Central sensitivity

I've been doing some reading as part of figuring out how to deal with my ankle pain, and I came across a couple concepts that seem related to TMS but somewhat different - central sensitization (or sensitivity) and chronic nonmalignant pain syndrome. I find these concepts interesting because while I had good success with treating RSI as TMS some years ago, and I believe really strongly in the concept of TMS and that many people do have it, I haven't had success myself again with the ankle. It was injured twice but didn't seem to heal fully (especially the second time, it's ongoing currently) even though organic tissue recovery occurred according to the doctors I've seen. Yet when I tried to treat it as TMS, I had a lot of painful relapses to a highly inflamed and limited state. I've had much more luck with physical therapy and extremely slow resumption of activities.

The big difference I see between TMS and central sensitization is that CS is presumed to be a conditioned/neurological (brain/body) process, while TMS is partly conditioned, but largely emotional mind/body process. CS is supposed to be treated with gentle manual treatment and paced resumption of activity, with no particular goal, just reaching a level that's as normal as possible given the body's sensations. On the TMS side, Dr. Sarno was perfectly comfortable with all-out rejection of physical limits for TMS. CNMP is a bit unclear; there's some mention of CS-style sensitization but also emotional factors. Some of the supposed predisposing factors for CNMP/CS are similar to TMS - being anxious, and inclined to overattend to symptoms.

All three share some main principles - that pain is serving some other function than signaling organic damage, that conditioning is involved, and that both the brain and the peripheral body are involved in creating the pain. All acknowledge that emotional factors are or could be a contributor. One thing that's discouraging to me about the CS/CNMP side is that while they don't say the pain will never go away, they don't say that it likely will, either, or that normal function is expected. There's more focus on pharmaceutical treatment and physical therapy.

But since I've had little success with Sarno on this ankle, I've started to wonder if this (and perhaps other "stubborn cases" of TMS) aren't TMS at all, but are something else. It's really hard to figure out, because I'd like the hope of eventual complete remission, and because it's easy to say "Well, you just haven't TMS-treated it correctly. You still have doubts. You still have attachment to your pain." I've said similar things to others (and I think they're often right) but at what point is it no longer reasonable to say that? I'm not the only one around here with stubborn pain that doesn't seem to respond to TMS treatment in a typical way. Is it possible that some of us have something slightly different?

 

I agree, there are many similarities between all these descriptions of a condition that the mind/brain and body are in - several of which I highlighted, notably the focus on structural soundness and reduction of fear and anxiety.

But as similar as they are, there are some notable differences, and my own experience points to a distinction that could be useful to me and possibly others. I've seen some similar discussions here about the underlying theories on TMS/PPD - here's an example. It's useful to discuss this sort of thing because the theory behind the situation impacts how to handle it.

In some ways I'd like it if there weren't two or three different possibilities, since it would be nice to have one method (with very encouraging treatment prospects) for everything, but I've experienced pain that actively worsens when treated according to Sarno's theory, and it leads me to question the appropriateness of that approach for me. If the answer to every failure is "Oh, just practice mindfulness/journal more/be patient/unhook your anxiety/see a therapist" - there's no end to what you can claim needs doing. Advice that never changes from "do more of the thing that isn't working" isn't useful advice.

Central sensitization theory would result in a different approach, under which the pain is generated by the malfunctioning of a circuit in the nervous system which will react even more badly to major increases in perceived pain level, creating a vicious cycle. In this scenario there is a problem with treating the pain like it's not there - which is that it could well get worse. And focusing on emotions because you got a badly conditioned circuit would be mostly a waste of time.

So if these ideas are valid - and to my mind that's still an open question, because of the same vagueness and similarity that you identified, and the lack of a concrete treatment plan on the side of CNMP/CS - then it does matter a great deal, because the approach is rather different, so I think it's useful to explore this idea space and not quickly dismiss it.

 

I find a definite "connection" with drinking a cup of hot milk and any anxiety, pain, etc.
I barely get 3/4 of a cup inside me while deep breathing and I am almost asleep.