Live Workshop 1

[Grace Batts]

[Grace Batts]

Live Workshop 1 Recording

[hschubiner]

Hello out there. Anybody home??
I was just able to access this forum and I don’t see any posts as yet.
Am I missing something? Is no one posting any questions? Or ideas? Or cases?
Looking forward to seeing everyone next week!
Best, Howard Schubiner

[khughes]

hi Howard
I’m excited to report that I just for the first time was able to logon to this forum today. Two questions that I have are about timing. Wondering if there is any research or if not then clinical experience to know how long it takes for a neural circuit disorder/mind body syndrome to develop? And wondering if you could discuss how likely and over what time frame are these conditions are reversible?
thank you
Karin

[abatson]

Hi Karin,
So glad you are on the forum now.
While we are waiting for Howard’s response, I will post mine based on my experience. Regarding how long it takes for a mind-body condition to develop, I think it can take a minute to decades. The reason for this is that these syndromes are driven by whether or not the brain perceives danger, either internal danger (inside the body) or external danger (outside the body). We all have different protective factors/resiliency vs. vulnerabilities combined with the different types of factors that trigger or maintain the danger signal (childhood trauma, adult trauma and stress, personality traits, conditioned responses and repressed emotions). All of these variables will play a role in the onset of the symptom(s). Oftentimes, someone might have small symptoms over time that do not play a large role in their life and are more easily ignored, and then they “blossom” into a larger, multi-symptom, multi-system syndrome or set of symptoms after a final trigger that tips one over the edge, creating more interference in one’s ability to function normally. When I say it could also take a minute, I’m referring to the power of a medical professional (or the 24 hour news cycle or social media) to scare someone into thinking they are damaged or irreversibly ill – it just takes one little comment to terrify a vulnerable person, thus keeping them in trapped in the pain-fear-attention-pain cycle.
Regarding how long it takes to heal, it seems to vary widely – from one visit, to years with most falling into several months I think. It is directly linked to how quickly you can turn off your danger signal – since this is directly related to your belief, on a conscious and subconscious level, of safety and wellness, it depends on the time to firmly establish that belief in your brain. I’ve see patients who have been sick for decades, in a wheelchair, walk-in pain-free by the second visit. Most patients can’t turn off their danger signal that quickly, but it is important to remember that this is like a light switch, or more like a dimmer switch – a little bit on, a little bit off, completely off. There is no physical thing to heal, so the time to heal (or have symptoms stop) is variable. It is a psychological/emotional healing, not a physical healing. There are instances where the persistent state of symptoms can create physiologic changes in the body, but that is probably for another forum topic.
Let’s see how Howard answers the question.

[khughes]

THank you ALicia! Very helpful to get this information. I am definitely curious about the “instances where the persistent state of symptoms can create physiologic changes in the body” as well. I will submit a case soon.

[khughes]

Case study: (I got permission from this client to submit her information and have changed identifiers).
59-year-old married female professional was referred to me at the behavioral health clinic by a LMFT therapist who has been seeing her for several years for Anxiety, depression, panic disorder, and ADHD with chronic low back pain. She has been told that she can rewire her brain and is interested in learning more about this and finding more ways to treat the pain without medications. She has undergone multiple back surgeries, injections of her shoulder’s and is in ongoing physical therapy. Her most severe area of pain over the last few years is her low back. She reports that she knows that she has overused her back and has done a lot of high intensity extreme athletic events such as cycling. The reason that she exercises so much is to treat her anxiety, depression and pain. She had some injuries as a gymnast and was told to push through the pain- that is an old pattern for her. Her pain correlates well with stress in her life and she is aware of this link. Most recently she had a spinal fusion done in a large metropolitan area in July 2022. She reports discomfort with prolonged sitting or prolonged cycling with some radicular symptoms down the posterior right buttocks into the posterior thigh. Given the amount of injuries that she has had, I asked her to contact the surgeon from July and clarify what the parameters are for her in terms of safe amount of exercise.

Past Medical Hx also includes Hashimoto’s thyroid disease, A/V nodal reentrant tachycardia status post ablation, dyslexia, history of multiple vertebral and facet fractures from injuries, GERD and glaucoma.
Spinal fusion of L4 -S1

OVIDDX handouts completed with client- body map reveals: Multiple areas of pain including left elbow bilateral knees bilateral ankles right hip low-back, both shoulders and neck. Lifetime stressors include: in utero severe stress of her mother, Emotional neglect, mental illness in her household; adult stressors include multiple accidents, two previous divorces, change in sexual functioning, multiple deaths in her family from COVID 19, work stress, financial stress, ongoing stress as a parent of a trans-young adult and a lesbian young adult (the father of these children has rigid religious beliefs which have been very stressful on these young adult children).
Lifetime Review of Symptoms: Is positive for TMJ, neck pain, back pain, piriformis syndrome, shoulder pain, knee pain conquered, frequent urination, menopause dysfunction, numbness, anxiety
Personality traits include perfectionism, high expectations, conscientious self, overly responsible, rule following, low self-esteem, putting others needs first, hypervigilance, and worrying although this is improving

Medications include: Escitalopram Oxalate 20 mg po qd
Vyvanse (Oral) 20 mg po qd
Montelukast Sodium 10 mg po qd
Levothyroxine Sodium 25 mcg po qd
Estradiol (Oral) 0.5 mg po qd
Cyclobenzaprine HCl 5 mg 1-2 po QHS Prn
Progesterone Micronized 100 mg po QHS
traZODone HCl 50 mg po QHS
Diclofenac 75 mg po BID prn

PE: thorough musculoskeletal and neurologic exam which was essentially normal except for Mildly tender posterior cervical muscles and mild-moderate anxiety.

Labs/data: 6/2022 basic labs are normal including TSH. 8/2022 lumbar xrays: Frontal lateral views lumbar spine are obtained. s/p posterior fusion and decompression from L3 to L4. Disc spacers from L3-L4, L4-5, and L5-S1. mild shift scoliosis noted centered to the right at L1 to the left at L4. Vertebral body heights are preserved. There is mild DDD at L2-L3..
2018 CT lumbar spine: Age-indeterminate right L3 transverse process fracture, likely subacute/chronic. L4-S1 posterior fusion without evidence of hardware complication. Minimal early partial osseous bridging across the intervertebral discs. MRI lumbar spine 2016 1. Moderate multilevel degenerative disc disease with mild central stenosis at L4-5 and borderline to mild central stenosis at L3-4 and moderate central disc protrusion at L5-S1. 2. Marrow edema in the left pedicle/pars at L5 likely DJD or stress related.

Questions: Clearly a lot of her symptoms seem to be related to a mind-body syndrome but she also has injuries/hardware in her back. Like to discuss working with her to turn off the danger signal. So far I’ve been working with her on psychoeducation, psychotherapy to help calm down the hypervigilance, increase mindful awareness, reduce her night time alcohol use, teaching more autonomic regulatory practices to help her calm the nervous system down (primarily in flight). She is responding well and appears much less anxious. Next steps will be to do more somatic tracking exercises..
thank you

[hschubiner]

Thanks for your first question, Karin.
The brain’s danger signal is there to alert us to immediate danger, so it can activate at any moment. If our brain feels threatened by some event (physical or psychological), it can create pain or other mind-body symptoms. Most people have had some of these in their lives, whether they recognize them or not. I tell all my patients: “You are just human, and it’s human for our brains to warn us if we’re in some kind of danger.”

Clearly, some people have had many stressful life events that lead the danger signal to be sensitized and more easily triggered to create pain or other symptoms with even seemingly small stresses.

How quickly one can recover also varies widely as Alicia has pointed out!

Best, Howard

[hschubiner]

The case Karin presents is an excellent one and there is lot going on; a lot to unpack. So many things point to so many mind-body conditions! You have to feel for this person who has worked so hard for so long, despite so many challenges, from childhood on.

It’s true that she has had back injuries and surgery, but I know that all injuries heal and scars don’t cause pain. It seems that her neurological exam is normal in terms of muscle strength, sensation and reflexes. And the MRI doesn’t appear to show any significant problem from surgery, such as a screw in the wrong place.

Obviously, the widespread nature of her pain suggests MBS. But it’s important to explore the back pain specifically if we want to know for certain that it’s also MBS; and more importantly that she can be certain of that. To do that, I would make a careful assessment of the FIT criteria and use provocative testing.

We will discuss these in the class, and of course, they are described in the OvidDx mobile app and in my book, Unlearn Your Pain.
If you’d like to test those with this patient, it would be useful for all of us to know what the results of that investigation.

Best, Howard

[hschubiner]

Hi everyone.
I think we forgot to tell the peppermint story. On the first day of class, a psychology professor places a jar of liquid on his desk. He tells the class that it’s a jar of peppermint extract and he asks if anyone can smell it. He then asks each person to raise their hand when they smell the peppermint. One by one, most of the students raise their hand. After a few minutes, he takes a drink from the jar, and explains that it’s just water. One of the students remarked several years later, “I can still remember the smell of that peppermint aroma.”

🙂
Howard

[hschubiner]

Thanks for being in the class with us!!

Grace will email you the intake forms that I use.

Here’s the youtube channel from my patient on mast cell activation syndrome:
https://www.youtube.com/@thehistaminedeception5378

The video on trauma and healing vision from Mark Wolynn, which is excellent:
youtube.com/watch?v=YqBhAgqZGSU

Here’s the reference on the article we published on racism and pain:
Racism as a Source of Pain https://doi.org/10.1007/s11606-022-08015-0

Thanks again!!
Howard

[hschubiner]

Thanks for being in the class with us!!

Grace will email you the intake forms that I use.

Here’s the youtube channel from my patient on mast cell activation syndrome:
https://www.youtube.com/@thehistaminedeception5378

The video on trauma and healing vision from Mark Wolynn, which is excellent:
youtube.com/watch?v=YqBhAgqZGSU

Here’s the reference on the article we published on racism and pain:
Racism as a Source of Pain https://doi.org/10.1007/s11606-022-08015-0

Thanks again!!
Howard

[hschubiner]

Hi everyone and thanks for being in the class!!
I’ve just sent my intake forms to Grace and she will email them to you.

Here is a link to a video by Mark Wolynn about healing his vision by changing his relationship to his parents:
http://www.youtube.com/watch?v=YqBhAgqZGSU

Here is the youtube channel from my patient with mast call activation syndrome:
https://www.youtube.com/@thehistaminedeception5378

The article I was involved with is in the Journal of General Internal Medicine, “Racism as a source of pain”
Racism as a Source of Pain https://doi.org/10.1007/s11606-022-08015-0

Thanks again, Howard

[Author]

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