TMS vs. neuroplasticity vs. somatic tracking

So I’ve read a lot of information about pain science, and I’m struggling to figure out the similarities and differences between 1) TMS/MBS methods (Sarno/Schubiner/etc), 2) neuroplasticity methods (Moseley/Moskowitz/Doidge), and 3) somatic tracking methods. They all seem to have the belief that calming down or rewiring your nervous system can help reduce/eliminate chronic pain, but there are some contradictory things that I’m not sure how to interpret:

1) TMS (Sarno, Schubiner, others) Suggests that repressed emotions and misfiring neural pathways are the source of chronic pain, and that expressing these emotions and calming the nervous system can help eliminate pain. Big on expressive writing, meditation, and education. I’ve tried this, but my pain doesn’t really seem to have an emotional component, so I’m more inclined to go with the other 2 approaches.

2) Neuroplasticity (Doidge, Moskowitz, Moseley): Suggests that chronic pain is caused by misfiring neural pathways, and that retraining these pathways via visualization/other sensations can help eliminate pain. Says you must aggressively counter each pain strike with other sensations to rewire the nervous system.

3) Somatic tracking (Alan Gordon and others): Suggests that fear and preoccupation contribute to maintaining overactive neural pathways, and that reducing fear/preoccupation by sitting with the pain but not fearing it will help eliminate pain.

I guess my confusion comes from the fact that approaches 1 and 3 (TMS and somatic tracking) involve focusing on the pain but NOT trying to get rid of it, while approach #2 (neuroplasticity) involves trying not to think about the pain and fighting to get rid of it. I’ve tried using elements from all 3 approaches, but I’m not sure what to do. My pain didn’t come from a previously existing injury—it just happened randomly—so would one of these approaches work better than the others?

So: Should I try not focusing on the pain and accepting it, like the TMS/somatic tracking methods, or should I try visualizing the pain and trying to reduce it, like neuroplasticity methods?

 

Hi Latitudes9
I’m a newcomer as well and you posted my question exactly! I too have circled back thru the exact 3 approaches and their proponents you’ve summarized and I’m leaning more towards #2 neuroplasticity augmented by some approaches and techniques outlined in the other 2 views. I have post-traumatic trigeminal neuropathic pain as a direct result of a botched dental procedure 2.5 years ago. Although I could be the poster child for TMS (history of childhood trauma, anxiety etc) the facial pain had a definite surgical/chemical cause at a specific moment in time. I’ve been finding some discussions in TMS FB groups can get dogmatic as in “it’s TMS and only addressing the emotions and rage within can pain be healed; you must drop all other interventions!” I’m not convinced that is the case for all chronic pain. But I’m here with an open mind to learn.

 

Hi Latitudes and Sterling,

With regards to the various approaches, it is probably worthwhile to read this. Miffy makes a great summary.
http://www.tmswiki.org/forum/threads/tms-mbs-community-inconsistencies.22873/ (TMS/MBS community inconsistencies)

There is no perfect application of these approaches. That is important to know. It is a process by which you're experimenting, and perhaps finding a tad of success. Then you do more. If you're not finding success, broaden your approach, go deeper into one or another, or get help. Something will work, and hope you have confidence in this.

The confidence that any of these elements will work is actually hugely important. So the various approaches, trying to figure them out and what is best can interfere with efficacy. The more, as Miffy suggests you see them as one in the same, and the less you try to find the best of the best, probably this is helpful. Relax and use something you think makes sense to you. Deepen into it, not pressuring yourself for results.

As /steve-ozanich has mentioned to me, it is probably not helpful to think of neural pathways as anything physical that have to be changed. This thinking brings us back to "something is wrong in me which I have to fix --and it's physical "

I suggest instead that when you read anything about neural pathways that you substitute "habits of mind." Because that is really what you're addressing.

Feeling safe, knowing the issues are not physical, giving full credit to "inner Hell Realms" which we all have inside, learning to "not believe everything you think," practicing kindness and ease with yourself, directing your mind to neutral or positive experiences, knowing your self-pressure patterns and connecting with symptoms, learning self-compassion (and more)----all work together to undo symptoms, through some non-linear, rather magical process which is not fully understood, even by the experts!

I've read stories here where all the person did was "slow down." Another learned to sing self-love songs to himself. Decades of symptoms gone. Crazy because these don't follow anyone's prescription, except they do! Gently find your own prescription, based on the scent of ease and self care.

Good luck to both of you.

Andy

 

Thank you Andy for your thoughtful and encouraging reply. Am taking a step back to regroup, refocus, and acknowledge that our journeys are indeed individual ones.

 

Hi latitudes! I am familiar with the work and theories of all of those you posted above. They may seem different but they simply boil right down to the same cause, fear. The pain is initially activated by some kind of threat, it may have been emotional (Sarno), an injury (Moskovitz), or stress/beliefs but it really doesn't matter for the majority of people. What started it is done. What perpetuates it is your thoughts and fears that keep kindling the pain cycle. Chances are the stressor is over or injury healed. All that's left is a fired up nervous system on alert.

What will ultimately help you overcome this is changing your response to and beliefs about the pain.
1 Sarnos treatment is to know your body is normal, not injured (changes belief of pain source). And then to shift thinking from physical to emotional.
2 Moskovitz requires intense concentration in things other than the pain. I believe that putting the focus on something else, you aren't going to be feeding into the thoughts of physical damage or have time to fear the pain. And you lose the kindling keeping the pain going.
3 Alan has really demonstrated the role of fear in maintaining chronic pain. I think his theoretical explanation is the simplest to grasp, which is super helpful when chronic pain makes critical thinking difficult. Somatic tracking is really exposure therapy. Helping you to gradually face your symptoms and teach your brain you are safe.

I hope that makes sense and is helpful.

I once read a member post on her success story that "Everything you want is on the other side of fear." And I have also learned from a great mentor that in order to overcome the fear you have to go through it, not avoid it. Face it, accept it, and let time pass.

My advice would be to get back to living doing things you love. You will be distracted in a natural way and not a way in which you are trying so hard not to focus on the pain, because that just makes your mind focused on it more. Your job is not to make pain go or figure it out. Your best bet is to try to care about it as little as possible. Let it do what it wants, and do things that bring you Joy the best you can. That will dissolve it.

 

Thanks so much, @ash86 ! I guess my problem is that my pain is severe and constant enough to prevent me from working, so it is hard to go back to doing the things that I used to do/bring me joy, or even much of anything, really. I have tried adding in a bunch of things that make me happy (exercise, reading, watching TV), and they're good distractions, but I haven't seen any effect on the pain. I guess I could force myself to get a job or have something to do, but I'd be worried about having to quit if the pain was too much. I can do things while in pain and I'm not scared of it, it just really sucks. To add to my confusion, when the pain first started, I kept on working, but the distraction didn't help and I ended up having to quit due to pain. I know you weren't exactly talking about work, just other joyful things, but I'm only 25, so I feel like I need to get back to work to have something meaningful to do with my life.

 

I can totally relate. My pain got really bad when I was 24, and I had to quit my job as an RN. I am 30 now, and I have been trying to "solve" my TMS pain for 6 years. I clearly see where I went wrong before. And I also know the things that helped. I have eliminated many of my TMS symptoms, I have one that remains. I also know my thoughts and feelings about this symptom in comparison to the ones I was able to overcome. My medical brain is really stuck on fearing a certain disease so I am going to have it ruled out at the end of the month to finally release my final symptom.

I don't know if this is how you feel or not, but when I couldnt work I felt that my life was pointless or on hold. Or maybe that I didn't deserve joy because I wasn't productive.

When I say get back to living, I mean gently turning your attention more towards what's around you than the pain inside. It's so hard. Pains purpose is to grab our attention. When it's from an actual injury, it serves an important function. TMS is different, it's overprotecting an area that is perfectly normal. The pain feels the same as if something is damaged, but it's not. The way out is through. It's easier if it's something that is joyful and naturally holds your attention. One of the most helpful things for me was to try new things. And it doesn't have to be physically demanding, make it something you feel capable of doing. And if it's something you can use creativity even better. You may pick up a hobby you love, that you would have never tried before.

The more you can experience life, even if it's not right where you want to be yet, the more you are taking back your brain from all the attention on the pain. And over time you will think and fear the pain less and less. And soon, you won't think about it at all. So even if it's not 100 percent the normal life you want, shoot for living despite the pain. When the pain comes up don't buy any thoughts it's damaging (assuming you've ruled in TMS). And this was my biggest mistake is constantly flipping back and forth structural of not. Know the pain is temporary and can't actually hurt you. Let it be there. In small increments expose yourself to things you are scared of, while teaching yourself you are ok. If you need, there are so many good TMS coaches. Birdsetfree on here and Jim Prussack have been life savers for me. And sometimes when you are in the storm of pain its hard to see outside, that's when having a coach helps.

Claire weekes has said that your weakness may one day become your staff of strength. And I totally believe that. This pain sucks, but doing this work will make you so much stronger in the end.

Good luck!

 

Oh, and don't do the things and look to the symptom to see if it's better. The goal is less and less attention on the symptom. Watching it will only keep it around. You won't be able to do this perfectly of course, just keep practicing. Don't worry about the time it takes. This is what is on the table for you to do now. If you can work, maybe try it. If you can't, that's okay too. You will have plenty of time to work when recovered. Only you can make that call.

 

Hi fishy,
What a great question! So somatic tracking (paying attention to the pain without fear) is just one approach.

The idea of paying attention to something else can be effective, and actually that’s the very subject of our next podcast episode coming out next Wednesday (you can find the first three here: https://www.tmswiki.org/forum/forums/tell-me-about-your-pain-q-a.76/ (Tell Me About Your Pain Q&A) )

The two approaches are not mutually exclusive, and in the next episode we talk about how they can be different ways of achieving the same outcome.

But if you are using the technique of bringing your attention to something else, the most important thing is the motivation behind that technique. Are you doing it as a means of gravitating toward something positive, or are you doing it as a means of getting away from something negative? The former is way of authentically engaging in something positive and will reinforce messages of safety, while the latter is just another word for distraction, which studies have shown isn’t an effective technique for reducing pain.

Alan

 

Hey Latitudes9, I just wanted to chime in here and relate to your fear or resuming work. My approach when I went through this was to find a volunteer job close to home that was enjoyable and didn't put too much pressure on me for attendance etc. It allowed me to gain my confidence back. Plus the funnest jobs are the ones that don't pay, so enjoy

 

That last paragraph really clicked with me. Distraction to escape from or avoid the nasty misfiring trigeminal nerve has never really worked for me. I’m exploring more creative and engaging activities to focus on.

 

What a great thread! I don't think I can answer any better than everyone else has already, but one thing I'd like to add is to not get hung up on an "approach". It's really not about that (the "how") as much as it the why.....what the lesson is in the TMS. TMS is merely a symptom of one's underlying emotional state. The question is not "what approach do I need to use?" but actually "how do I want to live my life in whatever years I have left?"..."Do I want to live in fear and worry or do I want to have connection, joy and fulfillment?". The way I see it is, we are all going to die anyway so you may as well go for it and stop caring about failure or others' opinions etc. Whatever approach or combination of approaches, concepts and modalities works for you...do that! There were time I read an entire book and maybe only got one thing out of it but that was ok because it was just one more thing to add to my toolbox. Some things resonated deeply with me and others didn't. I filed away the knowledge that helped me and threw out the rest. There was a lot of trial and error, but I knew that as long as I was willing to go "through it"(face my fears, overcome myself, dismantle all the false beliefs I had) I would eventually reach the other side. How long it would take was of no importance either, because this was a different kind of journey. Everything that I went through, was not happening "to" me, it was happening "for" me... to learn and become a better, happier person.

 

*This*

 

Yes, I totally agree!

I also would like to warn people not to get stuck on the terminology or the differences between the approaches listed. As @Alan Gordon LCSW pointed out, there is no contradiction between the approaches. Each one of them has validity, each one of them emphasizes different aspects of neuroplasticity, which is the ability of the brain to adjust itself in response to the external factors and impacts. The underlying issue is the same: imbalance in how our brain regulates itself and its ability to respond to the stress and pressures of life.

The key to all the approaches is mindfulness, which is the ability to look at our immediate life events in the perspective and at our mental state from the neutral view point.

Our brains are complex machines and we often do not understand them; the unconscious is as powerful, if not more, as the conscious. All three approaches give you a tool to look inside, from different angles. It may not be easy to formally pursue all of them sumultaneously but it will happen naturally as you go down your path of introspection.

To say that your pain does not have emotional components may only mean that you have not dug deep enough to find them. And when you find them, it is likely that it would be not what you had been looking for - that happened to me.

To re-wire your nervous system, you need to attend to both your emotions (and fear is one of them!) and to your pre-occupation (which is anxiety - another emotion!). And here is another paradox: in order to do those things, you need to relax, because your pain is likely to originate from stress which was put on your nervous system by external or internal stressors. How would you find the balance? To me, it was meditation.

I hope it helps, and I wish you the best of luck in your recovery!

 

Hi, All,

Great post! For those who find this thread helpful, I want to draw your attention to a similar thread: https://www.tmswiki.org/forum/threads/tms-mbs-community-inconsistencies.22873/ (TMS/MBS community inconsistencies) I posted a link on THAT post to this one because I find the related ideas they share are really helpful to anyone (like me) trying to find his or her own way through the rich welter of approaches to healing from TMS. I'm spending a lot of time just reading over and pondering what everyone has posted. My thanks to all inquirers and responders.