The Pain Strategy

This is something that is talked about a lot especially in the latest book I read the Master Practice by Monte. He made a lot of good points in the book of how to reverse the pain disorder but one thing I can't fully agree on is his perception of the pain strategy. From what I read and listened to with his books and audio, he makes it seem if you do anything, and I mean anything physical to treat your body when you're in pain you're supporting the pain strategy. It's kind of like you either have to have fully psychological generated pain or fully physically generated pain there is no "on the fence" as he says. This can't be true in all cases because there are a lot of problems that can be made worse by your thoughts and emotions and that doesn't mean you're feeding the pain strategy.

For instance with my chronic foot pain issue that began around 7 years ago, is it bad to stretch the muscles because I'm feeding the pain strategy by doing so? Or for my eye strain problem is it bad to stretch the eyes or do eye yoga because you're then feeding the pain strategy? It's pretty much creating more fear in my mind now in the opposite direction that if I do anything physical with my body that I'm feeding this strategy and keeping it around.

In my personal case i believe I have mild eye strain caused by using the computer but its my thoughts/emotions/way of paying attention to pain that makes it significantly worse where it became chronic. Why can't TMS exist as amplifying your pain rather than having to always be the sole creator of it? I think this is also a perfectionist attitude towards it and could generate more inner tension thinking like this in black or white terms and no gray area.

I fully understand that accepting the diagnosis is key to overcoming TMS but some believe that means none of the pain could possibly be generated by just doing too much of something. My brother had a moving job where he stood on his feet for 8-9 hours and he came home and said his feet hurt like hell. According to this type of theory he shouldn't treat his foot pain at all by stretching or icing or anything like that otherwise the pain strategy has him. I think there is a gray area in there where people can have TMS, accept the diagnosis and understand that their pain is caused by psychological factors but I dont believe that always has to mean that ALL of the pain is caused by TMS and TMS alone... there is such a thing as overusing the body to a point as well. Frankly reading the book made me kind of afraid to do anything now to treat my problem as Im going along because really, deep down, I dont want to feed this strategy of keeping my repressed emotions from coming out. But from what I've realized is that I dont have repressed emotions that I Just dont know about from the past but these emotions are from the way I was generating stress and pressure in my body on a daily basis with how I dealt with people, my negative feelings, my fear proned outlook on everything I did, etc.

I spoke with Dr. Clarke a while ago about stress induced disorders and he said something that struck me (Im paraphrasing) "If the pain distraction theory were real, when you tried to uncover the stressful emotions that were lying beneath the pain would get worse to distract you from feeling them. In his practice and from his experience he said this is the majority of the time not the case. When you uncover/feel the stressful emotions and deal with them, the pain from diminishes or completely subsides."

I want to treat TMS at its root cause which I know is psychological but I dont want to be afraid or fear doing anything physical to keep my body in shape so I dont perpetuate the "pain strategy". What are your guys thoughts on this? One of the other things mentioned was that even reading about TMS and talking on the forums like this feeds the pain strategy. I could see that if you were obsessing about the condition constantly and did nothing but research it, doubt it, fear it, but I dont see anything wrong with talking to people on this forum or others like it to build a support network to get through this problem. I dont want to have to fear that either. My true belief right now as it stands is that the pain is generated by these factors:

1. Fear
2. Attention and the way you think about the pain
3. Negative emotions and feelings that generate stress and inner tension during the day
4. Past conditioning on the way you perceive pain

I understand that the strategy theory is supposed to be the brain's way of protecting you but reading about it makes it sound like the brain has some secret agenda to fight you every step of the way so you dont have to experience emotion. Considering TMS is a mind AND body disorder it seems rigid to think that its one or the other and it can never be both combined.

 

Hi Dabatross,

I asked my TMS doctor a similar question--I was concerned because some of the physical treatments I was doing were for headaches AND general health, like taking vitamins or getting enough sleep. Those things might be good for anyone to do. Then there were some things like wearing orthotics (I also had TMS in my feet & legs) that were mainly for the condition. My doctor had suggested just letting go of those things gradually, and said that most TMS patients find they just gradually let go of these kind of supports as they figure they don't need them anymore. He did say it was good to drop the PT exercises I had been doing as they were a constant reinforcement that something was structurally wrong with me.

I do think that so much of what we think is physical, like your brother being on his feet or you looking at a computer screen all day, might really be TMS. Consider that centuries ago people stood more, walked everywhere, did close craftsmanship-type work, and didn't have the kind of pain that we have.

Maybe see if you can slowly let go of some of the exercises you're doing. As Forest mentioned, these things probably aren't helping you anyway.

Back in my gym-rat days my trainer had even said that stretching is way over-emphasized, most people don't even need to stretch that much at all before or after a serious work-out, never mind just going about a regular day.

I still do some physical treatments. If I'm in a lot of pain, I might take something like Tylenol while saying something to myself about how I understand this is just to take the edge off temporarily and that I am doing the inner work to eliminate the need for it in the future.

Take care,
Veronica

 

"MatthewNJ posted here that Dr. Evans had a saying that when you take pain medications tell yourself that I am taking this pill for the symptom, I am working on the cause by joining this group and doing the structured program"

Forest I like this way of thinking better too.. saying to yourself that you're treating the symptom and not the cause of the problem by doing this exercise or taking this pill. You also mentioned that even when you did all of the RSI guidelines, used the keyboards, mouses, etc. your pain was still there and didn't change from when you didn't use these devices. I'm in the same boat.. I've said to myself many times "I've tried these guidelines, did these exercises, they aren't working." Trust me I've given up pretty much all of that crap I still have my station at work setup so its comfortable for me and I pay attention to that but I don't do eye exercises anymore or the stretching for my eyes because I've tried them many many times in the past and it hasn't changed anything. I appreciate the support by saying theres nothing wrong with doing some of these things while building up confidence in your recovery. After reading the Master Practice I felt fear of doing anything physical to my body otherwise I would be prolonging this pain.

One question I do have is this: do you believe that TMS can amplify existing pain? Or can TMS amplify regular use of the body to make it hurt more than it should? The reason I brought up my brother and that he had foot pain after work is because went away.. thats the key point. He didn't fear it or worry about it so the pain went away on its own without him having to treat it. So in essence it was "normal" for him to have pain after standing for 8-9 hours but because he didn't fear it or try to fix it every day it dissipated on it's own. In my personal case, I believe that I have some normal eyestrain from using the computer but it's being amplified by TMS (fear, anxiety, worrying about it, trying to fix it constantly, etc.) which makes it chronic and much worse than it really is. My pain doesn't make sense because after I'm done using the computer it does stick around when it shouldn't which I believe is psychological and TMS related because I'm constantly trying to fix this or fearing that it's not going away (ie. calendar watching). For instance my fiance and even a coworker at work say they get eyestrain but they dont worry about it like I do. They're not concerned with it not going away and they just consider it "normal" to have some eyestrain after looking at the computer for a few hours. This is where I have the question can you have TMS pain in different levels such as:

1. Your pain is entirely psychological (ie. phantom limb pain), or if you had foot pain and you never walked on your feet you could easily tell that it was being generated entirely by psychoogical means.
2. Your get "normal" pain from just using your body for too long a period or whatever and then it's amplified, sometimes to the extreme, by your thoughts, fears, negativity, anxiety, trying to fix it constantly, etc.
3. Your pain isn't affected by TMS and it's just a physical problem that needs treatment.

This is where I brought up the gray area that Monte thinks is the stick point. Why can't TMS amplify existing pain to the point of becoming chronic?

Veronica, you bought up this statement "I do think that so much of what we think is physical, like your brother being on his feet or you looking at a computer screen all day, might really be TMS. Consider that centuries ago people stood more, walked everywhere, did close craftsmanship-type work, and didn't have the kind of pain that we have."

I'm sure some of these people back in the day, centuries ago, got pain in their feet if they stood for hours on end slinging a hammer at an anvil but they didn't worry about it. They didn't have the internet or constant reinforcement by the media that "oh this new disorder is out you better worry about it and prevent yourself from getting it". I think this creates the pain for people because they see its "legit" now and have to prevent it from happening. I mean come on every day on the news theres some new thing that causes cancer I remember years ago they said theatre popcorn was really bad for you and could cause some type of disease if you ate too much and then like 5 years later they were like "oh we were wrong thats not true at all". All of these statements are made so rashly and then taken back later when they didn't have a basis. Thanks to both of you for your comments I appreciate them.

So I guess the main question is can there be the gray area, #2, where TMS, mind body disorder, PPD, whatever you want to call it takes a "normal" type of pain that anybody gets and amplifies it to the point it becomes chronic and then a vicious cycle ensues?

 

I think too there is a difference between short term pain from overuse of a certain muscle and chronic pain that is coming on even when you're not doing anything. And I agree it's a HGUE part of our culture. I have thought about just keeping a list of how many times in a day I hear things that perpetuate TMS...ads for the latest gizmo or drug for pain, people complaining about being in pain because they are "old" (I've heard people in their 30s complaining about this).

 

Definitely I think it has to do with which things you fear and dont fear. As in my brother's case he didn't fear the foot pain when he got off work so it dissolved on it's own without his intervention. However for me I obsessed and feared the foot pain not going away so it stayed around. It seems like the opposite should occur right? You think in your mind the harder you fight it off and the more you treat it the faster it will go away but the mind doesn't work that way. It's like when somebody tells you don't think of the pink elephant.. thats when you have a really hard time not thinking of the pink elephant. As far as physical treatments, I actually stopped all of them. The only thing I was considering doing was wearing glasses I was prescribed by the optometrist to see if they would be of any benefit. They told me to wear them but I didn't want it to stop my recovery from TMS. I think Im going to try wearing them and just see what happens. I had worries in the past they were making the problem worse (this was around month 4 of my 6 month vision therapy) but I realize now that was just me worrying too much about if the pain was going down or not. The problem with the vision therapy was that it was a constant reminder to calendar watch to see if I was getting better... each week the therapist would ask me "how was last week?" and after a number of weeks of not getting better I believe my brain became conditioned to say "it was the same as last week" because I feared so.

forest like you said i tried all kinds of things to alleviate the pain (ergonomic setup, eye exercises, guidelines for computer use, etc) and even when I dont do the exercises I experience the same pain... so if these things aren't working whats the point of doing them. And this is definitely not a case of "oh I just didn't do it long enough" i've done some of these exercises for a very long time and didn't receive results from them. So I guess the last thing Im going to do is try wearing the glasses the doctor told me to wear I have some farsightedness and astigmatism in my eyes and see if it helps or not. Hope for the best on that avenue but I know that this is caused by MBS... like Veronica said theres just no way normal pain would stick around even when you're not doing activities. It happened again last night to me.. i wasn't even on the computer doing anything I was at my dad's house but the eye strain was on my mind. I was feeling the same symptoms I feel at work and I think its because I kept worrying about it and thinking about it even though I wasn't doing any nearpoint work.

 

do you guys think wearing glasses my optometrist prescribed me is a hindrance to TMS recovery?

 

Hi Dabatross,

I haven't heard of near/farsightedness being connected to TMS. I've worn glasses for so long I don't even think about them. But I've never had any eye pain either.

Are you talking about regular glasses or those new ones that are supposed to prevent headaches (yellow tinted)? I actually looked into those right before I found Dr. Sarno's books. I never got them because this started working.

Veronica

 

hi veronica,

no i wasn't talking about farsigtedness and astigmatism being connected to TMS. its just thought that having farsightedness/astigmatism can worsen eyestrain because you're looking at things and having to work harder to focus because of these issues with the eyes. those yellow tinted glasses are called gunnars im not talking about those.. those are made specifically for "digital eye fatigue" and they are really a gimic. they tint clear glasses, put a +.20 preception on them and sell them for 80 bucks. they are pretty much a ripoff and you can tell that by the way they market them with all of these fancy terms. it was just recommended to me by my optometrist to wear these glasses to correct the farsightedness and astigmatism while using the computer and just didn't want this to be a hindrance to my recovery is all. ive stopped all exercises, looking on the internet for solutions to eyestrain, pretty much everything except reading about TMS and going on this forum and was just pondering if i should wear the glasses and see if they help out or not.

 

Hi Dabatross--It sounds like the glasses are something your doctor recommended in general but because they also help with eyestrain you're worried they're reinforcing that this might be physically caused? I have a few physical treatments that I did for both TMS and other non-TMS reasons that I decided to keep up with. Unfortunately I did give up Pilates because it reminded me so much of PT (most of my PT exercises were Pilates).

Can you talk about it with your eye doctor? Is she open to the idea of TMS?

 

exactly veronica i dont see the eye doctor anymore because he pretty much agreed with me that things weren't working very well at the office.. i mentioned to him at my last visit that i thought this might be psychologically driven and he said that very well may be a possibility. Behavioral/developmental optometrists are much more open to the idea of stress causing problems in the body (there were a number of times my optometrist mentioned it to me and asked me if I was under stress at some points) than ordinary optometrists. thats why i asked though is because i was prescribed the glasses just dont want to reinforce TMS.

Forest I couldn't agree more with what you said. My brother is much more of a laid back guy than I am and he lets things brush off his shoulders. Since I have OCD and stuff I tend to obsess about things a lot more than most people especially things I think will interfere with my daily life. So even though he would frequently get pain in his feet from standing all day moving it went away in a short period but for me it stays around because I focused on it and reinforced the pain by constantly trying to fix it.

 

hey forest,

thanks for the feedback. yeah i really think is thats obsessiveness (at least for me) that drives a lot the pain symptoms. as ive been touching on a bit lately social anxiety seems to play a huge role in my symptoms going up. yesterday and today i have barely spent any time on the computer at all and my eyes are pulling like crazy.. they feel tight and they ache but i haven't been doing near work. i thought to myself "what emotions that im having right now could be causing this" and i related it to what i did yesterday which was i went to see some of my fiance's extended family and then some of her moms friend which always makes me really nervous. through journaling and stuff ive found out that im a really self conscious person even though i told myself for years i wasn't. i always said "i dont care what other people think of me" but i really do.. every time im around people i dont know very well or am not really comfortable with i get social anxiety about it and wonder what they're thinking of me. i just noticed this 20 minutes ago talking to my neighbor as he was talking to me i wasn't thinking about what he was saying but i was thinking about what he thought of me and stuff.

so i've drawn these conclusions and i can relate to increase in symptoms from when im stressed.. lately it really has been to social anxiety. as far as accepting the diagnosis and realizing which emotions are increasing pain, what can be done about this to decrease it? its obvious to me that my anxiety plays a crucial if not complete role in the generation of my symptoms. i know this and i've made connections like you said but pain still persists regardless. i think this is kind of what monte is saying with just being aware of your emotions doesn't change the fact you're having the emotions still. you have to change your perception of them i think so they dont have the same effect on you. i dont really understand what to do after realizing these connections though.. its not enough for me i guess just to realize them i think there has to be more change made. i was worried most of the day yesterday about going to that dinner with her family and i realized that was the connection to my increase of pain but that didn't change the fact i was still scared. any thoughts on this?

thanks

alex

 

I'm coming into this late, but in regard to stopping things like stretching/exercises/medications, etc., I've done a lot of thinking about this recently. Let's say you break your leg. You go to the Dr. and get a cast and crutches. Those crutches are necessary until the bone heals. It would not be wise for a Dr. to tell you to abandon the crutches before the bone is healed. You'd likely fall on your face.

I think it's the same with these other things. I think you'll know when you don't need the crutches anymore. When I broke my ankle several years ago, I got very impatient with the crutches as soon as I started feeling better. Then I "graduated" to a cane and then to no external "supports."

The same thing happened 12 years ago when I became a non-smoker (notice I didn't say I quit...we can only become "come to be" something new). I quit "cold-turkey." My only "support" was a plastic cigarette with cartridges that tasted like spearmint (no nicotine). At first, I thought I'd need that plastic cigarette for the rest of my life. LOL I called it my pacifier. But within a few weeks, I was reaching for it less and less. I finally lost it somewhere and never thought about it again.

If you're patient and kind to yourself, when the emotional pain is healed, you WILL graduate!

 

i wanted to post on this subject again about the pain strategy because im having second thoughts on my previous stance with it. you know how monte talks about that you can't be on the fence at all and that there is a distraction strategy going on.. it was really hard for me to accept the strategy part. i dont know why but it seems evil and conniving for the brain to create an intelligent strategy to distract you from painful emotions. i thought to myself "what emotions could my brain possibly want to distract me from?" and then i would be like "the strategy theory just seems too far fetched". i believed in emotions causing pain but i have to admit to myself that i still was on the fence about it in some regards. i know why im on the fence too and hope you guys can shed some light on this.

a couple weeks ago i came to the realization that some of my pain was caused by just using the computer too much and most of it was caused by psychological factors (TMS and mind body syndrome). As monte says this is a TMS hell but i just had a really hard time believing in the pain strategy for some reason. You know i talk to other people who use the computer a lot and they say they get eyestrain at times, but they dont focus on it and it goes away. they dont have it all the time like i do. thats the part that keeps me from getting off the fence i think is that I talk to other people and they say they get eyestrain to so in my mind its like "oh other people are getting eyestrain at the computer too so it must be normal". however the fact that i get eyestrain/pulling/tightness symptoms 24/7 is not normal. it should go away after work but it doesn't. they also dont get the symptoms as bad as i do.

so ive been reconsidering my whole thought process on the pain strategy. ive been trying to figure out what my brain could be trying to distract me from. the things i came up with were: positive stress (having a kid, getting married) regular stress like work and the job, and things that i have all the time like anxiety and obsessive compulsive disorder. so yeah being honest with myself i am on that fence still and i think its hindering my recovery. i've written down everything ive done physically for this eye problem and i can't think of anything i didn't do except for surgery (and the doctor said nobody would operate on me anyway because i dont have strabismus or an eye turn things like that). i talk to myself and say "i've done all of that stuff, it didn't work, treating mind body disorder is the right path, and each time I have a bad day these physical thoughts still seem to creep up with the "what if?" i didn't do something long enough, or the proper way, etc.

Thats the hardest thing for me to get over is when I talk to others and they say they get eyestrain and that its normal to get some after working on the computer for the whole day it kind of reinforces in my brain that "maybe this is partially caused by TMS and partially caused by using the computer full time". Does anybody have thoughts on this?

 

TMS is pretty wide-spread in our culture--just think about all the commercials on tv for back support, pain meds, etc. Your friends with eye strain might have TMS too. Maybe for now you could avoid talking about the physical symptom with people that don't know it's TMS?--they might be reinforcing your idea that there's something physically wrong with you.

Louise Hay has a really great affirmation that I use a lot when I hear someone going on and on about physical symptoms that sound like TMS: "That may be true for you, but it is not true for me." (I say this silently )

I think it is normal to have doubts as you work on all of this stuff. Be nice to yourself!

 

thanks for the thoughts guys. actually its not the fear of giving up a level of freedom by having a kid. I'm more worried that the stress of taking care of a kid will aggravate my pain. thats been a big fear of mine for a while. the other thing i was talking about above was that people without TMS get eyestrain too and its hard to differentiate I guess when you talk to other people who dont suffer like i do and they say something like "yeah i get eyestrain but i just dont think about it" it creates doubt in your mind about your symptoms. i dont know if you guys have felt like this before. i think you're right veronica its probably best i dont compare myself to others because then its just going to create doubt and fear that its physical symptoms again when i know they're not.

its when you talk to somebody else who gets some of the same symptoms as me, i know they dont have TMS and they dont have chronic pain, and then it starts making you think and doubt again. i guess the difference between me and them is that my symptoms turned chronic and theirs don't. they'll get eyestrain sometimes at the computer but they dont obsess about it and it doesn't turn into a long term thing. i think thats the differentiator between TMS and "normal" overuse type deals. do you agree?

 

Hi Alex,
One of my big fears was that I would have a lot of pain when I was supposed to be "on"--like teaching a class or leading a meeting--and that my pain would cause me to not do a good enough job and to let everyone down. I know now that this is all tied in to my perfectionist and goodist tendencies.

We all have minds and bodies that are connected so everyone probably has TMS at some point. It might not develop into something intense or chronic like it did for most of us here but that doesn't mean that it's not the same mechanism. I now tend to avoid talking about pain with anyone other than friends who really "get" TMS.

When is the baby due? Are you feeling any pressure to be better before that? Putting a timeline on recovery was one of the things that was making it worse for me in the beginning.

Take care,
Veronica