Naturopathic Perspective

Christopher Maloney, ND

As someone who has read hundreds of thousands of pages since graduating from NUNM back in 2002, I’d like to think that my intelligence is my major asset as a doctor. But everything I’ve learned is a distant second to the ability of my hands to find, feel, and fix the chronic ailments of my patients. It is humbling to realize that I still don’t fully understand the nuances of the human body and that I must continue to trust and rely on my own mind-body connection.

Finding the Song of the Body

When I first started doing massage in the main clinic at NUNM, I remember working on 2 recent divorcees, both complaining about muscle tension between their shoulder blades. I would eventually move away from that area to complete my massage protocol, but each of these women would ask me to work more on that mid-back area. Since they had very different jobs and activities (one an athlete, the other a desk worker) the matching pattern of muscle pain didn’t make sense. Why would 2 different women with very different lifestyles have such similar pain? In both cases, the pain was at the insertion of the rhomboideus major into the medial edge of the scapula, just below its spine. The pain was sharp, pronounced, and recurring almost as soon as I finished working on releasing it. I questioned them extensively on habits and exercise routines, but nothing really seemed probable as a cause. It was frustrating to spend 45 minutes releasing a small muscle group, only to have it retighten within a minute or 2. 

Then one patient stated the obvious about her ex-husband: “I feel like he stabbed me in the back.” When she voiced this insight, her back suddenly released under my fingers. Then, as she discussed her husband’s infidelity, her back retightened.

Here was the insight I’d been missing, which seems so obvious in hindsight. A patient’s emotional reality profoundly affects her back. We hold tension because of physical issues, but we can also hold that same tension for emotional issues. The mind-body connection here is direct and measurable. (I tell patients I believe in the mind-body connection: “It’s called the neck.”) We don’t need extensive machines to measure what’s happening. All we need is the patient and practitioner.

Writing Down the Music

In practice, I’ve worked with hundreds of backs. Many of them have muscular imbalance, but many have some level of emotional imbalance as well. More interestingly, I consistently find a pattern that relates different parts of the back to different life issues. 

I did not come to this “map” of the back through a thought process or some insight on my own; rather, it was simply by trial and error. I’ve asked patient after patient about these issues and each time get confirmation that, once again, the patient has “looked at my map” and decided to present with the exact symptoms right where they “should” be. In one case I was absolutely certain I was wrong. The patient was extremely tight in an area of the back that I associated with patients’ concerns about their parents. But, surely, a 78-year-old woman didn’t have that. After working out the tension a dozen times and seeing it return almost immediately, I very tentatively brought up my normal question about her parents’ health, expecting that her parents had long passed. The patient surprised me, explained she was terribly concerned about her 95-year-old mother who lived with her. Thus, her back told me something I would never have thought of on my own.

My reliance on my “back map” reached a point where I was referred a patient who refused to speak to anyone about past trauma, but who had unbearable (and opiate-resistant) shoulder and upper back pain. Rather than talk with her, I began to work on her back in silence. As I worked, I asked if I could tell her what I was finding as I went along. As we worked through trauma after trauma, each one released as I brought it up. It was almost as if her shoulders and upper back just needed to be heard by her conscious mind. By our fifth session, she began talking to me openly, telling me, “You somehow know it all, anyway.”

Teaching a Colleague to Sing 

Sometimes our most resistant and reluctant patients can be our most rewarding ones. At the time, though, they can be very frustrating. Especially when they know better than to listen to us. 

My patient one day was a 52-year-old male physician. He was unable to sit, stand, or lie down comfortably. His laboratory work-up for back pain over the years would fill this entire publication, but there was no legitimate reason to perform surgery on what appeared to be a perfectly normal back. The patient couldn’t do opiates because of his work, so he was limited to NSAIDs and daily alcohol use. To be truthful, the patient didn’t want to see me, but he had been pressured into it by relatives. He agreed to try a few sessions, but didn’t want to participate in my chats. So we worked mostly in silence, with occasional comments from me. 

 It took me a while to figure out what was wrong with this patient. He presented with what he thought was physical pain. It was in the area I associated with family; however, on questioning, family issues didn’t seem to bother him. He had problems with his extended family, but that didn’t cause his back spasms. When he did physical labor, things sometimes got worse, but other times it didn’t bother him. So I decided the pain must have a physical cause (I’m not attached to everything being emotional). Despite my utter failure to figure out what was causing his pain, the patient experienced some relief and decided I wasn’t a complete waste of time. However, our ability to affect his pain was minimal. 

The breakthrough happened on a day when one of the co-workers of my patient messed up. The patient called me for an urgent appointment, and on the table he wouldn’t stop talking about the screw-up at work. Meanwhile, I was releasing and re-releasing the same area of his right back. Finally, I started talking to him about how one of his co-workers messing up didn’t reflect poorly on him. His back gradually released as we talked about his work ethic and how unlike this co-worker he was.

In this man’s case, he had placed his co-workers very close to his heart. Their mistakes at work filled him with tension in the same way we might expect a parent to react to severe health issues in a child.

Because of the nature of our relationship, I never brought this up directly with him. We never discussed emotions or religion. In one of our sessions, he turned to me in alarm and asked me to explain what I did. I knew that his concern was that I had used some kind of trick to relieve his pain, so I told him what he needed to hear: All I did was massage his back and chat. But I reassured him, and his decades of pain gradually eased to nothing. We were able to stop seeing each other. Now he occasionally sees a massage therapist.

From the Physical to the Emotional

We are all familiar with the shift from physical pain to emotional distress due to our internal dialogue, ie, the internal stories we tell ourselves (and often mistake for reality). Nothing could be more straightforward. If I bang my shoulder, I immediately begin the cycle of blaming myself or something (or someone) else for my pain. A variety of catastrophic events may pass before my eyes: My shoulder might be broken, or maybe it could have torn the skin and I might risk getting infected. In a brief flash of paranoia, I might even see myself without an arm. Usually this is followed by a prayer, often nonverbal. A deal is made. “I’ll be good to my shoulder if it’ll be fine, just this once. Come on, shoulder, give me a chance. I’ll make it up to you. I need you, shoulder. You’re an essential part of the body team. I can’t do it without you.”

All this is done in less than a minute. The extent of the emotional response may end shortly afterward when I realize my shoulder is OK. I promptly forget it and go about my business. Maybe later on I notice a bruise or something.

But if I’ve really done a number on the shoulder, I may spend an hour or more complaining and cajoling my injury to go away. My day will be profoundly affected. The shoulder might heal slowly, lingering for weeks, possibly creating a new set of habitual responses as I favor it and use my other arm.

Even when the shoulder heals, I will likely remember how I injured it. I may remember the feelings I had about the injury. My body may remember those feelings as being associated with tightening the muscles around the shoulder to protect it. If I’m not paying attention, every time I have similar feelings, my shoulder may tighten. The tightening of the shoulder might remind me of the past injury, triggering more of those feelings, and around I go in a dysfunctional loop.

None of this is speculation. We can see it happening in the brain. Chronic pain actually alters the brain. Brain cells are lost and remapped in specific areas for each different type of chronic pain. Every individual has a unique response to pain based on how they deal with it. But there is an overlap in the base of the brain that gives a unique “signature” to the brains of all chronic pain sufferers.¹

The Song Echoes Inside the Mind

In the brain, sensing pain, thinking about pain, and reacting to pain all happen at the same time. Thinking about a pain can cause the body to re-experience it as if it is happening again. A person can also sense and react to pain without thinking about it. Think of the last time you touched a hot stove. You didn’t pause to ponder if you should move your hand. Pain can cause a reflex reaction, like when the knee jerks up when tapped. These reflexive responses can take place in the spinal nerves of the back without the conscious involvement of the brain.²

Just like our physical reactions, we may not be able to control our emotional reactions to pain. The mind relies on the conscious, thinking brain to block the strong feelings coming up from the lower, unconscious parts of the brain.³ This is the process we call willpower – the reason we don’t eat every dessert we see or blurt out all the things we’d like to say. 

We “think twice,” first with our lower brain and then again with our upper brain, which results in turning down the dessert or holding our tongue. It works really well when the brain is dealing with something outside the body.

But chronic pain coming up from the lower brain doesn’t go away just because the thinking upper brain tells it to be quiet. The emotional response to chronic pain appears on both sides of the brain. So, while the conscious mind is calming emotions about an injury on one side of the body, it’s not paying attention to the other side. That side of the body is also reacting to the pain, but only unconsciously in the lower brain.² Thus, the unconscious lower brain on the uninjured side is free to connect the physical pain to anything it likes: your emotions, moving that part of the body in the future, even the room or situation you find yourself in. Without any conscious thought, you can create a repetitive response.³ 

Think of this repetitive response like Pavlov’s dogs. Pavlov would ring a bell to bring his dogs in to dinner. After a time, the dogs would begin to drool just because they heard the bell ringing. The bell, which had nothing to do with food, became a habitual, reflexive trigger. In the same way, emotions or thoughts that have nothing to do with an original back injury can cause habitual, reflexive back pain.

We can test whether people are aware of the back tension that can create habitual chronic pain. In a study of back surgery patients,⁴ over half of the patients said they had anxiety before the operation. When researchers tested these patients’ backs for tension, they had areas of hyper-response in the muscles on both sides of their spines. If you asked these patients if they were tense, they would know they were, and their thinking brain could help them relax. But almost half of the patients in the study said they had no anxiety, that they were relaxed before the operation. However, when researchers checked their backs, these “calm” patients still had the same areas of hyper-response in their backs. In other words, even those patients who were not consciously aware of it experienced “back anxiety.” For some of those patients, chronic back pain after the surgery may occur. But if you were to tell them it was associated with anxiety about the surgery and that their backs tensed whenever they talked about the surgery, well, that might come as a complete surprise.⁴

Bringing the Song Into Consciousness

I am continually humbled by the levels of trauma my patients have lived through while still managing to function. They are capable of dealing with a background level of pain that I know would make me want to stay in bed and never leave it. But for them, that’s just how they feel in the morning. 

Overlaid onto physical pain are all the emotional triggers that are somehow unbearable. It is these triggers that I can help release. In many cases that release can happen, even after decades of therapy have not helped. It’s simply clarifying that the muscle tension is present, reactive, and directly related. Once we can agree on the origin of the pain, the patient can often release it, and keep releasing it when it arises. They are able to retrain themselves out of the pain cycle.

However, my work is simplified by not needing to engage the mental minefield that courageous counselors tred daily. I am blessed to be able to say that my patients can think whatever they need to think in my sessions. As the muscles tighten, I simply remind them that holding this tension is not going to help that family member, that situation, or that trauma resolve. I will often joke that, “person X certainly appreciates all this tension, but I think they can do without it, don’t you?” As the patient smiles, they release the connections between the emotion and the muscle. Blessed relaxation sets in. 

References: 

1. May A. Chronic pain alters the structure of the brain. Schmerz. 2009;23(6):569-575. [Article in German]
2. Peyron R, Laurent B, García-Larrea L. Functional imaging of brain responses to pain. A review and meta-analysis (2000). Neurophysiol Clin.2000;30(5):263-288.sults from the World Mental Health Surveys. J Affect Disord. 2007;103(1-3):113-120.
3. Levin OS, Moseĭkin IA. Efficacy of gabapentin in patients with discogenic lumbosacral radiculopathy. Zh Nevrol Psikhiatr Im S S Korsakova. 2009;109(12):60-65. [Article in Russian]

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Christopher Maloney, ND, graduated from NUNM in 2002, worked in family practice, and was diagnosed with colon cancer in 2015. He has recovered and now teaches science at a charter school. Dr Maloney welcomes responses to the question, “If you had a classroom of at-risk high schoolers, what is the one thing you would want them to know?” The case history and information in this article were taken from his book, Healing Your Back of Chronic Pain.