As part of getting back to normal life, should you push through pain?

[tag24]

From what I gather, there are two schools of thought on this. I've read through old posts here on the subject from 2015-2019, but I'm curious what the (current) consensus is versus 6 or so years ago where most of those old threads originate. TMS theory these days appears to be split between "don't push yourself too much because the pain is a danger signal and we want to gently guide the system back to homeostasis" vs. "because there's nothing wrong with you physically, easing-in or taking it slow reinforces that there's something to be afraid of. Push hard and fast and get through the fire."

I've tried both and am still unsure of which I think is the way to go, so I'm wondering what you've all discovered about this on your journeys. Obviously for most, the answer will be "it depends" and we do see success with both... but what's your own view?

 

[Ellen]

For me it depends on how certain I am that the source of the pain is TMS. When I'm certain, I talk to my brain, and say "nice try, but you're not fooling me", and I push through. For example, I occasionally get this symptom where my "back goes out" when I'm bending over in a certain way and there is a lot of pain. I know that there is no such thing as a "back going out" when performing a routine movement, so I'm now certain it is TMS when it happens and I immediately ignore it.

But sometimes a new TMS symptom pops up (my brain is very creative at this) and so I tread lightly until I reach that "ah-ha" moment, and I'm sure it's TMS. Then I "have a talk with my brain" and push through.

 

[Baseball65]

I know that there is no such thing as a "back going out" ,,,, so I'm now certain it is TMS when it happens and I immediately ignore it.
But sometimes a new TMS symptom pops up (my brain is very creative at this) and so I tread lightly until I reach that "ah-ha" moment, and I'm sure it's TMS. Then I "have a talk with my brain" and push through.

She nailed it. All of us have been fooled before, but as soon as I become aware that I am being fooled? Full steam ahead, and as Sarno said, the more vigorous, the better!

"don't push yourself too much because the pain is a danger signal and we want to gently guide the system back to homeostasis"

Sarno compared Rage to a FIRE
If suppressed RAGE is my problem, why would I approach it like a dandy and a gentleman? Imagine your house burning down...the firemen pull up and carefully parallel park. They meticulously uncoil the hose and lay it down softly. One of them gently knocks on the door
"What's going on here..is everything OK?" He says in a near whisper...

MY HOUSE IS BURNING DOWN! HELLLLP!
He turns and asks his second in command "It seems as if there is a problem here...call the company together so we can have a staff meeting and and put the correct action items on each persons to-do list". He calmly walks back to the Truck and pulls out 6 folding chairs. They sit down and begin to brainstorm on the best way to approach this problem.

MY HOUSE IS BURNING DOWN YOU DUMB $H!#$ !!!!!!
"YOU are interrupting our meeting! Do you want our help or not?

So, I grab the hose myself and start putting out the fire.

Sarno was really clear about this. The only exception might be someone who has been incapacitated for YEARS with TMS and has a lot of conditioning to undo...But anybody familiar with the drill...Get your self moving and right soon! "The more vigorous the better". I have been doing this for 25 years with no ill effects... I always do the exact opposite of what the symptom is telling me....shoulder? Go and play catch. Back? go do squats or run. It is the fastest way to tell your unconscious that 'we're not playing that game right now'

 

[JanAtheCPA]

Two great answers!
[edit:]
And two more below!!

 

[BloodMoon]

From my experience, sometimes 'pushing through' is about doing the best you can in the circumstances.

For example, one of my TMS symptoms was right hand wrist and thumb pain (and I'm right handed). One morning out of the blue (and for no apparent physical reason) my wrist and thumb started hurting. I knew it was TMS so I kept doing everything I would normally do, to include typing, but I ended up wishing I hadn't. The pain got worse and worse and worse and by the middle of the next day my hand was excruciatingly painful - and I really do mean excruciating - so much so that I couldn't do normal things like brush my teeth, wash my left armpit or wipe my derriere! In trying to move my wrist and thumb the pain was so intense that I felt faint and nauseous.

Then all I could do was to be determined to do what little I could despite the intense pain. In order to do this I had no choice but to wear a splinted wrist and thumb support which in restricting the movement of my thumb and wrist helped me to be able to still move my fingers a bit so that I could do at least some things for myself (without the splinted support I could do absolutely nothing with that hand, so I had no choice but to go against the general TMS advice to avoid using any disability aids). I then had to wait until my brain gave up on my hand and turned its attention to other parts of my body, which was over 9 months later -- Despite continuing with TMS work throughout all of this, my brain only gave up after I weakened and relented and Googled about the situation and started to think that I had something physically wrong called De Quervain's tenosynovitis (all the symptoms fit, but the condition usually resolves itself and the symptoms had gone on much longer than De Quervain's tenosynovitis usually lasts for). I believe what saved me was that my brain didn't at all like the sound of the surgery that I had read is sometimes needed to resolve De Quervain's tenosynovitis -- it feared it!

So, my brain then gradually gave up giving me hand pain over the next few days and my hand was fully back to normal function after about a further 3 weeks.

I don't think I'm special or a wimp, but I do believe that some TMS-ers have brains that are extremely good at behaving to the nth degree to stop us in our tracks, whereas others don't experience such extreme symptoms and can push on, getting on with life as usual despite the pain or whatever the TMS symptom(s) might be.

I don't feel that I am in a position to advise anyone what to do and what not to do as -- although I am quite a lot better symptoms-wise than I was than when I first started doing TMS work, I'm not a success story -- but my 'vote' would be for a measured, gradual, but determined approach, avoiding an attitude of 'gently does it' as that would imply that there is something physically wrong with you that you need to get over and/or there is something going on for your brain to fear.

 

[Booble]

For me it's less about do or don't do, it's more about don't dwell or think about. Let it be. Go about your business.
Which reminds me of a book I read about a married couple that decided to walk across France. As in, across the whole country. When they got started, the woman had a lot of pain in her legs (or maybe foot, or hip or I don't remember where). She wanted to stop and rest and didn't think she could do it. Her husband said something that was profound for her (and for me). He said, just because you have pain, doesn't mean you have to stop doing something.

*Mind blown*

We learn that if we are pain, that means stop. And generally speaking pain means stop. If your hand is on the stove and it hurts, pull it away.
But does it have to mean that? Can we be in pain and still be? Still live? Do we have to give it agency? Can it just be?
And as we know, when we don't give it attention, most of the time it just eventually goes away such that someone says to you, "Hey, how's that pain in your _____?" and you say, "Oh, I forgot about that. I guess it's gone."

And what happened to the couple that walked across France? Did the woman make it? Yes! She said that once she realized pain didn't mean she had to stop, she kept going and was fine. They wrote a book about it.

 

[tag24]

Interesting answers in the thread for sure. I think it's something worth considering because many newer-wave TMS doctors like Schubiner etc. do not advocate as strong a "you must push through it" approach as Sarno did... though to be fair, even Sarno himself didn't really talk about that too much/gave advice to the contrary. Notably, in The Divided Mind, he says "when the pain is gone, or almost gone, start to do physical things you have been afraid to do.” (p. 145). I finished The Mindbody Prescription with the idea that you've gotta just get RIGHT back to living, do everything you're afraid of, show your pain who's boss; but either I misremembered or he changed his view in later years, because this is quite the opposite to it. And more in line with that idea of pain being a danger signal -> the way to turn off the danger signal being communicating safety to the body, which is the current dominant narrative in the space from doctors like Schubiner and practitioners like Alan Gordon, Nicole Sachs, etc.

In that approach, diving straight into the pain at full intensity is counter-productive because the intensity of sensation will reinforce that there's something to fear, so they suggest slower transitions into it. Visualisation, somatic tracking, graded exposure... and maybe there's something to it, but both approaches seem to work for different people.

I think there's a level of coddling that is unhelpful and unnecessary - the image of the young, healthy man hobbling around in fear of aggravating a back injury that may never strike again, but keeps him living in fear comes to mind - but I also think that blazing straight through is an approach that will work for some and not others. Perhaps it differs based on the flavour of TMS too; pain vs general autonomic dysregulation. My own symptoms aren't necessarily a classic, "invisible" pain disorder (which I've also dealt with and am a big fan of just Pushing Through for those when they strike) and are closer to dysautonomia. I've received mixed advice from TMS therapists and physicians re: whether to push and test my limits, or to ease back and chill. Several of them worked with/under Sarno and still have mixed views! I've tried both and feel like I'm still at the same plateau - but part of me feels quite certain that's because I haven't fully bought into either, tbh. Belief/faith seems to a big element to this too, which makes sense when fear lies at its root.

It would be nice if there was more of a "consensus" on which way to go across the spectrum, but obviously that's wishful thinking. Each TMS sufferer's approach will be different because we're all individuals. But it sucks that the poison of uncertainty/doubt is hard to escape even in treatment. Even in this space, it's not as simple as "take this pill, take this tincture" and instead there's still large elements of trial and error. That's just life, I suppose.

 

[BloodMoon]

I think it's something worth considering because many newer-wave TMS doctors like Schubiner etc. do not advocate as strong a "you must push through it" approach as Sarno did... though to be fair, even Sarno himself didn't really talk about that too much/gave advice to the contrary. Notably, in The Divided Mind, he says "when the pain is gone, or almost gone, start to do physical things you have been afraid to do.” (p. 145). I finished The Mindbody Prescription with the idea that you've gotta just get RIGHT back to living, do everything you're afraid of, show your pain who's boss; but either I misremembered or he changed his view in later years, because this is quite the opposite to it.

I did a quick search on my Kindle and see that in The Mindbody Prescription he says:

"The pain will return unless you overcome those fears. So patients are advised to resume normal, unrestricted physical activity once the pain is gone, or nearly so, and when they feel confidence in the diagnosis."

and

"The path to resumption of full physical activity, without fear, may be slow and uneven. Don’t worry if you begin to exercise too soon and experience some pain. You cannot hurt yourself; TMS is a benign process. Continuing pain with activity means the brain is still in the process of changing its programming. You must bide your time, try and try again, and stay secure in the knowledge that you will prevail in the end. This has proven to be the case for thousands of patients. On the other hand, don’t start the physical program too soon—not because of potential physical harm, but because the brain may still be programmed in the TMS mode. I recommend waiting a few weeks after you accept the TMS diagnosis so the pain can diminish, confidence can be strengthened, and the brain will have had time to be reprogrammed."

So the advice was seemingly along the same lines.

I remember reading Steve O's book The Great Pain Deception which terrified the life out of me when he described how his recovery involved sitting through extreme pain and running and playing golf when he was in agony. I later read somewhere that he doesn't advise others to be so gung ho.

 

[tag24]

I did a quick search on my Kindle and see that in The Mindbody Prescription he says:

"The pain will return unless you overcome those fears. So patients are advised to resume normal, unrestricted physical activity once the pain is gone, or nearly so, and when they feel confidence in the diagnosis."

and

"The path to resumption of full physical activity, without fear, may be slow and uneven. Don’t worry if you begin to exercise too soon and experience some pain. You cannot hurt yourself; TMS is a benign process. Continuing pain with activity means the brain is still in the process of changing its programming. You must bide your time, try and try again, and stay secure in the knowledge that you will prevail in the end. This has proven to be the case for thousands of patients. On the other hand, don’t start the physical program too soon—not because of potential physical harm, but because the brain may still be programmed in the TMS mode. I recommend waiting a few weeks after you accept the TMS diagnosis so the pain can diminish, confidence can be strengthened, and the brain will have had time to be reprogrammed."

So the advice was seemingly along the same lines.

I remember reading Steve O's book The Great Pain Deception which terrified the life out of me when he described how his recovery involved sitting through extreme pain and running and playing golf when he was in agony. I later read somewhere that he doesn't advise others to be so gung ho.

Interesting, thank you very much for checking.
I suppose the time in which one's feeling terrified/doubtful isn't the time to challenge the symptom itself then, so much as it is the time to work on that fear via understanding, TMS knowledge and self-compassion... and when that abates, begin to push your physical boundaries bit by bit.

 

[Ellen]

I think a consistent element is to not focus on the body so much. My TMS disappears when I'm not watching it. Time goes by and then I notice that it's been gone for a while and I can never pinpoint the moment when it left.

 

[JanAtheCPA]

Excellent, @BloodMoon, THANK YOU.

And for f***'s sake, @tag24 - stop overthinking and just go DO. Whatever it is that DOING looks like for you.

Doubt is normal. The way past doubt is to decide to DO in spite of doubt, under the premise of "what have I got to lose?"

Overthinking instead of Doing is your TMS brain turning a little bit of normal doubt into a big ol' stinking pile of intellectualization, instead of just doing. Which makes overthinking a bigger roadblock to recovery than simple doubt.

Nike got it right all those years ago. Just do it.

 

[tag24]

I appreciate why you're delivering the sentiment like that, but I feel I should be able to make posts about TMS on a forum about TMS without it being immediately called out as overthinking.

 

[BloodMoon]

Excellent, @BloodMoon, THANK YOU.

You're most welcome!

 

[JanAtheCPA]

I appreciate why you're delivering the sentiment like that, but I feel I should be able to make posts about TMS on a forum about TMS without it being immediately called out as overthinking.

@tag24, you're right to call me out for saying for f**** sake, which was over the top. But I want to assure you this has nothing to do with what you should or shouldn't post on the forum. In fact, it's the posting that allowed me to see what your TMS brain is doing to you, and I apologize if I didn't take the time to explain this more fully.

Look at all the time and energy you're spending on analyzing this whole topic to the Nth degree! Seriously, this is your TMS brain which has essentially fooled you into thinking that you're accomplishing something, when all you're doing is spinning your wheels after all this time doing this work.

Remind us again, have you done one of the programs? Specifically the emotional work and writing exercises in the structured educational program? Where do you stand regarding emotional discovery?

 

[tag24]

@tag24, you're right to call me out for saying for f**** sake, which was over the top. But I want to assure you this has nothing to do with what you should or shouldn't post on the forum. In fact, it's the posting that allowed me to see what your TMS brain is doing to you, and I apologize if I didn't take the time to explain this more fully.

Look at all the time and energy you're spending on analyzing this whole topic to the Nth degree! Seriously, this is your TMS brain which has essentially fooled you into thinking that you're accomplishing something, when all you're doing is spinning your wheels after all this time doing this work.

Remind us again, have you done one of the programs? Specifically the emotional work and writing exercises in the structured educational program? Where do you stand regarding emotional discovery?

It's all good, I'm just not doing very well today so it wasn't really what I wanted to see!

I'm on mobile so my ability to type a long answer is curtailed but yes, I've done the program (twice) and read a ton of the TMS books. I Journalspeak daily + am currently in TMS therapy (I guess that's what you'd call it) with one of the contributors of the Psychophysiologic Disorders textbook. But I've made little progress, even on the fear, in the last year and I feel like I'm getting worse. This post was made by me because I'm anxious and afraid, but I was trying to be careful and make it a relevant contribution vs. a selfish one.

I may post something about my own halted journey in the support sub forum because I hadn't intended this post to be about this, I was genuinely just wondering where people stood on this topic because I saw posts from 2017/2018 featuring you and others where you gave answers, but ideas change over time.

 

[Baseball65]

I suppose the time in which one's feeling terrified/doubtful isn't the time to challenge the symptom itself then, so much as it is the time to work on that fear via understanding, TMS knowledge and self-compassion... and when that abates, begin to push your physical boundaries bit by bit.

Nope. That is from the "other" TMS school that is a for profit, ongoing forever therapy, "Its OK to have pain for a long time" school of thought...and the tuition is always due. That is a massive corruption of Sarno's work . I guess the guy saw a potential income stream and maximized it...and the 'method' you just described is EXACTLY what they taught in the chronic pain clinic (Dumpster) that I was in right before I lost all patience and finally read and DID what Sarno said. Take it easy...self compassion....don't shock your system....your pain is a warning...yada, yada, forever and ever amen. Oh yeah...Here's the BILL. $$$$$$$$

You asked a question, got numerous simlar answers and it seems you decided what to do before you asked the question...just wanted some confirmation and didn't get it?

but I feel I should be able to make posts about TMS on a forum about TMS without it being immediately called out as overthinking.

We are a community. The last time I was stuck, I reached out to a forum member...she didn't tell me what I wanted to hear...she told me the truth. I took the uncomfortable truth for a run...and I thought about that truth while I was running and I got good and pissed off and then came home and passed out....and then the pain was gone. Not tomorrow, not next week or whenever IT wants to stop...right f-ing NOW.

but ideas change over time.

You're right...and that's why people aren't getting better fast like they used to...been completely eviscerated and turned into a revenue stream for a lot of 'really nice sounding' Doctors . Sarno taught TWO classes and gave people time to let it soak in... Virtually all of my friends in person (not online) read the book, went back to activity. Yep....it is scary. Yep, I almost puked a few times, but I got better in weeks and continue to see people get better in weeks who embrace the idea's and confidently move forward..Those were SARNO's idea's and they suck compared to the compassionate, warm and fuzzies available for money. I just ran out of money. Blessed are the poor.

 

[tag24]

You asked a question, got numerous simlar answers and it seems you decided what to do before you asked the question...just wanted some confirmation and didn't get it?

This is a needless jab, and definitely comes across as you just being annoyed at the climate around TMS as a whole nowadays. I am not looking for confirmation of a currently held idea. I've done both approaches and am in the same place I was before embarking on this journey, likely because I'm tug-of-warring between multiple approaches, so I sought input on how others felt about it.

You said your piece above and I didn't disagree, disrespect or criticise it - not sure why you'd have a problem with me continuing a discussion after that fact. Especially when others in this very thread quoted Sarno directly giving advice that lends itself more to the "ease in" mindset than "going till you puke." It's fine if that worked for you, and I'm not saying it won't work for others or that it wouldn't work for me, but that cashgrab school of thought you talk about doesn't come from nowhere - it's in his books, too. And while this goes without saying, I definitely think there are a lot of regular users here who'd disagree that Schubiner/Sachs/Gordon etc. are in this just to moneygrub. (Obviously, some are. But it's a little baby-with-the-bathwater to completely handwave the whole concept like that, IMO.)

Finally, while Sarno's books are good, useful and he contributed a ton to this space... they're almost solely focused on pain. Other disorders and TMS manifestations are given only passing mention, which is understandable because of how common chronic pain is, but does mean that his advice may not be directly applicable to all forms. Issues like POTS, MCAS, Long Covid, in my case erythromelalgia... these are issues that get no mention in his books because they either didn't exist or weren't in the public sphere then, so it's perfectly normal for me to consider whether his approach is a neat fit for it. Again, perhaps it is. I have not said I think it's a terrible idea - but his ideas and the ideas of the "other" TMS school as you call it do sometimes conflict.

FWIW I do not mind disagreement or being challenged, that's all fine and it's part of discussion, but it seems important particularly in this space to do so with patience. I don't read here every day, perhaps it's gotten really tiring seeing people ask the same stuff again and again. But I try not to contribute to that where possible and handle things alone.

 

[BloodMoon]

Especially when others in this very thread quoted Sarno directly giving advice that lends itself more to the "ease in" mindset than "going till you puke."

Yep, I just looked up Dr Sarno's other book Healing Back Pain in which he also gives similar advice to that in The Mindbody Prescription and The Divided Mind, as follows:

"I suggest to patients that they begin the process of resuming physical activity when they experience a significant reduction in pain and when they are feeling confident about the diagnosis. To start prematurely only means that they will probably induce pain, frighten themselves, and retard the recovery process. Patients are usually conditioned to expect pain with physical activity and so must not challenge the established programmed patterns until they have developed a fair degree of confidence in the diagnosis."

 

[Booble]

But it sucks that the poison of uncertainty/doubt is hard to escape even in treatment. Even in this space, it's not as simple as "take this pill, take this tincture" and instead there's still large elements of trial and error. That's just life, I suppose.

I think we make it much more complicated than it is. Once you understand the general concept and not worry about whether you believe your conditions are TMS or not, and act "as if" it's TMS and go about your business and work to untuck repressed emotions then your body can take care of the rest.

Trying to be a perfectionist in how you solve your TMS probably isn't helpful.