The Shifting Narrative

The Shifting Narrative

When I walk in the meadow making images, I often try to find new ways of seeing the landscape. I find that seeking new perspectives visually helps me to think differently about everything else. As I took a walk the other morning, I reflected on the flood of reports and studies that confirm the importance of the mind body connection. Some of these studies intentionally focus on this link, and some are frankly blind to it – yet even these studies still point toward the role of the mind in regards to chronic pain as well as other health issues. I’ve been posting some of them to the All The Rage Facebook page, but there’s simply no way to keep up with all of them.

A report relating to back pain was discussed on NPR last Monday (1/11/16). Hinting at the mind body connection, it confirmed that of 21 different studies (covering 30,000 patients) none of the treatments, devices, or surgeries that were looked at seem to aid in the prevention of recurrence of pain. According to this survey the only thing that helped – at a rate of 25-40 percent- was exercise. It wasn’t simply core strengthening exercises but instead any exercise at all. The report did not discuss what it was specifically about exercise that helped. I think some answers to this question can be gleaned by looking at the work of Dr. John Sarno.

While the study didn’t focus on, or even look at the role of emotions in regards to the recurrence of pain, anyone who has looked at the writings of Dr. Sarno will see the connection quite clearly. He argues that the vast majority of chronic pain syndromes are the result of repressing one’s emotions, and sees the pain as a distraction from these unthinkable thoughts. For this reason his prescription is knowledge arguing that, “Once people understand the reason for the pain it ceases to exist”. One of his main admonitions to patients is to get out of the physical ballpark and into the psychological one with both feet. He also counsels patients to resume all physical activity as soon as possible to help retrain the brain not to fear, or be distracted by fear, of movement. He further recommends that patients stop using all physical aids or devices because these simply re-affirm to the brain that the cause of the pain in physical and keeps them stuck in a pattern of allowing the pain to distract them from the becoming aware of the repressed emotions that are driving their pain syndromes. In his milieu exercise is less a means to an end than a way to banish fear. This study shows us that when we “medicalize” health issues like back pain, and come to believe that it is others who can cure us rather than us who can cure ourselves, the results don’t look very good. As the lead researcher Chris Maher pointed out, “It’s a universal experience. You’d be a really uncommon person never to have had an episode of back pain.” Pain is a part of life, and it is how we respond to it that often determines the course it will take.

At the same time, we don’t only respond as individuals, we also respond as part of a cultural milleu. As the author of the study’s commentary, Dr. Tim Carey, pointed out,

If a medication or injection were available that reduced LBP recurrence by such an amount, we would be reading the marketing materials in our journals and viewing them on television. However, formal exercise instruction after an episode of LBP is uncommonly prescribed by physicians. This pattern is, unfortunately, similar to other musculoskeletal problems in which effective but lower-technology and often lower-reimbursed activities are underused. In one study,3 fewer than half of the patients with chronic LBP or neck pain who were surveyed received exercise instruction despite a good evidence base for its effectiveness. Passive treatments (eg, physical modalities) with limited evidence of effectiveness were relatively commonly used.

When I heard the piece on the radio he emphasized that our medical system simply isn’t set up to prescribe something that can’t be sold. It’s not easy to shift a cultural narrative and our current narrative revolves around the idea that science will work it out. This has certainly not been the case with pain syndromes. The cost and incidence of pain has skyrocketed over the past two decades even as we have redoubled our efforts to combat this scourge. We have seen a rising stream of evidence that this approach isn’t working, but that evidence is largely ignored. When I just used google to find the article about the study that was just released the first thing that popped up was another NPR story from 2 years ago which argued pretty much exactly the same point.

America spends more than $80 billion a year on back pain treatments. But many specialists say less treatment is usually more effective. In fact, there’s evidence that many standard treatments for back pain — surgery, spinal injections and painkillers — are often ineffective and can even worsen and prolong the problem. (emphasis mine)

It’s clear that we have known, and that the medical community should have responded to the fact that the evidence has stacked up against the vast majority of “evidence based” approaches to back pain. Yet the system has ground on prescribing these things despite a profound lack of evidence that they work, while ignoring things like exercise, that reams of data show does work. The sale of products and services is deeply encoded in the industrial practice of medicine, and the medical community has now way to sustain itself by prescribing exercise. Part of that medical system DNA is the tendency to ignore emotions when dealing with health.

Two days later I heard another story on NPR which focused on research that looked at how we are affected by the fear of being stereotyped. This study looked at Christians responded to the stereotype that Christians aren’t as good at science. When Christians were reminded of this stereotype while being asked to do science tasks, they performed much worse than if they weren’t reminded of it. The authors of the study postulate that people do worse because they are anxious about living up to the stereotype. In other words, their unconscious emotional response affects their performance. While this study may seem tenuously connected to the one about back pain, both make it clear that our unconscious responses have a major impact on how we interact with ourselves and the world around us. Belief not only shapes our decisions, it shapes our sense of who we are which in turn shapes how we unconsciously react, both physically and emotionally. When we look at only one or the other we only get half the picture. Knowledge and balance are essential elements of any cure.

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