Alan G. Can pain be part TMS and part structural?

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Question

Hello everyone! I have found the TMS phenomenon fascinating and I think it has helped with some of the pain I have experienced in the past.

With that said, I have also seen a lack of conversation about combinations of different types of pain. It is my personal belief that TMS, structural pain like herniated disc/pinched nerves, and muscular pain or contracted muscles that pinch on nerves can exist simultaneously. I would agree that generally such pain should usually go away or simply lead to numbness, and not become chronic (read: last for years), but I think too much emphasis is placed on an 'all-or-nothing' diagnosis.

That would seem to leave out people who saw (as this website recommends) a traditional medical practitioner and were correctly diagnosed with a structural problem. Is it not also valid that some portion of their pain is caused by TMS, leading to much more suffering than would normally be caused by the condition diagnosed? Could this be why people have chronic, lingering pain after the physical source of it has been corrected? Could this be a factor in why people have such hugely different pain responses to the same physical ailment?

 

Answer

This is really interesting question, and the one docs ask most when presented with the idea of TMS. In truth, overcoming your TMS pain requires belief that your pain is caused by your brain. It's just the nature of the beast. Without believing that the pain is psychogenic, the pain continues to serve it's psychological purpose and continues.

I've worked with clients who have been told that their pain is part structural/part TMS, and that "part structural" diagnosis makes it very difficult for them to improve. In some situations, these clients have had experiences of being completely pain-free when engaging in an activity that, if structural, would have caused them pain. This is the evidence they need to fully believe that it's TMS, at which point the pain usually begins fading.

All that being said, sometimes the pain of a structural injury can be exacerbated by your TMS brain. I tore my meniscus 5 years ago. It hurt when I walked for a few months then it went away. But early on, it also hurt when I would lie down. I called up Howard Schubiner and asked him if a torn meniscus should hurt when you lie down, he said no. Actually, I forgot what kind of injury I had and asked him if a torn MCL should hurt when you lie down. He said no. Even though I didn't get my condition right, his response was all I needed and the pain went away when I would lie down thereafter. It was still a structural injury though, and took a few months for me to get full range of motion back.

Alan

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Despite the fact that I am convinced that the root cause of my sciatica is TMS I feel that there are physical aspects of the pain that can have a
dramatic effect. In my case my muscles on my back down into the piriformis become very tight. As a matter of fact when I see my neurologist pain
doctor he always comments that my muscles are tight. Why can't I relax he says?

Certain exercises make it worse and others make things better. For example, if I perform 3 reps of 20 push ups then stop to relax within 30
minutes the pain is excrutiating. The fact that it takes until 30 minutes later for the pain to come on made it difficult to associate the
reaction. Similarly if I eat too much or eat foods causing gas in the stomach the pain is similar. A full stomach presses down on the pelvic floor
against already tight muscles. Obviously I don't do push ups or situps anymore and I stop eating once my hunger is slightly satisfied. I
graze all day to avoid the too full problem.

On the other hand if I go play competitive tennis that invokes a lot of muscle balance I come home almost pain free. Similarly, a session with my
PT helps to stretch out those muscles and provides relief. I can go out and dig a ditch, swing a pick axe, and shovel dirt and my pain will go
down. These actions seem to stretch out those muscles over time. However, it is a big mistake to lift something over 40 lbs. That selective
straining is bad for the piriformis tension.

I don't feel that these observations contradict the TMS theory. I think my subconscious knows that it can invoke pain by tightening those muscles.
I am currently going thru Schubiners work plan. Getting to root cause is not easy. I had hoped that when I retired that the loss of work stress
would fix it, but it didn't happen. I may have to see a therapist since there are no dramatic bad things in my youth, however I am a solid INTJ
personality type. That may be enough. BTW, this has been going on for 17+ years and I have had every surgery possible including fusion at L5S1.

 

I believe my brain is causing the problem, but now there is so much written about brain inflammation causing depression, anxiety and chronic pain with research studies supporting it, I don't know if I should also be following advice to decrease inflammation (like gluten free diets, etc.) I get myself all confused because I think my brain is "messed up" and that's as bad, or worse, than having a structural issue!

 

It's more challenging when I tell a patient that their pain is both TMS and structurally derived. Perhaps I say it's a TMS amplification syndrome. It's harder to accept and to treat, I agree.
But I believe that sometimes it's valid and there is objective evidence to that effect. Therefore, I continue to diagnose just TMS, just structural/chemical or mixed. I discuss this in my book, as well.
I feel that this remains the most intellectually honest way to deal with chronic pain. I wish it didn't make it harder.

 

Hello - I am new here and have the same question. I have only heard of this for a few days and am completely onboard and fit the profile to a "T."

Still, it would feel foolish to immediately go %100 into the life I was living before the pain started since I can not help but wonder if there is some structural issues to still be addressed.

Also, should I tell my chiropractor doctor that I think I have TMS?

Thanks for any ideas!
Heather

 

Hi Heather,

If you really want to use Dr. Sarno's work to cure your pain, you should do what you can to eliminate structural or medical causes. As Alan says, the approach we explore on this site works only if you attempt to embrace TMS as the cause, rather than attributing physical, or systemic causes for your symptoms. This can be helped a lot by consulting with a TMS trained physician. If you get the OK from a TMS trained doctor, then you can move forward with much less fear.

As far as the chiropractor goes, the main reason to not bring it up is the risk that he will challenge the TMS diagnosis and create more doubt in you. 98% of doctors of all types have no understanding of what we know to be true here.

Congratulations to you on finding Dr. Sarno's work. I had at least 8 doctors ready to operate, but there was nothing wrong.

Andy B.

 

Thanks so much for the reply Andy. I am very grateful to receive some advice and like I assume many people here are, am really challenged mentally with how to proceed. Perhaps going off my pain medications entirely today was not a wise plan. Feeling lots of pain is a slippery slope.

I fit the TMS profile to a "T" but am terrified to screw things up with what is diagnosed as a herniated disc so the mental terrain needs to be conquered a little more. I am hoping it will help to read the book.

Thanks for everyone for making this forum possible. Best wishes to all - stay optimistic!

 

Hi Heather,

Not knowing your case, I would advice taking it slowly. Dr. Sarno recommended meds for pain. He said increase activity when you have less pain. He said that reading and learning needs to soak in.

In our desire to feel better, we can push ourselves in familiar ways, and this is not always helpful. Try to let your knowledge cure unfold at its own pace. And getting good medical advice is needed on a lot of levels. Dr. Marc Sopher does long distance help to assess TMS, if you don't have a doc in your area. There is a doctor search page at the wiki.

Andy B.

 

Thank you.
I am really touched by your words and again, grateful for the advice.

YES, I wanted this to be a miraculous (read instant) scenario - a pattern in my life. I just found out about TMS and the book has not even arrived in the main yet.

I will do as you suggested.
Thanks!

 

I prefer to follow the ancient advice of Cherokee Indian medicine men who said:
"It you don't believe in something, it won't help you."

I believe that TMS knowledge healed me of severe back pain. Dr. Sarno and others say
that it takes 100 percent belief in TMS. Even 99.99 percent won't work.

 

I came back to look at this thread because I just had a significant experience of doubt. I bumped up by accident pretty hard against a metal door frame.
Instantly, no thinking at all, "the spot" (that deep achy thing by tailbone that got banged many years ago in a minor fender bender that never hurt until recently and is now L5S1 herniated disk blah blah blah) hurt like hell and is still aching. Not necessarily more than on other days when "the spot" acts up, but in a different, "ok, i hurt myself, aggravated an injury way" I cant explain it - it's just a feeling. So logically: say you have a broken toe (a structural problem), its going to hurt more when you accidentally bang it compared to banging your non-broken toe. So if I'd accidentally bumped the other side (not the "spot" side) I just dont think it would hurt. I am seeing that my brain can and has done some amazing things - is one of them making it so when I accidentally bump into a door on the "spot" side, it hurts like hell, like i'd banged a toe that was actually broken? This is similar to the "why does it hurt when i sneeze thread" Its a tough one to believe. Can anyone explain? I'm really trying to believe 100% , 100% of the time.

 

Can't explain it, but do believe it. I have an exercise dvd, the instructor says you can do it barefoot, but not recomended unless your used to being barefoot etc. It is not a problem, usually. I broke a bone spur in my rt ft a year ago and tms sometimes tests me if I am stressed. A friend of 40 years died on Wednesday and when I did the workout my foot hurt, pretty bad for awhile. I just talked to my brain about the foot is fine, but my emotions are not. Tried to feel emotions so brain could...um...relax? I have had quite a few tms symptoms the last few days and I am telling myself this is normal and ok. I think the SEP program here on the wiki is realy helping me.

Your brain is conditioned to have pain around that part of your body. TMS wants to keep you convinced so it can keep you fearfully occupied. You are onto the path that will change your pain and yourself. It is a good journey. I am glad we are all learning here together.