in another version my twin brother and I step out of the road to let it go by, too numb and dis-empowered from the tension to get involved.

According to Dr. Sarno, the primary driver of the pain syndrome he describes (as well as ulcers) is repressed rage. The part of the goodist that wants to do the right thing at all costs, the part that has a need to be a caretaker, a good son/father/husband, forces all anger at the situation deep into the subconscious. This powerful force fights desperately to keep these emotions of anger or resentment locked up deep inside. When there is danger of these uncomfortable emotions escaping from their unconscious tomb, the brain kicks in, disrupting blood flow to a tendon or muscles, which causes a pain that diverts ones attention, leaving little room for these thoughts to exist.

My father was a powerful caretaker. He worked hard at his job, came home and cooked dinner each night, paid all the bills, took care of extended family members, etc. On one level his need to take care of others (his desire to be a good person) was being met, but his subsumed need to be taken care of was not. In talking with patients Dr. Sarno often found very obvious causes of the tension- an unwelcome mother in law living with a family, being passed over for a promotion, recently arrived children, etc. In many instances the patient didn’t need to kick his mother in law out, quit his job, or get rid of his child. Simply acknowledging that presence of the hidden rage over these circumstances, and recognizing the connection between the rage and the pain, helped the patient to overcome the situation. In other situations therapy might be required.

Shortly after my father recovered from his ulcer we had a small car accident which gave him a painful bout of whiplash. The accident was fairly minor, and no one else was hurt. However, I remember my father sitting in some sort of torture device that hung from a door and pulled his head from his body, in an attempt to relieve the pain in his back. It should come as no surprise that Dr. Sarno views whiplash as the subconscious’ opportunistic use of an accident to give a plausible reason for pain. It was at this point that my father read the book, saw himself in its pages and recovered significantly for a long time.

The behaviors that cause they syndrome to kick in tend to run in families. When my brother was in graduate school he began to have extreme pain while typing. Soon his fingers went numb, and he was unable to do much of anything. He was even incapable of driving so he gave me his car. He was by the pain he was even that the pain would get worse. He went from one specialist to another and no one was able to help him much. An extremely well regarded surgeon at a major hospital in NY instructed him that the only way he could relieve the pain was by having surgery to cut away some of his collar bone to relieve the pressure on his nerves. My father had suggested the Sarno book to him and I think he had read it but it hadn’t helped. Finally in desperation he arranged to visit Dr. Sarno. Three weeks later, he called me to ask for his car back, as he had improved enough to begin driving again.

What did Dr. Sarno do to him? He examined him, pointed out to him how all of the previous diagnoses that he had received had no basis in science, and clearly and charismatically illustrated for him how the TMS (his diagnosis for the pain syndrome) process works. I want to emphasize the charismatic part here. My brother is a social scientist who has a powerful belief in data. He had read Dr. Sarno’s book, understood the methodology, and yet had been unable to overcome the pain. In all honesty, my brother recovered a great deal, but to this day he still suffers from many of the same issues. However, one of the key drivers of this syndrome is belief; belief that the pain is being caused by some very physical issue like a torn muscle or a herniated disc. Several recent major studies have show that there is no correlation between a herniated disc and pain. While they can be seen on MRI’s Dr. Sarno has argued for years that there is not reason to believe they cause pain. It took a few decades for the science to catch up. From his point of view it’s basically criminal to be doing back surgeries on people using methods that have no research to prove they work.

At this point I read his book and immediately recognized myself as a “goodist”. For the past 5 or so years I had had minor bouts of back pain. Lifting something heavy, my back would “go out” and I would be laid up for a few days. In every instance I would be up and around after a short time. However, after reading the book I didn’t throw my back out for nearly a decade. There were a few times that I felt like I might but I concentrated on what might be stressing me out and I was able to avoid problems….. until I had a two year old.

When my younger daughter was about 2 my wife and I got a deal on a vacation house that was way to good to be true. Financially, it was an awesome deal, but it took an emotional toll on me. The house was a three bedroom Victorian foreclosure in upstate NY foreclosure. The previous owner had stripped the inside of all its historic details and was about halfway through a renovation when he was arrested for fraud. It turned out that he had used a stolen identity to get a credit card to fund most of the work. While we didn’t love that all of the details were gone, we appreciated the fact that the house had all new plumbing, windows, roof, and electric hooked up. I’m not a skilled handyman by any means, but most of the work that needed to get done was cosmetic and a lot of it I figured that I could do myself so we took the plunge.

Unfortunately, the added responsibilities of fixing up this place proved to be much more than I could handle. Actually, the pain had started a couple of months earlier when I began to shoot our Atlantic Yards doc. For the first couple of weeks I shot for 5 to 10 hours a day, walking around in snowy and icy conditions, and I started to experience numbness and pain in my left leg and hip. I chalked it up to the extreme nature of my shooting schedule and assumed that it would get better when I slowed down. I thought about Dr. Sarno and concentrated on overcoming it but the pain persisted and steadily got worse. Finally, when the pain made it nearly impossible to shoot I went to see my doctor. I remember telling him about my belief in Dr. Sarno’s treatment methods, but he dismissed his ideas and told me that I really needed to see a physical therapist. I should have told him no, argued harder, but I didn’t and I started a long downward spiral. I should have gone to Dr. Sarno right then and there, but instead I went to the physical therapist and the pain bloomed. Once I went from considering the pain as a manifestation of my stress to thinking of it as rooted in a physical problem it increased dramatically. Soon I had difficulty standing, but I still had the same level of responsibility in terms of my child, my wife, and our new house.

I remember talking with a guy who was helping me on the house. Every few minutes I had to lay down on the ground to quell the spasms in my leg. The work on the house was manageable in an abstract way. “Manly work” has always been super hard on me- it really challenges my sense of self – and it’s often a trigger for the pain syndrome for me. In this case the stress of the decision making, juggling the needs of my wife and child, and the physical exertion built up until it exploded. My friend and I were working on the place while my wife and kid were back at home in the city. I woke up to go to the bathroom very early on a Sunday morning when the pain erupted. I screamed out in agony and I couldn’t make it stop. I was still laying down and I couldn’t find a position that would relieve it. Eventually, my nerve went into shock and it went from a screaming pain to a dull ache. However if I tried to move at all it would come back with full force. My friend was able to get a prescription for a muscle relaxer and eventually he got me into the car and back to Brooklyn.

The next day, I tried to call Dr. Sarno’s office but got the machine and I didn’t get a call back. The message referred to the fact that out of state patients wouldn’t be accepted, and I had the sense that he had more patients than he could handle. I was upset that no one called back and couldn’t bring myself to call again. A few days later, I got an MRI which revealed a herniated disc. At this point I was basically a cripple, barely able to get out of bed and incapable of doing anything beyond laying in bed- and even that hurt like hell. The doctor who read the MRI suggested that I try a cortisone shot before having surgery. I scheduled an appointment for the shot and then gave Dr. Sarno another call. This time he was there and we talked. For some reason I was extremely nervous and I stammered out details of my situation. He was calm and serious yet cracked a few jokes, and agreed to see me in a couple of days. My wife had to help me down the hall to his office. We talked for a bit and then he examined me and laughing at the MRI he explained that a herniated disc wouldn’t have anything to do with the problems that i was experiencing. At the same time, during the examination, I discovered that my calf no longer had the strength to lift my weight from the floor. He assured me that the strength would come back. The nerve had gone into shock, but it would come back in time. It helped immeasurably to have him confirm what I had originally believed. I remember being very emotional as we talked after he had examined me. The next day I went to his lecture. His treatment consists of 1) a phone consultation to make sure that the patient is right for him. 2) a physical exam to rule out anything like a tumor or some other problem that might be causing the pain. 3) a lecture that outlines a great deal of details about the syndrome. 4)small group follow up meetings to discuss progress and ask questions 5)success events where patients who have been successfully treated tell their stories. A great deal of his treatment method has to do with using knowledge to defeat the mind’s process of causing the pain.

The treatment worked for me for the most part. I have had a few relapses over the years but have been able to overcome my periodic bouts with debilitating pain. I don’t think it’s any coincidence at all that it happened again when my second daughter was 2 years old.

As a filmmaker I want to tell his story. I’ll write a second post about that process tomorrow.