Dr. David Schechter and Barry Kibrick discuss the importance of asking the right questions when dealing with patients suffering from chronic pain.
Dr. Schechter, who has helped countless patients overcome chronic pain by addressing psychological factors, stresses the need to look beyond physical symptoms and ask broader questions about a patient’s emotional status, personality, and childhood experiences.
The interview also touches on the fact that the mind can both hurt and cure, and emphasizes the importance of being open to new ideas when traditional treatments fail.
Does it seem patients and doctors don’t always ask the correct questions?
There really are a lot of people suffering from pain. These people have tried conventional and alternative medicine and often have not found the answer to their problems.
What I find is I ask a different set of questions. The questions are about their stresses in their life, their emotional status, their personality, their childhood.
And by opening up the discussion to a broader arena of questions, I can get a different diagnosis and a different set of answers that lead me to a different type of therapeutic approach to their problem.
Everyone kind of acknowledges that emotions play a role in our perception of pain and our experience of pain. But the question is how do we use that in a way to help the ordinary person who is suffering from pain?
There are people who have just a structural issue or a chemical diagnosis. Let’s say a herniated disc, squeezing a nerve where they have a weak foot.
On the other hand, there are many people who come in with pain that has not been clearly diagnosed. And that’s where I often spend more time with them and find that the issues relate more to their personality, their childhood experiences, stresses at work, stresses at home, rather than the physical area where the pain is manifesting itself.
If you took X-rays of almost anyone’s back, they all have bulging discs. And yet some of them don’t cause pain, some of them do. And it’s not necessarily a surgical procedure that’s going to help it.
Exactly. The key thing is that the type of imaging that we have now is so good that it finds things that nobody even knew were present in the body before.
But studies have shown that bulging discs, and I’m making a distinction now between a bulging and a herniated disc pushing on a nerve, that bulging discs are basically a normal part of aging.
It’s like gray hair of the spine. And people’s gray hair doesn’t hurt. And in the spine, it doesn’t hurt either.
When we talk about thinking away your pain, my only concern is that it would seem that people could feel very guilty if they can’t think away their pain. If the doctor says I can think away my pain, then I’m causing my pain. How do you make that distinction?
It’s very important not to think of the person with pain as creating their own problem. And one could misunderstand this concept of pain being due to both psychological and physiological factors as well as your fault that this is going on.
That’s not what we’re looking at here. We’re looking at how to get solutions. We’re looking at how to take people forward with an issue. And we all have our personality quirks.
Most of the doctors I’ve talked to are perfectionists. Yet perfectionism is one of the risk factors for chronic pain, as it’s being too hard on yourself. And these are common characteristics.
In fact, many of the characteristics that are risk factors in my experience for chronic illness or chronic pain can lead you to be a person that is envious, desirable in your community, is an upstanding citizen, has high integrity.
But at the same time, you put a lot of pressure on yourself. And so the pressure you put on yourself can be manifested as a physical condition.
I thought one of the great ones was goodism. When you’re so good. You’re so kind. You’re so empathetic. You’re in a sense vulnerable to causing this pain.
Some people have certain vulnerabilities. And goodism is a concept where people take the world on their shoulders, things that bother them in the environment or politically or with family members.
They’re very highly responsible. They take care of others. But putting all that pressure on oneself can lead to physical pains, can lead to physical conditions not getting better as they would normally do so.
You say the most important realization in the healing process is recognizing that your mind can both hurt you and cure you. It’s the ultimate double-edged sword, isn’t it?
The mind gets us into traps. It gets us into stuck-in situations. But with the right guidance, with learning about this condition we call Tension Myositis Syndrome (TMS), you can get yourself out of these traps.
Is the first step to keep an open mind?
Openness can sometimes occur after a period of resistance. So many people have said to me, ‘I was given my book or preceding books in the subject material. And it just didn’t seem to apply to me. So I put it on the shelf. And you know what? Last week I picked it up and I realized this is exactly what I’ve got.’
What changed in that time? Somehow they became open. Sometimes desperation leads to openness. When nothing else has helped, you might become more open. Or you might hear a story on television of someone who tried a different type of approach and got better.
So you say, ‘You know what? I’ll look at this in a different way than I have before.’
The pain is there and it’s not specifically related to an injury.
It’s real pain. It’s not imaginary. But it’s not going to get better by continuing to treat the area where you hurt. It’s going to get better by looking at the most complicated structure we know of in the universe, which is the human nervous system, the brain, the trillions of connections in the human brain and how we can impact upon those by what we think about and how we go about our lives in terms of emotional processing.
And I have some things I can say about that. And that’s the way forward.
You have some things to say about emotional processing. Say them.
Okay. So we take someone who’s in chronic pain and we say to them, ‘We need you to begin to connect with your emotions in a different way. And so we have them journal.
We find that writing about your feelings for about 10 or 15 minutes a day in a notebook or a workbook is a great tool for expressing yourself, becoming aware of how you feel about things and just releasing some of that stress intention.
And that’s one of the key things that we use to help people get out of pain.
We all know physical flexibility helps, but emotionally. Can you be flexible in your emotions?
When looking at pain, it’s an essential aspect of the human condition.
It’s a signal that something needs to change, a signal that a person needs to look at things in a little different way, that’s hopefully the force that propels a person forward to become more flexible, to change. To open themselves up, to be looking at other diagnostic approaches.
You say you are not a passive player in your pain experience.
The medical system often makes patients feel like they are a passive player. They sit at a chair, doctor examines them, they get a shot, they get a prescription, go pick it up at the pharmacy.
My approach is different. My approach is to talk to the patient, get them to understand the condition, and get them to participate. In fact, be the key force moving forward in healing their condition.
I’m a guide and I’m a teacher, I’m explaining to them how to get to the healing path, but they’re ultimately walking down that healing path themselves.
There are some things you want to listen to and there are some things you want to ignore. If you’re experiencing a pain in your lower back and you’ve had all the tests and you’ve had all the treatments, you’ve had all the evaluations and they tell you there’s nothing seriously wrong here.
And you come in to see someone like myself or perhaps another physician who says it’s a muscular problem, you don’t have to worry about it. Well, the solution actually becomes to ignore it, to get out and go for a walk. Maybe hit some tennis balls, maybe go for a swim.
So awareness of your body can lead you to then mentally say, ‘You know what, I don’t need to listen to this signal anymore.’
In some ways, chronic pain is a person paying too much attention to nervous signals that no longer are important. They’re old news. We can forget about them now.
What about the term psychosomatic?
That’s a term that people struggle with because the term psychosomatic has an implication in our culture that you’re faking it, that you’re malingering, or that you’re a psycho in some way.
And that’s not what the term means. The term is connecting the psyche, the mind, to the body, from the Greek. And therefore almost everything in life is psychosomatic because things affect the body and the body is affected by both your mind, how you’re feeling, your emotional status.
Everything is really psychosomatic but the term has a lot of negative connotations.
You also make the point that pain relief is not a straight line. It’s more jagged like a lightning bolt with ups and downs.
With pain, it doesn’t tend to be a straight line. My patients who improve tend to get better for a while. They may have a bad day or two. And I just explain to them that’s a normal part of how the nervous system is working this all out.
And then you get better again. And gradually your pain is hopefully dissipating and going away down to zero as the goal. You actually have it separated out.
What about inflammation?
That’s more of the acute process. That’s the acute sprained knee or the sprained ankle. It’s inflamed, maybe even sprained.
But as things go along, the inflammation goes away, but it still hurts. And that’s really the kind of patient that I’m dealing with.
Whereas the more acute person, maybe they need to put an ice pack on, take ibuprofen. Conditions like that are very inflammatory and not conditions that I would think away.
I would tend to treat them more medically speaking and more chemically based.
That’s what cortisol does by breaking that cycle of pain?
That’s very true. I use a metaphor of a cloudy day. Somebody with chronic pain who has it all the time, and some of my patients unfortunately have it all the time, every day feels like a cloudy day to them.
So I say to them, ‘What we’re trying to do now is we’re trying to have the sun break out just for a little bit every day or a couple of times a day, a little bit of blue sky amidst of those clouds.’
If you can do that using your mind and using these techniques that I teach in the book and in my office, then we hopefully can gradually have each day moving forward, have more of the blue sky breakthrough, and eventually have a clear day, meaning no pain.
So this is a challenge for someone who’s really been stuck in chronic pain for a long time, but this metaphor sometimes helps them.
Is changing the fear response to an I understand and I am in control response the key?
Pain is very scary and it hits us at a very deep level. At an emotional level, a limbic, amygdala level of the brain.
But we also have a cortex. We have our human brain. Our human brain can do some calming and soothing of that lizard brain and say to ourselves, once we understand and believe this, ‘I am going to be okay. I am actually healthy. I am strong. I am improving. And I have control over this.’
And those are in fact some of the key messages that I teach people to say to themselves and teach themselves and it leads to their improvement.
Self-talk has physical manifestations.
I tell people that you’re going to be able to break their pain down and reduce it by thinking certain positive thoughts about getting better, about nothing being seriously wrong, about improving.
The first time it happens and the pain starts to dissipate from these self-talk messages, they think it’s magic.
But it’s really not magic. It’s just how the brain works. It’s how the nervous system works.
When you start putting new words into your brain, not ‘I’m always going to have this pain or I’m stuck in this pain or I’m never going to get better,’ but rather, ‘I’m improving. I have control over this. I’m healthy.’ These new messages go in there and they become like new software that changes your brain.
By experiencing this better connection between yourself, your mind, your world, your environment, your everything, you become less of a victim.
We’re stuck in a very busy world and we’re constantly going, going, going.
Take a step back and think and listen to yourself and write about your feelings and connect that to your health.
Is it just our human nature that we are so resistant to this type of thing?
It seems that many people are resistant to looking at something psychologically, rather than purely physically. In some way, it feels like it’s a weakness, but it’s not.
It’s really more of a strength. It’s really more of a willingness to broaden your mind rather than narrow it. And it does seem like there’s resistance in a lot of cases.
It’s being open to the fact you may already have insights and awareness that you’re just not seeing.
That’s really what we’re talking about here. And I find that the writing and the journaling do it. Thinking, of course, is helpful as well.
But sitting down and writing, it’s amazing the connections that come up. And you don’t have to be a writer, you don’t have to be good at it, it doesn’t have to be grammatical.
It’s just about putting a pen to paper and just expressing yourself.