Can pain be an interplay between neuroplastic/TMS and physical?

Can pain be an interplay between neuroplastic/TMS and physical?

I’m still relatively new to TMS but am a 100% believer. I have explored my childhood, been journaling, and talked with a mental health professional and I believe my TMS issues are a combination of perfectionism and catastrophizing/fear. The perfectionism runs through most things I do, and I'm working on it, but the fear and catastrophizing are predominantly centered around athletic performance, particularly triathlon.

I’ve gotten the impression from several TMS resources that there’s a somewhat absolutist view that you should not attribute anything physical to your TMS pain and that thinking some part of it might have a physical origin will hold you back and suggests you aren’t fully convinced about the reality of TMS. Some example quotes I really like but hint at this absolutist view:
• Nicole Sachs “The pain is not in your head but the solution is not in your body”
• Monte Hueftle “The very simple and truthful answer is, if you are a TMS person then 99.999999% of all these other aches/pains/strains and other mind body symptoms are TMS.”
• Sarno himself “I must think psychological at all times, NOT physical.”

In my case, however, I’m wondering if it’s possible that my pain isn’t 100% TMS or 100% physical but an interplay of the two. Like I mentioned, I believe the primary source of my TMS symptoms are because of the high athletic goals I set for myself and my fears that I won’t achieve them. As a result, my TMS pains are any combination of hip, glute, low back, leg, etc. pain that can contribute to fear and worries that I may have an oncoming injury that will set back my training and keep me from reaching my goals. Here’s an example of how I could see this relationship playing out:
I really love racing triathlon so I train a fair amount –> training often results in real, though normal and generally harmless sensations of physical pain and soreness –> my brain/subconscious is hypersensitive to these (normal) sensations and interprets them as a danger signal –> this danger signal accentuates the sensations of pain and my conscious mind freaks out because now I worry and fear that I actually have injured myself, and the downward spiral of reinforcement continues the pain-fear cycle.

One additional, possibly important, component is that I was diagnosed with ankylosing spondylitis about 15 years ago. Fortunately my case is mild and I have no signs of spinal fusion. With ankylosing my immune system is hyperactive and can begin attacking my own body, typically in the area of my sacroiliac joint/hips/glutes. So the disease can cause an inflammatory response right in the same areas of the body that cause me to freak out, and flare ups can be triggered by stress – just like TMS! So this seems to be another possible contributor to the TMS-pain/fear cycle I’m describing, and I’ve likely conditioned myself for 15 years to worry about glute/low back/SI pain such that my subconscious mind is quick to freak out about normal sensations in those areas and generate pain even though my conscious mind can now know not to worry about them.

A TMS analogy I really like here (I think from Alan Gordon?) is that I have trained some of my neural pathways to be like an oversensitive fire alarm that goes off any time you burn toast. In my case legitimate (though non-threatening) soreness from training is my burnt toast, and my subconscious is the oversensitive fire alarm that freaks out with fear and creates pain signals when in reality the physical sensations are a normal and expected adaptation response to training.

Does any or all of this seem reasonable? It’s easy to read about TMS and conclude that any thought of the pain sensations having some actual physical reality means I’m setting myself back by not believing it’s 100% psychological. However I’m not so sure it’s that simple and clear cut, especially when a primary driver of my fear–pain cycle has to do with physical training that will inevitably make me sore and fear (subconsciously or consciously) that I’m setting yourself up for injury.

Apologies for the long ramble. I’d be curious to hear anyone’s thoughts – thanks!

 

Angel, there is such a thing as a TMS hybrid which describes what you question. If you search on the forum for TMS hybrid and include my name you should be taken to a thread where @Tennis Tom posted a video featuring one of Sarno’s colleagues discussing this. I’d post the link but I’m experiencing a moment of technical idiocy.

edit: https://www.tmswiki.org/forum/threads/watch-these-two-tms-videos-and-all-your-questions-will-be-answered.17360/#post-92053 (Watch These Two TMS Videos and ALL Your Questions Will Be Answered)

 

Just wanted to point that I can really relate to what you describe here. I am not a triathlete (though I've dabbled in duathlons) but I have trained for ultra marathons so the principle is very similar. High training volumes, plus high intensities sometimes cause overuse injuries to raise their ugly head. After 5-7 years of learning to be "in tune with my body" to notice these niggles before they became full blown injuries - has also made me particularly prone to TMS (i.e. body/symptom focused).

Ironically, being an endurance athlete has also given me plenty of evidence that TMS can occur. What runner hasn't heard of "taper madness?" It's the onslaught of little aches/pains that come in the last 2-3 weeks before your big event (marathon, triathlon, etc), despite it being a time period of greatly reduced training (i.e. a "taper"). To the unitiated, these aches/pains can be of great concern, sometimes causing the person to do crazy things like cancel their race, or at least reduce their goals. But with a TMS mindset, it's easy to see why taper-madness occurs.

 

@Northy: I agree it seems totally logical/possible there can be a mix, or rather everybody has pains or discomfort from legitimate physical issues occasionally, but the difference being whether it becomes chronic or worse because you are obsessing about it, or get very anxious about it, or have a personality type that leads to that. But I also agree with the statements that the real problem is in your (my) head and is psychological, the hypersensitive fire alarm, or hyperfocus on what should be a trivial problem blows it up to something much more.

I went to a TMS doctor, Dr Harold Goodman, who basically said that, that some people may have legitimate physical issues that may or may not cause them actual pain, but have TMS loaded on top of that. I think he says that here:

https://www.tmswiki.org/forum/threads/any-luck-with-tinnitus.24767/#post-131980 (Any luck with tinnitus)

 

The medical community LOVES thoughts like this. Probably because deep down they know that they can't really predict who gets better and who doesn't; the only way they accept ANY psychosomatic anything is in conjunction with a "real' symptom . In fact, they absolutely reject psychosomatic symptoms if they don't have a physical diagnostic pedigree.

We always like to search for the reason for our pain...anywhere but the really scary place which is in our life sitting out in plain view. So much easier to have a 'syndrome' or a 'diagnosis'.

Virtually everyone on this forum came here with a 'real' diagnosis. Convinced by enough pain or desperation we were finally willing to let go of our old idea's and those of us who did are 100% free of that diagnosis. That includes the symptoms that sent us to go out and get it in the first place.

"I know I am wrong half of the time, I just don't know which half"

 

Oh man, can I relate to the "taper madness" (or taper tantrums)! As I mentioned above I only first learned of TMS about 6 months ago, and I haven't raced since that time, but looking back at my training and racing I've been seeing/recognizing so many examples of this. With hindsight it's actually kinda funny – it's amazing how the number and severity of the (phantom) aches and pains that showed up in the week before a race were in direct correlation with how much I cared about the race! Before a little local B- or C-priority race I wouldn't even do a real taper and I'd feel fine heading into the race. But if the A-race is coming up I'd be sure to have every single injury I'd ever experienced rear its ugly head and have me questioning whether I'm going to DNF! I'd complain to my wife and she'd say "you always feel like this heading into your races." It's as if she knew it better than I did. I'm actually quite curious to see what happens racing this year now that I'm much more aware of the situation.

I also agree that thinking back over my past training history gives me so much evidence of the reality of TMS. So many examples where I now recognize I'd get worked up about a particular ache, pain, sensation, etc. that it would take on a life of its own for months until, as if miraculously, after a key race I'd stop caring about or worrying about it and notice it was gone! So, so many examples.

Interesting you mention being "in tune with your body." As I've been reading more about TMS, mindfulness, and being grounded I've been trying to be more in tune with my body and my emotions while also trying not to reflexively judge them or react to them, but instead just observe them and recognize them. I'm sure I have a long way to go, especially since my default approach is to be overly analytical about things, but I do think in the long run it will be helpful. For example, my right hip had been bothering me for the past week or two and I was planning to take my boys (7 and 10) skiing at the local hill yesterday. I'd been fixating on the pain and trying to get rid of it all week, but it just kept waxing and waning. As we started skiing it was really bothering me and I was frustrated because my kids are really getting into skiing and I used to be a reasonably competitive freestyler. At one point I decided (or remembered) to stop trying so hard, just accept that I'm experiencing a sensation, and quit "walking (or skiing) on eggshells." Within the next couple runs the sensations were gone and I was back to hitting jumps and teaching them tricks in the park! It was both a corrective experience from taking my fear of the sensations head on and further direct evidence that the pains were simply TMS – after all, if the pain had a true structural origin I don't think jumps in a terrain park would be an appropriate cure!

 

Thank you for this video. I admittedly haven't watched it yet but I plan to tonight or tomorrow. The concept of a TMS hybrid, which sounds similar to the Dr. Goodman quote that hawaii_fiveO linked to, sounds like what I'm describing. I look forward to watching the video.

 

I probably should've phrased it more as "laser-focus on the body" as this was not a healthy "in tune" as I attempt to be from a TMS mindset. I think you get it though, all the stuff you describe about the many aches/pains that crop up in direct proportion to how much you care about the particular race. I have seen it in myself and I continue to see it in my training partners, listening to them as they near their particular A race. Funny, I used to think this kind of chatter was a type of "humble-brag" or trying to set up the race as some unachievable thing, and their overcoming these obstacles making it that much more of an achievement - but generally I think these are just normal reactions on their part.

But - from massage therapists to ART treatment to chiros to orthopedists to acupuncturists to foam rollers to trigger point tools to etc - there is a full-on cottage industry orbiting around endurance athletes. Triathletes in particular are known to have ample discretionary income to spend on treatments (not to mention bikes, and all their accessories).

 

Nailed it.