On spinal mobilisation & repressed emotion (Case study #2)

Can ‘repressed emotion’ cause pain? I’m sure most of us will have experienced times in our work with people in pain, when the problem resolves completely after the acknowledgement or expression of emotion – usually grief or sadness. When this happens i’m often taken aback and I wonder: how much of the pain we see in our day-to-day work is simply the mind spilling over into the body?

Mrs S had neck pain for 6 months. She was 70 years of age and smartly dressed. She was seeking a second opinion. Her problem had not shown any improvement; a physiotherapist had apparently ‘prodded and pushed’ on her neck with her lying face down (once a week for four weeks) and she had also been given some range of motion exercises.

Her neck pain had come on ‘out of the blue’ and it was clear she was puzzled as to why. So we discussed the usual mechanical factors that can sometimes be part of the picture. I was being much more thorough than usual: sleeping in a different bed? Any changes in exercise routine? Been ‘off your feet’ or more sedentary than usual? Longer periods at the computer? She shook her head. It appeared not.

Red flags next and thankfully, nothing to report there either. Risk factors for neck pain? No trauma, general health good, no problems with depression, anxiety or panic attacks (‘can I ask about your mental health….?’).

Pain related psychological questions next. Not fearful of any movements (‘it just hurts’) and no problem moving into the pain. Mrs S thought that exercise would help and was surprised it hadn’t. Active coping. Not overwhelmed by the pain.

Now i’m starting to scratch my head. Final question in the salvo: ‘what was going on in your life around the time the pain had started?’ She paused to think. And then…

‘Well in April last year my uncle went into a home and had three months respite care. Then he decided he wanted to stay in the home. So of course I had to start emptying the flat and sorting it out to be taken over. It’s hard getting rid of things that you know meant so much to them – cutlery, curtains, old cameras and photos. He loved his photography. I had to get rid of it all. Quite emotional time. You almost go through the grieving process of having lost them….without having actually lost them. He’d been in that flat for nearly 50 years.’

‘And your neck?’ I asked, trying to keep things as open-ended as possible.

‘It was when I started clearing out the flat. It all sort of ties in, really. I did it without really thinking much about it…because you do it because you have to. I couldn’t talk to anybody about it. My husband works full time and my son works all the time too. It was just me.’

She looked to the floor and repeated ‘It was an emotional time.’

I asked her if she thought how she was feeling at the time might be related in some way to the neck pain and she agreed.

‘I don’t think it is an uncommon story when we get aches and pains,’ I said. ‘I’m not suggesting for a moment that it is all in your head, but very often people have a story to tell. If a problem has not got better with physical treatment, it can be helpful to think back over things. Talking it through can be enough to help….as part of the physical recovery. As part of the picture…’

‘I haven’t really given this a lot of thought. You just get on with it,’ she replied.

So we went on and explored the physical aspects of her neck pain, but it felt to me as if we were just ‘going through the motions’ of a physiotherapy appointment now, when it was clear to us both what the true cause of her neck pain had been.

Turning her head to the left was the problem and on examination left rotation was painful and stiff at end range. As she said she would like some exercises to do at home, I suggested some functional exercises that she could perform looking in a mirror and that would encourage movement in the painful direction.

She dressed, shook my hand and left the room. I had left it with her to make an appointment if she felt the need, but I made it clear I was hopeful of a quick recovery. A week later I was handed a note from reception saying she was ‘better’ and thanking me.

So what did I learn? Two things come to mind.

Firstly, to me this vignette serves as a reminder to hear each and every person’s story. Ironically enough it’s probably the Maitland-style clinical reasoning, you know – ‘make the features fit’ – that often has me off, searching for the nub of people’s pain, be it physical or emotional. It’s got to make some sort of sense to me, and when people come for a second opinion, it is time to be especially thorough and vigilant. Why haven’t they got any better?

But in allowing each person’s story to breathe and fill the room, with few interruptions – it often becomes obvious in which direction we need to travel.

And secondly, can repressed emotions cause pain? Undoubtedly, I think they can. But whilst there are those that believe all ‘aches and pains’ arise from unconscious processes and repressed emotion (see as an example Dr John E Sarno here and here) I don’t feel capable or willing to make that leap. Not just yet.

But as each day goes by and yet another imaging study demonstrates the lack of correlation between this pathology and that clinical sign, I feel more and more like i’m dancing on the head of a pin when it comes to explaining precisely what it is that is causing ‘The Pain.’

Ah yes, above our heads the joists may creak beneath the ever increasing weight of systematic reviews, but is it not reassuring to reflect that the answers to some people’s problems reside not on some pdf on a University Computer Server but within their very own self – even if hidden from view?

Let’s shun our screens and hear the patient out. Aye, there’s more to most pain than meets the eye.