In 2003 Dave, a lorry driver from Yorkshire, was referred to me with acute, severe neck and shoulder pain. At the time I was working in the NHS and visited him at home to assess and treat him with Adapted Reflextherapy in Spinal Pain. After half a dozen treatments he was discharged pain free and not restricted in any way.
In 2007 the pain returned, initially in his neck and right arm and then spread to his left arm. Despite Physiotherapy treatment and medication nothing seemed to resolve the pain and an MRI scan of his cervical spine showed evidence of a prolapsed cervical disc. During a follow up visit to the Specialist it was recommended that he be referred for surgery to remove the bulging disc, which was assumed to be causing his pain. At this point Dave said he was not prepared to consider that yet and mentioned he wanted to see if he could find the lady who had cured him by massaging his feet last time he had the pain!
Assessment findings and conclusions
After finding me through Google Dave made an appointment to see me in April of 2008 with the expectation of being treated with Adapted Reflextherapy in Spinal Pain (AdRT). On assessment Dave told me he had had constant pain for 12 months which was now in his neck and down both arms, with the right more severe than the left. He described this as being on a level from 2 – 7 on a scale from 0 – 10. He was also complaining of a 2 week history of the recurrence of an old back problem, plus pins and needles into his right hand and toes.
Throughout the assessment Dave had been rubbing his right arm to try and ease the pain. His neck movement was severely limited due to pain but he had non-specific tenderness along the whole cervical spine. He had neurological signs, and although he did not know which disc had prolapsed, the signs were bilateral and multilevel, plus involved the lower limbs. Dave had never had a neck injury and apart from a prolapsed disc, any other more serious conditions, such as cancer, had been ruled out. Due to these factors and the lack of consistency in his pain over the years, I suggested to him that his symptoms might be stress induced.
I explained how his pattern of neck and shoulder pain, which covered the areas fed by 4 nerve roots, could not be due to the compression of just one nerve root by a bulging disc. I also suggested that this diagnosis also didn’t explain why he had had severe pain 5 years ago, then a recurrence in the past 12 months despite being pain free for so long in between. I went on to say that I could treat him with AdRT, but that it might be beneficial trying to find the underlying cause rather than treating him now, but not being able to prevent future relapses.
I explained about the concept of stress illness and how pain and other persistent symptoms are an escape mechanism for the build up of inner emotional turmoil that has no other outlet.
The history of Dave’s symptoms
Although initially unsure whether he wanted to go down this route, Dave began to explain that a year or so after his episode of pain settled in 2003 he had developed depression. In the end he resorted to Psychotherapy, which did help, although he said he found it difficult to talk about his problems. The depression then lifted, but after a period of time his neck and arm pain returned 12 months previously and had remained constant since then.
I explained to him how in 2003, although my treatment had resolved the pain, we had not addressed the root cause, which was the internal emotional turmoil due to stress. Because the underlying cause was not address, in time as his stress levels built up again the depression manifested as another outlet. When the depression lifted he managed for a while until an outlet was again needed from his inner emotions, hence the recurrence of his neck and arm pain.
At this point I noticed that Dave had stopped rubbing his arm, so I asked him how his pain was. He looked baffled as he realised that the pain he had had constantly for a year was gone completely. We therefore again discussed his choice of treatment and he realised that his pain resolving was a powerful indicator that the pain was psychophysiological, so there was no point in having a hands on treatment.
At this point we went through a basic timeline to see if he could begin to recognise what the main stressors had been in his life, including current ones and how the symptoms he had experienced fitted into this.
Despite the pain resolving so quickly, Dave realised how important it was to gain a full understanding of the concept and follow the advice in order to prevent a recurrence. On following him up a few days later Dave said he had slept through on the Sunday night after the assessment for the first time in months, indicating the stress he had been experiencing with his job. He said his neck and arm pain had not recurred, but occasionally he would get twinges in his back, but on talking to himself he could get rid of it in minutes. Dave found that reading Dr Sarno’s book, ‘The Mindbody Prescription’, gave him the information he needed to understand the whole concept and that listening to the TMS (now SIRPA) Recovery CD enabled him to review this, as well as pick up more techniques to help him in his recovery. Offloading how he felt by journaling was something he found very helpful in learning how to deal with what was happening in his life and letting go of things from the past.
On following up
At the end of May 2008 Dave emailed to tell me that he had had no further neck and arm pain, but was having some stiffness in his neck and shoulders, which until I mentioned it he had not realised was also a symptom of stress illness. He had also had a brief spell of low back pain which he had dealt with by talking positively to himself, working out what was bothering him and then telling the pain to go away.
Effective, but sneaky recurrence!
Dave continued to use the techniques as and when necessary until the end of June 2008, when I received a text saying, “I’m in the Algarve. Bad back pain. Can’t move. Tried everything. Any suggestions before I call Dr?”. I sent a text back suggesting he work out what was going on, how he felt and write about it to offload. I received another text 30 minutes later asking if he could call me, which he duly did about 30 minutes later.
Working it all out
While speaking on the phone Dave told me that he had just woken up in agony despite no having been absolutely fine the day before. It was apparently day 10 of a holiday with his wife when you would have expected him to have relaxed from any work issues and less likely to be stressed and therefore develop symptoms. He told me however that he hated the Algarve and hot, sunny holidays, but they went there every year because his wife liked the area. He also realised that he hated having to make decisions for them both every morning as to what they were going to do and had begun to feel resentful about everything, although he wasn’t consciously aware how angry he was deep down.
Dave told me that he had begun writing and worked out what had been bothering him so was able to offload about it onto paper. This resulted in him being able to get up, dressed and showered and prevented his wife from having to call an ambulance. He then sat down with his wife to explain how he felt and to discuss what they should do in the future to get around these problems. By the time he called me he was considerably better and his email on his return, said “Just to say thanks for your help while on holiday. After we spoke on the phone it was only another 30 minutes before I was back to normal and having no ill effects whatsoever. Once again thanks”
On talking to Dave this last weekend he told me that although he is still under a lot of pressure, he is able to deal with it much better these days. He said he still has occasional back ache, but this rarely lasts more than about 5 – 10 minutes and he recognises it as a sign that he is not dealing with something very well and starts to journal again, reviews the CD and where possible deals with whatever is causing him stress.
I asked what techniques he finds most useful and his answer was;
1) Reviewing the information on the CD
3) Shouting, swearing and screaming while in his cab!
Interestingly he also told me that he hasn’t had any recurrence of his neck or back pain since his first consultation a year ago. The measure of his internal pressure is twinges in his lower back, but never his neck.
Finally I asked Dave what, apart from the pain relief, were the benefits of learning about the concept of stress illness. He told me it has changed his life for the better. Although he says he still has a temper, he is less likely to lose it these days because he has learnt to offload how he’s feeling by journaling and instead of brooding about something he will come straight to the point and speak out about it.
And finally, Dave told me; “I feel this is for life ……. I feel I can deal with pressure and my emotions better now …. I know I can now prevent future problems”