Philip Guo (Phil Guo, Philip J. Guo, Philip Jia Guo, pgbovine)

My Back Pain Story (guest article)

Guest article written by Shaddin Dughmi

While looking up information about how to prevent repetitive strain injury (RSI), I found this article by Aaron Iba: How I Cured my RSI Pain. Aaron is an MIT alum and successful high-tech entrepreneur, so I was fascinated by his story of how he was able to cure his chronic pain using only his mind. I then learned that my friend Shaddin, a top graduate from the Stanford Computer Science Ph.D. program, had a similar story of pain and recovery. I asked Shaddin to share his story on my website, and he agreed. Here it is in his own words:

Introduction

I'm writing about my long and illustrious experience with upper back pain, and the eventual cure, in the hope that others will find it informative. Since my story may be hard to believe for anyone with a healthy dose of scientific skepticism, I should introduce myself and attempt to convince you, the reader, that I have my wits about me.

I'm currently 29 years of age, and I'm a computer scientist by training. I hold a B.S. from Cornell, a Ph.D. from Stanford, and will soon be an assistant professor at USC. My work is in the mathematical aspects of computer science, so I spend much of my life thinking logically. Like most academics in a technical field, I am a strong believer in the scientific process, and I can spot "quackery" a mile away. This made it difficult for me to accept the cause of my back pain, seeing as the theory behind it appears like a bunch of phooey at first glance. I hope that detailing my experience here will help others overcome their pain sooner rather than later.

The Short Version

Since I'm not trying to sell you anything, let me open with the short version of my story: I started getting occasional back pain and spasms, often debilitating, in my late teens. This became chronic during graduate school, and remained chronic (daily) and almost debilitating for 3 years. I tried every therapy and lifestyle modification to no avail, before finally discovering Dr. John Sarno's theory of Tension Myositis Syndrome (TMS).

TMS is a mind/body explanation for back pain and some other pain disorders, which posits that the physical processes causing the (real, not imagined) pain are initiated unconsciously by the brain, and can be halted by the brain. There's a lot more to it than that, of course, but this is the short version. Once I diagnosed myself with TMS, read some of Sarno's books, and did the mental work they suggested, I was cured in a matter of weeks from my years of chronic pain. It was the most surreal experience of my life, and it felt as unbelievable as it sounds. 16 months later now, I remain cured.

If you already believe me, you can stop reading now and go order some books on TMS by John Sarno or others. Otherwise, you may keep reading.

The Beginnings

Now, the long version. One morning in my late teens, 17 if I had to guess, I reached for a glass from a cabinet. A muscle in my upper back, probably my left trapezius and/or latissimus dorsi, promptly went into an excruciating spasm. I was bedridden for a couple of days, barely able to shift in bed without reactivating the spasms. For the next 8 years, this scenario recurred once or twice a year, with minor variations in the location and intensity of the pain. The events triggering the pain varied, though most commonly it would begin suddenly the morning after a day of strenuous exercise or after a lot of sitting in front of the computer.

I saw many doctors throughout this period, got X-rays and MRIs, tried physical therapy, and went to chiropractors (against my better judgement). However, during this period, I made no progress in understanding the cause of my back pain or how to stop it from recurring. I got used to it as part of life, much like catching a cold. I reconciled myself to the assumption that I had a "trigger point" in my back that would act up when misused; since I was pain free between episodes, and the episodes were on average many months apart, this ailment did not greatly reduce my quality of life. Other than a couple of trips to the emergency room in my early twenties, during which I was pumped full of muscle relaxants and anti-inflammatories, each of these pain episodes would resolve gradually over a period of a few days with ice, heat, rest, and Advil.

The Chronic Phase

But then, it got worse. It was 2007 and I was 25 years old, a little over a year into graduate school and in the midst of confronting many personal and professional pressures. One morning after a week of strenuous sports, I had the worst upper-back spasm attack I had ever experienced. Despite the severity of this episode, bed rest and pain medications halted the spasms and put me back on my feet as usual. However this time, unlike all previous episodes over the years, the pain did not completely resolve with the resolution of the spasms. I was left with a lingering ache between my shoulder blades. My back pain had finally morphed into a chronic condition.

This lingering pain persisted for the next 3 years, the bulk of my time as a graduate student. I had pain in my upper back, usually between my shoulder blades, almost every day. The pain would move around, up to the neck sometimes, down to the mid back other times. It was usually on the left side, but often on the right side too. The "steady state" was a dull ache, one which occasionally evolves to a burning sensation as it gets worse, and then into spasms and immobility at its apex.

I saw many doctors during this three-year period, in an attempt to understand what was happening. Spinal specialists, chiropractors, physical therapists—you name it, I tried it. An MRI showed some mildly herniated disks in my back; but according to my doctor (a spinal surgeon) such bulging in the discs is quite common (in fact, ordinary) and did not explain the pain I was in.

Some activities and situations made my pain worse: sitting, hunching over, stress, laying in bed in the morning, sleeping on my stomach, a period of unproductivity at work, or—strangely enough—spending a day at home. Others made my pain temporarily better: exercise, ice, heat, massage, chiropractic manipulation, and productivity at work. In particular, exercise became a focus of my life out of fear of the alternative. Lack of exercise would allow my pain to progressively get worse so as to culminate in an episode of spasms, whereas regular exercise (the more vigorous the better) decreased the pain to a mild ache more often than not.

I made many drastic, and somewhat comical, modifications to my life to keep my back healthy enough so that I could live a semi-normal life. The main component was exercise. Towards the end of the three-year period during which I suffered from this condition, I would exercise and stretch my back for two to five hours every single morning just to stave off the pain. I would follow this up with foam rollers, ice, heat, massage, etc. I carried tennis balls in my backpack everywhere I went, in case I needed to roll on top of them on the floor to relieve my back pain. I kept ice packs both at home and at work, and packed one with me any time I traveled.

I spent thousands of dollars on fancy beds, ergonomic chairs, and exercise devices. I thought that sleeping on my stomach was aggravating the pain, so for several years I used a rope to restrain myself during my sleep—in addition to driving my girlfriend at the time crazy, this prevented me from sleeping on my stomach and consequently seemed to improve my pain... kind of... maybe. I also stopped sitting at my computer, as that reliably aggravated the pain within minutes and set in motion a chain reaction of pain that would last for days or weeks. Instead, I installed an HD video projector at the foot of my bed, pointed at the ceiling, and hooked it up to my computer so I could use my computer while lying in bed. To work on my laptop or scribble math in my notebook, I used a reclining beach chair in lieu of regular sitting.

But even with all these changes to my life and expensive equipment designed to accommodate my back, the pain always returned. In fact, each time I made a lifestyle change to cater to my back, the pain would improve temporarily, and then return ... only now, the lifestyle change had become necessary to stave off even more severe pain! In general, trying to find patterns in the pain, or trying to deduce its causes or remedies, proved a futile effort. The pain simply evolved to counter every move I made.

The Cure

At some point during my three years of chronic pain, I had stumbled on a book by Dr. John Sarno on Tension Myositis Syndrome (TMS). I bought the book, read the first couple of pages, and then tossed it aside as quackery. There it sat on a bookshelf for over a year, until one December morning in 2010 I reached a state of desperation—I had tried everything, I was going to a physical therapist weekly, I was spending hours on my back each day, and my pain was as bad as it ever was. So I finally dusted off the Sarno book and started reading. I was in a desperate hurry to understand my pain, so after a few pages I went to my computer and looked for videos online that would deliver a large dose of "convincing" in a short period of time. I watched a video of a 20/20 segment on TMS by ABC News anchor John Stossel, where he examines the condition through his own personal experience with back pain. The segment was excellent, and I found that it helped me overcome much of my skepticism. I then went back to the book and read some more, with an open mind and a willingness to take it seriously.

I wasn't very far into the book before I had to get to work that morning. Between the Stossel segment and what I had read of Sarno's book, I had acquired a new sense of hope and a nascent belief that I finally understood what was going on with my back. As I walked to work, I put into practice some of what I had learned that morning: I simply talked to my mind. "Stop it!" I said to my subconscious. "I know what you're doing! You are trying to distract me from something else! I'm onto you!" Within hours, and despite what started as a "bad pain day," the pain promptly melted away for the rest of that day!

That uncharacteristically warm December morning in northern California saw the beginning of the end of my years of back pain. Over the next few weeks, the pain would come back regularly, often severely. But each time it came back, I used the strategies I was learning from several books on TMS to beat it down (more on these strategies in the next section). The pain did not want to go: when I conquered it in my upper back, it would come back in my lower back, pretending to be something new and unrelated. When I conquered it there, it would move to my neck, or even morph into a headache. During those few weeks, the pain often became particularly severe, as if it knew that it was losing the battle and was trying to fight back. But I stuck with the treatment, as I believed deeply that I knew what my condition was: my subconscious mind restricting blood supply to specific muscles in an attempt to cause pain—pain that would distract me from worries which were uncomfortable to tackle directly. That is TMS, and the key to defeating it is knowing thy enemy, and appreciating that it is as intelligent and cunning as you are.

After a battle that lasted perhaps a month or two, I had won. I was pain free, day in and day out. I could sit at my computer, I could hunch over, and I could do anything I pleased like a normal person. I no longer spent hours each day tending to my back. This was more than a year ago, and I remain victorious. Sure, every once in a while after months of pain-free living, the condition would attempt to rear its ugly head. But all I have to do is remind myself of what I was dealing with and it would promptly melt away, often in a matter of minutes. My experience with this condition was surreal, and it changed my perspective on the human body and mind.

What I learned about TMS and the Mind/Body Interface

Given this experience, I naturally spent many hours analyzing my condition. There is much I want to share, but in reality the best resources are those written by the experts. I highly recommend John Sarno's book "Healing Back Pain", as that was the book that helped me the most. I hear that Sarno's later books are also good, in particular for similar pain conditions such as RSI that are not localized to the back, but I never got around to reading those since my condition resolved relatively quickly. Other medical doctors have also written on TMS and the family of "mind/body disorders." A quick search online should reveal much in the way of reading material. For those readers anxious to know more, I recommend watching the 20/20 ABC News segment on TMS as a teaser.

That being said, I will share my personal thoughts on my condition. I stress that I am not a medical doctor, and I am certainly not an expert on back pain or TMS. You should not apply any of my recommendations before having more serious diagnoses ruled out by a qualified physician, or without the supervision and approval of such a physician. Anything I say below should be taken as my own personal interpretation of the literature on TMS and of my experience, rather than an established scientific fact or a credible medical recommendation. Specifically, I will detail my understanding of how the mind/body pain disorder works, using some analogies which were useful in my own healing process.

The first thing to understand is that the physical pain in TMS is real, not imagined, but is caused by processes in the brain. Specifically, the subconscious mind, in an attempt to distract the conscious mind from worries and thoughts that are uncomfortable, directs the autonomic nervous system to withhold blood supply to specific muscles. This causes mild ischemia (oxygen deprivation of the muscles), and hence pain. Oxygen deprivation has been documented in laboratory studies conducted on muscle tissues of people with back pain, so there is some scientific evidence of this. This phenomenon is an adaptive mechanism gone awry: your subconscious is trying to protect your conscious mind from thoughts it perceives to be too stressful or painful to tackle directly, and it does so by creating this pain as a distraction. If you spend your time preoccupied with your pain, and adjusting your life and activities to accommodate the pain, these problematic thoughts are prevented from moving from the subconscious mind to the conscious mind.

I found it helpful to understand that this condition is self-reinforcing for two reasons:

  1. Once you become worried that there might be something inherently and structurally wrong with your back, it becomes easier for your subconscious to get you stressing about your pain (instead of whatever your conscious mind might otherwise stress about). Your subconscious' distraction strategy is now more effective, and therefore it will use this strategy more frequently and with greater intensity, which in turn makes you worry even more about your body, and so on and so forth.

  2. The more your subconscious applies this strategy, the better it gets at doing so, and the more accustomed your nervous system becomes to inflicting this pattern of pain. The pain becomes habitual, often associated with specific events or activities. In my case, this explains why sitting at a chair in my bedroom would inflict pain almost immediately, whereas a chair at a coffee shop would take a while.

In some cases, as in mine, as a result of both reasons, the pain becomes constant, rather than episodic. By habit, there is almost always a basic level of "background pain," which occasionally escalates due to triggering events or activities.

To combat this condition, I used three strategies that I gleaned from books on TMS:

  1. The first and most important strategy is to convince yourself, at least for the most part, that the cause of your pain is TMS rather than a structural problem with the back. Absent that belief, your subconscious will play on your uncertainty in order to preserve the cycle of tension and pain. Once I overcame my skepticism, I found that my average pain levels decreased, and I was almost immediately having more good days than bad days. Believing in the diagnosis is best put into practice by not allowing the condition to scare you, make you panic about your pain, prevent you from doing any activity you would otherwise want to do, or force you into activities that you wouldn't otherwise normally do. If there is no structural problem with your back, then there certainly is no reason to validate the condition by cowing to its demands of special exercises or stretches, icing or massaging the back, not hunching over, not lifting heavy objects, or whatever those demands may be. In the absence of validation, this condition weakens almost immediately, as its strategy of getting you to focus on your pain becomes less effective. Nevertheless, in my case believing the diagnosis alone was not sufficient for a complete cure.

  2. The second strategy I used was to always think psychological. When faced with an escalation of pain, instead of worrying about a physical cause I would instead respond by rummaging around in my mind for those thoughts or worries that my subconscious was trying to keep under wraps. In some cases the answer was clear, and once I would dig up those thoughts and examine them with my conscious mind, the pain would promptly melt away in a few hours, if not minutes. In other cases there was no clear answer, but nevertheless the mere act of rummaging around seemed to help the pain gradually resolve; perhaps the fact that I was not falling for the distraction strategy was sufficient to invalidate it.

  3. The third strategy is to communicate with your subconscious. Any time I was facing pain, I would consciously think to myself something along the lines of: "Hey you, unconscious mind, I know what you're doing. I know full well that this is not a physical condition, but merely trickery designed to distract me from something else. You are not fooling anyone, and it's not going to work. Stop it now!" Whether this actually sent a signal to my subconscious is something I can't know, but I do know that the mere act of trying to talk my subconscious down in this manner was extremely effective at resolving many pain episodes quite rapidly.

Closing Thoughts

I will close with a note on the main challenge that I faced during my recovery. Specifically, I found it difficult to come to terms with, and adjust to, the cunning and sophisticated nature of my subconscious. It knew before I did that there were troubling thoughts or concerns brewing in my mind, and would deliberately inflict pain in order to prevent those thoughts from becoming conscious. Additionally, during my recovery process, the pain moved from place to place, escalated in intensity, and changed in nature, in what felt like an intelligent attempt at fighting back. How can this be? How can such complex reasoning and behavior be occurring in my own mind unbeknownst to me?

I found that demystifying this phenomenon was key to truly understanding and defeating this condition. Consider this: What happens to your body when you get embarrassed? Your cheeks redden and you get a distinct "flushed" physical feeling. What about after a breakup or the loss of a loved one? The pain of loss often manifests as a distinct physical pain in the pit of one's stomach. Both of these are physical responses produced by the subconscious through the autonomic nervous system, in response to an emotionally and intellectually complex situation. The processes in the brain producing these responses are for the most part hidden from the conscious mind, and can't easily be "turned off." The same is true for the pain of TMS. Only in TMS, the subconscious can be particularly cunning and sophisticated, as it is as intelligent and adaptive as its owner.

I have found it helpful to think of my mind as two different people, in fact two copies of myself. I am aware and in direct control of one (the conscious mind), but the other is equally sophisticated and operating unbeknownst to me in the background. There are, however, two things I can do to control my subconscious. First, I can foil its plots by refusing to fall for its distraction-by-pain strategy. Second, I can send it disparaging signals through a one-way communication channel, signals such as "I know what you're doing and why you are doing it, and it's not going to work."

In conclusion, after accepting that my pain was a manifestation of Tension Myositis Syndrome, coming to terms with the nature of this condition, and applying the tactics I described in this article, my subconscious gave up its old ways, and I was cured of years of pain. Sure, once every few months my subconscious tries to pull the same old crap again—almost testing me to see if it can reestablish the old order, but when that happens I know how to quickly put it back in its place.

Created: 2012-04-04
Last modified: 2012-04-06