Dr Nick Straiton - Back Pain Physician

TMS/Stress related illness

Physical symptoms on some occasions are the manifestation of emotional distress.

For 14 years I had been working in the NHS for the Back Pain Service at the local hospital. I have always been interested in psychosomatic medicine and a few years ago a psychotherapist colleague introduced me to Dr Sarno's books. His description of the frustration of working in a hospital environment where high tech investigations and treatment strategies fail to alleviate many people suffering from back pain mirrored exactly my own experience .

I became fascinated by his approach and eventually went out to New York to sit in at his clinics at the Rusk institute in order to learn first hand the process that he uses to diagnose and treat patients with TMS. This experience was truly valuable and enriching to the degree that I would say that my practice has changed significantly since that time.

I believe that many, but not all, of patients suffering with chronic back pain are manifesting emotional distress through a physical symptom and for any long lasting relief to be achieved the factors relevant to this distress need to be recognised and addressed.

Dr Sarno has written many books on this subject and I would certainly recommend these if you suspect that your symptoms may have an emotional basis. 'Healing back pain' is a good starting point and this can be found on Amazon.

Dr Sarno's pioneering work precipitated a resurgence of interest in the diagnosis and treatment of stress related illness particularly in the USA where a number of physicians have continued the work in this field. The Psychophysiologic Disorders Association was set up by a group of physicians interested in this approach to stress related illness.

Recommended Books:

Pathways to Pain Relief by Frances Sommer Anderson PhD and Eric Sherman PsyD. A book for therapists and the public summarizing decades of experience diagnosing and treating PPD. Available in paperback or for the Amazon Kindle (or Kindle app).

They Can't Find Anything Wrong! by David Clarke, MD.
Uses dozens of case histories to illustrate the many hidden life stresses that can cause physical symptoms. Discusses effective treatment techniques in detail. All author profits are donated to the PPD Association.

Unlearn Your Pain by Howard Schubiner, MD.
Reversing chronic pain is possible by understanding its underlying cause. This book explains that most pain is due to learned nerve pathways. It helps you determine if you have PPD and how to cure your pain with a revolutionary step-by-step process.


Back in Control: A Spine Surgeon’s Roadmap Out of Chronic Pain by David Hanscom, M.D. he is an orthopedic spine surgeon who trained in orthopedic surgery at the University of Hawaii. His spine fellowship was in complex adult and pediatric spinal deformity. He completed it in 1986 at the Twin Cities Scoliosis Center in Minneapolis, MN. He currently practices at Swedish Medical Center in Seattle, WA. He is a member of Swedish Neuroscience Specialists and has eight neurosurgical partners.

A large part of his practice is to salvage situations in which patients have undergone multiple failed attempts at surgery. A consistent theme is that the first operation should never have been.

Synopsis

Pain always is perceived in your brain. Unless pain centers in your brain are stimulated you will not feel pain. “Back in Control” looks at both the source of the pain and the brain as relevant. The nervous system aspect is viewed in terms of pathways not psychology. Once a pain pathway is formed it is permanent. The solution is to utilize methods that create “detours” around these established circuits. With engagement the decrease in pain is consistent.

It is important to “calm down” the nervous system in addition to creating the new pathways. “Back in Control” offers many specific tools as well as illustrative stories to learn these methods. The author is a spine surgeon who has found relief from chronic pain. It was from sharing his own journey with his patients that this whole process evolved.

The reader will also gain an understanding regarding the role of spine surgery. Surgery is only indicated for a clearly identifiable structural problem with matching symptoms. It is not helpful for generalized back pain.

"The sorrow which has no vent in tears may make other organs weep."
Henry Maudsley



For more details regarding psychotherapy please contact TMS Psychotherapist

Psychophysiologic Disorders Association is the current term used for a stress related disorder and this website has some useful information for patients and practitioners.

tmswiki is a website again providing further information and a forum for discussion.



Visiting an osteopath


Osteopaths consider each person as an individual. On your first visit the osteopath will spend time taking a detailed medical history, including information about your lifestyle and diet. You will normally be asked to undress to your underwear and perform a series of simple movements. Please inform the clinic before your appointment if you would like to have a chaperone present.

Osteopaths use their hands to identify abnormalities in the structure and function of a body, and to assess areas of weakness, tenderness, restriction or strain. By this means, your osteopath will make a full diagnosis and discuss with you the most appropriate treatment plan, estimating the likely number of sessions needed to treat your condition effectively.

Then they work with your body’s ability to heal itself. They will usually start any treatment by releasing and relaxing muscles and stretching stiff joints, using gentle massage and rhythmic joint movements. The particular range of techniques your osteopath uses will depend on your problem.

The first treatment generally lasts about 45 minutes (to allow for case history taking and diagnosis) and subsequent treatments tend to last around half an hour. Osteopaths also offer added exercises and health advice, to help reduce the symptoms and improve your health and quality of life.

Do ask questions at any time if you are unsure or have any concerns regarding the proposed treatment of your condition.



National Institute for Clinical Excellence GUIDELINES

Low back pain: Early management of persistent non-specific low back pain

Information, education and patient preferences
Provide people with advice and information to promote self-management of their low back pain.

Offer one of the following treatment options, taking into account patient preference:
1 An exercise programme
2 A course of manual therapy
3 A course of acupuncture .


Consider offering another of these options if the chosen treatment does not result in satisfactory improvement.

Physical activity and exercise

Consider offering a structured exercise programme tailored to the person:

This should comprise up to a maximum of eight sessions over a period of up to 12 weeks.

Offer a group supervised exercise programme, in a group of up to 10 people.

A one-to-one supervised exercise programme may be offered if a group programme is not suitable for a particular person.

Manual therapy

Consider offering a course of manual therapy, including spinal manipulation, comprising up to a maximum of nine sessions over a period of up to 12 weeks.

Invasive procedures

Consider offering a course of acupuncture needling comprising up to a maximum of 10 sessions over a period of up to 12 weeks.

Do not offer injections of therapeutic substances into the back for
non-specific low back pain.

Combined physical and psychological treatment programme

Consider referral for a combined physical and psychological treatment programme, comprising around 100 hours over a maximum of 8 weeks, for people who:

have received at least one less intensive treatment and

have high disability and/or significant psychological distress.

Assessment and imaging

Do not offer X-ray of the lumbar spine for the management of non-specific low back pain.

Only offer an MRI scan for non-specific low back pain within the context of a referral for an opinion on spinal fusion .

Referral for surgery

Consider referral for an opinion on spinal fusion for people who:

have completed an optimal package of care, including a combined physical and psychological treatment programme and still have severe non-specific low back pain for which they would consider surgery.
NICE guidelines



AUTOGENIC TRAINING



What Is Autogenic Training?
Definitions

Autogenic Training (AT) – a form of treatment to help people help themselves.
A non-drug method of mindful self-help using structured and specialist relaxation.
A method you carry out by yourself, for yourself, with yourself and because of yourself!



These are not complete definitions of AT but they do get close to what it is about.

With its roots firmly in medicine, AT is a long established form of treatment which addresses imbalance in mind and body. Many symptoms caused by inappropriate stress reactions over a long period of time, can be significantly helped or even eliminated by using this simple method.

ATpos2The autogenic methods of mental exercises are practised by using:

special sitting or lying postures, to minimise disturbance
an attitude of mind which is passive (observing / being aware)
silent repetitions of phrases associated with the body’s experience of relaxation.

Despite its unusual name, Autogenic Training (AT) really does describe the treatment.

The word ‘autogenic’ means ‘self-generated’, from the Greek ‘auto’ (self); ‘genus’ (from within).

Although AT is not a talking therapy (psychotherapy, psychoanalysis or counselling), the outcome can certainly carry psychotherapeutic benefit; if any analysis occurs, it emerges spontaneously, through the changed cognitive awareness the client experiences; AT is not a mind-altering substance, and yet it really does ‘change the mind’; AT is not meditation, but the meditative state which can be induced is often very deep and brings key insights to the surface; AT uses relaxation and the gentle habit of practice (training). This is the start of a unique process.

In summary, AT is a mind-body therapy, taught to, and then practised by, the client.

The passive observer attitude which is adopted during practice, opens us to perceiving the mind and body objectively so that we can take the position of witness.

Dr Johannes Schultz, AT’s developer in the early 20th century, described the move into the passive observer, witnessing stance as the “Concentrative Experience of Switching Process” (Schultz, 1973, p322). Umschalten can be translated into English in many ways: we shift, switch, change the channel, switch over. Thus we see that as we move to a witness stance, this may be described as being on a spiritual pathway.

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