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Outcomes of a mind-body treatment program for chronic back pain with no distinct structural pathology - A case series of patients diagnosed and treated as tension myositis syndrome

Authors:
David Schechter at Cedars-Sinai Medical Center
David Schechter
Arthur Smith at Choju Medical Institute
Arthur Smith
  • Choju Medical Institute
Jennifer Beck
Jennifer Beck
Jennifer Beck
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Janine Roach at OLIVE VIEW-UCLA MEDICAL CENTER
Janine Roach
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Abstract

Chronic, nonspecific back pain is a ubiquitous problem that has frustrated both physicians and patients. Some have suggested that it is time for a "paradigm shift" in treating it. One of them is John Sarno, MD, of New York University's Rusk Institute of Rehabilitation, who has argued for this in 4 books and several journal publications. We believe that a mind-body approach is more effective and involves much less risk and expense than conventional approaches in appropriately diagnosed cases. To determine if a mind-body treatment program addressing a presumed psychological etiology of persistent back pain merits further research. Case series outcome study. Single physician's office in metropolitan Los Angeles. Fifty-one patients with chronic back pain, diagnosed with tension myositis syndrome, a diagnosis for "functional" back pain and treated in the principal investigator's office in 2002 and 2003. A program of office visits, written educational materials, a structured workbook (guided journal), educational audio CDs, and, in some cases, individual psychotherapy. Pain intensity (visual analog scale scores), quality of life (RAND SF-12), medication usage, and activity level (questionnaires). Follow-up was at least 3 to 12 months after treatment. Mean VAS scores decreased 52% for "average" pain (P < .0001), 35% for "worst" pain (P < .0001), and 65% for "least" pain (P < .0001). SF-12 Physical Health scores rose >9 units (P = .005). Medication usage decreased (P = .0008). Activity levels increased (P =.03). Participants aged >47 years and in pain for >3 years benefited most.
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OUTCOMES OF A MIND-BODY TREATMENT PROGRAM FOR CHRONIC BACK PAIN WITH NO DISTI...
David Schechter; Arthur Preston Smith; Jennifer Beck; Janine Roach; et al
Alternative Therapies in Health and Medicine; Sep/Oct 2007; 13, 5; Health Module
pg. 26
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Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
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... He hypothesizes chronic pain can be treated without targeted physical interventions by addressing underlying stressors and psychological conflicts. Findings from previous small research studies and case series support the hypothesis that treatment methods targeting psychological processes can lead to improvement in functioning and pain levels for chronic pain patients without obvious organic causes (12, 68,73,74). A related approach by Lumley et al. focusing on emotional expression (Emotion Awareness and Expression Therapy; EAET), resulted in better outcomes for overall symptoms-widespread pain, physical functioning and negative affect-compared to the education control group in a randomized trial with fibromyalgia patients (75). ...
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  • Jul 2024
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Full-text available
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... Thus, the pain serves to distract attention away from distressing emotional states. However, it is important to note that this psychosomatic manifestation produces -real‖ physical symptoms and is not considered to be a conversion disorder, malingering, or hypochondriasis (Schechter, Smith, Beck, Roach, Karim, & Azen, 2007). Rashbaum and Sarno (2003) explained that these psychosomatic symptoms are mediated via autonomic pathways. ...
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Article
Full-text available
  • Sep 2021
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Full-text available
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  • Evid Base Integr Med
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Article
Full-text available
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Article
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Article
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The Thematic Apperception Test as an Aid in Understanding the Psychodynamics of Development of Chronic Idiopathic Pain Syndrome
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41 chronically ill low-back pain patients (27 women, 14 men) with a long history of work disablement (median = 2 years and 8 months) were submitted to thematic apperception testing (TAT). The tape-recorded protocols were evaluated by 2 independent, experienced clinicians well acquainted with the TAT, as well as with psychoanalytic theory and technique. The 2 evaluators judged almost all the patients as depressive, alexithymic, passive and antiaggressive with clear tendencies to reaction formation towards underlying aggressivity. Many patients were further judged as guilt-ridden with an unresolved oedipal conflict, while others had a deep oral problem with suicidal tendencies. Two of the patients were judged by both evaluators as having psychotic or prepsychotic traits. Overall interrater reliability was very high, with a correlation for the different categories between 0.50 and 0.76 (median 0.72 and p value never below 0.005). Our results indicate that one of the main characteristics of low-back pain patients is the denial of aggression. Other main features of our patients were depressivity, passivity and oral or oedipal conflicts, alexithymia and lack of internal locus of control. Also we find the TAT as a very suitable test for achieving the understanding of the complexity of the problem of pain.
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A Life-long Prospective Study on the Role of Psychosocial Factors in Neck-Shoulder and Low-Back Pain
Article
  • Oct 1991
The predictive value of psychosocial factors in the development of neck--shoulder and low-back symptoms was investigated in a life-long follow-up study of 154 subjects. Measurements taken in adolescence, such as intelligence, alexithymia (low verbal productivity in projective personality tests), social confidence, hobbies, and the socioeconomic status of the family, showed no consistent associations with neck--shoulder or low-back symptoms in adulthood. Of the variables recorded in adulthood, weak mental resources for promoting health (poor sense of coherence) were consistently associated with neck--shoulder pain, whereas low fundamental education predicted low-back symptoms. The results suggest that psychosocial factors in childhood have a minor role as direct predictors of later symptoms.
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Alexithymia Among Empirically Derived Subgroups of Chronic Back Pain Patients
Article
  • Feb 1990
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Synopsis: Workshop on Idiopathic Low-Back Pain
Article
  • Mar 1982
Low back pain is a major medical disorder wich significantly affects 50-80% of the population. There is a paucity of research directed toward solving this problem. The workshop was held to concentrate on idiopathic organic spine pain. Five neuromechanisms, were sessions: epidemiology, anatomy, biomechanics, biochemistry, and neuromechanisms,were held to summarize the existing information in these various areas concerning low back ache. This will hopefully lead to substantive interdisciplinary collaboration and cross fertilization of ideas in the area of low back pain research. (S.L. Weinstein - Iowa City, Iowa)
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Hypnosis compared to relaxation in the outpatient management of chronic low back pain
Article
  • Dec 1983
  • ARCH PHYS MED REHAB
Chronic low back pain (CLBP) presents a problem of massive dimensions. While inpatient approaches have been evaluated, outpatient treatment programs have received relatively little examination. Hypnosis and relaxation are two powerful techniques amenable to outpatient use. Seventeen outpatient subjects suffering from CLBP were assigned to either Self-Hypnosis (n = 9) or Relaxation (n = 8) treatments. Following pretreatment assessment, all subjects attended a single placebo session in which they received minimal EMG feedback. One week later the subjects began eight individual weekly treatment sessions. Subjects were assessed on a number of dependent variables at pretreatment, following the placebo phase, one week after the completion of treatment, and three months after treatment ended. Subjects in both groups showed significant decrements in such measures as average pain rating, pain as measured by derivations from the McGill Pain Questionnaire, level of depression, and length of pain analog line. Self-Hypnosis subjects reported less time to sleep onset, and physicians rated their use of medication as less problematic after treatment. While both treatments were effective, neither proved superior to the other. The placebo treatment produced nonsignificant improvement.
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