Emotions or Pain Pathways? Help! I am losing hope.

Thank you Duggit for explaining Butler & Moseley so well to us! I looked into one of Moseley’s book and could not make use of it at that time. How you explain their approach does really make sense and fits very good to Sarno’ and Schubiner’s approach. All three books seem to be an interesting reading!

 

Neural pathways, central sensitization, TMS, functional neurological disorder, somatization - they all mean the same exact thing. Don't get hung up on this. My favorite neurologist told me this after I said another doctor was looking to diagnose me with central sensitization - "That just means pain caused by your sensitive emotions. It's the same as my diagnosis." I also had a doctor at an ER confirm this for me.

Steve Ozanich himself agrees:

I'll quote one of my previous posts about central sensitization, as it applies to neural pathways as well:

I've spoken with some great doctors about this, and central sensitization is 100% caused by strong emotions such as fear and anger. Emotions that cause health problems mean - as we know all too well on this board - TMS! The brain is highly neuroplastic and can change anytime, making central sensitization a very healable condition. The brain is also extremely opportunistic, and loves to piggyback off injuries that have already healed.

In many ways, central sensitization is comparable to the football player who suffered an ankle injury that healed within a few months, but it mysteriously begins to hurt and become debilitating throughout his divorce a decade later. The only difference is that central sensitization makes it feel as though the injury never healed/the problem never resolved (I say problem because any TMSer knows that pain can start without an actual injury), despite the fact that it certainly did. Here's a description of central sensitization...

An injury that healed/a problem that resolved, but still pain? Classic TMS.

Ignore anyone who claims a "low cure rate" for central sensitization - that's only if the patient isn't made aware of neuroplasticity techniques and/or TMS healing. When one becomes aware of and truly believes in their ability to heal, healing happens every single day.

The same can be said for conversion disorder, functional neurological disorders, etc. Ultimately, the terms used to describe these conditions mean and point to the same thing: TMS!

Also, note that a variety of visible symptoms can occur in TMS. I had Raynaud's, mottling of the skin, white fingernails, sweating so bad it looked like I had just taken a shower or ran through a puddle of water, skin that dented very easily (from vasospasms), etc. All were TMS, and all went away once I relaxed and believed I could heal.

If your doctor says the inflammation is from central sensitization, you've got TMS. And that is 100% fixable.

 

Certainly, there are deniers of modern pain theory in the health professions. Butler & Moseley recognize this and put them into four categories:

1. They don't truly deny it but say they do because they think other people can't understand it.

2. They don't actually believe what they say but are frightened by the potential implications of it.

3. They find the concept too difficult to understand.

4. The deniers are correct. "There is a veritable mountain of evidence against this but we can't fully rule it out. [Modern pain theory] deniers, climate change deniers, flat earth deniers unite!" Explain Pain Supercharged p. 15.
​

One has to wonder if categories 2 and 3 might have something to do with Sinclair Lewis's observation: "It is difficult to get a man to understand something when his salary depends upon his not understanding it."

By the way, I specifically said not to abandon Sarno. I also tried to explain how Sarno's focus on repressed emotion fits perfectly well into modern pain theory as a subpart of it. Furthermore, Sarno recognized that conditioning is a cause of TMS apart from repressed emotion. See, e.g. Healing Back Pain pp. 21-23. If you invest the time to actually understand what Schubiner calls neural pathways, you will know that conditioning is simply neural pathways.

 

We have to remember that there is nothing new under the sun, that none of these ideas are new, and all that changes are our descriptions of them. (There is a fascinating book called The Wayward Mind by Guy Claxton which explores the history of our various understandings of the unconscious mind).

I have mentioned here before the books of a doctor and neuropsychiatrist called David Harrold Fink who wrote in the 1940's and 50's. His first book was called Release from Nervous Tension which sold more than 300,000 copies in America and Britain alone. His theory? That emotional conflicts produce bodily disease.

He went on to pen a couple more: Be Your Real Self and For People Under Pressure.

He fully acknowledged the neurology and went on, in all three books, to thoroughly describe the psychology behind the suffering. Although the books are of their time (reminiscent of Claire Weekes, her books were written in roughly the same period), the wisdom is exquisite.

I agree that the various theories can appear confusing, especially to newcomers, but this partly derives from an insistence that 'Sarno's theory is the only theory'. While it may be subtle it remains a devastating fundamentalism that can put the mockers on healing because it panders to obsessive thinking and perfectionism. There is no one way or one theory. There are nuances, and individuals, and preferences.

In many ways Sarno's work is a poor dilution of Fink. Fink's books are generous in explanations and ways of recovering and living a full and beautiful life. Sarno's are woolly and although based upon psychodynamic theory are surprisingly thin on suitable explanations. The literature of the time wasn't lacking and to have not incorporated it into the body of his work was an error. It left too many people vulnerable to a hope that was not fulfilled precisely because they had nowhere to rest their faith or build their belief. The mind~body prescription in his books was too vague and the notion that his word is inviolable (which has snowballed over time) has left many souls mired in pain, hopelessness and despair.

Steve Ozanich makes a valuable point when he discusses the obsessive mind. I fell into this pit myself when Sarno's theory and more specifically the remedies didn't work for me. I spent years mulling over the same things from the past, to the detriment of myself and my relationships. I see people make the same mistake all the time. This stubbornness *is* the problem and is exactly why people switch their obsession from 'finding the repressed emotion' to 'getting rid of neural pathways'. Once you see these for what they are, obsessive and ultimately self-destructive behaviours, then you free yourself on a basic level. The driving force behind pain is the same irrespective of the explanation.

To this end we should welcome advances and opportunities in the full understanding that each generation must evolve it's own ways of discovering and explaining their world. TMS is not a religion nor is it a science. It's one more turn of the wheel not a reinvention of it.

We heal when we take the pressure off ourselves. Fretting over theory is another form of pressure (and perfectionism). There is no need for it. When something jibes with you, go with it, in healing and in life and have the generosity of heart to grant others the same.

 

This sounds like the rage to soothe ratio, so elegant in its simplicity that it becomes the elusive obvious. When I focused on enraging memories, relationships, interactions and journeled the hell out of them my pain got worse and endured.

However when I gave all that up (thus releasing a ton of tension and pressure in that act alone), and naturally began to enjoy my life irrespective of the pain, my pain started to go away. Soothers are incredibly important. If only Sarno had devoted a chapter or two to them...

Could I trouble you to list the seven categories?

 

This is an awesome discussion and so helpful to me today. I'm in the middle of a really bad scapular flare (spasms from hell!). Typically, I journal during my lunch break. Frankly, I just don't want to do it today. I don't want to drudge up painful emotions on this dreary, rainy Friday. So instead, I'm going to close my office door and visualize something that makes me happy and gives me comfort. Maybe I'll go into Time2be's room filled with wood, books, and cozy fireplace (smile). Or, into a garden paradise with the sun on my face. And, I'll definitely check out Butler and Moseley.

 

Wow, this is incredible information! I read every word; thank you for sharing!

 

In addition to the four categories I listed above, a fifth is information provided by our five senses (vision, hearing, taste, smell, and touch). For example, if you see an x-ray that shows a bulging disc (vision) and your physician tells you that is causing your pain (hearing), that can be a DIM and make your pain worse. This category can overlap with the category I listed above of what you think and believe. Maybe you saw the x-ray and your physician said nothing about it, but elsewhere you had (mis)learned that bulging disks always cause pain.

A sixth category is things you say. An interesting element of this category is metaphors that we use without realizing their psychological impact. For example, “my knee is like a rusty hinge” and “I have a splitting headache” are DIMs. In contrast, “my meditation releases some pressure” is a SIM.

The seventh category is things happening in your body. Acute inflammation is an example. For many people this is a DIM, but it can be a SIM if you understand the biophysiology of acute inflammation and realize the healing process is underway. Obviously, this category also overlaps with the category of things you think and believe.

Regarding the rage-soothe ratio, the only place I am aware of where Sarno discusses it is on page 29 of The Mindbody Prescription. His discussion is brief (2 paragraphs) and seems tentative—“I believe a rage/sooth ratio may play a role in determining when physical symptoms will occur.” (I added the emphasis.) By the rage part of the ratio, I think Sarno means the reservoir of rage—“Patients frequently ask, ‘Why did the pain start now?’ Invariably I reply, ‘Because your rage has reached a critical level; because it now threatens to erupt into consciousness.’” As for the soothe part, Sarno refers to “pleasant elements in a person’s life,” and on page 29 he lists six basic human needs, one of which is “To be soothed (so we seek gratification through food, drink, smoking, sex, entertainment play.)” For Butler & Moseley, the concept of DIMS is much broader than accumulated anger in Sarno’s reservoir of rage, and the concept of SIMS is much broader than pleasant elements in one’s life and gratification through food, drink, etc.

Now for something I think is quite important, namely, a congruence in Sarno’s and Butler & Moseley’s approaches. For Sarno, the key to treating TMS was educating patients about “The Psychology of Psychosomatic Disorders” (to borrow the title of chapter three in The Divided Mind.) In chapter four, he wrote: “It soon became evident that knowledge was the key to treating TMS. . . . Another crucial therapeutic element became clear early on as well: the person must not only understandthe nature of the process but be able to fully acceptit as well.” (The emphasis is Sarno’s.) As far as I can tell, Sarno does not regard patient education about the process as fitting on the soothe side of the rage/soothe ratio. It is instead the key treatment. For Butler & Moseley, educating patients (albeit about the biopsychosocial model of pain and its neuroscience of basis), is a gigantic SIM if they understand and accept it. But education is their key treatment.

To finish on a bit of a tangent, I think the big difference between Sarno and Butler & Moseley is that they come from different eras. Sarno was a brilliant clinician and keen observer of what did (and did not) work with his TMS patients. He naturally wanted to place what he was seeing with his patients into a coherent conceptual or theoretical framework. The best such framework available at that time was Freud’s hydraulic model and structural theory. Hence Sarno’s reservoir of rage, id-ego-superego conflict, and pain as a defense mechanism. I think Sarno’s reliance on Freud, together with the dominant view in the medical establishment that Freudianism is “unscientific,” accounts for much of Sarno’s lack of success in gaining acceptance by the medical establishment. A fond remembrance of Sarno written by a former patient upon Sarno’s passing that appeared in the New York Times Magazine recounts Sarno’s lack of success in that regard and how “enraging” it was to him. His medical colleagues at NYU regarded him as a laughing stock.

Within the last two or three decades, neuroscientists have learned much about the neuroscience of pain that was unknown during Sarno’s era. With this new body of knowledge available, reliance on Freudian theory is no longer necessary to explain what is going on with psychosomatic pain. Butler & Moseley pay no attention to Freudianism but rather focus on the biopsychosocial model of pain and its neuroscience foundation. While I believe their regard of emotions as DIMs and SIMs is implicit, I wish they would have given some explicit attention to that. More important, though, I think they undoubtedly would agree with Sarno that patient understanding and acceptance of the process that produces psychosomatic pain is the key to treatment. Perhaps their neuroscience foundation, rather than Freudian foundation, will lead to greater acceptance by the medical establishment than Sarno achieved.

Aside from the medical establishment, what about patients? In the Divided Mindp. 6, Sarno wrote: “After many years of experience it is our impression that not more than 10 to 15 percent of the population would be willing to accept a psychosomatic diagnosis.” I noted earlier that David Butler got a Ph.D. in education to further his “professional love of devising ways to take the complex ‘gifts’ of neuroscience to students, clinicians and sufferers in ways that can change their lives.” Perhaps Butler’s tips in chapters 8 and 9 of Explain Pain Supercharged about educating patients could raise the percentage. (To temper over-optimism, Butler admits that some people’s misconceptions about pain are so strongly held that the most one can do is plant a seed and hope it will flourish at another time and place when the situation is right for that person.)

 

@Duggit.

Thanks for this elaboration. It's a shame that Butler and Moseley's work is less available. A quick look on amazon UK puts their books well out of my price range so I do appreciate the time you have given to further the explanation. Who knows, maybe a second-hand book-buying sortie will yield fruit. I am often lucky in such ventures.

Yet if Sarno had explored Carl Jung he would have found a more promising vein.

Here is Jung writing on the nature of the unconscious (emphasis mine):

"The unconscious is the psyche that reaches down from the daylight of mentality and morally lucid consciousness into the nervous system that for ages has been known as the "sympathetic".

This does not govern perception and muscular activity like the cerebrospinal system, and thus control the environment; but, though functioning without sense-organs, it maintains the balance of life and through the mysterious paths of sympathetic excitation, not only gives us knowledge of the innermost life of other beings but also has an inner effect upon them. In this sense it is an extremely collective system, the operative basis of all participation mystique, whereas the cerebrospinal function reaches its high point in seperating off the specific qualities of the ego, and only apprehends surfaces and externals - always through the medium of space.

It experiences everything as outside, whereas the sympathetic system experiences everything as an inside."

~ Carl Jung

Which is not to say that Jung was viewed in a more credible light, more that he was on the right track. Indeed when I was a Psychology Undergraduate in the early 90's any and all of the Psychoanalytic theories were considered nonsense. They were accorded one lecture during the six week Introductory period, to be followed by Behaviourism and then onto the Phenomenological theories.

So even had Sarno cast his net wider, the same ridicule and rejection would have doubtless prevailed. How does the saying go? "Science progresses one funeral at a time". Dark thoughts for such a bright day.

 

Hi Kerrj74,

I might be totally wrong, but what comes across from your original posting is that you seem to have jam-packed a whole lot of stuff into your 2 or so years of using TMS techniques, which to me smacks of pressure, pressure, pressure. I'm aware that I'm not really 'qualified' to give any advice because I've been doing the TMS approach for a lot less time than you and I'm not cured from my own chronic pain (fibromyalgia and chronic pelvic pain) but I know that my mind/body rebels when it's under pressure...So I was wondering whether there was anything that you did TMS techniques-wise that, although it didn't reduce your pain at the time, you found peaceful/pleasant/enjoyable? If so, perhaps it might help to concentrate on regularly doing that and only that (or at most a couple or so things that you've liked doing) for a while to take some possible 'steam' out of the situation and possibly put at least a tiny glimmer of joy back into your life.

I've only recently joined this excellent forum and, what with all the helpful suggestions people were kind enough to give me, was feeling somewhat overloaded with all the possibilities of what might work for me...And then I thought: 'just try some things and see what gives you some enjoyment and/or peace'. So, I don't know whether they will work for me to cure my own chronic pain but - because I tried them and like doing them - I've now whittled it all down to just doing three things each day, which I'll possibly change eventually if I don't see any long-term results, i.e. the savasana yoga pose http://yogaartandscience.com/poses/restpos/shavas/shavas.html (Shavasana) which I find relaxing and Rick Hanson's 'Take in the good' (he has videos about this on YouTube) which lifts my mood (both of these were either mentioned or suggested by Plum) plus a visualization exercise of my choosing which I will vary (but at the moment I'm using Dr James Alexander's Guided Imagery for Chronic Pain - an mp3 that I downloaded from his website https://www.drjamesalexander-psychologist.com/apps/webstore/products/show/3402664 (Dr James Alexander)). (I expect you've heard about these things before, but I thought I'd just mention them anyway.)

With regard to pain pathways, have you read Norman Doidge's book called 'The Brain's Way of Healing'? In case you haven't, this article covers the first chapter of the book, which tells of a physician called Michael Moskowitz who stopped his own severe back pain by using the neuroplasticity of the brain and he has apparently helped many of his patients to stop their pain too https://www.theaustralian.com.au/news/health-science/training-the-brain-to-beat-pain/news-story/45ad7b7daaaf3c4bbbab6c76b0190ac7 (Nocookies) and this is Moskowitz's website http://www.neuroplastix.com

All the best...

 

Kerry
Thanks for starting such a great thread. Lots of food for thought and useful information.

I too am still suffering from seemingly intractable pain from hip/back-sacrum/thigh pain and try as I might, find myself frustrated more than not.

I thank Duggit for his/her insight and great information on the DIM/SIM theories from Butler and Moseley, Plum for her sound advice on the downside of journaling our negativity, and the lead to David Harold Fink's books on living pain free and learning to be our real selves, BloodMoon for her sharing of her current practice, including Shavasana yoga, Rick Hanson's videos and Alexanders guided imagery for chronic pain, along with Caufield's great discussion on central sensitization. The comments and suggestions from the other forum participants also rang true to a real interest in what is one to do with seemingly intractable pain. Is there hope? What is best? How can we progress in this world of ever growing information on how our brain has created this conundrum we call TMS.

I appreciate all of the varied comments. I understand being weary of the negative journaling, the questioning of whether or not my belief in TMS based on solid ground. My general distrust of the opinions of doctors notwithstanding, how do I make sense of my pain, your pain, what is it that is driving me to continue in this cycle?

So, thanks to all, thanks to you Kerry for being bold enough to admit to your dis-ease in your understanding of this seemingly ever-changing strategy we call TMS. I wish you the best, I wish you joy, and a future that can be rid of this pain you have been suffering.

Kind regards to all,
Lainey

 

Hi @Caulfield,
Did the mottling look like livedo reticularis https://www.mayoclinic.org/livedo-reticularis/img-20006069? (Livedo reticularis) (I ask because I have this on my thighs.)
Thanks in advance.

 

i want to ask a question about this. i see a lot about journaling. however, the few times i tried it, i found myself constantly returning to a certain topic. i'm dating a person who hurt me really bad a couple years ago, and we never really resolved the issue. it led to some trust problems that exist today (though, because we have such strong feelings for eachother, we never broke up, and i still dont feel like want to break up). There was another person involved, and she still is "around" because of the circle of friends, and i have such pent up rage for this person, and i find myself just writing scathing awful things about her and him, and the situation. Like i said, there was never really a resolution to the issue, it just sort of...faded away without a real fix. Do you think writing hateful, angry things out on paper is even helpful? to me, i feel like it's just rehashing old feelings that i should just let go. But since the guy never really admitted fault (i think he's a little dense sometimes, has trouble understanding things from other people's perspectives) forgiveness has been hard. My pelvic pain had been dormant for a long time, but "woke up" during this relationship. When we're together, we have a lot of fun, but when we're apart, i feel so angry and hateful and just cant forgive. I have a feeling it's keeping the pain alive. i dont know how to let it go.

 

It sure did! This is also a common symptom in Ehlers-Danlos, which I have. I could easily blame it on that, yet it does decrease with stress.

 

Thanks @Caulfield. Mine's been blamed on my having 'fibromyalgia' so, hopefully, as fibromyalgia = TMS, it might eventually disappear.

 

Fibro is 100% nothing more than TMS. It’ll go away.

Ehlers-Danlos is structural, but I suspect the fact that we’re more prone to autonomic and adrenaline dysfunction makes us perfect TMS candidates. Many (not all) of the symptoms are worsened or even initially caused by stress. So many of my symptoms calmed down or went away as I relaxed and better handled my emotions. If you have autonomic and adrenaline issues, not relaxing or handling emotions is playing with fire!

 

It's good to hear that the symptoms of structural conditions could improve with doing TMS techniques. In my case, I have sero-positive hypothyroidism (high TPO anti-bodies in my blood) and sero-negative Ocular Myasthenia Gravis. As I'm sero-negative for the latter, I'm hoping it will turn out to be TMS. (Ocular Myasthenia causes constantly present, but wildly fluctuating, binocular double vision and droopy eyelids; my neuro-ophthalmologist at a big teaching hospital in London said it was the worst case of the disease symptoms-wise that he'd ever come across...maybe that's because it's not the right diagnosis...I live in hope )

 

[QUOTE But since the guy never really admitted fault (i think he's a little dense sometimes, has trouble understanding things from other people's perspectives) forgiveness has been hard. My pelvic pain had been dormant for a long time, but "woke up" during this relationship. When we're together, we have a lot of fun, but when we're apart, i feel so angry and hateful and just cant forgive. I have a feeling it's keeping the pain alive. i dont know how to let it go.[/QUOTE]
This is not a question of journaling, the question is why you want to be with this guy? Maybe your body tells you something? And you could be together with him and being angry (because that’s what you are- you cannot just get rid of this emotion). And then again! Why being with someone who makes you feel like that? Apologies if I am too frank.

 

How are you doing with the myasthenia gravis, BloodMoon?

 

I'm doing just the same, I'm sorry to say...but thanks for asking. Have you got a particular interest in myasthenia gravis, Dorado?