New member - input welcome

hi everyone - I'm new here and was hoping for some input from experts on what I suspect is likely a relapse of TMS affecting my low back.

Short history: I've had low-back pain intermittently for roughly 25 years. Mostly I'm fine but every so often it gets really bad. Imaging shows some moderate disc degeneration at L4-L5 and some mild disc protrusion in L3-L4 and L5-S1 but nothing dramatic and the MRI results haven't changed over time. I initially tried all the usual medical stuff - PT, chiropractic, etc - but nothing provided lasting results. I discovered Dr. Sarno's book about 7-8 years ago and concluded TMS is the most likely diagnosis. I definitely have a "Type T" personality! Since then, when my back started to act up, I would re-read several sections of the book, repeat the daily affirmations for a bit, and things would resolve. I had a pretty bad flare in 2024, probably related to work stress, and fell back on some conventional things for a bit but then got back on track with the TMS approach and got better.

Current situation: In mid-March, I had probably the most serious flare I've ever had - I was literally yelling, the pain was so bad. Reading the book and the affirmations did nothing. I happened to be seeing a PT for other reasons so I talked to her about my back and she diagnosed SI joint instability and gave me some exercises (very mild as the pain wouldn't allow much). I started getting better but then relapsed badly after about 10 days. Ended up on muscle relaxants and Aleve just to get through the day (and night).

My questions:
1. I accept that the disc issues aren't causing the pain - it doesn't make sense that they would be the cause since the disc changes are there all the time and my pain isn't. But that knowing isn't helping me deal with 10/10 pain from severe muscle spasms. I find myself having much more of a "fear" response to this pain than I have in the past, and I know that's counter-productive. When simple "education" isn't working, what are suggested next steps?
2. My understanding from Dr. Sarno is that the physical component of TMS is due to oxygen deprivation. He's pretty clear that there is no inflammatory process or other physiological changes. But the most helpful thing for me has been OTC anti-inflammatory meds. Furthermore, the PT and physicians who have examined me clearly find palpable muscle spasms, trigger points, and spinal instability, which suggests something physical is happening in my back even if something psychological/neural is the root cause. Has thinking around inflammation in TMS changed at all since the original work?

I just bought David Schechter's MindBody Workbook to try that approach and am looking to see if there are any TMS-focused therapists/counselors in my area who might help dive deeper into the emotional vs intellectual aspects. Any additional feedback or ideas welcome! Thanks all!

 

I’m pretty sure this is outdated.

I’m just gonna let the experts take care of ya.

Most likely the first tip will be to start the SEP

Good luck! Hope I’ll see you around

 

Why else are you seeing a PT? Is that reason TMS or is it simply reinforcing the idea that something is "wrong" with you?

What else is going on in your life that causes you stress or anxiety? How are you feeling aside from the relapse?

"My understanding from Dr. Sarno is that the physical component of TMS is due to oxygen deprivation." No, this is not and never was the true reason...in a way. When people experience anxiety, their breath rate changes and we may either have a little lower C02 or have more (because we don't exhale fully) - it's simply part of the fight/flight mechanism.

My suggestion is to start going through Dr. Schecters book - and if you are struggling and need re-assurance, email him and see if you can book a call or Zoom. I'm not his patient, but I've seen him speak, and he is re-assuring. Personally, I think that if you are having relapses you might not attend to your emotions and your stress as much as you need to. You may have personality traits that tend to assist the build up of stress (interpersonal skills and understanding your traits and where they can help or hinder you can be very valuable). You may have some deeply held beliefs that (may be subconscious or unconscious) that keep you in certain patterns - especially perfection (since you mention "type T" personality).

I'd steer clear of focusing so much on the physical. Your focus on the physical is a pointer to the fact that you still believe on some level that there is "something wrong".

@Mani suggested the free SEP here, and Dr. Schecters book is very similar - there are differences but I don't think that matters much. As you are working through the book you might explore ways to move your nervous system from fight/flight to rest/digest - for some people that's sports, meditation, music, writing, walking in nature, creative hands on stuff: woodwork, art, craft - things that get you out of your head a little bit. You might also explore a little self-compassion if you tend to be hard on yourself (even in subtle ways) - relapses are tough, they suck!

I found that learning some interpersonal skills (that TMS work doesn't teach eg. boundary setting and keeping) and figuring out how to use things like perfectionism to my advantage (this is a method called Gallap, generally available for professionals. I just read up on some of the gysts of it and use them to my advantage!) and disengage where they don't serve me has gone a long way after doing the "meat and potatoes" work of TMS stuff.

You'll get this!

 

Agreed - TMS can cause real physiological changes, but if you agree that the psychological is the root cause, then that's the answer and you don't need to focus on what it's causing (unless it's medically dangerous, but 99% of the time it isn't). If the solution isn't in the physical then what TMS is producing physiologically isn't all that relevant for recovery.