Perhaps it can, if that's part of the cause
I did't expect to do another self-indulgent post on my neck & shoulder troubles. So I'm doing this because I think it might be my last or second to last post, once I report full recovery -- and just as importantly, might give a clue as to a course for others suffering from chronic, agonizing pain.
Very sorry to hear about your shoulder girdle pain. Are you under any (perhaps unacknowledged) stress lately? I am a big believer in John Sarno’s conception of TMS. I actually have a quite a lot of clinical experience with this. One clue which many are amazed to hear is that psychogenic or psychosomatic pain is often WORSE than that associated with cervical herniated discs, fractures or tumors!
Your comment “sharp, agonizing pain that had me fantasizing about either cutting off my own arm, or having a .40 caliber for dinner” is typical in patients with TMS type pain.
While I didn't brush it off entirely, I was under the "sound obvious conclusion" that the cause was simple: I'd been lifting more weight (at 50-yrs-old) than ever before in my life, by a large margin. I overdid it (and in fact, the condition first manifested most prominently at the gym), injured my rotator cuff, and now I have to pay the price.
The thing is -- and I didn't really take stock at the time -- but I was already a good month or more into the pain by this point and it just was not improving, but seemingly getting worse. My wife saw Kurt's comment and would regularly look at me and say: "TMS." Perhaps she knows me better than I know myself or care to acknowledge. We'll see. At any rate, it simply struck me, at a glance, as a little woo woo and magical.
Fast forward a few weeks and I posted this: This is One Big Ass Pain in the Neck! Here, I revealed that what I had learned in the interim is that I actually had no shoulder injury, which counted as my first error in assigning a cause. From there, MRI results are in, and it's a narrowing of the spinal canal in my neck as well as narrowing of the nerve root at C5/6. Yesterday at my spinal consult the doctor called it a "pinched nerve." I'm not up on the technical lingo and whether that implies any sort of stenosis or herniation of the disk, I don't know. What I saw on the MRI myself on the side view was a protrusion about 1/4" in diameter by about 1/32" to 1/16" into the spinal canal. A pimple. The top down cross sectional was more difficult to understand, for me, but apparently, the nerve root is crowded or pinched by the disk protrusion.
So what caused this? Is the disk protrusion causing the pain, or is it a consequence of the pain? Or is it a coincidence altogether?
Actually, I have no idea and the information I have gathered suggests that many or most disk herniations present without symptom. Kurt Harris in an email told me that half the MRIs he looks at for people of my age have disc herniations and there are no symptoms.
Are we looking for a convenient cause? And when surgery repairs the disk, is that surgical repair the real cause of the amelioration of the pain? Or, does the event of having a surgery and associated expectation invoke another effect altogether? I suspect that both structural repair, especially egregious, does a lot of good and that there are also cases where surgery is expected to improve things, setting the mind at ease and in comfort, and voila: success.
Hmmm, live long enough and become increasingly uncertain of what you think you know.
Alright, some of the foregoing and most of what remains is speculation on my part -- it's a bit of a game; like, when you go to see a movie and because it's crafted after a formula, you know how it ends but want to see it anyway. In this case, the formula -- at least to me -- is revealed on page one of the introduction of the book I'm going to discuss.
An article in Forbes magazine in August 1986 reported that $56 billion are spent annually to deal with the consequences of this ubiquitous [emphasis mine] medical disorder. It is the first cause of worker absenteeism in this country and ranks second behind respiratory infection as a reason for a doctor visit.
All this happened in the past thirty years. Why? After a few million years of evolution, has the American back suddenly become incompetent? Why are so many people prone to back injury? And why has the medical profession proven so helpless to stem the epidemic?
Well, even if you're only a casual reader of this and other "paleo" oriented blogs you will clearly recognize: thems are fightin' words -- in a good sense, of course. Perhaps we're dealing with something beyond pure diet but that still holds deep evolutionary context? Did our paleolithic ancestors have to get the kids to ballet and soccer, all in one afternoon? Did they own a dozen rental properties, or a business with employees? Did they have a concept of unemployment? What, like the jungle disappears?
So I only read the first three pages or so of the book intro and had one of my best nights of sleep in weeks. I had a staunch conviction I was onto something and to some extent the pain, still present to some extent, had lost a lot of its power to invoke anxiety, perpetuating the cycle and downward spiral of chronic pain.
...I didn't take this whole event seriously until about 2-3 weeks in. It was a shoulder injury. I took nothing for it, save some ibuprofen when I might wake up in the middle of the night with pain. It would go away on its own, as has every ailment I've ever known counting 50 years of life on Earth. And then, weeks later, I found that drugs like Vicodin and Percocet didn't even touch the pain. Might as well drink water.
And oh, yea, sorry. You want to know: what book? Healing Back Pain: The Mind-Body Connection. That's by John E. Sarnos, MD. He's been working at this since only about 1965 at the New York University of Medicine. Feel free to dismiss.
Fast forward; to my best night of sleep in weeks. I still had to get up almost every couple of hours and move around for a few minutes to loosen up (1:30, then 3:30, but then lasted to 6:30 for 3 hours in the final round). But while the pain upon getting up is usually the worst and takes hours to resolve, and then gradually over the course of the day until time to hit the torture chamber once again (bed), this was mostly gone in a few minutes. Bea left, the maids were not due to arrive for another 2 hours, so I decided to read Sarno for a good 30-45 minutes; but really read, integrate. Think hard.
And as I went through the rest of the introduction and got to about page 20, I could literally feel the pain somewhat "melting away" while at the same time, experienced transient tinges as if to ask, are you sure?
Let me cut to the chase. This book immediately raises the possibility that my status in life, my circumstances recently, and the way I have dealt or haven't dealt with them may be the real, fundamental cause of my chronic pain.
I have never seen a patient with pain in the neck, shoulders, back or buttocks who didn't believe that the pain was due to an injury, a "hurt" brought on by some physical activity. "I hurt myself while running (playing basketball, tennis, bowling)." "The pain started after I lifted my little girl" or "when I tried to open a stuck window." "Ten years ago I was involved in a hit-from-behind auto accident and I have had recurrent back pain ever since."
The idea that pain means injury or damage is deeply ingrained in the American consciousness. Of course, if the pain starts while one is engaged in a physical activity it's difficult not to attribute the pain to the activity (as we shall see later, that is often deceiving). But this pervasive concept of of the vulnerability of the back, of ease of injury, is nothing less than a medical catastrophe for the American public, which now has an army of semidisabled men and women whose lives are significantly restricted by the fear of doing further damage or bringing on the dreaded pain again. One often hears, "I'm afraid of hurting myself again so I'm going to be very careful of what I do."
And wow, the very first page of chapter one set a stage for me. If you've never experienced any of the foregoing, you've heard it a million times from others. And without getting too deeply into the reading, here's other tidbits that hit me like bolts of lightning. Rather than spend time typing quotes, I'll bullet; which is, admittedly, not like bolts of lightning.
- Common "growing pains" in children are unexplained but resemble sciatica in adults.
- The mind can command a physical reaction over an emotional one. I.e., if you can weep uncontrollably, why can't you feel physical pain uncontrollably?
- In a study, 77% of patients for these types of conditions were 30-60 years of age. Only 7% were in their 60s and only 4% in their 70s. If these sorts of maladies are the result of general degeneration and aging, how to explain that? Interesting that the lion's share of injury takes place during the average stressful, productive years of one's life.
So here's how I think it ends, and here's where I also ask for commenters to chip in. Holy Jesus Facetious did I ever strike it rich with the best commenters in the paleosphere. Just look at that. So many avenues to pursue. I feel deeply fortunate and thank you all for the many insights, suggestions and well wishes (and the emails too). Do know that the high traffic of this blog means that when you give a few minutes of your time like that to share, you are probably helping many people who really need the benefit of your experience. It's a huge part of why I do this.
...Yes, I have endured various and many faceted stresses in the last few years. Without a total airing of dirty laundry: much money lost in the markets, decided to "strategically" dump a number of rental properties either to foreclosure or short sale; and I had to personally attend to my company and primary source of income after being absent for some years. Once I dug back in there, I realized I should have gone back a few years ago; which caused tremendous anger, directed primarily at myself. ...And some anger that would justly be directed at others, potentially repressed and unexpressed explicitly, due to sensitive circumstances. And so maybe, the rage often expressed on this blog just didn't make up for that.
So what caused my pain? Lifting weights, or my mind? I didn't ever cry my heart out, I really didn't. Maybe I should have. Or, maybe I should have laughed at it. maybe I should have said to myself that so long as I have my Beatrice, two doggies, my guns & ammo, I'll be totally fine even living in a tent.
...And so I sat there; reading, laughing. I laughed & laughed as pain drained. I gathered my stuff and went off to my office with a certain resolve and anticipation and not dread...not the dread that had made me stay home and do minimal work remotely, most days recently. Many dark, very dark days.
And then, I stopped. It was nearly at the top of the 2nd flight of stairs at the office building. I realized I just bounded up them and had a smile on my face the whole way. And I laughed. And I kept laughing.
The thing is, as I see it, faking it will not work. The first step is to totally dismiss the fear and anxiety of your pain. The rest is automatic. Once you've done that, you can't help but laugh.
Alright folks, as I said, I wanted to see if I could guess how the book ends and so Sarno fans, jump in and tell me where I'm wrong, right, or misguided. And get your Facebook and Twitter folks to chip in with the buttons, above. You might really help a friend or loved one.