Could really use some advice

Hello all. This is my first time in this forum and I'm searching for some advice. I feel rather hopeless at the moment.

My lower back pain began one year ago on my left side, running down my left leg (sciatica?). It became difficult to sleep on my left side and sitting for long periods caused pain. Prior to this, the only back problem I'd had was a very stiff back after sitting for prolonged periods. But that was more of a difficulty fully straightening out than actual pain.

When the lower back pain began, I remembered hearing about Dr. Sarno and read his first two books. TMS made sense because I thought I could pinpoint a specific emotional trigger that immediately preceded the onset of pain. I also went to see a physician who worked with Sarno and contributed to his latest book. She also diagnosed TMS.

Over the next several months the pain was present, but not as bad and I was able to workout (lifting weights, running on the elliptical, sit-ups). But then in August the pain shifted to my right side and into my right leg. It became so bad that walking was painful and by September I had to cease my workouts entirely. Unlike before, sleeping on my side and sitting was now fine, but laying flat on my back became too painful. The fact that my pain shifted helped reinforce the logic of it being TMS, but the pain was so great I still may have had doubts.

I had my primary care physician order an MRI in December. I was most concerned about something much more serious, like a tumor. I thought if I ruled that out, I could fully accept the TMS diagnosis. Much to my relief the MRI showed nothing life-threatening, but did show a serious L4, L5 herniation. That reinforced my doubt and I went back to see the TMS physician who again assured me it was TMS.

The pain remained, worsening, and since I was having trouble walking without a limp and standing straight, I went to a chiropractor. After 12 sessions there has been no improvement. He referred me to a spine and pain center. Yesterday the physician showed me the cross sections of the MRI where the herniation was occurring (represented as a dark space where the fluid was leaking out and pressing on my nerve). He told me surgery may be necessary if it doesn't heal on its own (50-50 chance) and that I was at risk of "Cauda Equina Syndrome," where I could develop numbness, weakness, or loss of bowel or bladder function.

That sort of freaked me out and I don't know what to do. TMS makes sense on a conscious level, but I don't know how to make myself a believer in my subconscious mind. And now I have concerns as to whether the MRI shows a truly physical problem, even though I understand Dr. Sarno explains that most of us have these deformities in our spine due to the aging process.

Sorry for the long history. Has anyone with a similar MRI/herniation recovered by accepting TMS? Are there cases where a herniation is so severe that it really is a physical problem that needs to be treated with surgery rather than TMS?

- Mark

 

Hi Mark

I'm afraid I have no personal experience of the disc herniation scenario, but I would strongly recommend you read "The Great Pain Deception" by Steven Ray Ozanich who describes in great detail about how he overcame years of chronic back pain supposedly due to herniation etc, with TMS healing.

Myself I had chronic migraines and severe "fibromyalgia", which is the "cash cow" term for several TMS symptoms at once. I had pain, numbness, weakness, trouble walking, standing, sitting, sleeping, driving and living all without a herniation diagnosis. I also had bladder control problems. I'm 80% better and counting with TMS healing.

I self diagnosed in order to get well, I didn't have access to a TMS doctor to reassure me. I would go back to your TMS doctor again before you decide your next course of action.

I wish you well, and send you my love & blessings

 

Everyone has a degenerate L4/L5 after their 20th birthday. Of course, I'm not a physician and can't diagnose or treat, but these do sound like typical scare tactics. "Numbness, weakness, and loss of bowel and bladder function" can be due to the symptom imperative moving TMS symptoms to new areas too. This is entirely your own choice about whether to submit to surgery or not, but, as Mermaid recommends, I'd take a good long look at what Steve Ozanich has to say about herniations in his TMS pain recovery autobiography, The Great Pain Deception (2011) first.

 

Bruce, Can you explain symptom imperative. Is this a good thing and why?

 

I had a ruptured disc L4L5 20 years ago. I had surgery but unfortunately I was still in chronic back pain for several years after the surgery. I have had all kinds of pain syndromes since then and now clearly know that I have TMS. This last year I had severe rights sided shoulder/neck/head pain. Numbness in my hands, side of my face, front teeth. I had a cervical MRI shortly after I started working on the TMS(to rule out tumors etc) that showed multiple herniated discs and also had a really difficult time not thinking structurally after the MRI results. I stuck with the TMS work though and here I am, 9-10 months later with only occasional pain in my shoulder/head. The numbness has been mostly gone for quite a while. Although I find when I write or think about it, it sometimes returns for a day or two. I am now completely convinced that the herniated discs are not the cause of my pain and numbness but it took some time to get here. Have you taken a look at Back in Control? I highly recommend that book as well.

 

Gladly G.R.! On p. 48 of The Divided Mind (2006) Dr Sarno himself does quite a good job of explaining the workings of the "symptom imperative":

"Because of the importance of the symptom imperative, I'm going to repeat the rationale behind it. If the psyche has induced a physical symptom (such as back pain) or an emotional symptom (such as depression), which is then temporarily relieved in some fashion without dealing with the underlying emotional dynamic [my italics], the psyche will simply create another symptom to take its place. For example, if surgery is employed to relieve back pain due to TMS, it will prove to be only a placebo 'cure,' and similarly, if Prozac is used to treat depression, it will prove to be only a chemical 'cure.' In both cases the patient will soon develop new symptoms. The TMS and the depression are not disorders in themselves; they are symptoms of unconscious conflicts and must be treated with psychotherapy to avoid the inevitable return of new symptoms."

Of course, I've read about the symptom imperative before in Sarno and understand the concept behind it, but never realized exactly how it worked until I recognized it in someone I knew named Janice P (name changed). She has a PhD in micro-biology and works at a prestigious biotechnology company in the Bay Area. She comes from a large but very poor Italian family on the East Coast and had to really work very hard to gain her degree, which she used to really improve her financial status with tremendous zeal. Well, lo and behold, just when she was beginning to research her dissertation thirty years ago, she began having "back problems," which required constant trips to chiropractors, acupuncturists and massage therapists. It goes without saying that Janice is an ambitious perfectionist who's very, very hard on herself, working many long hours on numerous scientific experiments. About two years ago, she partially tore the rotator cuff in her left arm while indoor rock climbing at a local gym. The doctors told her to take it easy, do PT shoulder exercises and let it heal itself. Well, after a year, the pain was still there, so she had a rotator cuff operation and the pain disappeared. Now move ahead two years. A new pain began to develop in Janice's right shoulder. Again, the doctors advised rest and PT exercises, but after a year the pain was still there, so she had a second shoulder surgery, only this time on the right side.

If you look at this as an example of Dr Sarno's symptom imperative, it all becomes quite clear what happened. After the first operation fixed the problem in her left shoulder, Janice's psyche moved the pain to the other side, to her right shoulder. Since both rotator cuff tears were only partial, there was no real physical reason why they both didn't heal themselves with 6 to 8 weeks rest and a bit of physical therapy to regain strength. Since Janice already had an ongoing back problem, it is very tempting to diagnose her as having TMS that manifested first in one shoulder and when that was fixed with the very strong placebo of surgery, the pain moved next to the other side. Her hard-driven ambitious, perfectionist personality was what really caused Janice to focus her attention on her shoulder injury so much so that it wouldn't go away in a normal course of time. Interesting to note how her back problems began in grad school when she was really bearing down on her dissertation topic and that her second surgery occurred about the time of her retirement. I think the first shoulder surgery took place at around the time she turned 60.

Incidentally, it was amazing to watch Janice's story unfold in light of what I knew from reading Dr Sarno's take on the symptoms imperative. All I needed to do was hint to her that there might be something psychological behind her back "problems" for Janice to go into a towering rage: "I'm a scientist! I know about the concept of the placebo!" And of course scientists are always dead certain about being correct, right? But they really shouldn't be given the tentative nature of the hypotheses behind the scientific method, which are never fixed but always subject to revision in light of new discoveries.

Hope this gives you a better idea about the concept of the symptom imperative G.R. And, to answer your question, no, the symptom imperative is obviously not a good thing; that is, unless you understand what's happening and don't get suckered into having an endless series of surgeries to cure symptoms that are essentially psychological in origin.

 

One good thing about the symptom imperative is that it is a clear sign that TMS is at work, and there is not a physical/structural problem.

 

Hi, Markt54, You sure got a lot of diagnoses from doctors to scare you.
No wonder you're in pain. You could have been without any pain before you saw them
and they would have given you pain.

My suggestion is believe 100 percent in TMS from repressed emotions and journal about what
they might be. They often go back to our childhood and some have said it even goes back into
when we were in our mother's womb. We inherited her TMS stresses.

Don't let doctors or anyone make you think your pain is structural. It's from your repressed emotions.