Dr. Bill Salt recently shared his expertise on unexplained pain with LoveToKnow Seniors. A physician and the co-author of Still Hurting? FIND HEALTH!, Dr. Salt advocates for the body - mind/brain connection of holistic health. Co-authored with Thomas Hudson, the book provides unique insights into holistic self-care.
LoveToKnow (LTK): What inspired you to approach the topic of unexplained symptoms and how seniors can deal with them?
Dr. Bill Salt (DBS): As a gastroenterologist, inspiration came from:
- Seeing nearly half of all my patients suffering with medically unexplained symptoms (such as abdominal pain associated with bowel trouble) that couldn't be explained with medical tests (i.e., colonoscopy)
- Feeling the futility of labeling collections of these symptoms with a diagnosis of a medically unexplained syndrome (such as irritable bowel syndrome)
- Observing that these symptoms and syndromes were often associated with at least one other medically unexplained non-gastrointestinal syndrome (such as fibromyalgia)
- Finding intrigue in their frequent relationship to stress, depression, and/or anxiety
- Concluding there is a strong connection between pain and symptoms and patients' self -care behavior (or lack thereof)
Patients had often seen many specialists and caregivers from multiple disciplines. I faced the same virtually irresolvable dilemma that all physicians do: trying to explain the unexplainable, account for these interrelationship and associations and provide effective treatment to suffering patients in office visits lasting fewer than 10 minutes (the time of an average office visit).
LTK: How many people have unexplained pain? Is this percentage different in different age groups?
DBS: Kurt Kroenke, MD is professor of medicine in the Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine. Dr. Kroenke is one of the world's leading authorities in the research and management of symptoms. He says that "Half of all outpatient encounters are precipitated by physical complaints, of which one-third to one-half are medically unexplained symptoms, and 20 to 25 percent are chronic or recurrent." Pain is the most common symptom, which becomes more common with aging.
Anatomy of Unexplained Pain
LTK: How and why do people experience pain if there is no diagnosable problem?
DBS: This is the central question that inspired us to write our book. Even if we had sufficient time together, most doctors and patients are not aware of exciting and amazing new science that clearly confirms the importance of seeing our symptoms and pain in the context of the body and mind/brain connected as an integrated and inseparable whole. Our book explains our relationship with the environment (the nature/nurture issues) and basic physiology of how the connection works and why pain and symptoms occur when it malfunctions.
LTK: How does pain actually occur when there is a malfunction that impacts the body-mind/brain connection,?
DBS: Here's an executive summary on how and why symptoms occur.
First is how: the short answer is that the body and mind/brain respond to environmental stimuli in the world, which are stressors (e.g., infection, injury, and psychological stress), which trigger dysfunction and commonly result in pain and symptoms.
Picture that the brain contains four mind/brain systems that all talk freely with one another.:
- Body talk
- Stress response
The body talk system is responsible for interpreting feelings from the body (the example here is pain, but others are: temperature, itch, muscle ache, internal organ sensations, and hunger), which are sent through tiny nerves in all body tissues and organs that connect to the spinal cord. Then the pain feeling is sent up to the mind/brain. Health and survival depend upon the mind/brain knowing about these feelings at all times.
After interrelating with the other three systems, the body talk system "explains" the feeling to the body in four different ways:
- Intensity: perception of severity
- Affective:pleasant versus unpleasant
- Motivation: desire to alleviate
- Autonomic: autonomic nervous system output (e.g., sweating and rapid heart rate)
Second is why: the short answer is that why symptoms and pain occur depends upon the interpretation of the experience by the mind/brain. All four mind/brain systems are involved in why we have symptoms because they all talk with one another and have different things to say.
Let's look at these systems:
Return again to the radio metaphor representing dysfunction and expression of symptoms and pain. The other three mind/brain systems can turn the radio volume up too loud or alter the tuning. Problems can occur with the electronics within the radio, such as a short circuit.
Life is hard, too fast, complicated and very stressful. Science confirms that we weren't designed to live this way. The stress response is designed to protect us, but when it is turned on all the time, the stress response system itself can malfunction. Hearing about this, the body talk system becomes dysfunctional in sympathy.
We aren't aware of much of what's going on within us. The consciousness system remembers a lot of old hurts (both physical and psychological), even without our conscious awareness. So the consciousness system talks with the body talk system about them subconsciously and contributes to malfunction, as do conscious negative thoughts, such as "I'm never going to get better."
Just like the consciousness system, a lot of old negative emotion is hidden within the emotion system. These negative emotions, often accompanied by depression, talk with the body talk system and contribute to malfunction.
LTK: What is the result of seeing several doctors and specialists and not getting a diagnosis?
DBS: Visits are commonly disappointing for both doctors and patients because neither know how and why the symptoms occur or what to do about them other than try medication, which may help but often doesn't. Even if they did understand, how can meaningful dialog and partnership occur trying to explain and understand what, up to now, has been unexplainable - in fewer than 10 minutes?
LTK: How can seniors go about relieving this debilitating condition?
DBS: There are some medications available that can help, but the most important step is to see the big picture of the mind/brain - body connection in relationship to the environment and both how and why these symptoms occur. Knowledge is therapeutic, as is appreciating the relationship between pain and symptoms and self-care. It is crucial that patients see and buy into the impact that personal health behavior has upon symptoms and pain.
Engaging in health promoting behavior (e.g., healthy diet, exercise, stress management, social interaction) and avoiding health damaging behavior (e.g., smoking, being obese, and immoderate alcohol consumption) can help relieve symptoms. To give an example, consider the importance of regular exercise: it can help reduce and manage pain by lifting mood (emotion system), providing a sense of taking control (consciousness system), reducing harmful effects of stress (stress response system), and strengthening muscles while conditioning the autonomic nervous system (body talk system).
LTK: How can individuals be sure that there is no medical diagnosis that requires treatment?
DBS: One of the reasons that life is difficult is that it's hard to be sure about lots of things, but it's important to be confident in your relationship with your doctor and of the diagnosis. If either don't feel right, consider getting at least one more opinion and also consider whether the opinion would best be sought from a specialist. If necessary, consult at a center of excellence. Then recognize that the symptom or symptom syndrome may well be medically unexplained and consider reading Still Hurting? FIND HEALTH!
LTK: Why is holistic health so important and is holistic health more important in the 21st century than ever before?
DBS: It has never been more important. If people can truly see the importance of their behavior choices in relation to their pain and symptoms, they will be more likely to assume responsibility for their own care. This is why I recommend Sharecare, a question and answer website that is designed to help people ask the right questions to get the right answers about their health. I answer questions for Sharecare, and they have based several hundred Q& As on my books.
LTK: How can your new book help seniors suffering with chronic pain and symptoms?
DBS: My wife says that I need to be able to answer this question in less than 30 seconds, so here it is:
"We offer a new way to understand pain and symptoms that doctors can't explain with an original medical model that shows how and why these medically unexplained symptoms and their syndromes occur in our bodies. Understanding this is powerfully therapeutic. The model also explains the relationship between symptoms and self-care and provides the tools we need to feel better."
For more information on unexplained pain and how to go about relieving the symptoms, pick up a copy of Dr. Salt's book. While not all pain can be clearly linked to a medical diagnosis, there is hope that you can be rid of the pain if you see your body and mind/brain as one whole and treat it as such.