Easing The Pain
Several local doctors tell why you don’t have to live with pain.
Janice Fialka was almost out of options when she turned to Dr. Howard Schubiner for help. For more than five years, Fialka had suffered from generalized aches, pains and frequent bouts of fatigue. After a misdiagnosis of rheumatoid arthritis, her symptoms were attributed to fibromyalgia, a syndrome of unknown cause often accompanied by chronic body-wide pain, joint and muscle tenderness, fatigue, headaches, depression and anxiety.
Fialka was familiar with the program described in Schubiner’s book Unlearn Your Pain, but she had reservations about trying such an unconventional approach.
“I admit I had my skeptic hat on,” Fialka said.
Her doubts began to dissipate during the initial consultation, where Schubiner took a detailed medical and emotional history. Fialka said he immediately began making connections that made sense, so she decided to proceed with the program.
“He was an excellent listener, which is an important part of any healing process,” she said. “I sensed his empathy and kindness.”
Fialka attended a four-week group session and her symptoms began to disappear almost immediately. More than a year later, she is still pain free, and the medication she used to take is a thing of the past.
“The powerful piece for me was that he [Schubiner] is a physician, and he was acknowledging that the pain is real but that you don’t have to feel it,” said Fialka of Huntington Woods, a social worker, national speaker and author.
“This was a sharp contrast to other physicians who said I was going to have to learn to live with it. He gave me a sense of hope.”
Chronic pain is an invisible, inaudible villain that can devastate the life of anyone unlucky enough to cross its path. A 2011 study by the Institute of Medicine of the National Academies in Washington, D.C., concluded that more than 113 million people in the United States live with chronic pain, usually defined as pain that lasts longer than six months.
Schubiner is one of a host of local physicians achieving success using traditional and/or unconvential treatments to relieve patients in pain.
“Pain can take your breath away; it takes your life away,” Schubiner said. “All pain is real. The question is what is causing it.”
Traditional medical approaches to alleviate pain don’t always work, so some physicians turn to less conventional methods to help their patients.
Schubiner, director of the Mind Body Medicine Center at Providence Hospital in Southfield, claims that some pain can be caused by nerve pathways rooted in the brain rather than the body.
“The whole medical approach is to find structural damage,” Schubiner said, “but not all pain is caused by tissue or structural damage.”
He explained that pain, especially chronic pain, can stem from a learned pathway, the same kind formed when a person learns to walk, talk or ride a bicycle. Emotional injuries, such as abuse or constant criticism, can create nerve pathways triggered by certain situations or events.
The good news, according to Schubiner, is that pain caused by learned nerve pathways is reversible. It is this kind of pain, caused by a condition known as Mind Body Syndrome, that Schubiner’s program is designed to treat.
As a board-certified physician in the areas of internal medicine and pediatric and adolescent medicine, Schubiner wants to make it clear that his program is based on science and research. He does not dismiss the value of biomedical treatment such as surgery or medication when warranted, such as in cases of disease or tissue or structural damage. Part of the process involves ruling out such pathological causes, which he says is usually fairly simple.
“Most people who come to me have already had a lot of tests,” he said.
Headaches, back and neck pain, fibromyalgia and temporomandibular joint syndrome (TMJ) are some of the most common chronic pain syndromes Schubiner treats. His program has also helped patients with nervous system disorders such as irritable bowel syndrome and other conditions that include insomnia, depression and chronic fatigue. Patients are asked to make a commitment to spend about an hour a day on the program.
“I can’t make you better, but I can help you make yourself better,” Schubiner said. “You have to be willing to do the work.”
Schubiner also asks prospective patients to read his book, Unlearn Your Pain, before scheduling an appointment, to make sure they understand and believe in the concept of Mind Body Syndrome (MBS). He then takes a detailed history of the patient’s medical and emotional background to rule out pain caused by disease or other biomedical issues.
“It takes courage to do this program; it’s not for the weak of heart,” Schubiner said. “You have to stand up to the pain and say ‘I’m asserting myself in my life and in my pain.’”
The emotional work occurs during four weekly group sessions, facilitated by Schubiner, where participants engage in a variety of exercises that include writing, affirmations, meditation and other techniques to increase self-awareness and retrain the brain. There is also a behavioral component, where patients are asked to confront their pain instead of refraining from activities that typically bring it on.
“I ask people to say to themselves, ‘I can reverse it; I’m going to be more active.’ I encourage them to challenge the problem, not avoid it,” he said.
In addition to his local practice, Schubiner travels throughout the country teaching doctors and therapists how to use his program.
Although Fialka was familiar with some of the acti–vities, she found the structure and focus that Schubiner provided, as well as the group experience, particularly valuable.
“There’s a certain kind of healing that occurs in a group,” she said. “The sense of community is very important.”
Dr. Talia Ziv is a West Bloomfield psychotherapist who has referred patients with chronic pain to Schubiner.
“I do believe that human beings are mind-body-spirit connected,” Ziv said. “Basically, what I learned from him [Schubiner] is that their pain is not imagined; it’s real even though quite often there are no medical problems or pathology present, and I learned that people do not have to suffer and live in pain for the rest of their lives.”
Effective Mix Of Treatments
The majority of patients seen by Dr. Joel Schechet at the Michigan Orthopedic Institute in Southfield have pain caused by various spine-related issues. Schechet uses a combination of treatment methods that include local cortisone injections, physical therapy and medication.
Bill Berlin of Oak Park was in severe pain from a degenerative disk in his lower back when he sought help from Schechet. Despite his high level of discomfort, he was reluctant to try the cortisone injections that Schechet recommended. Finally, he agreed. To his relief, the pain disappeared after a single series of injections.
“I crawled into his office, and I ended up dancing out of there,” said Berlin. “He was like a magician with that needle. The relief was almost instantaneous; it was incredible.”
Two years later, Berlin is still pain free. He has not had subsequent testing to determine whether the disk has actually healed; he says he is content to be free of the debilitating pain he experienced when he first saw Schechet.
Schechet and Schubiner agree that changes or abnormalities that show up on an MRI (Magnetic Resonance Imaging) scan do not always account for the pain a patient is experiencing. Many people whose MRIs show spinal irregularities or herniated disks never have pain or other symptoms, which can make chronic back or neck pain more difficult to treat.
When traditional methods such as injections or therapy are unsuccessful, Schechet uses acupuncture, which he studied more than 10 years ago at UCLA in California.
“Acupuncture is a small part of my practice, but it is sometimes effective when nothing else works,” said Schechet, who is board-certified in the areas of anesthesia and pain management. “We don’t know exactly how acupuncture works, but studies show it seems to increase endorphins.”
Schechet also uses a procedure known as trigger-point injections, which, unlike acupuncture, is covered under most health insurance plans.
He prescribes pain medication sparingly, especially drugs that contain narcotics.
“I don’t want to subject people to a lifetime of addiction,” he said, adding that many patients have gotten relief from non-steroidal pain medications or antidepressants such as duloxetine (Cymbalta) or milnacipran (Savella). “One patient said she had gotten her whole life back.”
When Schechet encounters a patient who has persistent pain with no discernible cause, he will usually make a referral to a local neurologist.
Because the Michigan Medical Marijuana Act (MMMA) was passed in 2008, more than 200,000 patients have applied for registration identification cards, which are necessary to purchase the drug from a licensed caregiver. According to the law, which has come under criticism for its many ambiguities, chronic or debilitating pain is one of the eligible conditions for obtaining a prescription.
Critics contend other equally effective forms of treatment are available that do not involve the use of a drug still technically illegal, according to federal law, even though its use for medical purposes has been legalized in several states.
Schechet also has prescribed small doses of marijuana to about a dozen patients, with favorable results.
“It’s not a miracle cure, but it’s one of the tools in our kit,” he said.
Dr. Ken Sherman, Novi-based alternative medicine practitioner and founder/owner of Sherman Health Systems, recommends a pain management tool called the Alpha-Stim, a handheld device that uses ear clips or probes to transmit microcurrents. Sherman said the system is effective for pain, insomnia, anxiety and depression and has eliminated the need for medication in many of his patients.
Schubiner first became interested in treating the Mind Body Syndrome when he read the works of Dr. John Sarno, a New York-based physician and author of Healing Back Pain, The Mindbody Prescription and The Divided Mind.
“It was very eye-opening,” Schubiner said.
The cost of the initial two-hour consultation is $400, which Schubiner said is covered by many insurance plans, and the four-week group session is $250.
“It’s cheap, easy and effective,” he said. “Many patients have gone to Mayo Clinic and many other treatments. If this (MBS) were more widely accepted, it would help people save medical expenses and avoid needless testing or surgery.”
Schubiner has treated approximately 400 patients since he started using this program eight years ago. His research data indicates that half of the patients with chronic pain showed an improvement of 50 percent or more, while 67 percent improved by 30 percent or more.
According to Schubiner, migraine headaches are another condition that can be alleviated by reprogramming the brain.
“Migraines are a mind-body issue,” he said, “although there can be a genetic predisposition. The headaches can be triggered by food, wine or lights, but a trigger is different than a cause. It’s possible to unlearn triggers.”
Ziv, who also works with patients struggling with various kinds of addiction, agrees.
“When we understand what triggers and amplifies those neural pathways, we can do something different about it,” she said. “Through raising self-awareness, meditation and other strategies, the nerve pathways that cause the pain can be retrained; our brains can be retrained. I’ve seen people experience change, and the pain stops dominating their lives.”
Fialka said she no longer worries when she feels an occasional twinge because she now has the tools to apprehend pain and prevent it from taking over.
“I know I can get my footing back,” she said.
By Ronelle Grier | Contributing Writer