Dr. Alexander Long term evidence of TMS model?

This is my reply to the query from a woman on another TMS help forum (not sure if there is any cross pollination between the forums? but here goes anyway- i think its a really important question she raises, and one that deserves a considered answer). She was questioning how many people actually get better as a result of using this approach, and whether there is any long term research which tracks outcomes over a 10 year period. Her impression, from reading posts on the forum, is that most people don't actually get better. My response is as follows:-

The answer to your question surely lies in the definitions and ratings of both the starting points (baseline levels of pain) and the end point (what is meant by ‘better’). I would also be very interested to see 10 year results of Sarno’s sample, 88% of whom got better (ie. eliminated or radically reduced subjective reports of pain; off pain drugs, and resumption of pre-pain activities). My guess is that the vast majority of them would still be fine 10 years later- but this is only a guess, and only research can answer it. And you have raised the valid point that this sample was not one which is representative of the general pain population, ie. it was taken from people who were open to the TMS model (Sarno suggests the level of openness to this approach in the general population is probably around 25%- probably right). So, you could conclude that of the minority of people who are open to this approach, most of them ‘get better’ in the relative short term (i think his sample was of former patients of around 1-2 years?)- but it hasnt (to my knowledge) been followed up to 10 years.

Why conclude that most of these people would still be better 10 years later? I think once a very significant relief is created in a pained/troubled person, the natural healing/self correcting tendencies are activated (or at least, no longer held back and hampered by the problem). Positive spirals happen just as often as do negative spirals, and relief often leads on to new and additional improvements in a whole range of ways, many of which may seem unrelated. As a shrink, i view the TMS model as a form of psycho-education, and even psychotherapy in that it is using a psychological notion to heal physical/emotional pain (no distinction between these in reality). Over 40 years of research of psychotherapy outcomes reveals a consistent finding- around 80% of people who receive psychotherapy are emotionally better off as a result when compared to people with the same problems who do not receive psychotherapy (for more info on this, look up Scott Miller- psychologist). There is simply no reason to suspect that this result would not apply to TMS therapy. TMS is both treated by professionals and with a self help modality. Research evidence demonstrates that for problems which are not of the most severe kind, self-help (including books, journaling, etc) are as effective as is psychotherapy, ie. 80% of self-help treated people are better off than those with the same problems not treated.

When it comes to more severe problems, it appears that professional assistance is often required. In terms of TMS, this could mean when the pain is being fueled by trauma, PTSD, massive dilemmas, unsolvable problems, etc. So, like with most other problems, the more extreme the base line level of problem is, the more professional help may be needed. And the reality is that professional help is often/usually not available in regards to TMS bec lack of TMS health practitioners, and financial barriers. This means that there may be many people in the TMS community who are trying to overcome their pain without professional help, where in an ideal world, they would have that help (thus the importance of forums like this one). And then there are multiple stories (my own included) of people who have pretty severe issues (eg. trauma) who managed to overcome their pain using self-help only (eg. books, self analysis). These cases are entirely real, but your queries is ‘how many of them become better, or stay better?’. As stated, i dont think the research has been done yet- research is incredibly expensive to do. However, apples still fell to the ground before one landed on Isaac Newtons head and allowed him to come up with the theory of gravity. That is, the real world operates pretty independently of researcher’s activities- and there is plenty of anecdotal evidence that TMS cures exist in the real world.

Why then so many reports of people still suffering on forums like this one? Three reasons i suspect:- i) TMS forums are not a random sample of the general population, nor even of the TMS population- if this is where you are getting your impression (of no cures) from, then it could be misleading, ii) people who get better probably have a tendency to leave the issue behind, and to not remain involved in TMS forums (altho, some do)- again, you are seeing a ‘skewed sample’ in TMS forums (perhaps you should focus on the success stories), and iii) overcoming a TMS pain does not result in one becoming a ‘super-human’. As Sarno has stated, and i agree, TMS seems to be the human condition. He reports to still experience headaches. Even though i overcame 18 years of chronic groin pain (and never had chronic pain from fracturing 3 vertebrae in my neck + 2 disc bulges), i still experienced a couple of days of abnormal back pain 2 weeks ago- the day after i scattered my father’s ashes. Does this mean a ‘treatment failure’ in researcher's terms? It may do (depending on definitions used by the researcher), however I dont see any reason to view it in that way. To me, it reflects ‘the human condition’- we are vulnerable to emotional pain resulting in physical pain simply because of how nature evolved us as a species/how God made us (your choice).

I suspect that of the 88% of Sarno’s patients who were found to be ‘better’ as a result of his psycho-educational intervention, many/most of them would continue to experience occasional bouts of pain like i did recently. Personally, i still consider myself cured (despite very rare pain experiences). Were one of my children to die, i suspect that TMS pain may become a more chronic feature of my life, as would the emotional pain. Just because we can internalise and productively work with these ideas does not mean that we are exempt from human condition, or reactions. There is no ‘cure’ for the human condition, as it really isn’t an illness- its just a reality, like most of us having 2 arms and 2 legs. And the reality seems to be a self protective tendency from emotional pain which our mind/brain is able to utilise with a range of defense mechanisms, including chronic pain. To me, it is possible that some very unique people (like Echart Tolle) may be able to transcend the human condition and not suffer in many of the normal ways.

I would also like to see the long term research being done, but in the meantime, we need to focus on the style of evidence which is currently available. And this is primarily in the form of many, many anecdotal reports; Sarno’s own outcome studies; and other sources of research based evidence (eg. that reported by Miller) which provides indirect support. Unfortunately, thats all we have to work with at the moment. Ideally, we would have long term research results, but as stated, this is very expensive to do- so if you know a rich philanthropist who is willing to fund it, let me know- i’d be happy to do it. James

 

This is so important! I needed this reminder. I'm 95% pain free and it's nice to know that I don't have to get to 100%

 

Being human and experiencing reality is great when there aren't any problems . I think many people in pain want return to a time in life when they didn't hurt and stay that way indefinitely. Is that a touch of magical thinking ? I still need to do the daily mindful work and understand that when we cut ourselves we will bleed and understand, we will heal. Really great writings Dr. Alexander, thank you so much !

 

Having been involved in the other forum since 2008, and this once since it began I can agree that most people, once cured, move on. Some of us who are cured call in from time to time to see if we can offer help but we are few. Therefore the forums are indeed skewed. For the record I have been pain free for about 4.5yrs after 10 years of crippling back pain.
Maybe we should send out a simple questionnaire to all our members to see how they are doing now?

 

That is a FANTASTIC IDEA !!

 

Yep, I was unable to even go to work late 2006, and I've been back pain-free since January 2007. I expect I will still be pain-free when it's been 10 years since I saw Dr. Sarno !!!