Dr. David Schechter: Think Away Your Pain

Welcome to Episode #8 of the Healing Pain Podcast with Dr. David Schechter!

Today we are joined by Dr. David Schechter, MD.

Research continues to point to the vital role of emotions and the mind in the cause and cure of a variety of illnesses. From ancient perspectives in different cultures to recent research on the physiology of the nervous system, more insight is being gained on this mysterious, yet self-evident mind-body connection.

Research suggests that chronic and acute back pain of all types in addition to tension and migraine headaches, skin rashes including eczema, irritable bowel syndrome some pelvic and prostatic pain can be caused or worsened by emotions such as tension, anger, fear, and grief.

People with chronic pain are often suffering from a mind-body disorder known as TMS, or Tension Myositis Syndrome, Tension Myoneural Syndrome, or the Mindbody Syndrome, a diagnosis that is relatively unknown or understood in both the medical and alternative communities.

In This Episode You Will Learn:

What are Tension Myoneural Syndrome, Tension Myositis and Mindbody Syndrome?
Be able to decipher if you have Tension Myoneural Syndrome and how to treat it.
Which personality types are more likely to develop Tension Myoneural Syndrome?
How pain is linked to emotional centers in the brain.
Why mind-body therapies are a healthy alternative to medication and injections.

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Welcome to another episode of the “Healing Pain Podcast” I am your host, Dr. Joe Tatta. Today’s title of the podcast is “Can You Think Away Your Pain?” I have a wonderful guest today his name is Dr. David Schechter. He is one of the pioneers in MindBody medicine and he’s gonna teach you how you can leverage your thoughts and your beliefs to eliminate pain in your life. This is a really great interview your gonna really enjoy it. Please make sure to stay connected each week by signing up for the “Healing Pain Podcast” at www.drjoetatta.com. And if you know someone who could benefit from this podcast, please share it out with them, either on Facebook, on YouTube, on Twitter, on whatever social media service you use and enjoy the podcast and we’ll see you next week.

Dr. Schechter, it’s great to have you here on the “Healing Pain Podcast” I know you have a great book and some things that you’re gonna share with us today, welcome.

Thank you it’s good to be here.

So I know originally you trained in New York City, not too far from where I’m located and you trained under one of the greats, Dr. Sarno and started to you know really kind of take hold of his technique but how has that influenced the way that you practice today?

Well, Dr. Sarno exposed me to an approach to treating pain that was very different from anything else that I had learned in other settings. And because it had occurred early in my career and because it both helped me and helped many of my patients, it really set a foundation for me in terms of my career and my special interests in MindBody healing methods.

To tell just a little bit more is that I was having chronic knee pain. I used to play a lot of basketball and running as the release and exercise as a medical student. I walked into Dr. Sarno’s office seeking some maybe intensive physical therapy because I had been through medical doctors and I’d even seen the Yankees orthopedist at that point. And Dr. Sarno was know as a physiatrist so I thought he might have some specialized treatment for me and when I told him about my knee pain, he said “I don’t know if you’ll buy this son, but 95% of this chronic pain is psychosomatic.”

And so of course that through me for a loop, that was not what I was expecting to hear and I attended his seminar that he did for diagnosed patients which he later diagnosed me with this condition he called TMS. And the seminar made a lot of sense to me, that the stress and worry of medical school and how I was approaching the experience was contributing to and perpetuating this pain, that was real physical pain in my knee. And many of the patients in the audience had back pain and other sorts of pain as well.

And when I went home that night, I felt as if a weight was lifting off of me, a pressure of not knowing what was wrong. And kind of berating myself seeking a diagnosis. Within a matter of a couple of weeks, I was back to physical activity instead etc. So it really was a dramatic improvement in my health that I’ve since learned how to translate into the care of my patients.

Excellent so, just to give people some background, you’re training is in internal medicine, correct?

Yeah, I have a, I’m board certified in family medicine and I have and additional certification in sports medicine and a credential in pain management. So you know I take care of a lot of different types of pts and many of them I treat physically with medications and injections and referrals for physical therapy and chiropractic and all of the sorts of things that we hear about in medicine these days. But there’s some set of patients for whom I apply a different type of approach, which I’ve eluded to in the work with Dr. Sarno that I was originally exposed.

So I’m just interested from a physician perspective, obviously you have gone through medical school, you’ve had some traditional training and you know some of the tools that physicians use first are injections or drugs of different types. How was it to arrive at a place where you realized that this is really kind of much deeper than you know biomechanical issue?

Well I think that I can differentiate between someone who’s had an acute injury and there is a biomechanical issue to deal with. Whether it’s something that I deal with, whether it’s something that I have to get imaging on, or whether it’s something that I involve my colleagues in physical therapy, etc. Versus someone who may be dealing with a more lingering type of pain. Chronic pain is a very different animal in my experience and in the research than acute or subacute pain. Acute is defined as new-onset. Subacute, perhaps six weeks to three months and chronic, depending on the definition somewhere between three to six months and longer.

Yeah.

Many of the patients that I see with pain, have had it for years. Although when you’re dealing with pain in this type of duration in general, in my experience, once I’ve reviewed the appropriate imaging and lab work etc. it tends not to be any more of biomechanical origin. And that’s because individuals who are well trained in physical therapy and chiropractic and podiatry etc. have addressed those biomechanical issues. They’ve helped most of those people, sometimes in collaboration with me. But those individuals not getting better, we have to look at the most complex structure in the human body, the brain. Or if you will the mind and the emotions to get an answer to their problems and get them out of chronic pain.

Right, so I know you bring the kind of the MindBody into your practice and you mentioned earlier, something called TMS syndrome and I’d like for you to just explain what that is so people have an idea of what we’re kind of talking about.

So I’m looking for individuals in my practice and some of them are seeking me out because I’m well known in this area. With a chronic pain that has not been clearly explained by other physicians and other practitioners, or for whom the explanations and the treatments they’ve been given, just haven’t worked. So I broaden the scope from looking purely at the chemical and biomechanical aspects of that individual to asking them questions that will range from the stresses in your life, how their relationships are going, their financial situation. What was their childhood like? What kind of personality do they have? Are they hard on themselves, are they a perfectionist, a people pleaser, put a lot of pressure on themselves?

And as I begin to broaden this view many of them have said to me, “You know Doc, no other doctors have ever asked me these questions.” So typically you have to ask different questions to get a different answer, the answer I am looking to see is if they may be a candidate for a diagnosis and treatment program based on this concept of tension myoneural syndrome. Where tension refers to both emotional tension and tension sometimes in the muscles and fascia. Myo is muscle and neural is nerves and syndrome is the fact that it causes pain but it can also cause other related symptoms. It’s not a perfect name, it’s a complex phenomenon but we’ve learned how to treat it, by changing the direction of treatment from medications, and biomechanical, and conventional, and alternative medicine as it’s currently known to a more educational and psychological approach.

So you’re saying that it’s currently seen as a form of alternative medicine almost?

I think that for some, the diagnosis and treatment of TMS is considered alternative medicine because it’s not widely accepted in the conventional medical community. For me it’s fundamental, for me it’s a scientific approach to the pain and where the science is continuing to be understood. As we move into the 21st century we’re learning more about this complex structure called the brain. Most complex structure we know of in the universe. There’s more connections in the human brain, between the neurons in the brain than there are stars in the galaxy and that’s a lot of stars.

So it’s a complex structure, we’re only beginning to learn about it but Dr. Sarno had insights 30 and 35 years ago into the people who were not getting better from back pain and other types of pain. And that the problem was more, if you will psychological, or if you will mental, or if you will brain related then it was just a physical problem.

And so to kind of expand on that a little bit. When you start to mention things that are psychological, that are mental. It doesn’t necessarily mean that you have a psychopathology. But that the actual generator of your pain may start in your brain or in your mind basically.

That’s what I’m trying to clarify and explain because people do get confused with that, many of the people I see are very high achievers, successful in their lives, etc. But their individuals who, may put more stress on themselves. They put more pressure on themselves than other people. Regardless of how their career or their personal life is going, or they may have had a more challenging childhood or growing up period then other people have had. And so these things are not psychopathology like, intense depression, or schizophrenia. But they are manifestations of changes that occur in the central nervous system, the brain. That we seem to be able to impact upon with a program of education and a program of getting people to focus away from the body. Which they focused on, in my experience long enough, to focus more on the emotional life, the psychological life. Which is a way to impact upon the brain, in the most productive way.

Excellent so I’d like to get into a couple of ways or a couple of items that your program entails but first can you articulate for our viewers and listeners, how the brain might be the generator of pain? How does that happen physiologically? You know we have clinicians as well as the average lay person on here so we don’t really want to get too technical. But let’s say how can the brain generate, let’s say back pain?

Well I’ll give you one example that I think of recent scientific research, I discussed quite a bit other in my book. I have a whole chapter designed kind of for healthcare providers in the book to help them understand this. But there was a study by a doctor Carrion a researcher of Northwestern, who looked at the brain imaging, functional brain imaging. So not static brain imaging but actual imaging of the flow of nutrients and things of the brain, comparing acute pain and chronic pain patients.

And what he saw at around three to six months is that the focus of the nerve pathways and the focus of the blood supply and the circulation of the brain began to shift from the sensory cortex. The area of the brain where sensations are coming in from the body etc, the sensory motor cortex. To the amygdala, the thalamus, more of the if you will primitive or emotional brain. So I can draw from that scientific research, a conclusion that there is a process of change in how the brain is wired, so to speak. Soft wired in terms of neurons when we’re dealing with a pain that just hasn’t gone away.

The brain is complex enough that it’s still the black box inside, in terms of truly understanding how emotions go into different aspects of our nervous system and effect us. But I think everyone who’s listening to this and watching this, at some point in their life has been embarrassed. And if you’ve been embarrassed, you’ve probably had your face flush. Somebody said something, now the embarrassment and the flushing of the face is a great MindBody example for people.

Because you’ve not been touched, you’ve not been hit, you’ve not been given a chemical but it’s a result of your brain understanding something in some way as an embarrassment. If you didn’t understand the language that the person is speaking then you’d just be sitting there, blank faced but you wouldn’t be blushing. As a result of this emotional sense of embarrassment you get a physiological change in your body, typically your face of increased blood flow of the blood vessels to your face briefly. And you turn a little bit pink, depending on your complexion. That’s an example of a MindBody reaction.

People have also had examples when they were nervous for a test or a ballgame that they’ve played or something and you kind of had to go to the bathroom beforehand, if you will “the runs”, another example of the psychophysiological reaction. So the brain is a complex structure and the relationship between both acute and chronic emotions and pain is a fascinating one. But this just gives you a hint into some of the thinking and some of the background that you need to understand this concept.

Excellent, I think that’s a great example. The flushing of the face.

Yeah.

So if I’m a patient and I struggle with let’s say, chronic neck pain and I come to you for treatment and I work through the traditional system of you know choices out there. What can I expect as far as you know what your program entails? How will it help me? What are the pieces of your program?

Okay well I just briefly start with a detailed history of your problem and of course I’m looking more at the psychosocial in addition to the where it hurst type of questions. I’m examining you, I’m touching you, mostly looking to see if there might be tender points in other parts of your back other than your neck. People tend to have myofascial tender points in my experience with this conditions. It’s different than fibromyalgia but it’s a number of points that doctors find first to identify and continued to find and I’m looking to find that there’s nothing structurally, terribly wrong in your MRIs etc. I’m doing my due diligence to confirm that.

If I find, you have this condition TMS and I’m putting you into this program then you’re gonna be expected to take some responsibility. Which I think is exciting as a practitioner and sometimes it’s a little bit challenging for patients although they typically like it. Which is you might be asked to read a book, or you might be asked to listen to a podcast. I’ve got a number of them linked on my website. Maybe I’ll add this one as well. You’re gonna be asked to do some journaling. Journaling is a key element of our program, where you write about feelings, it’s not a pain diary where you write about your pain. But it’s rather a day to day survey of some of the things going on in your life. Things that are making you upset, angry, happy. We’re trying to tie that in if you can to things that happened earlier in your life that may be contributing to the chronic pain. You come back for a follow-up visit, typically in three or four weeks. We’ll see how you’re progressing and we’ll ask you answer further questions and deal with doubts you might have about the diagnosis itself.

And in some of the cases, people do find it’s helpful to meet with one of the trained TMS therapists that I work closely with in Los Angeles who also do work by Skype. There’s also therapists and doctors in other cities that do this work. Although, not as many as I would like. So that’s the kind of of program that I have, it’s educational, it’s psychological it’s not medication focused, it’s not injection focused for chronic pain of the TMS origin.

The treatment is specific to the problem that you have so if you have a biomechanical problem I’m gonna treat you differently. But if you have a TMS problem, I’m gonna treat you with my mind and your mind in education and psychology and understanding and reassurance and kind of shifting these neuro pathways that have become entrenched. Perhaps in your amygdala limbic system and seem to change after this program is successful. Which it is very often.

Excellent, so these neuro pathways that you talk about which is really kind of cutting edge as far as the neuroscience around pain goes. How long can it take someone to kind of unwind, or retrain those pathways so that they have a new, we call it a neuro tag in neuroscience, a new kind of a neuro tag that’s one that does not create pain but is painless [inaudible 00:15:38]

It’s a very good question and it depends in part of the person, it depends on how long the pain has been going on. It depends on the person’s resilience or willingness to change or adaptation to change. Because what we’re relying on now is neuroplasticity, the ability of the nervous system in people of all ages to go through changes. For example, initially discovered with things like stroke which is a dramatic damage to the brain and this neuroplasticity that allows our brain to find other ways to resume some of it’s activities that are lost initially from a stroke.

Of course here we’re dealing with chronic pain, so we’re talking weeks to a few months in my experience. I’ve seen people literally get 50 to 70% better in three weeks and I’ve seen people take three to six months and sometimes more to see full improvement. And it’s very variable from person to person and it’s not a competition. Many of my patients with this condition seem to have a competitive or pressured style and so, I don’t pin them down to an exact amount time. I’m speaking now in generalities, the dramatic cases are always great to hear.

I had a guy with 25 years of back pain, who’s 10 year old son had never seen him run during his entire life. Because he was afraid to run, even around the block. And after coming to the program and really understanding this, he seemed to really grasp onto it. He called me 10 days later and said, I went on my first jog today, in 25 years and my son got to see me run.

These most dramatic cases are of course the most exciting but there’s, it’s rewarding whether it takes two months, three months, or four months as the patient’s pain is going away, their progressing, they’re getting more functionally active and even less medication if they were on it originally. All of these positives and I published a research study that showed, these kinds of changes occur both in increased function, decreased pain and if they are taking medications then decreased or elimination of medications. So that’s the goal and I work with them as long as it takes, as long as we’re making progress.

So with other programs that involve or leverage neuroplasticity usually they’re kind of shorter treatments but they’re more frequent because that’s typically the way, your brain tends to work. Is your program involve kind of shorter duration sessions or are they kind of spread out over a long period of time?

That’s a good question, you know I think we have found a method to rely on the pt to do short treatments daily so we have them write everyday journaling. It could be five to fifteen minutes, but they’re kind of thinking about this process of healing by doing this. They’re thinking bout the emotions that may be stuck in their nervous system, if you don’t mind the expression of that. We’re getting them to do more physical activity everyday, gradually. So that’s part of what reinforces a positive neuroplasticity, we’re having them read a chapter of a book, or two chapters of a book, re-read a chapter. So their getting reinforcement, so I keep the program very, I think, time and cost effective but it’s still clinically effective. So I’m not bringing people back everyday for a treatment or a discussion or to see a therapist. But they’re doing things everyday on their own.

And I think that’s an important part of this, as you mentioned change of the nervous system. It’s not enough just to have a dramatic experience, seeing me or meeting with me and hearing a different diagnosis, it’s important to follow-up with it. So those people who really dig into it and do the work and we have workbooks and CDs and DVDs and homework. People who do that tend to get better more effectively and quickly.

And I would imagine that this program is very approachable for people because for people with chronic pain, moving obviously causes a lot of fear, causes a lot of anxiety and this is a way they can start to kind of retrain their brain, retrain their nervous system in a way that is non-threatening before they get back to the movement stuff that all of us need to do on a regular basis.

Yeah I think, we combine it but we do emphasize, if you can get some of the reassurance and some of the shift in how you perceive what you perceive to be wrong with you. If you can get that down, if you can get that corrected, so to speak. Because unfortunately there’s a lot of negative messages that the healthcare system has kind of implanted on people’s brains with chronic pain, you’re never gonna get better, or that you’re always gonna have to be a certain way. That they’re damaged in some way. And so we explain to them that pain does not always mean damage. Especially chronic pain, this is an important distinction for your listeners as well. If you touch a hot stove there’s a reflex arc and your finger moves away to obviously avoid damage, avoid getting burned, that’s acute pain.

But when you’re dealing with chronic pain, that you may have real physical pain but it does not necessarily mean damage. So I, once I can change people’s understanding of that, I can get them moving even a little but. People that have that kinesiophobia that fear of movement. It’s so common in chronic pain and they break through that, they start walking, they start swimming. Just a little bit at first but at the same time they are doing this as you say gentle psychological educational works that they have been underpinning and an understanding for which, to break forward into the movement and the functional activities. And hopefully getting back into all of the things that they used to do tennis, hiking, whatever it may be.

Sure, as you’re talking, I’m thinking about our chronic pain epidemic and one of the areas, one of the kind of branches off that epidemic is our opiod epidemic so I wonder if this is a good positive solution to offer people who have been on opiod who maybe want to get off them, or are looking for solutions to get off them.

Opioids as you mention, are a huge problem you know there was a 10 year period where physicians were told, “there’s no risk to giving opioids, you can keep them on them for the rest of their lives and there’s not a lot of side effects, etc.” We are finding that a lot of those statements were incorrect. So now you’ve got people on opioids and you’ve got people in chronic pain, you’ve gotta try to find some alternatives so that they can be on less and less medications, and so they don’t have to get on it in the first place, etc. So I think that this approach should therefore become more well known, more important. Certainly one of the treatment options given that, that prescribing of meds is going to be much more closely scrutinized in terms of clinical protocols and in terms of the regulatory agencies etc., over the next number of years. It already is being more scrutinized now. So I’m excited about the fact that this work might achieve greater acceptance as a result of a need for alternatives to a medication only approach.

Yeah it sounds like a very positive program for people looking for a solution that is obviously non-drug based. Now I know a lot of what we talked about today is in the great book that you wrote, can you tell us about your book?

I wrote the book “Think Away Your Pain” sometimes your brain is the solution to your pain to give people an idea of kind of a combined the traditional Sarno methods that he discussed in his four excellent books. But to try and update it a little bit. To try to make it very user friendly, to try to focus in a little more on treatment than some of his books did which focused a lot on theory. And to also include some of the scientific research by the aforementioned Dr. Carrion and others who are not specifically testing my diagnosis of TMS but who are finding things out about the brain, the nervous system, emotions, chronic pain that I think help corroborate the insights of Dr. Sarno, which now go back 35 or more years to the beginning of his work. He’s retired at this point.

And so my book “Think Away Your Pain” is available through a variety of channels, the usual: Amazon, Kindle, iTunes, etc. I also wrote the “MindBody Workbook” which is a journaling book, it’s a 30 day journal where people can write about feelings and things and it’s good for any kind of stress release. And insight and understanding and detention in pain and recently came out with an app called “MindBody Journal”. It’s an app on the iTunes store, iPhone, iPad, where people can write about their feelings on their phone if they wish. Everybody loves electronics these days.

That’s awesome. So this has been a great lecture, id recommend everyone check out your book. I know you have it there somewhere it’s called “Think Away Your Pain”, correct?

That’s it, “Think Away Your Pain”.

“Think Away Your Pain” and if someone wants to contact you or learn more about you, how can the find you?

My website mindbodymedicine.com, I was one of the early, got that open early, so it’s a, no hyphens or apostrophe, it’s mindbodymedicine.com. It’s informative in this area and schechtermd.com also tells about my practice, S-C-H-E-C-H-T-E-R-M-D.com but mindbodymedicine.com is probably of interest for people who are interested in the MindBody chronic pain area.

Excellent, so I want to thank Dr. Schechter for being on the “Healing Pain Podcast” please check out his book, it’s called “Think Away Your Pain” and stay connected at www.drjoetatta.com for the podcasts, the “Healing Pain Podcasts” and we will see you next week.

About Dr. David Schechter, MD

Dr. Schechter attended medical school at New York University and fortuitously met Rehabilitation Professor Dr. John E. Sarno while seeking relief from a nagging knee problem. He achieved a rapid recovery after learning about Tension Myositis Syndrome (TMS), a diagnosis that emphasizes the role of tension in causing and perpetuating many painful ailments.

The following summer, under the auspices of Dr. John Sarno, he telephoned 177 former TMS patients of Dr. Sarno. The results confirmed his personal experience with this diagnosis and treatment approach and demonstrated a success rate above 75% in back pain patients. Dr. Schechter has served on the faculty of the USC School of Medicine since 1990. His last academic appointment was as an Associate Professor. His focus now is on clinical practice on the Westside of Los Angeles emphasizing mindbody approaches, sports medicine, and the treatment of injuries and back pain. A growing proportion of his patients are seeking out his expertise in the treatment of Tension Myositis Syndrome and related mind-body disorders.

To learn more about Dr. David Schechter visit www.mindbodymedicine.com

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If you would like to appear in an episode of The Healing Pain Podcast or know someone with an incredible story of overcoming pain contact Dr. Joe Tatta at [email protected]. Experts from the fields of medicine, physical therapy, chiropractic, nutrition, psychology, spirituality, personal development and more are welcome.

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