The Migraine in My Butt: The Surprising Cure for a Mysterious Problem
I haven't yet considered Botox for wrinkles, but five years ago I had it injected into my left butt cheek. It was my umpteenth attempt at unclenching my piriformis, the tiny muscle deep behind your glutes that in my case throbbed every time I sat down.
By the time I resorted to Botox, I'd had piriformis syndrome for 14 years. The pain developed a few months after I joined the cross-country team in my freshman year of high school. The most common causes are trauma and overuse, but having weak hip abductor muscles that force your piriformis to pick up the slack; pronating your feet when you walk; running on sloped surfaces; or sleeping with one leg hitched up toward your chest can also cause or exacerbate the condition.
Addressing those triggers should have cleared up the discomfort, but the pulsating pain persisted. To rest the muscle, I quit exercising for six months. I was in and out of physical therapy for five years. I got pricked by an acupuncturist and realigned by a chiropractor. I sat on lacrosse balls and then avoided sitting altogether. I even considered mental surgery to make the pain disappear by cutting the troubled tendon or muscle.
And then, three years ago, a family friend suggested that the pain might be in my head. I was offended—how dare she imply I was making it up!—and hugely skeptical when she recommended I read The Mindbody Prescription, which she swore had helped her find relief after years of back pain. The book was written by John E. Sarno, MD, former director of outpatient services at Rusk Institute of Rehabilitation Medicine in New York and something of a messiah to chronic pain sufferers everywhere. His theory hinges on the premise that your mind tells your nervous system to decrease blood flow to your muscles in order to cause painful oxygen deprivation—and thereby distract you from simmering anger, anxiety and other feelings your subconscious would rather keep tamped down. Excuse me? It sounded crunchy, crazy and insulting. On the other hand, I was running out of options.
Sarno coined the term tension myositis syndrome (TMS), for which he prescribes deep soul-searching to uncover and resolve unconscious emotions. In two surveys he conducted in the 1980s, the majority of his patients were leading pain-free lives after TMS treatment; a small study coauthored by a former research assistant found that people with a moderate level of chronic back pain saw their discomfort reduce by 52 percent.
As you might expect, TMS isn't widely accepted by the mainstream medical community. While well-known integrative medicine expert Andrew Weil, MD, has advocated Sarno's methods, "many physicians are incapable of accepting that there's a mind-body connection," says Sarno's successor, Ira Rashbaum, MD, now the lead TMS physician at Rusk. (Sarno, 91, no longer sees patients.) "Even when injury has been ruled out, it's still very difficult for some doctors to believe that physical pain can originate in the mind."
New evidence of the brain's influence over pain has helped bolster Sarno's theory. In a 2014 University of Oxford review of 53 clinical trials comparing real surgeries intended to treat mostly non-life-threatening conditions, such as low back pain, to those designed to elicit a placebo effect, 74 percent of the trials revealed that subjects showed improvement even when no procedure was performed. "Placebos cause the brain to release opioids, neurochemicals that are natural pain relievers," explains Tor Waver, PhD, director of the Cognitive and Affective Neuroscience Lab at the University of Colorado, Boulder. "Your brain does this when you're in pain—and when you believe you're receiving therapeutic treatment."
Unfortunately for most people who suffer from chronic pain, you can't undergo such sham procedures outside a study setting. Still, you can outsmart the mind by treating it, as Rashbaum says, like the "big phony" it can sometimes be. For me, this meant no more stretching, no more injections, no more MRIs (none of which revealed anything conclusive anyway). Instead, I had to focus on unearthing my repressed emotions. I began filling pages of a journal with all the ways I'd felt I was falling short around the time the pain started. I'd overprepared for tests and obsessed about papers, which got me into a top public college that I bemoaned because it wasn't Ivy League. In addition to working a part-time job and taking a full course load of AP classes, I walked the family dogs, made dinner and babysat my younger siblings—but would still give my parents birthday cards in which I'd apologize for not being a better daughter. TMS sufferers, I learned from Rashbaum, tend to be highly competitive, critical, overachieving perfectionists. The more I cataloged, the more convinced I became that the pain really might be coming from the top down.
After about four months of journaling, the throbbing pain in my butt became sporadic; then one day it was just gone. I remember nervously anticipating its return on a flight from New York to San Diego, waiting for the dull ache that usually brought me to tears when I had to sit for hours. But this time I stepped out of the airport into the bright sunshine, bursting with the news that I felt...nothing! I stopped sleeping with the band around my ankles that kept me from bending my leg at night. I quit kneeling at my computer and rolled my office chair back into my cubicle like a normal person.
For years afterward I was an evangelist, spreading Sarno's gospel to every friend and family member with a supposedly bad back or pinched nerve. But my faith was tested last fall after my husband and I relocated to Portland, Oregon. I quit my job; we bought a home sight unseen. With the stress of a fresh start came that old familiar sting in my butt, so I dutifully returned to journaling. This time, though, that felt like nipping the problem in the bud. I wanted to kill it at the root. So I signed up for a mindfulness meditation course. I'd come across a recent review of 47 studies from Johns Hopkins University suggesting that the practice could help reduce anxiety and pain.
At first, meditation actually made the throbbing worse. "That's such a common reaction, I've come up with an analogy for it," says Judson Brewer, MD, PhD, director of research at the University of Massachusetts Medical School's Center for Mindfulness. "Your mind is like a river that has always had sediment at the bottom, and meditation kicks it up and makes it very cloudy. But as it gets washed downstream, your mind becomes clear and the pain is much more manageable."
So I've kept at it, and Brewer is right: The pain is again subsiding. I've dragged a velvet cushion out of the garage to sit down on as I meditate. Not, mind you, because I think my piriformis needs cosseting, but because I hope the pillow's bohemian vibe will hep me become the person whose uninhibited feelings bring me only a sense of relief.