Alan G. Overcoming relapses

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Question

I've been dealing with horrible back and sciatic pain for over a year. I've read Healing Back Pain at least 3 times I feel like this is the solution, however after 3 good weeks I suddenly am going back to horrible pains/no new stress that I can think of/feeling a lot of anguish and sadness/any thoughts? I exercise twice daily and take tramadol at least once a day/so frustrating /like everyone I would like to have my normal life back it's unbelievable that the symptoms don't go away forever/my name is Debbie and I'm 56 yrs old.

 

Answer

Ah, the setback. Is there anything more frustrating than thinking you having your TMS symptoms on the run, and then having them come back with a vengeance? This probably happens with 90% of the clients I work with. As strange as this sounds, it’s actually good news. Those 3 good weeks you had is the experiential evidence you need to know that this is in fact TMS, as opposed to some structural problem.

So why did the pain come back? Debbie, you just had your first extinction burst. This is common, and in many cases expected.

The extinction burst is a phenomenon in behaviorism. When you stop reinforcing a behavior, you’d think that the behavior would just immediately stop. But they’ve found that that isn’t the case. When you stop giving a rat a food pellet every time he runs on the wheel, he actually runs harder and faster at first, before he stops running altogether. When you stop giving a two-year-old child candy every time he throws a tantrum, his tantrums actually get worse before they go away. No one likes to lose a behavior that’s working, so there’s a little resistance once the reinforcement is taken away.

How is this relevant to the pain? The purpose of the pain is to scare you, to bring you to a state of fear. When you take away the pain’s reinforcement (fear), the pain can come back even worse before it goes away. The mind does not like to lose a defense mechanism any more than a toddler likes to lose his candy-getting behavior.

So the real question is, how do you respond when the pain comes back? Do you resort to fear, dread, and preoccupation, or do you say, “Ha, I know what you are! You’re trying to bring me back to this state of fear. Give me your worst…I’m on to you!”

I used to teach parenting classes. I would tell the parents of tantruming toddlers to stop reinforcing the tantrum with candy or attention. They would, and as expected, after a little while the tantrums would get worse. Most of the parents would give in, and resort back to giving the kid candy. They got sucked in by the extinction burst, not realizing that they just had to hold out a little longer.

Most TMSers are absolutely beset by fear and preoccupation about their symptoms. This reaction, difficult as it is to resist, actually serves to reinforce the symptoms (see the article, Breaking the Pain Cycle for a more thorough explanation: http://www.tmswiki.org/ppd/Breaking_the_Pain_Cycle,_by_Alan_Gordon,_LCSW)

If after a successful break from your pain, you view your symptoms getting worse as nothing more than your mind desperately trying to bring you back to a fear state, like a two year old desperately trying to get that candy again, it's a lot easier to laugh it off and resist the fear. You know what it's doing, you're on to it's strategy.

We can either go through life scared, or go through life empowered. You can’t feel empowered when you’re in a state of fear, and you can’t be scared when you’re in a state of empowerment.

If you work toward honing a stance of empowerment, and work toward standing up to/not buying in to the fear, the dominos will start to fall. The purpose of the pain is to scare you, if you undermine that purpose by developing an empowered stance, the pain won’t have a leg to stand on.

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I'm right there with you, although I've lost track of which relapse this is... Now it's stubborn sciatica... I constantly think, no, not again...this relapse has been going on for two weeks now. The cause could be a number of different unresolved issues... Where do I go from here?

 

Alan describes a useful approach and I would like to add another. For some of my patients relapses occur because they have strong emotions (anger, fear or grief most commonly) that they do not fully recognize and so are not able to think or talk about. Consequently these emotions are expressed via the body and this is what causes symptoms (often pain but can be any of a variety of other symptoms). Most often the source of these emotions can be traced to adversity in childhood (or to a trauma in adulthood) which for some is obvious but others suffered a more subtle harm to the self-esteem in childhood. One way to assess for this is to imagine what it would be like to raise a child you care about exactly as you were raised. Would that be painful to do? Writing about that imagined experience (or your own personal experience) has helped a number of my patients recognize buried emotions and convert them from bodily expression into words with subsequent reduction in symptoms.

This is a lot to compress into one paragraph. There is more information at stressillness.com, unlearnyourpain.com and pathwaystopainrelief.com.

 

I get a relapse of back pain every time I get another bill in the mail. Or I fill out a form on the computer and just before completing it,
it vanishes. Or I lose something in the house and it seems it just vanishes.

The way I handle it all is to remind myself none of it is very important, if at all. And do some deep breathing for a while,
and they laugh. It's just not worth being troubled about. Jesus said we should live in the now. If the now means bills and other
bugaboo, let that part of now vanish. It usually does anyway.

 

Happy to have read this. Thank you Alan and all who replied. Alan, your answer explains SO MUCH to me of the "why?" of TMS returning. And, David, that exercise in reviewing childhood (even if it wasn't traumatic abuse) is brilliant.

 

I feel so inspired by this response. I recognize myself in this process hugely!

"We can either go through life scared, or go through life empowered. You can’t feel empowered when you’re in a state of fear, and you can’t be scared when you’re in a state of empowerment."

Yes. My new mantra. Thank you.

 

I'm having a relapse of worse back pain after around 3 months of drastically reduced pain that I thought I was completely in control of. Could this be an extinction burst even after 3 months? I know my pain is TMS as I have a few things going off emotionally that I can't change right now. Im feeling down and thinking I'll always have pain when things go emotionally wrong, and because I can't change them I'll be stuck with pain forever. I think this is feeding the pain. The above article really helped and reminded me I need to treat the pain with indifference. But I just wondered if I could still apply these principles after a longer pain free period?

Thanks

 

Whenever I take a road trip usually to see one of my children, I have relapses of migraines. I am on a trip now actually. I also have terrible asthma, allergies which make me sneeze and make the migraine worse, coughing, heartburn. I have felt out of control on this trip and I'm "afraid" it will ruin my vacation.

This is the perfect thing for me to read this morning. I will try the breathing. Be empowered.

 

Walt, are you saying that when you lose something and it seems to vanish, that this is related to TMS? I am very interested in this. It has been a problem my whole life!

 

Or did you mean that the pain vanishes.

 

Yes, absolutely.

I remember back a year ago when I had been about 2 months pain free on my lower back, which had started 15 months before. I was singing joy to the world and then I decided to jump a fence, not once but 5 times ( long story). Instantly my lower back pain showed up and I just knew that was it. Punished myself for weeks, knowing I messed it up after all that work. Well, when I stopped punishing myself and realized the TMS returned the pain ceased immediately. I have been pain free in my lower back for 11 months. It seemed the pain tried one last time in that spot, well I recognized it about 2 weeks in and was able to control my outcome.

Now , as you know, I need to apply the same principle, to my new found pain location. Easier said then done.