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The Brain-Pain Connection with Dr.David Schechter
Episode 4421st March 2022 • Back Talk Doc • Sanjiv Lakhia - Carolina Neurosurgery & Spine Associates
00:00:00 00:37:29

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Dr. David Schechter didn’t always buy into the idea of the mind-body pain connection. As a medical student, he relied on conventional and traditional approaches to pain management.

But that was before he developed knee pain that felt almost impossible to resolve. He tried mechanical therapy and strengthening exercises as is typically recommended, but nothing seemed to work. So he approached an NYU physiatrist for help: Dr. John Sarno, who became one of America’s most famous back pain doctors.

Dr. Sarno told Dr. Schechter that his pain was psychosomatic. “That really threw me for a loop,” Dr. Schechter said. “It was not what I was expecting to hear.” 

But it worked. And Dr. Sarno’s theory of Tension Myositis Syndrome, or TMS — that the mind creates pain in order to suppress traumatic events or subconscious thoughts and feelings — has been supported by independent research showing how the brain reacts differently to chronic and acute pain.

It’s an idea that has unfortunately come with social stigma: patients who suffer from TMS worry that the pain is “all in their head.”

But psychosomatic pain is real, Dr. Schechter says, and understanding how our brain impacts our physical bodies is the first step to accurate treatment and recovery.

Dr. Schechter joins us on episode 44 of Back Talk Doc to discuss the research behind mind-body medicine and the mind-body methods that best help address pain. 

“It's a more effective way to treat a particular type of symptom, typically chronic pain,” he says. “And it's a better way to define it. If you make the correct diagnosis, you're more likely to move forward with the correct treatment program.”

Read the Full Show Notes on our website BackTalkDoc.com.

💡 Featured Expert 💡

Name: David Schechter, MD

What he does: Dr. David Schechter is a physician in Culver City, California with a medical degree from New York University. He specializes in sports medicine with a particular focus on non-surgical approaches and mind-body medicine. Dr. Schechter is the author of several books including The MindBody Workbook.

Company: David Schechter, MD (private practice)

Words of wisdom: “If you're afraid of failure, if you're afraid to not get there those opportunities may not ever become available. So don't be afraid to fail. Try it, and if it doesn't work out, learn from it and move on. And do even better next time.”

Connect: LinkedIn

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👉 If you enjoyed this episode of Back Talk Doc, check out our recent episode All About Radiofrequency Ablation for Spinal Arthritis with Dr. Stephanie Plummer.

🔎 For more information on Dr. Sanjiv Lakhia and the podcast visit BackTalkDoc.com.

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Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.

Transcripts

Voiceover (:

This podcast is sponsored by our partner, QxMD. QxMD builds mobile solutions that drive evidence-based medicine in clinical practice. Check out Read, for easy access to research personalized for you, and Calculate, for over 500 easy-to-use decision support tools. Try them today at qxmd.com/apps. Again, that is qxmd.com/apps.

Voiceover (:

Welcome. You are listening to Back Talk Doc, where you'll find answers to some of the most common questions about back pain and spine health brought to you by Carolina Neurosurgery & Spine Associates, where providing personalized, highly skilled and compassionate spine care has been our specialty for over 75 years.

Voiceover (:

And now it's time to understand the cause of back pain and learn about options to get you back on track. Here's your Back Talk doc, Dr. Sanjiv Lakhia.

Sanjiv Lakhia (:

Welcome back to another episode of Back Talk Doc. And before we jump into today's topic, I want to express gratitude for those of you that have followed me for the last two years. I started this podcast as a bit of a labor of love just to share information and help individuals make better informed decisions about the care of their spine.

Sanjiv Lakhia (:

Quite honestly, I fit this podcast in on the periphery after clinic, at times in between my busy patient schedule and my family life. And it's my hope that I'm delivering some really good information that's actionable for you. And I want to show appreciation for those that have subscribed to the show. And if you have liked episodes, please, number one, share it with friends and family. That's really all I care about is getting the information out.

Sanjiv Lakhia (:

And then if you do have time, we always appreciate leaving a five star review on Apple iTunes. It helps promote the visibility of the podcast and it allows me to attract really cool guests. Like the one we have today. Today's episode is really going to be switching gears to a topic that is near and dear to my heart, and that is mind body medicine. And I want to welcome Dr. David Schechter to the show.

David Schechter (:

Thank you. Good to be here.

Sanjiv Lakhia (:

All right. So, David is a family sports medicine physician in private practice in Culver City, California. He's an author, he's got several books one of them called Think Away Your Pain that explained the connection between stress and persistent or unexplained physical symptoms, such as back pain.

Sanjiv Lakhia (:

In addition, he's an author of The MindBody Workbook, which has helped thousands of people process emotional tension by writing about it through journaling. David graduated from Princeton University and NYU Medical School and has completed his residency at the University of California, Los Angeles, otherwise known as UCLA in Santa Monica with the family medicine residency program. And he has a certificate of added qualification in sports medicine.

Sanjiv Lakhia (:

He's been named a top doctor by several publications, including Men's Health, U.S News & World Report, Hollywood Reporter, and the Los Angeles Times. Dr. Schechter's websites are, and we'll link to these in the show notes, www.mindbodymedicine.com and www.schechtermd.com. He's published research in this area and is on the board of a nonprofit devoted to his work. And he recently launched an online course, The Mind Body Healing Journey, which I have gone through, which is excellent and is accessible through his website.

Sanjiv Lakhia (:

He's on the board of directors of the Psychophysiologic Disorders Association, has developed a curriculum to teach high school students more about managing and understanding stress. Quite the background. Thank you for taking time to speak with me and my audience about the topic of mind-body medicine as it pertains to pain.

David Schechter (:

Glad to be here and thank you for that kind introduction.

Sanjiv Lakhia (:

Yeah, absolutely. Now, let's jump into it. There's a lot to get into here. I've really tried over the course of my podcast to bring on guests to talk about structural causes of pain. And we've interviewed just in the last month a couple of my partners about facet pain, and disc pain, and [inaudible 00:04:20] pain. But we're really talking about a different aspect of pain in your works, in your book and in your course.

Sanjiv Lakhia (:

So, I want to ask you an open ended question to talk to the listeners about how you got into this and then jump into the definition of TMS or tension myositis syndrome.

David Schechter (:

I appreciate the opportunity to discuss this. I got into this when I was a medical student and was having knee pain that was difficult to resolve. And as patients who were listening, I approached it initially through this conventional biomechanical and physical therapy, strengthening exercises, that type of thing, but I wasn't getting better.

David Schechter (:

And this is a clue to those that might not be improving with the conventional and traditional approaches to musculoskeletal problems. In my case, the knee pain wasn't getting better. And I approached the physician who was a physiatrist at NYU. I did not know that he was a mind-body medicine doctor or had an interest in that area. His name was John Sarno.

David Schechter (:

And when I presented my case to him very briefly in his office, in between patients, he was willing to speak to me. He said, "In my experience, a lot of this pain that persists and doesn't get better with the things you've already tried doing is actually psychosomatic."

David Schechter (:

And that really threw me for a little bit. It's not what I was expecting to hear. Psychosomatic, of course, is another way of saying psychophysiologic, it's another way of saying mind-body. It's just using Latin or Greek to say the same thing.

David Schechter (:

And so, for patients that I see with acute symptoms, and I'm a sports medicine doctor. I had a gentleman this morning who came in with hip and low back and groin problems for two weeks. I approach it probably like anybody you've spoken to on your podcast would, which is a careful history physical exam. And then typically something like physical therapy referral, anti-inflammatory medications, sometimes imaging, if that's appropriate.

David Schechter (:

However, there's a large number of people out there who are not responding over three months or six months or more and fall into the category of chronic pain. Often it's back pain, but sometimes I'm seeing people with neck pain, I'm seeing people with arm pain, headaches, other types of conditions.

David Schechter (:

So, this overall catchphrase of TMS or tension myo-syndrome, originally called tension myositis syndrome. And it has other phrases or names as well, including mind-body syndrome, psychophysiologic order. And now neuroplastic pain is another term. This whole concept is based on the idea that acute pain and chronic pain are very different.

David Schechter (:

And there's research that shows that acute pain as we would expect is experienced in a part of the brain called the somatosensory cortex, where sensations are experienced. But if you look at somebody with six months or a year of pain, they typically, on FMRI, a Functional MRI scanning of the brain.

David Schechter (:

So, the part of the brain that lights up is more the prefrontal cortex and the amygdala, areas that are more closely associated with emotions. So, we have a scientific basis for saying that chronic pain is different than acute pain.

David Schechter (:

And my mentor, John Sarno, and then my own research and those of others, have demonstrated that a treatment program that's more based on education and psychology is often effective for chronic pain. Whereas it wouldn't get rid of that ankle sprain or that knee sprain or probably help that patient that I saw this morning.

David Schechter (:

And so, that's the overall concept is that real physical pain experienced by a patient that continues and persists and hasn't responded, it could be that physicians and others haven't been looking in the right direction for it. They haven't been looking in the right place, in a sense, in the brain and they haven't been looking with the right approach to help that patient's pain go away.

Sanjiv Lakhia (:

That's a key distinction. I just want to stop there real quick. You talked about acute versus chronic pain, and I know there's people listening who are saying, "Oh my God, they're saying my pain is in my head." And I think years ago, at least when I was in medical school, there might have been a bit of a stigma attached to that concept.

Sanjiv Lakhia (:

But I believe what you just said is that the research, the scientific research has given us an actual model that we can use to explain it to people and make it real. I think one of the concerns I have about any of the mind-body approaches that I recommend to patients is that I don't want them to feel like we're dismissing their pain.

Sanjiv Lakhia (:

And in fact, what you're just describing is, we're not dismissing it, we are diagnosing it better than maybe we used to able to do based upon the research.

David Schechter (:

That's absolutely right. And that phrase it's all in my head is such a terrible phrase that's been around for a long time in medicine and media, et cetera. I tell you, what is our head is our brain. And our most important organ is our brain, which is processing all the sensations from all over our body.

David Schechter (:

And our brain is the leader of our nervous system, which is another key element of our health and our wellbeing. And so, by understanding the fact that if you are dealing with chronic pain, it may be more effective to deal with the top down approach rather than a bottom up approach. It doesn't in any way stigmatize the patient.

David Schechter (:

As I said, I had knee pain that ended up responding to this approach in medical school. And I consider myself a fairly normal person. Although we'll talk about some personality characteristics later that I share with many of the patients who have chronic issues in this regard.

David Schechter (:

But it is not a stigma. It's just a more effective way to treat a particular type of symptom. Chronic symptoms is typically chronic pain, sometimes other issues that have not responded to conventional and sometimes alternative approaches as well over a period of time. And it's a better way to define it.

David Schechter (:

And as you said, if you make the correct diagnosis, you're more likely to move forward with the correct treatment program. And also, it doesn't make sense to apply the treatment approaches that work very effectively for acute pain and assume they'll be as effective for chronic pain because it really is a different diagnosis as we see on the scientific imaging and the like.

Sanjiv Lakhia (:

That's excellent. Now, do you want to elaborate on the concept of TMS? And also if you can, I don't recall but I want to link to it. Dr. Sarno wrote a book, did he not, on the topic?

David Schechter (:

Yeah. His book, The MindBody Prescription or Healing Back Pain are some of the seminal works in this area. And his books are very Freudian-oriented. So, there are people who find that a little bit off-putting, but they're generally extremely powerful. And then the work that's moved forward that I've written about and that others have written about, I think, adds some more of the neuroscience and some of the more recent research efforts in this regard.

David Schechter (:

So, I use that acronym, TMS, a lot, tension myo-neuro syndrome, with my patients. When Sarno came up with the term tension, he was thinking of both emotional tension and muscular tension. Myo referring the fact that muscles were often involved, neuro that the nerves are involved as well, initially called tension myositis and didn't really like that name as much, and so later changed the name.

David Schechter (:

And syndrome because syndrome means that there's going to be a number of different manifestations in terms of symptoms, including pain, but sometimes numbness and tingling as well, and sometimes other symptoms. So, the diagnosis really changes the way you're going to treat the patient.

Sanjiv Lakhia (:

For sure. You approach your patients in the clinic with this concept of TMS. Share with my listeners some of the evidence that you like to reference that there is a connection, neurologically, with the nervous system and pain. And I know you went through several articles in the course that you shared with me. And I thought you might want to touch on a few of those.

David Schechter (:

Well, one of the ones that's very powerful. I mentioned briefly before, it's written by [inaudible 00:12:33] from Northwestern. And he's a scientist who has studied the brain and chronic pain for many years, along with his associates, including Dr. Hashmi.

David Schechter (:

And they've published on chronification. So, this is the process by which acute pain shifts into this chronic phase. And I found that that was very powerful research. Recently, there have been colleagues of mine who've published a number of papers, outcome studies, within a couple of randomized controlled trials that have been exciting because they got excellent results.

David Schechter (:

One of them was associated with an FMRI study as well, using what they called pain reprocessing therapy, which is PRT is another terminology in this area. And that was published in Journ of Psychiatry recently. So, there've been a number of outcome studies. And then there have been a number of other scientific studies.

David Schechter (:

There's even been studies on hypnosis in the past, where the experience in the brain of thinking about pain and of having physical pain is so similar. Another thing that's interesting is that social pain is experienced very similar to physical pain.

David Schechter (:

So, by social pain, I mean, if we put a group of people in an experimental situation and the other people are told to reject that one person in the group. Maybe some of us have experienced that in high school or in college, a rejection by a group. Well, if you quickly throw that person in an FMRI scanner and look at their brain, the parts of the brain that light up are very similar to the parts of the brain that would light up with physical pain, physical injury.

David Schechter (:

And so, social pain, which is purely an emotional reaction, is very similar to physical pain, which is a physiologic reaction that then goes into the brain. So, there's just a lot of interesting things about pain that point out that it's more complicated than we think it is, even though all of us have experienced pain since we were young at one point or another in our life, and think we understand it pretty well.

Sanjiv Lakhia (:

I think it's just fascinating. And just from experience, I know when I'm sleep-deprived or stressed, my little back talks to me more than usual will. So, you don't have to look very far, I think, if you're honest with yourself to really buy into this kind of mind-body connection.

Sanjiv Lakhia (:

Now, when you have a client patient in your office and you're talking to them about this concept, I know you've developed a questionnaire and almost a set of diagnostic criteria. Do you want to share a little bit with the listeners about how you can come to the determination that someone may be dealing with the tension myo-neuro syndrome as you call it?

David Schechter (:

Yeah. Obviously a general medical history about their symptoms is very important. But then I hone in on some things. Like I ask them about their personality. There's a type T personality that is associated with this condition. And several of the things that we ask are, are you very hard on yourself? Self-criticism. Are you a perfectionist? Are you a people pleaser? Which doesn't necessarily mean you're trying to please everybody, but certainly that you're very sensitive to how others perceive you.

David Schechter (:

And these are some of the criteria. These are some of the questions we ask, self-criticism, perfectionism, people-pleasing. Are you very responsible for others? So, people who take a lot of the weight of the world on themselves, Sarno use the term good-ism to describe this. People who want to change the world. We know it's hard enough to change ourself much less to change the world.

David Schechter (:

This kind of pressure tends to be associated with this condition. So, I give points for the number of positive answers in this personality quiz that we give. Then we're also looking to see if people have had, in their life, other potentially tension-related illnesses. For example, the most common one that we see associated with back pain would be at another point in their life having irritable bowel syndrome, IBS, also headaches, tension headaches are commonly associated with back pain as our other potentially functional conditions like teeth grinding, temporal mandibular joints and jaw pain that is not due to any particular structural problem. Sometimes even skin rash is brought on by tension like [inaudible 00:16:41].

David Schechter (:

So, looking for these other tension-related or functional illnesses can be very helpful in making a diagnosis and in looking at whether or not someone's at risk for this problem. I also ask people about their childhood. And this is something that they often remark to me after I ask them about it, "Well, nobody's ever nobody's ever brought this up."

David Schechter (:

And of course, we know from research that adverse childhood experiences, also known as ACEs, there's even a quiz out there developed independently of my group that you can get a score on this. If you had a very challenging childhood emotionally, it makes you more prone for a variety of health issues. But specifically with chronic pain, we ask about childhood connections, emotional issues, divorce, difficult teenage years, and sometimes just a mismatch between the child and the parents. Even if both are pretty healthy emotionally, maybe there's just a mismatch there.

David Schechter (:

So, we're trying to delve a little bit deeper into the psychosocial personality, other health issues that help us to make this diagnosis. And I developed a questionnaire, which is a rough reformer that's on my website that you can self-score. Of course, you can't make a diagnosis just by self-scoring, but it's a way of pointing you potentially in the right direction when it comes to psychophysiologic disorders like TMS.

Sanjiv Lakhia (:

The reason I think the type of work you're doing is so important is that those of us in clinical medicine, I feel like I've been in practice now for over 15 years. I feel like the ratio or the number of people who come in that we say to them, everything looks fine, but you don't feel good, is escalating dramatically. Meaning MRI looks good, x-ray looks good and then they back and say, "But I don't feel good."

Sanjiv Lakhia (:

And this type of work you're doing gives practitioners and patients another path to walk down and just at least be curious about and ask the question, "Could there really be a mind-body connection that's driving my pain syndrome, and more importantly, a healing pathway?"

Sanjiv Lakhia (:

And you talk about, in your coursework and in your writings, this sort of healing pathway where, and tell me if I'm accurate, but it sounds to me like a simplistic way to look at this is, we all have some degree of suppressed emotions, whether from our youth or from recent events and that the healing can happen once we figure out mechanisms to express those productively. Does that sound about right?

David Schechter (:

I think that's very well stated. First thing you mentioned, boy, that would be a separate podcast. If I was interviewing you, I would be asking you, why do you think there's been this increase in number of people presenting with normal imaging and that sort of thing?

David Schechter (:

But the key thing to start off with is validating the patient's pain. This is a real situation for them. It's not something imaginary. It's not something made up intentionally. I make it very clear to the patient, "You are the victim of this. You're not at fault of this. You didn't know that holding tension and stress inside of you might produce physical symptoms. You had no awareness of this. So, in no way should you blame yourself for this."

David Schechter (:

However, by starting to ask the questions of what's going on in your life and finding out that maybe they were going through a difficult relationship at the onset of these symptoms, or they had a very difficult boss right before or during the onset of the pain and the perpetuation of the pain cycle.

David Schechter (:

And then as you mentioned, helping them to make that shift from the idea that there's something terribly wrong with me that's going to lead to long term pain and perhaps disability. So, making the shift from that to, I have a very real condition, but it's something different and there's a way out of it. There's a healing path, as you mentioned. And then we can talk about more the details of the healing path, but specifically as you said, it's learning a better way to process your feelings.

David Schechter (:

Because so much of us are rushing. We have our responsibilities at work, with our children, sometimes with our elderly parents. There's a lot of pressure on people right now. And certainly the pandemic has exacerbated that five fold.

Sanjiv Lakhia (:

For sure.

David Schechter (:

And to learn how to take a little time for yourself. We call these self-care strategies work. So, to give people a chance to just take care of themselves a little bit, put themselves on the list, can be a very helpful part of that healing path.

David Schechter (:

But it all starts with, almost closing the chart. We don't use charts anymore, but closing the chart, looking at the patient in the eye and saying, "I totally get what you've got and your imaging is fine. The good news is, you don't have a structural problem. You don't need surgery. You're not going to be disabled, but there's a path out of this that's going to require you to do a different kind of work. And I can help you with that."

David Schechter (:

I think that really empowers the patient to get better rather than having them feel like, oh, you're just another doctor either dismissing them or telling them they have to go do some more treatments or do some more procedures or whatever. So, that's the exciting part of this work.

Sanjiv Lakhia (:

I agree. And it does shift the paradigm from a patient having something done to them versus they get to drive the car and we sit next to them. And I think that's very, very important. This topic is really been exploding, I think, in the last five years. There's another really good book that we'll link to in the show notes. I don't know if you're familiar with it. The Body Keeps The Score.

David Schechter (:

Oh, of course. Yeah. Yeah, yeah. Yeah. That's very much related to this work. It comes from a different pathway, but it's very much related.

Sanjiv Lakhia (:

Yeah. And it talks about the connection with trauma and healing. And just as a point of how I think this topic is going to resonate with people right now at this moment in time, I went and looked at that book on Amazon and it's got 43000 five star reviews.

David Schechter (:

Wow. Wow.

Sanjiv Lakhia (:

People get it, right? I think people get it. And they're looking for clinical leadership in this area to help them walk down that path, which leads me to the next question is, I would like for you to touch on some of the tools that you think are productive for patients as they go down their healing pathway and just share your thoughts on how you recommend them.

David Schechter (:

So, let's say I've made the diagnosis in the office and what do we do next? As I said, that shift in attitude and belief is very important, trying to help them to understand the diagnosis. So, education is part of the so-called penicillin for this approach.

David Schechter (:

But more specifically, we get people to start journaling. So, writing about your feelings is a very inexpensive and time and cost effective way to begin to process emotions. The workbook that you mentioned at the beginning of the show that I wrote is a guided journal. Some of my patients use that. Some of them write in a blank notebook. And it's 10 to 15 minutes a day, most days of the week, sitting down and not writing about your day's events, but what got you upset? What got you angry.

David Schechter (:

You can spend some time doing gratitude as well, and you can spend some time writing about some good things. But really it's emotion-focused journaling. So, that's one of the things that we find extremely helpful. Sometimes what comes out of that journaling leads me to make a referral down the line to a trained therapist in this area, psychotherapist, to go a little bit deeper. Sometimes the journaling is enough by itself.

David Schechter (:

Then I make educational recommendations. So, I will recommend that people read one or two books in the area. You've mentioned a couple of them already today. I will recommend that people look at a video or a podcast, maybe this podcast after this. That they listen to some podcasts that are available. Perhaps look at my online course.

David Schechter (:

I individualize this depending on how far along people are in understanding these concepts and what I think that they need. Some people for whom it's clear that there's a tremendous amount of childhood trauma or adult trauma that needs to be dealt with, well, part of my initial treatment recommendation is, you should see an individual therapist.

David Schechter (:

And I typically help to guide them to people who are expert in dealing with chronic pain TMS, and also obviously trauma and other emotional issues.

David Schechter (:

So, therapy can play a role, but not everybody has to be in that. I also lead some online groups on Zoom with a psychologist. So, some people do really well in that group format. And that's something, if there's any physicians listening, could be a really good thing for you to consider doing in your practice as well.

David Schechter (:

I really also emphasize physical activity. A lot of people with chronic pain haven't been moving very much. Once I determine that the chronic pain is not due to a structural problem that should be prohibiting them from moving, I start getting them to move. I could start with walking, maybe it's 5 minutes a day, maybe it's 10 minutes a day, just start something, swimming, stationary bicycle, try to get them moving as well.

David Schechter (:

In addition to that, calming the nervous system can be helpful. So, things like meditation, prayer, reflection, just lowering the level of autonomic arousal, the fight and flight response, can be extremely helpful as well. So, those are ways that we help people to express their emotions productively.

David Schechter (:

We know that physical activity as you do more of it, more vigorous is a great way to reduce anxiety and tension in general. So, that's the overview of how I approach it. Of course, there's follow up visits and things like that. But it's really as you said. We're walking beside the patient or guiding them on the path, but they're really finding their individual ways of understanding this from the materials that we present to them.

Sanjiv Lakhia (:

Dave, I'm really happy you mentioned the physical activity piece. Obviously as a physiatrist, that's important for me. And what I've come to learn, I like to say more than just physical activity, but more of restorative physical activity. For example, Tai Chi, Qigong, yoga, these types of movement-based activities that also in and of itself have a very profound mind-body component with a lot of good data and research behind how it can affect the autonomic nervous system.

Sanjiv Lakhia (:

Other tools that I've talked about with patients that may or may not apply to what you're trying to accomplish here would be breath-work. I just graduated the Andrew Weil Integrated Medicine Fellowship. And we highly recommend the 4-7-8 breath, which is a way to shift and lower our respiratory rate to shift to a parasympathetic state that's more calming and relaxing.

Sanjiv Lakhia (:

These are all these little tools that people can be given that don't take any time that I think can really augment the journaling, the meditation and even if they're doing formal therapy. I think your approach is very, very good.

David Schechter (:

Those are great ideas. In fact, I was thinking about ways that people can develop a daily routine to avoid getting TMS. And of the things I thought about was breathing. We don't often take the time to just slow our breathing and 4-7-8 breathing or square breathing or other variations on this are very calming.

David Schechter (:

You don't have to do it all day. It can just be a minute, it can be 30 seconds, it could be two minutes once or twice a day. And it's very helpful. Another one, just staying physically active if you're trying to avoid TMS and all of the things you mentioned like yoga and Tai Chi are great ways to stay physically active and also integrate that with the nervous system.

David Schechter (:

Check in on your emotional state from time to time, but try to avoid excessive body checkings. This is something that with my chronic pain patients, I noticed that they're constantly checking in on how they feel physically. What we really want to get them to do, and you can do this preventively or after you're already being treated for pain is to check in on your emotional state. How do I feel right now? There's tension building up. Maybe I need to just get up from my desk and walk around and breathe and talk to another person in the office or another person at home, if you're working from home.

David Schechter (:

So, those are all ways that I think relate to what you're talking about in terms of restorative movement, breathing, checking in on the emotional state is a great thing as well.

Sanjiv Lakhia (:

I love that, because the longer I practice, the more I tend to despise the visual analog pain score and asking people what their pain number is and using pain diaries, which we do often ask because we frankly use those for insurance purposes, but I do feel like they put the focus on the wrong thing.

Sanjiv Lakhia (:

And I love hearing you say that. It gives me an idea to maybe develop a separate rating scale that can account for that idea you just shared. So, thanks for sharing that.

David Schechter (:

Well, yeah, I'd love to work with you on that. I mean, the pain diary was actually a misfire by the people who developed it. Because what it did is it got people with chronic pain to focus on their pain, which is exactly what you don't want to do. You want people with chronic pain to shift from attention on their pain, and again, the pain is real. I'm not in any way denying it.

David Schechter (:

You want them to shift from focusing on the pain to focusing on their life, to focusing on their emotional state, to focusing on their self-care. And so, the pain diary was incorrect. The journaling that we have them do, the writing that we have them do is about their feelings and about their life.

David Schechter (:

And that's what we want them to focus on. And so, yeah, you're right. The score, every visual analog score for... I often say to people in a follow up visit, how much better are you? You're 20% better, 50%. I might try to get some quantitative. We're doctors, we like numbers. We want to have some kind of quantitative sense of how much improvement there's been, but I don't want them to be thinking about that a lot during the day or the week. Maybe just when they come to the visit just to give me a sense for whether they're improving or not so I can guide the journey going forward.

Sanjiv Lakhia (:

Absolutely. One other "technique" that comes to mind, maybe get your thoughts on it if you're familiar with it. I recently have been exposed by a friend of mine to a technique called TRE, trauma release exercise. And I think this technique was designed by David Berceli is a PhD, and he's written a book called Shake It Off Naturally. And then in our final week for our fellowship, we had a talk on neurogenic tremor. Are you familiar at all with this concept?

David Schechter (:

I'm not familiar with TRE certification or program, but it sounds interesting.

Sanjiv Lakhia (:

Yeah. So, the general idea is that, we talk about a daily routine to prevent or avoid TMS is that TRE is a concept where you basically fatigue the muscle system and then you lay in certain positions and it literally triggers tremoring in the legs, that's more centrally oriented. And then if you go through that for a period of 5 to 10 minutes, it can really calm the nervous system down.

Sanjiv Lakhia (:

So anyway, I could put a link to that in the notes. It's just another option to review if you're looking for, because some people I come across, they don't resonate with writing in a journal. They don't resonate with sitting and meditating, but they love to move their body.

Sanjiv Lakhia (:

So, I'm always on the lookout as well for what are ways that people can move their body that fill the cup and don't deplete it?

David Schechter (:

Right. I'll say for people who don't like writing, and there are definitely people who resist it, those are the ones who probably need it the most. I would just say, start with a shorter writing schedule. So just like with rehabilitation of injuries, we might start with a five minute stationary bicycle instead of a 30 minute. I might have somebody write for three minutes for the first week a day, and then maybe five minutes a day the next week.

David Schechter (:

So, I always am willing to work with people and start low and build it up. But I do find that writing is helpful if we can get people to do it. Not everybody wants to do it but most will do small amounts.

Sanjiv Lakhia (:

It's a good segue as we near the end here. Can you go ahead and elaborate a little bit on your workbook and then the other materials that you have out there for people?

David Schechter (:

Okay. Well, thank you. The MindBody Workbook is something I wrote 20 years ago and it's still very popular. It's a guided journal. There's an introductory section that explains a little bit about pain and TMS and journaling and some of the data behind journaling. There's actually a tremendous amount of data supporting the benefits of journaling and most physicians don't know about it because there are no pharmaceutical companies coming to us handing us a notebook.

David Schechter (:

They're obviously interested in medication. But the concept is that you sit down every day in a quiet space. Most people do in the evening, although I have some people do it in the morning. And you look at the questions and you see what flows. You just start writing in response to the question.

David Schechter (:

I could pick one random question from the workbook. Let's see. What activities make you feel centered and whole? Okay, that's the question for you to think about today if you're listening. And after the podcast, you could sit down, what kind of activities make you feel centered and whole? And you just start writing about those experiences. Those don't have to be structured activities. They could be spending time with family or friends or that type of thing. But the workbook gives you 30 days of questions, prompts and then space to write in it. And the idea is it's a guided journal.

David Schechter (:

And for people who have finished the 30 days, they'll often say to me, "What should I do next?" And I'm thinking of coming out with a volume 2, but in the meantime, I just tell them, "Take a blank notebook. You've now got your bachelors in journaling. Go ahead and start writing in that in a free form fashion."

Sanjiv Lakhia (:

Oh, I love that.

David Schechter (:

The other book that I wrote about six years ago was called Think Away Your Pain. And it's an updated look at the mindbody connection and chronic pain. It certainly builds on the work of Dr. Sarno and adds to the modern science and a lot more treatment methods and approach.

David Schechter (:

And so, that's Think Away Your Pain. And then this past November, Dr. Barker, a psychologist, and I released The Mind Body Healing Journey, which is a five hour video program with some downloadable PDFs that feature me speaking, Dr. Barker speaking about psychology and then we'd come together and answer 62 questions that are the most commonly asked questions that we've experienced in our careers for this type of mindbody approach to pain. And we answer them in detail.

David Schechter (:

So, people have found it very helpful. You can do a little bit at a time. You don't have to listen all five hours in one stretch. I don't recommend that actually. Do 30 minutes, skip a couple of days, do another 30 minutes, take notes. And that's been an effective tool as well for patients. So, those are some of the things that I have out there. I've written some other smaller books and stuff, and they're linked to my website.

Sanjiv Lakhia (:

All right. This has been very informative over half hour conversation. And I feel like we could really probably talk for several hours on every one of these components and break them down. But I really wanted you to just give a broad overview of the work you're doing. If people have other questions or even want to get a hold of you, are you doing virtual consults or how would people connect with you?

David Schechter (:

Yeah. I'm able to do virtual consults right now. With the pandemic emergencies, some of the rules have been loosened in that. If you go on my website, mindbodymedicine.com, there is a contact page, and that will lead you to direct email to my assistant who can discuss with you an appointment, or if there's questions that are appropriate to me, they forward it to me.

David Schechter (:

And again, I can't answer detailed medical questions online, but I certainly can in a medical visit, whether it be in-person or virtually. And there's a lot of good information on the website as well that can help you to understand the mindbody connection and pain and other conditions.

Sanjiv Lakhia (:

Well, that is great. We'll put that information for sure in our show notes, also to your books. And I do highly recommend the course that you developed. It's very easy to follow. It's got excellent PDFs that accompany it, and you can do it at your own pace. So, if you're at all listening to this and wondering, "Could there be a component of healing for you through this pathway?" I'd say, dive in and go for it. Connect and reach out to some of these resources that he is providing for us. And thanks again for the great work you're doing and taking time to share it with our audience. I look forward to further conversations in the future.

David Schechter (:

You're very welcome and thanks for having me. I'm glad to have an opportunity to speak about this with you.

Voiceover (:

Thank you for listening to this episode of Back Talk Doc brought to you by Carolina Neurosurgery & Spine Associates with offices in North and South Carolina. If you'd like to learn more about Dr. Lakhia and treatment options for back issues, go to backtalkdoc.com. We look forward to having you join us for more insights about back pain and spine health on the next episode of Back Talk Doc. Additional information is also available at carolinaneurosurgery.com.

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