Christie U. The Challenges of Conditioned Responses

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Question

I was diagnosed with TMS and I have been having right lower back and leg pain for over 2 years.

Pain only comes in the following conditions:
- When I lay down in bed and then increases in the middle of the night
- When I get stressed
- AFTER I finish doing sports

Then the pain goes away totally. Even during sports practice I don't feel any pain.

Question: How do work on getting rid of the pain, especially when it comes programmed at nights?

I have read the Sarno books and watched the private session videos. I understand very well all what TMS is about, but the pain seems to be programmed/memorized.

 

Answer

Thank you for reaching out to us. It sounds like you are dealing with a few deeply ingrained conditioned responses, which are notoriously difficult to break. The pain is, like you mentioned, programmed to the activities that you mentioned (laying down and participating in sports). The reason that I note conditioned responses as particularly tricky to break is the mere fact that they have likely been reinforced hundreds and hundreds of times.

The first step to breaking a conditioned response is simply defining the pain as just that -- a conditioned response to a harmless stimulus. If you are diagnosed with TMS, then the pain that you are experiencing is not caused by the act of laying down or by the act of finishing sports. Rather, the pain is caused by the belief that these activities cause pain. If every time you go to lay down, there is some degree of expectation for pain, your brain will learn to fear the activity and activate your pain response every time you do it. Start by redefining these activities as safe and harmless to your body, and reminding yourself over and over again that it's not the laying down that's causing the pain, but the fear around laying down that's causing the pain.

Chances are that this knowledge will not be enough to sufficiently break the conditioned response. So what's next? PRACTICE! Every time you lie down and experience a pain increase, I want you to say to yourself, "Yay! A practice opportunity! It's time to re-program my brain!" Anything that can be learned can be unlearned. If you have learned to fear the activity of laying down, then you can also unlearn the fear around this activity. Every time the pain comes on after laying down, it's not time to get disappointed...it's time to get excited! What better time to break the pain cycle than while you are IN the pain cycle?

Instead of getting upset or annoyed the next time the pain comes on (which often sounds like "Ugh! I know laying down is safe, and that this is just TMS, so why won't it go away then?!"), try to hone a stance of genuine excitement that you have a practice opportunity to respond to the pain differently. The mistake that most people make is beating themselves up for the pain coming on, especially they when they know and believe their TMS diagnosis. We cannot control when the symptoms come on, we can only control our response to them. Frustration with the pain is just another manifestation of fear, and we all know that fear reinforces the cycle of pain.

You can also practice this when you wake up in the middle of the night and realize your pain has increased -- practice responding with confidence, free of fear, while honing a sense of excitement that you have a chance to re-wire the experience.

Best of luck. You've got this!

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