Dr. Schechter's Blog Blog 10: Pain and Fear

Originally posted: January 15, 2015




Okay, clearly a person in pain can't do the above. Or can they? Each person assesses the risk of an activity or movement in relation to potential injury. For example, a normal person doesn't lift up a car. First of all they can't, secondly they can get hurt (exception: reported cases of parents lifting cars off of children with superhuman bursts of muscle power).

A patient brought in a quote today that connected this for me. The truth that many people never understand, until it is too late, is that the more you try to avoid suffering the more you suffer because smaller and more insignificant things begin to torture you in proportion to your fear of being hurt. (Thomas Merton).

This really connected because I see a lot of my patients who suffer from chronic pain avoiding activity, exercise, even movement in order to avoid pain. However, I've learned that it often accomplishes the opposite. The pain pathways are heightened and the muscles are tightened when we are afraid, avoid, and obsess about movements and activities. Part of healing is learning to let go and move more naturally more fluidly, more comfortably.

Patients come in unable to bend (flex) past a 90 degree angle. Sometimes (injuries, other processes), they simply can't-- it's too painful. Other times, they report being afraid or being told by other practitioners to "be careful". How long can you "be careful" when it's chronic pain and there is no specific, significant cause found?

I tell them to gradually start moving more, exercising more... at follow-up visits, they invariably move more (flex better at the waist, for example) and feel better. Of course there's more to it than this. But Merton really hits it with "the more you try to avoid suffering....

 

If I could do that exercise I would book a flight to Mars.
But I did okay today. I'm 84 and shoveled about 2 inches of snow off my driveway and front walk.
Pushed it away, not lifted it. And it was light snow. I didn't feel any back pain
and later this morning made a big pot of split pea soup with a ham bone that has lots of ham left on it.

And I'm always dropping something, so I bend a lot.

I followed Merton's advice without knowing it... I decided not to avoid clearing the snow and just did it.
It made me feel a lot emotionally stronger.

 

The first time I took a pleasure walk (only about 75 feet) in about three years was my first big breakthrough. This was moments after inquiring into my doubts about the TMS diagnosis that I had. I saw how my mind interfered with really contemplating the truth of this TMS information, how it applied to me.

That first experience of pain-free walking opened the door. It does not take much for the mind to learn new things! I increased that first walk a little bit every day for three weeks, and then one day, I just climbed a small, very steep mountain in my "therapeutic" shoes! I feel tears coming back remembering.

 

I do notice that I have retained fear of weighting my left leg ever since I broke my heel in a fall in 1990. Talk about programmed pain pathways! Not surprisingly my TMS symptoms, which manifested as a so-called 'herniated disk' in 2001 (shortly after the death of my mother) have all been on my left side and left leg. Obviously there is some kind of connection between physical pain, emotional pain, memory and trauma driving my TMS. Even today, I notice how much I'm afraid of falling off boulder problems in the cave at the climbing gym I go to, much more afraid than other gym members bouldering there. However, I've been gradually teaching myself to overcome this fear by jumping off boulder problems higher and higher up onto the well padded floor on the bottom of the bouldering cave, much as other people do. When I first started out, I was hesitant to jump off from only a foot up, but have gradually increased this distant to around 4 feet. Just have to wonder how much of the fear associated with my TMS was imprinted by the trauma of my original accident back in 1990? In any case, the more confident I become at overcoming my hear, the less my TMS symptoms have become. Interesting too how my TMS relapse occurred in 2007 after taking a fall out running where I tripped on the trail and landed on my left side. These body-mind interactions are fascinating because they suggest how much the body and the mind are interconnected in ways we don't yet completely understand. New knowledge!

 

Bruce, you love "boulder climbing," but it has its dangers, and I doubt you want to give it up,
so you may be "between a rock and a hard place" as far as convincing yourself which your pains
are... structural from falling, or psychological from TMS which can include fear of falling.

If you're in fear of hurting yourself in boulder climbing, it will be important for you to not think that way.
Enjoy the sport and it will probably make you more relaxed and safe doing it.

I'm 84 and glad I can walk to the kitchen and bathroom, and my sports were mainly
limited to golf and tennis.

 

Less fear = more confidence. Falling off in the bouldering cave at the gym is not dangerous, but my TMS mind still thinks it is based on a real fall over twenty years ago. Emotions and memory are two components of TMS obviously. Makes me think of Dr James Alexander's head-on car crash when he was 18 and how it set him up for TMS pain for many years afterward until he recognized and defused the complex.

 

I can really relate to what this post is saying! Recently during a relapse, I was feeling really sorry for myself and listening to my TMS mind telling me all the horrible things the pain will bring (which I KNOW I should never do). We had dinner with a friend of ours who fell from the mast of a boat about 2 years ago. At one point in the conversation, he remarked that, after his accident, he was told he would never walk again and he was now running every day. Well that brought me right out of it, if he can do it, I can do it. The next day I started running also, slowly at first. Now I am running every day also and have almost no pain. Then ten days later, I started having trouble sleeping and getting acid reflux. My husband reminded me this morning that it was the TMS. He is right!! Never fails.

 

Great responses above. Insightful and important. Chickenbone's comment on how a friend's inspiration allowed him to break thru fear and run again is fascinating. All great comments.

 

Great post, doc. And Chickenbone, your post really encouraged me too. BRAVO!!!