Alan G. What if I have an abnormal MRI?

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Question

Can a person with chronic back -neck pain be helped by the TMS method only if the pain is psychosomatic and there are no clinical issues with his/her spine? Can a person with clear MRI findings still benefit from the method?

 

Answer

The answer is: probably.

Most people have structural abnormalities on their MRI. In fact, a study in the New England Journal of Medicine found that 64% of people with no back pain had a disc bulge or herniation.

In many cases, findings on an MRI are incidental, meaning the findings are real, but not directly responsible for the pain. Our bodies are robust, and can often tolerate tears and bulges and degeneration without pain.

That being said, some structural findings are relevant. Not everything is TMS.

Generally, if I'm referred someone who has real structural findings, I'll assess for TMS (history of other pain conditions, pain moving around, inconsistency of symptoms, etc.) and will also refer them to a TMS physician for a proper diagnosis.

A diagnosis of TMS from a physician who specializes in discerning meaningful structural findings from incidental ones serves two purposes: first, it allows me to treat the patient with a clearer understanding of the cause of their pain, second, because acceptance of the diagnosis is an important part of recovery, a TMS diagnosis serves as a wonderful psychological intervention for the patient as well. It allows them to more readily accept that their pain is not structurally caused and begin to neutralize the fear associated with their pain.

Alan

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