Unlearning Pain, From a Doctor Who Lived With It for Years: An unorthodox treatment for my chronic neck pain also transformed the way I practice medicine.
Guest Blog by Howard Schubiner, MD
I was in my mid-30s when I turned my neck to the right and heard a faintly audible crack. From that moment on, the simple act of turning my head was no longer easy.
I lived with that pain for years, on and off. I couldn’t move or sleep well for a week or two. Then the pain would go away, but it always came back.
An MRI eventually showed degenerative discs and bulging at three levels. I was told what most patients are told: This is part of aging. You’ll live with it.
At the same time, I was a practicing physician, helping patients manage their pain every day. I gave the same explanation to them that I accepted for myself.
Years later, my wife and I were out to dinner with our friends Marty and Kim. As a doctor, I find that it’s not uncommon for medical questions to come up in conversation. That night, I decided to be the “good doctor friend” again, and asked Kim how she was doing.
As we sat there enjoying bruschetta, Kim flipped the script. Mid-bite, she said something that nearly made me spit out my food: “I read an eight-dollar book, and my pain vanished.”
Kim went on to tell me about The Mindbody Prescription, written by Dr. John Sarno, a physical medicine and rehabilitation doctor from New York City. Sarno believed something radical: that much of chronic pain is not caused by structural damage, but by the brain responding to stress and emotion.
That dinner marked the biggest change in my medical career, and perhaps in my life. The idea that chronic pain could be caused by learned neural circuits in the brain and be completely reversible sounded impossible. It challenged everything I’d been taught. Sarno’s book described patients just like Kim who often had miraculous recoveries after adopting this unorthodox viewpoint.
I learned that Sarno did thorough evaluations of his patients to rule out biomedical conditions. These conditions were infrequent. Most of the time, he diagnosed them as having a mind-body condition that he believed they would recover from. Could this really be true?
I started reading everything I could about the emerging neuroscience of pain and the brain. I learned that real pain can be caused by structural damage in the body or by the activation of neural circuits in the brain in response to stressful situations. The second type, called neuroplastic pain, can be every bit as painful as a broken bone or a kidney stone.
One of my patients, I’ll call her Janet, had back pain for more than a decade. Surgery was already scheduled. Her MRI scans showed what appeared to be extensive damage. Yet there’s a secret about back MRIs that many doctors don’t share. Most people without pain have similar MRI findings as Janet did: degenerative discs, bulging discs, and other signs of aging. I had similar MRI findings with my neck.
Janet was one of the first people I saw after my introduction to Sarno’s work. Her life had been filled with stress. The pain was real. However, a detailed evaluation revealed that her pain often turned on and off, as did my neck pain. Furthermore, it often shifted to different areas of her back and leg; it was triggered by stressful situations and by the weather; and it was better when she was on vacation. These findings suggested that Janet’s pain was caused by neural circuits in her brain that had gotten stuck in a loop. It was neuroplastic, meaning it had been learned by her brain. Therefore, it could be unlearned.
