Evidence sheet

I redid my lists tonight for JournalSpeak. I've also been reading Unlearn Your Pain and decided to do an evidence sheet from Schubiner's lists. It got lengthy. I'm still in a place right now where I'm more doing this for anxiety than pain relief, but it was a lot. Thought I might share if that's okay. I can't remember when most started so it was hard to do his section on connections to events or emotions, indicated what I remembered.

Symptoms/syndromes
acid reflux
abdominal pain (high school, pressure to get scholarships)
IBS
tension headaches
migraine headaches
anxiety and panic attacks (started after abusive relationship and cancer dx)
obsessive-compulsive thought patterns (same as above)
eating disorder (after major weight loss)
trouble sleeping
back pain
neck pain
shoulder pain (when fiance moved in with me from another state)
caramel
carpal tunnel syndrome
TMJ
chronic tendinitis
numbness, tingling sensations
fatigue
muscle tenderness

Test and evaluations
Left hip MRI (FAI, arthritis, labral tear, hamstring tendinopathy)
Right elbow MRI (low grade common extensor tear/tennis elbow)
Lumbar MRI (two bulging discs)
Cervical MRI (three bulging discs, one with ventral cord effacement)
Thoracic MRI (one minor bulging disc, syrinx ruled as incidental)
Left lower body NCV (normal)
Right arm NCV (mild carpal tunnel)
Multiple EGDs (negative for Barrett's, bile reflux)

FIT criteria
Worse first thing in the morning and at night
Sometimes "mirrors" to other side
Affects almost entire right side
Spreading
Down whole right arm
Many body parts
Electric, burning, hot
More pain after exercise than during
Increase with stress
Increase before work
Increase thinking about exercise

Personality traits
Low self-esteem
Perfectionist
High expectations of self
Wanting to be good or liked
Frequently feeling guilt
Conscientious
Hard on self
Overly responsible
Difficulty making decisions
Difficulty letting go
Tending to hold in thoughts or feelings
Tending to harbor rage or resentment
Not standing up for self or expressing true feelings

 

That's good. I find it helpful with my evidence sheets to create categories for Pro/Con whether it is or is not TMS. I try to be honest about both columns.

Examples for my knee pain:

For TMS diagnosis:
- Pain moves around (not always in the same spot)
- Comes and goes seemingly randomly
- Hurts most at odd times (like at rest or when sitting)
- I'm a TMS prone personality per Sarno
- Pain never goes beyond a certain level
- Pain goes away in certain circumstances (when distracted or when another pain pops up)

For actual structural diagnosis:
- Pain worsens after activity
- Hurts in certain specific movements
- NSAIDs make it feel better
- Visible swelling (this is controversial as apparently TMS can cause actual swelling)

 

I'm a huge fan of evidence sheets. I agree with Mr. Hip Guy. You may want to take note of inconsistencies with your symptoms. I'll share a few of mine from over a year ago that may be helpful:

- Sat forward in the tub with no abdominal or back pain tonight (if it was structural the pain would be consistent every time)
- Acknowledged and moved on with my life and my rib/chest tension went away or was less extreme
- Pain moves around day to day (back to pelvic, pelvic to knee). If it was structural, it wouldn't be so inconsistent.
- Pelvic pain moved to knee on my walk and then down to my ankle. So funny!
- Pain completely disappears when I was doing my hair and makeup to go out. I was excited and engaged in doing something I loved again and when I went out, it didn't come back!
- Pain completely went away when I read my favorite books. Wouldn't the pain be there regardless if it was structural!?
- Why did the back/pelvic pain move to my foot when I read the MindBody Prescription while telling myself (verbally) that the pain isn't structural & to cut it out!?
- Pain down = anxiety/OCD increase
- Focused on deep belly breathing and pelvic pain calmed down

Even when I was putting down things in my evidence sheet, my mind would argue with me and try to steer me away. It takes time for things to sink into your brain and to break habits. But we have more power over our minds than we think.

 

I thought more pain after activity than during was a TMS sign, at least according to Schubiner. Thank you for sharing this.

And thank you, @HealingMe!

 

Not sure about Schubiner but I'm used to having actual injuries (stress fractures, etc) that would hurt after activity and then level off. Rinse and repeat. But I can see what you mean, in this case you could put it in both columns as long as you know the context.

 

Yep... When I had my first Knee issues , I remember looking down and thinking 'This can't be TMS...it's all swollen and ugly'

I got better and quit looking at my knees for awhile. After It was gone, I looked down and my knees were still swollen and ugly???

I have been going through this with my hands. They both look bad. Like I got hit. However, when I didn't treat or address the first one because it didn't hurt, the OTHER one swelled up and did hurt. They look identical....THAT is a TMS giveaway. Why do I need this distraction?
That's too long of a list for this post.

A herniated disc is 'real' but doesn't cause pain...my swollen knees are real, and I am in No pain. Why would this magically hurt?
Oh yeah...those 'ten thousand things' to quote Lao-Tse

I have had 100% pain free days. Guitar, jack hammers, throwing balls...nothing. Then where I am literally doing nothing? "Ow." and THEN I look at the swelling. It's like my own little personal circular thinking module. Who came first, the chicken or the egg? When your being needs a distraction, your body will keep amping up the volume until you finally 'Hear' what it is saying.

I read him. I am not sure HE fully embraces the scope of TMS. I know that sounds cocky coming from a construction worker, but He just seems to qualify too many things as 'real'. He doesn't seem to be able to let go of his earlier training as an MD. Or maybe he's just covering his Butt..which is also a TMS trait...perfectionism

A forum bro sent me a link to a century old book by one of the earliest MB advocates. They thought EVERYTHING is a result of an unconscious drive. I tend to agree with them. If I paraphrased him here? You guys would think I am nuts. But he sure hit a lot of nails on the head. And he discusses swelling very early in the text, as being of psychogenic origin

 

I just listened to a "Mind and body fitness" podcast that was a re-air of an interview with him from a few years ago. I'm with you, again I'm not too sure about Schubiner. Was it him that coined the phrase "the investigation is over" for when you've determined a facet that makes your chronic pain TMS? If so, I like that one.

 

I started listening to that podcast on your recommendation.

 

If you really think about it, it shouldn't be so hard to believe that a mindbody condtion that can cause the following could also cause swelling:

- Pain
- Migraines (including visual/aura migraines)
- CRPS/Dystonia (hands/limbs deforming and seizing up)
- Blood rushing to the face turning it red (i.e. blushing)
- literal water to flow out of the the eyes (i.e. crying)

 

100%!!!

 

I don't think that can't happen with TMS?
The pain is real, so painkillers can work, and certain movements can put pressure on nerves, muscles, whatever, and sensitized brain perceives it as danger. That's my understanding of it.

 

I see your point, but I traditionally view TMS pain as mostly immune to NSAIDs.

 

NSAIDs working can also be a placebo effect.

 

I witnessed TMS backpain was temporarily relieved with high dose of aspirin, whether it was placebo or not, the pain was real and the pain was cured by Dr. Sarno's method.

 

When I have gotten Hit and have a Gnarly Bruise, Ibuprophen seems to make it stop throbbing a little. But when I have TMS it doesn't seem to do much. When I had OMG kill me neck spasms late year I did take some Aleve....The chemical in it used to be prescription and was a muscle relaxer. I am not sure it helped, as I knew it was TMS, but I needed to try anything just to get a moment to think, meditate,etc. It made me drowsy, that's for sure.
I didn't for a second doubt it was of emotional origin, I just didn't have any Dilaudid lying around (LOL)
Sarno said he did prescribe painkillers for the acute portion, but just to wait it out until the spasming stops.

Yep...or Chiro, or OTC supplements. I think it really has to do with our beliefs. I have seen a lot of people get over their TMS quick just by being told (and believing) it's not physical. I used to think all of the miracles in the Bible were metaphors. I no longer think that.

 

Real talk, only reason I stopped taking NSAIDs is because I have a history of ulcers and I can tell when things are getting rough in there again. I still take Tylenol here and there.

 

Sometimes when I’m in a lot of pain I take Motrin before bed. I know it’s not supposed to work on TMS but I think it’s a placebo and it does help me sleep. Lol