Part 1 in a 2-part series
Special to the Village News
When the term 'pain' comes to mind, you might automatically think of recovery from a surgery or a noticeable physical injury. But what about pain that feels somewhat widespread, achy, and you can't pinpoint the source? Another question, what is a prevalent feeling that no one is immune from, with or without acknowledging it? Stress.
Dr. David Clarke, president of the Psychophysiologic Disorders Association said, "Stress is capable of changing the structure of the brain."
Medical experts like Clarke are seeing that circuit changes in the brain "have come about as a reaction to stress."
By no means did he allege that your pain is "all in [your] head," "that [you're] imagining this," or "that [you're] mentally weak and can't handle [your] own stress."
He said that the reality is "the level of stress people are coping with is usually far higher than they realize at first."
Fortunately, evidence is presenting itself through new treatment programs that "circuit changes can be restored to a healthy pattern," he said.
The correlation between stress and physical illness is interesting and not altogether surprising. Learning what stress we are carrying around, how we can lessen its burden, and in turn, minimize the uncomfortable or limiting symptoms could brighten up even the darkest of days.
Clarke is an international expert, who is also board-certified in gastroenterology and internal medicine. In addition to numerous other medical institutions, he is affiliated with the Stress Illness Recovery Practitioners Association.
An example he offered was to take a person living with fibromyalgia or irritable bowel syndrome (IBS), "Studies now show that the parts of the brain that light up when you have experimental pain inflicted on you are different in people with [these conditions] than they are in healthy people – people who don't have those conditions."
In order to gain a stronger understanding of brain-generated symptoms, Clarke provides very relatable examples.
"It's important for people, including health care professionals, to recognize that there are two sources of symptoms," he said. "It can be at the place where you are feeling it; for example, if you have low back pain or a migraine, the source can be in your skull or in your lumbar spine where you are feeling the symptoms. But a lot of symptoms are also generated in the brain."
How do we pinpoint if we may be experiencing brain-generated pain symptoms?
Clarke said when it falls into one of two categories:
• "If the symptoms are not responding to usual treatments or
• If the diagnostic evaluation is not showing a definitive organ disease or structural abnormality that is responsible for the symptoms."
For example, "blushing with embarrassment is a brain to body phenomenon" or "feeling a tense knot in your abdomen when you're in a difficult or challenging situation."
Clarke explained that it's now understood that our brains generate this pain in response to stress. As a physician, it is key to "finding the stress, because many people who have this don't recognize completely how much stress they are experiencing and where it is coming from," he said.
Not just stress from today's freeway traffic or last week at work, but stress that you have been holding on to for potentially years – decades.
Clarke said, "In a majority of my patients, the biggest source of stress was actually from when they were children that they experienced what we call ACEs (adverse childhood experiences) which can be any of a number of things from abuse to more subtle things."
It's becoming more and more clear that our childhood experiences impact us in our adult and senior years. "One of my patients was still experiencing childhood stress at the age of 87," he said.
The silver lining? No matter how old you are – "the good news is that when these stresses are identified, they can almost always be treated, and when they are, the physical symptoms can be relieved, sometimes dramatically quickly," Clarke said.
It's being identified that a scientific mind-body approach can be taken to eliminate or help reduce chronic pain. And this isn't limited to a handful of conditions. Chronic pain from myriad conditions can be stress-induced – migraine, pelvic pain, IBS, unexplained symptoms, fibromyalgia – the list goes on.
Clarke revealed three new psychotherapeutic approaches. Instead of one that has been relied on in the past – cognitive behavioral therapy – these new approaches "focus on powerful, negative emotions that people have and they also bring into play the (adverse childhood experiences) ACEs." These therapies focus on the idea of helping patients alleviate symptoms – not solely just learning to co-exist with them.
1 – Pain Reprocessing Therapy
2 – Emotional Awareness and Expression Therapy (recently endorsed by Health and Human Services)
3 – Intensive Short-Term Dynamic Psychotherapy
The gold standard in the science of treatments is through randomized controlled trials. When comparing these new treatments to older ones, they "are showing dramatic [positive] differences in the outcomes," Clarke said.
Take back pain as a primary example, as I think we all know at least a handful of individuals who suffer daily from it.
"The Boulder Back Pain Study took people with an average of 10 years of back pain, [and] with just eight sessions of Pain Reprocessing Therapy, pain scores went from 4-4 1/2 range on a scale of [1-10] to a 1. And stayed [at] the score of 1 ... for a full year."
Simply put, "We are finally getting the scientific evidence that shows what many of us as clinicians have known for decades – that these new forms of treatment work," Clarke said.
Living with chronic pain (which commonly involves more than one medical condition) can make it hard to reach treatment and success if it requires extra time from the house, travel, scheduling, etc. Fortunately, these new therapies have the ability to be done at home.
Clarke said, "Everybody is a little different." Some patients reach a good outcome via attending therapy sessions in person, others "have simply read evidence-based books in this field, haven't used a therapist at all, and have achieved dramatic improvement just from that."
Patients have options.
It might be hard to swallow initially, but Clarke said, "Stress alone can make you physically ill."
Accepting this can be one of the very first hurdles both physicians and patients have to overcome. He understands that. "It was hard for me as a physician. I am very traditionally trained. I'm board certified in two specialties. I went through perfectly normal Western training to become a physician."
The evidence (starting in just his eighth year of formal medical training), patients, and successes have changed his perspective as well as his patient-centered approach in practice.
"Stress is capable of causing every bit as many severe symptoms as organ diseases and structural abnormalities. And it also shocked me how many people have this – 40% of people who go to see a primary care physician," he said.
These are key pieces of information and statistics we, in the general public, need to be aware of. This is one of the most important barriers individuals come to – "accepting the idea is real," he said.
As Clarke put it, "The number of people who have this, and the severity of it, is extraordinary and that's a barrier for people."
We aren't meant to carry around stress that makes us physically ill. The stress you are under and have been under, "can absolutely cause symptoms the equal of organ disease or structural abnormalities," he confirmed.
As an adult, it may be tough to discern just how complicated and tough your childhood years were. But your childhood can be another barrier. Did you experience adverse childhood experiences?
Clarke suggests individuals look at it through a third-party lens, i.e., imagine your child or nephew living your exact upbringing. We can cut ourselves a lot of slack and grace, but when we swap the analysis out for someone we look after, ACEs can be recognized more easily.
Once those memories are shared and released, it can become clear how "often the source of the negative emotions is being expressed via [our] bodies," he continued.
There are a plethora of things impacting our bodies and wellness. From the environment, food we consume, medical decisions, stress, and yes, inaction.
"Many of my patients have had anger, fear, shame, grief, and guilt that is much more powerful than they know it to be," said Clarke. And since "they are not consciously aware of it, it has to come out via their bodies."
Through various forms of communication (talking, thinking, writing) about traumas, experiences, and feelings "the emotions don't have to be creating symptoms in their bodies quite so much," he said.
Individuals might have personality traits that lead to physical symptoms. Take "stress inducing personality traits [where] they are very critical of themselves; they may be perfectionists; they may be people who try to take care of everybody else in their world but they don't know how to put themselves on the list."
"If you live like that, it's like being on a treadmill that you never get off," Clarke said.
A final barrier can be triggers, which understandably vary person to person. Be it a bad childhood memory, triggers "can be highly stress-inducing, much more so than they would be for the average person, just because of those links to the past."
To learn more on these topics, suggested reading would be: "They can't find anything wrong," by Dr. David Clarke; "The way out", by Alan Gordon and Alon Ziv; "Intensive short term dynamic psychotherapy," by Allan Abbass; and "Psychophysiologic disorders," by Dr. David Clarke. Phone apps: "Curable; DOC Journey."
Dr. David Clarke serves in many roles, including at Oregon Health & Science University, Arizona State University, Pacific University, Cummings Graduate Institute, and at the Stress Illness Recovery Practitioners Association. He is well-published, has had many television appearances, and has lectured widely to medical professionals and the public across North America and Europe.
Shelby Ramsey is the author of the blog, thehonestmigraine.com, which also features interviews with patients and medical experts.