As a spine surgeon, I see patients with devastating back problems whose lives I can transform with surgery. I also see people with acute injuries who can, fairly quickly, return to their lives after simple, non-surgical treatment.
Unfortunately, the majority of my patients reside in a vast middle territory where neither solution is obvious. These men and women have complex chronic conditions, layers of problems that make their lives miserable. Their lives are filled with deep suffering — mental and emotional, and physical. Living with pain makes people angry. The medical solutions aren’t easy, the treatments don’t have great success rates, and it’s frustrating for all involved.
Recently, I had a patient in that middle territory, a woman in her early 60s named Jane. She’d lived with severe scoliosis all her life. Then, in 2001, she was rear-ended while driving, and the following year, she had a bad fall while grocery shopping.
By the time she came to see me, she had severe pain everywhere. She’d been using an electric wheelchair for nearly a decade. She took multiple medications, including high-dose anti-anxiety drugs and 200 mg of morphine/day.
When I examined Jane, she was tilted forward and to the left, barely able to stand. Her spinal curve was severe enough that I recommended surgery, but warned her that the treatment had a high rate of complication. Because of this, it was unsafe to do the operation until her medications were stabilized, her pain significantly diminished, and she was more mobile.
A little-known fact is that this magnitude of surgery actually has a significant chance of increasing back pain, which is why I wouldn’t perform it until her pain had lessened. Also, I have seen too often that surgery fails in patients like Jane, who are anxious, depressed, and deeply discouraged about their prospects.
Surgery often is ineffective in patients like Jane because they’ve developed something called Mind Body Syndrome (MBS). In Jane’s brain, pain signals continually fired along what had become permanent neural pathways of pain — and would continue to do so until new pathways developed.
The premise behind MBS is the same one that has athletes endlessly practicing their sport: With practice, you can create new neural pathways. The treatment for MBS works by calming down and re-directing these disruptive pathways of pain.
I gave Jane some materials outlining a self-directed, structured care program she could do on her own and referred her to a colleague at the Pain and Headache center here in Seattle.
Eight months passed.
A few weeks ago, I saw her name on my schedule of patients and, I’ll admit it, I dreaded the visit. I was shocked when I walked into the room and there was no wheelchair, walker, or cane. There was just Jane standing up to greet me.
She was off all of her medications, had no pain, and was working out in the gym three times per week. She was animated, smiling, and engaging. I ended up an hour behind in schedule, as I wanted to find out what had turned her life around.
Jane admitted that she had spent the last 12 years sitting alone in her house stewing over all the wrongs that had been done to her. Understanding the linkage between anger and the pathways of pain in her brain, Jane decided to forgive.
She forgave her ex-husband, the person driving the car that had hit her, the people involved in her legal battle, and the medical system that had not helped her. This process took several months to work through – but within weeks of doing so, her pain began to abate. She still had scoliosis but as her pain diminished, she stopped stooping over protectively to guard her back. She can now stand up straight and tall.
Forgiveness researchers, such as Dr. Fred Luskin, director of the Stanford University Forgiveness Project, have shown how rumination and anger influence central and autonomic nervous system function and impair functioning of the hypothalamic-pituitary adrenal cortical axis (stress system).
While forgiveness is seen as a coping mechanism that helps to relieve the stress of anger, it also has direct and indirect effects on health and nervous and endocrine function.
Forgiveness has been linked to less pain in physical therapy and decreased chronic pain, including low back pain. Jane forgave; she rewired her brain. She relieved her symptoms of MBS and didn’t need surgery. Many others in pain can do the same.
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