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THE PSYCHOLOGY BEHIND CHRONIC PAIN1Opioid Crisis2PAIN AS A REACTION TOSTRESS Stress Can affect brain function Stress Can alter brain's pain-processing circuits Stress-related pain is real and not self-inflicted Effective treatment is availableStress can be from current issues, past traumas,personality traits 34*THE PSYCHOSOMATICHAZZARDVARIOUS NAMES USED 5PSYCH: MINDTMS (TENSION MYOSITIS SYNDROME) PPD (PSYCHOPHYSICOLOGICAL DISORDER) MIND-BODY SYNDROME PSYCHOSOMATIC DISORDER* SOMATIZATION DISORDER* STRESS ILLNESS NERVE PATHWAY DISORDERSOMA: BODYUNFORTUNATE STIGMA WE ALL SOMATIZE; IT IS NOT A MENTAL ILLNESS NEED TO SEE THIS AS A NORMAL FUNCTIONTHAT HAS GOTTEN OUT OF HAND Can use NERVE PATHWAYS DISORDER (Don vs Carol - “When Stress Hurts”) 61
What Causes TMS?Too Much StressThe Psychology Behind the PainRepressed Negative EmotionsChildhood Trauma,Current Stressors,PersonalityAnger/RageHigh correlation between exposure to trauma andchronic painShame, Conflict Guilt (Feeling guilty about feeling anger) TMS is a defense against these unacceptable,painful emotions. Lady Ga Ga: Sexual Assault. Now havingchronic pain More women than men with TMS.Why? Very few men with fibromyalgia.Why?7The mind causes physical pain to keep you fromexperiencing or being aware of emotions. 8PSYCHOSOCIAL CAUSES Stressful job Stressful marriage Abusive/toxic relationships Multi-tasking Caretaking Cumulative stressors over the years CONFLICT OVER ANY OF THE ABOVE9Don and CarolStress reaction vs TMS Carol’s Childhood10Personality StructureLevels of Awareness 11 CONSCIOUSThoughts and perceptions. We are awarePRECONSCIOUSMemory, stored knowledge. We can bring it up by focusingUNCONSCIOUSInstincts, fears. Completely unaware122
Parts of the Personality ID The child part of the personality. There from birth EGO The adult part of the personality. Balances and keeps peace SUPEREGO The parent part of the personality.13Personality14MEDICAL DIAGNOSESPersonalityThat Can Be TMSMusculoskeletalBulging/Herniated DiskDegenerative DisksTennis ElbowTMJStenosisTunnel SyndromeFacet Joint SyndromePinched NerveCarpalFrozen ShoulderPlantar FasciitisSciaticaFibromyalgiaChronic Tendonitis15Symptoms Can Be SymbolicOTHER MEDICAL DIAGNOSES Hiatal Hernia Migraine Headache IBS Tension HeadachesPatient with low back pain and migraines Patient with stiff neck: Constipation Tinnitus/Dizziness Diarrhea Rashes Chronic Lyme Disease Spasmodic Dysphonia GERD (Reflux) Insomnia Irritable BladderSyndrome 17Bursitis/Bone Spurs16 RSI (Repetitive Stress InjuryHe's a pain in the neck, she's a pain in the A--, theymake me sick EMOTIONAL STRESS AFFECTS THE BODYIt is a normal reaction and happens to everyoneChronic FatigueSyndrome 183
Symptom ImperativeAssessmentTMS Stress Evaluation (Shows what symptomsoccurred and possible concurrent life stresses) During treatment it is normal for a symptom to vanish and thenshow up in another area of the bodyPerson with frozen shoulder got rid of shoulder pain but thendeveloped back painOR: Person with frozen shoulder developed back pain, but thencould move shoulderIt is what the person is focused on, and fearful of, that will becomechronic (back pain more disabling than shoulder pain and thereforetook preference with this client).Fill out form and discuss Ecomap Explain and help them draw their own ACE ScaleLets them see how adverse events in childhoodcan be causing symptoms now A lot of time person will get rid of physical symptoms but thendevelop anxiety or depression19 20ECOMAPTreatmentGoal is Recovery vs CopingJCHPetFour major components of treatmentEducation on the nature of the disorder Reduction of the danger/alarm mechanisms of the brainCSP PMaking necessary changes in activities and lifesituations Processing emotions that are linked to the symptoms F21(Schubiner 2018)22THE CURE KNOWLEDGE Tell them what is going on Acceptance of Diagnosis is Essential to CureFEAR IS THE BIGGEST OBSTACLE TOGETTING BETTER. Need to eliminate fear. That is what ismaintaining pain You will give them the tools to cure themselves 23244
BEHAVIORALCBTGoal is not to prevent pain from coming, but to alter theway they respond to it when it does.Affirmations. Reducing fear of the pain decreases the power the painhas over them. Increasing activity might HURT but it will not HARMthem.I am healthy and strong; there is nothing wrong with me. Pain, you are nothing; you cant hurt me anymore. I am not stopping my activities or giving in to you anymore. I am not afraid of you. I don't need you. I am fine; Im safe; I'm not in danger. I am retraining my brain. I am committed to my recovery. I'll find time for myself to enjoy life and move forward. They need to find time for themselves to do things theyenjoy 25Speak directly to the symptoms 26On-Line ResourcesDocumentariesTMSwiki.org Free treatment programs Alan Gordan’s free recovery program Support Group/success stories PPDAssociation.org Training for Clinicians List of TMS/PPD practitioners Research Alan’s free recovery program27 All the Rage This Might Hurt Search online for Trailers and how to see the entire film.28Clara CurableRESOURCESWe're all just a bundle of neuropathways TMSWIKI.ORG Dr. David Clarke: They Can't Find Anything Wrong Georgie Oldfield MCSP: Chronic Pain: Your Key to RecoveryDr. Jackie Gardner-Nix: The Mindfullness Solution to ChronicPain Dr. John Sarno: The Mindbody Prescription, The Divided Mind Peter A. Levine, PhD: Freedom from Pain Nicole Sachs, LCSW: The Meaning of TruthFrancis Sommer Anderson & Eric Sherman: Pathways to PainRelief 29Dr. Howard Schubiner: Unlearn Your Pain, Second Edition305
SOURCESClark, David D. (2007). They Can't Find Anything Wrong. First SentientPublicationsLandau, Meryl (2009). Reader's DigestSagon, Candy. (2016). Marital Spats A Pain in the Neck. AARP BulletinSarno, John. (1991). Healing Back Pain: The Mind-Body Connection. NewYork: Time Warner BooksSchubiner, Howard (2012). Unlearn Your Pain. Pleasant Ridge, MI: Mind BodyPublishingAbass, Allan MD, Schubiner, Howard MD (2018). Hidden From View. PleasantRidge, MI. Psychophysiologic Press.Simply Psychology316
Dr. Jackie Gardner-Nix: The Mindfullness Solution to Chronic Pain Dr. John Sarno: The Mindbody Prescription, The Divided Mind Peter A. Levine, PhD: Freedom from Pain Nicole Sachs, LCSW: The Meaning of Truth Francis Sommer Anderson & Eric Sherman: Pathways to Pain Relief Dr. Howard Schubiner: Unlearn Your Pain, Second Edition 30
