Pain in the neck
This morning I have neck pain, I’ve had it before, it tends to go away and there are no red flags. My neck pain is probably “phone neck” or hours sitting at a bad workstation causing things to get a bit tight, but something else happens when I start to notice even a little tension in my neck.
I tell myself a story of symptom.
The story often starts unconsciously before I even have pain and goes like this, “Oh no I’m getting that neck pain again, I hope it doesn’t get really bad, maybe the episodes are getting closer together and maybe my neck is just stuffed and I will end up with chronic, unrelenting neck pain.”
This story is not irrational but definitely future fear-related and the story makes me focus my attention on the tightness and next minute I have pain. I have no doubt the pain I now have is caused or at least amplified by the story I have just told myself.
Often it is not so much the symptom that needs treating but the story of symptom needs to be spoken and changed.
I can do this myself when I feel the neck tightness. I can tell myself that it will go away as it has before, if I just breathe and relax my neck, stretch, and watch my phone and laptop posture. I can speak nicely to my neck, reassure it, send it for a nice rub, give it a warm wheat bag and maybe take a couple of paracetamol, because I know if I let the pain carry on that will encourage my negative story.
What I am doing is telling myself I have some control of the future story of my neck pain and it doesn’t have to be bad. It’s gone in a day.
If I wasn’t a doctor/patient I might have taken my neck pain to my GP and I would need my GP to help me by retelling my future neck story. I would want the GP to give me a placebo story with absolute reassurance that I am unlikely to end up with horrendous, chronic neck pain, and because I trust my GP’s wisdom and experience, I will believe the placebo story, and that will have a profound effect on my symptom.
The problem is that it is hard for doctors to do this.
We worry we might miss a terrible diagnosis so we always give ourselves an out such as, “Oh, but do come back when and if it gets worse and we will do some investigations,” at which point I would start to worry again and the placebo story loses its potency. What I need to hear is, “In my experience, most people with pain like this manage it really well as you are and don’t end up in terrible pain. Tell me about the things that help already and what else you think could help?”
Sometimes, GPs find it hard to reassure people because we have clinical bias, in that we tend to see the people with neck pain who do badly and have to keep coming back to the GP, so our bias is towards a negative story rather than a positive one.
Also, we like to offer the solutions because we are the doctors, but our solutions are often limited by our desire to be evidence based. So, my GP might offer more analgesia or another round of physio, but what I need is my GP to cheerlead me into harnessing my capacity to change the story. Most people with a symptom are already doing things that help and their solutions will often be better than ours.
My neck pain is also complicated by the fact it is not just a story of symptom but a symptom of story. By this I mean there is often something in my life story giving me a pain in the neck.
Luckily, I have found a qi gong master who specialises in stressful stories stuck in bodies. He always asks, and usually if I speak that story and can do something about it, the pain settles.
Sometimes the story giving us symptoms isn’t easy to resolve, for example, if we are in a bad relationship but we feel we can’t leave, if we are being treated badly at work but have few other work options. Our powerlessness over the story can prolong the symptom in the body.
If I use the example of my burnout, my symptom was mental and physical exhaustion, and the story was one of deteriorating relationships and relentless work pressures, creating a feeling of being overwhelmed and ultimately shut down of my mind.
I didn’t feel able to change the story of my situation, so the bodily symptom became worse and worse until I had to give up work.
So, I can think about my burnout as a symptom of story, and it was not until I changed the story by changing my situation that I was able to recover.
But my burnout was also a story of symptom because the story I told myself about the symptom was terrible. It rolled like this, “I have some awful thing that will not go away, I probably caused it myself, I am so ashamed to have this because I should have been able to cope, I may never be the same again.”
These negative stories of symptom can be called nocebo stories in that they can amplify and prolong symptoms.
What I needed was a different story of symptom.
I searched for another story by reading about people who had recovered from burnout, so I sensed I was not alone and could recover. Luckily, I had a marvellous GP who told me a relentlessly positive placebo story and harnessed my capacity to recover. (She may well have had some doubts about my prognosis, but she never said and I didn’t need to know!)
So, my burnout can be seen as a symptom of story exacerbated by story of symptom.
There are many more examples of symptoms of story.