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Answer

Good question. The part of the brain that generates psychogenic pain is the same part of the brain that generates fear (amygdala). So it stands to reason that the experience of pain becomes correlated with fear. The way to shut off this danger switch is simply to neutralize the fear associated with the pain.

For many TMS sufferers, being afraid of doing physical damage is one of the primary sources of fear around the pain. We're evolutionarily wired to associate pain with physical injury, so it makes sense that pain would elicit fear of doing structural damage.

I had a friend who had knee pain that ended up being TMS. Whenever she would go running, she'd have physical symptoms. She has so much fear that pain = damage that it became a constant source of preoccupation. When she finally gathered enough evidence that it was in fact TMS, it neutralized the fear associated with the pain and the symptoms eventually went away.

When you can change your interpretation of the pain from pain = damage to pain = brain's tricky way of trying to keep you in a state of preoccupation, it can become a lot less scary, thus neutralizing the fear associated with the symptom, thus turning off the danger signal associated with the pain.

Here's an example. I had a patient who had groin pain. It was clearly TMS, but because she'd had a previous (probably unnecessary) surgery on her right groin, every time she had pain, she had this image of cartilage tearing. Nothing I could do could shake this belief, so I suggested she get an x-ray. Her doc did the x-ray, and told her that her right groin (the bad one) looked even better than her left one.

X-rays don't even show cartilage, so I don't even know what that means, but just hearing that was enough for her. By the next day she was out of pain.

In her case, she needed a diagnostic test and her physician's positive feedback to help her neutralize the fear. That's why getting a diagnosis of TMS from a TMS physician can be so powerful, it can help to neutralize the fear associated with the pain.

If you already believe 100% that there's nothing structurally wrong with you, then it's just a matter of reemphasizing this to yourself (and your primitive brain) :

"I know it hurts, and even though my primitive brain is telling me that I'm doing damage, I know that because of x,y, and z that this is just learned neural pathway pain from a previous injury that has already healed. I'm not doing any damage, my back/neck/wrist/knee is healthy. I'm strong and I'm safe."

Or something along those lines.

Eventually the message starts to sink in, you become more confident, engage in more activities, continue to reinforce that message, continue to gather even more evidence as you go, and after a day or a week or a month the danger signal turns off.

Hope that helps.

Alan

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