Back/Leg Pain that appears to be a new Manifestation of TMS?

M

mysteriousmonkey29

Peer Supporter
Hello,

I previously had severe RSI symptoms that I eventually concluded were TMS. After discovering TMS, the symptoms resolved within about 1 week–1 month and have not meaningfully returned. My original post and recovery story are here:
Since then, I have also recovered from a few other pains that I now believe were TMS:
  • Upper back pain that I initially attributed to scoliosis (resolved in ~1 week).
  • Knee pain that appeared when running ~3 miles. This one was harder because the pain was intense, but after continuing to run through it for a couple weeks it disappeared and has never returned despite much higher running mileage.
Recently, during a primary care visit, my doctor detected premature ventricular contractions (PVCs). A cardiologist found that they occur about 20% of the time, which is considered high and can increase the risk of sudden cardiac death. I am scheduled for a catheter ablation procedure, which apparently has a high success rate and low risk.

Further testing also showed that my right ventricle is dilated, which raised the possibility of Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC), a genetic heart condition. However, it’s also possible the dilation is simply from endurance training, or that I just have PVCs without ARVC. More tests are ongoing, but currently it sounds like I probably don't have this, but they want to make sure. While they are evaluating this, my cardiologists have asked me to avoid intense exercise (keep HR below 120) as a precaution. This restriction has been difficult for me because I REALLY enjoy intense exercise.

Around the same time the cardiologist warned my about the severity of 20% PVCs and the potential that I had an underlying genetic heart condition, I developed back pain that started minor but progressed into fairly severe sciatica. The pain started in my right leg, later moved to my left, and includes numbness and tingling when standing or walking. I initially thought it might have come from lifting my garage door, although the pain did not appear immediately after any specific activity.

Resting for a couple weeks did not help, and the symptoms worsened. One day, I woke up and realized this could be another manifestation of TMS. I reread The Mindbody Prescription and Healing Back Pain, and made a list of arguments for and against it beingTMS, and was pretty much immediately convinced:
  • The pain moved from one leg to the other.
  • It started soon after significant stress about the possible heart condition.
  • It appeared days after the suspected physical trigger.
  • Rest did not help.
  • I have a strong prior history of TMS.
Fortunately, since concluding the pain is caused by TMS, my the symptoms have improved significantly. I went from barely being able to stand or walk for 3 minutes (with around 5/10 pain and/or leg tingling) to being able to walk for hours with variable pain between ~1/10 and 5/10. Typically the pain is worst when I first start walking. I often have to pause and squat down briefly, which temporarily relieves it. Interestingly, if I walk for a long time (1+ hours), the pain often disappears by the end. Although standing invariably produces leg numbness after about 10 seconds.

I'm further convinced by this improvement in symptoms that my leg pain is caused by TMS. Also the fact that I have gone back to lifting ocassional heavy items and paying no attention to my technique, and this has not affected my pain at all, whereas just walking and standing set off my leg pain almost immediately, makes me strongly suspect this is a conditioned response.

My previous TMS recoveries were generally faster, although those symptoms were less severely painful. I do wonder whether running would resolve it faster because it would be more distracting, but for now I’m avoiding intense exercise due to the cardiac evaluation.

My question is: should I simply stay the course, or is there anything else that might help accelerate recovery?
 
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**“There’s no doubt that you’ve had a lot of success with your previous TMS symptoms, so congratulations. But now we know how this works. Extreme worry, constant fear, work pressure, or frustrations can bring back other symptoms. I know this because I’ve read so many stories. However, there are people who have been free from these discomforts for a long time. That’s why it’s important to learn how to manage emotions, although misfortunes can always happen in life.
I suppose the frustration and fear of not being able to do the exercises may have triggered this new symptom. It’s true that milder symptoms, especially when there is only one, are easier to reverse. I’ve seen this many times, especially with back pain. Many people recover quite quickly when the symptom is mild or when it affects only one part of the body. On the other hand, those who have many symptoms often take longer, because it’s harder to lose the fear when so many things are happening in the body or when the pain is very intense.
I know you’re used to your symptoms going away more quickly, but the urgency to get better may actually be contributing to this not happening. Remember that the brain believes it is doing you a favor by sending a false alarm signal because it thinks you are in real danger, but in reality it wasn’t a physical danger, but rather an emotional one due to your health worries. So let’s try to take it a little more calmly. What I mean is simply: keep walking.
I also want you to avoid putting your heart at risk. Walk longer distances and gradually increase your pace. Remember to lose the fear of the symptoms, not to worry about them, and not to constantly monitor your progress based on whether the pain improves or not.
This type of nociplastic pain creates a kind of sensitivity that can be reversed, but we already know that neural pathways do not break; they simply weaken and stop being used. That’s why we should always take care of our emotions, even though we know that sometimes life circumstances make that unavoidable.”**
 
Thanks for the advice! Responding point by point here:
1) On frustration of not being able to do the excercise I'd like to causing symptoms, I think that's totally possible. Also possible it was fear of the heart condition itself--it's potentially deadly so definitely scared/is scaring me. It's scaring me less now that they think I don't have the heart condition, just the PVCs, but the pain was worst right after the previous appointment where they told me they thought I did have the condition, so that's a bit of a smoking gun. Also if I have the condition excercise limitation will likely be permanent so it could be both lol.
2) "I know you’re used to your symptoms going away more quickly, but the urgency to get better may actually be contributing to this not happening."--Totally fair, and a good point. I don't think it's really possible for me to NOT want them to get better faster, I could pretend I don't but of course I always will want this. But I could spend less time actively thinking about it, for example I didn't have to make this forum post (but I chose to). Either way I am continuing to walk a lot, despite the sometimes significant pain. Fortunately that's something I'm good at.
3) "Remember that the brain believes it is doing you a favor"--I've heard Sarno say this a lot, but honestly I was never convinced on this point. I feel like he's proven that these symptoms have psychological origin, and that they generally get better people start to believe that they are psychologically caused (a 90%+ cure rate with only an education program is hard to argue with). I don't feel like his theories about exactly how and why the brain is doing this are very well supported though. I do see why he's come to those conclusions (for example, the circumstancial evidence of symptoms going away when you start to believe they're psychosomatic, symptoms moving around, ulcers on the decline and back pain on the rise, etc.), but there could be other explanations for these phenomena as well. I personally don't believe in the "the pain is deliberately created to distract you to prevent negative subonscious feeling becoming conscious" as strongly as "negative subconscious feelings somehow cause pain", and then also conditioning (having had pain in a particular circumstance for a while) causes pain
4) Thank you, but no worries about my heart! Or at least not from walking. Walking only gets my heart rate up to 100 or 110, I think it's running that would put it at risk, which I am not currently doing (even though it makes me unhappy to do so).
 
I think people who heal, or who used to heal, through Dr. Sarno’s books mainly did so because they focused on the emotional work, which distracted their minds from the pain and helped them lose their fear. From a neuroscience perspective, that literally weakens the maladaptive neural circuit until the pain eventually disappears.
I tend to see it from a more neuroscientific perspective. When the brain keeps generating that pain signal, it’s because it believes there is a real physical danger. However, in many cases the danger was actually emotional. We know that the brain processes emotional threats and physical threats in many of the same areas.
In other words, the brain reacts to emotions in a similar way to how it reacts to real life-threatening danger, which made sense from an evolutionary perspective. But nowadays people often experience many more emotional stressors because of life circumstances. So the brain can make mistakes.
That’s why it can send pain signals as if there were a physical threat, when in reality the trigger may have been an emotional situation in the past that the brain got “stuck” on. This can lead to a kind of sensitization that, in some people, appears in a specific area of the body, while others may develop several different symptoms.
From what neuroscience suggests, chronic pain often persists because people respond to sensations with fear, excessive attention, and catastrophic thinking. This can cause the brain to constantly monitor the body and amplify normal sensations, creating a cycle of pain, fear, and anxiety. Because of this, many researchers believe that the “antidote” is a sense of safety. When symptoms appear, what can gradually weaken the neural connection is learning not to focus on the pain, not to fear it, and not to emotionally engage with it. Over time, the neural pathway can start to weaken, which is when many patients begin to improve. If this continues long enough, the pathway may become so weak that it is essentially “archived.” It may not be completely erased, but it becomes inactive because the brain no longer uses it. That may also explain why some people can experience a return of the same pattern or even a new symptom later in life, especially if they go through another intense emotional period or loss. The pathway was never destroyed, only weakened enough to stop being used. This is how I tend to see it, because I lean more toward the scientific side. Although Sarno was very advanced for his time, he did not yet have the scientific tools to fully explain these mechanisms. He proposed theories to explain why the brain could create these sensations. While emotions clearly play a major role, some of his explanations may not have been completely accurate, but his approach still helped many patients recover.


mysteriousmonkey29 said:
¡Gracias por el consejo! Respondiendo punto por punto aquí:
1) En cuanto a la frustración por no poder hacer el ejercicio que me gustaría y que me cause síntomas, creo que es totalmente posible. También es posible que fuera miedo a la propia afección cardíaca; es potencialmente mortal, así que definitivamente me asusta/me asusta. Me asusta menos ahora que creen que no tengo la afección cardíaca, solo las extrasístoles ventriculares, pero el dolor fue peor justo después de la cita anterior, donde me dijeron que creían que sí tenía la afección, así que eso es una prueba bastante contundente. Además, si tengo la afección, la limitación del ejercicio probablemente será permanente, así que podrían ser ambas cosas, jaja.
2) "Sé que estás acostumbrada a que tus síntomas desaparezcan más rápido, pero la urgencia por mejorar puede estar contribuyendo a que esto no suceda." —Totalmente cierto, y un buen punto. No creo que sea posible que NO quiera que mejoren más rápido; podría fingir que no, pero por supuesto que siempre lo querré. Pero podría dedicar menos tiempo a pensar en ello; por ejemplo, no tenía por qué haber escrito esta publicación en el foro (pero decidí hacerlo). De cualquier manera, sigo caminando mucho, a pesar del dolor a veces considerable. Por suerte, es algo que se me da bien.
3) "Recuerda que el cerebro cree que te está haciendo un favor": he oído a Sarno decir esto muchas veces, pero sinceramente nunca me convenció del todo. Creo que ha demostrado que estos síntomas tienen un origen psicológico y que, por lo general, mejoran cuando la gente empieza a creer que tienen una causa psicológica (es difícil refutar una tasa de curación superior al 90 % con solo un programa educativo). Sin embargo, no creo que sus teorías sobre cómo y por qué el cerebro hace esto estén muy bien fundamentadas. Entiendo por qué ha llegado a esas conclusiones (por ejemplo, la evidencia circunstancial de que los síntomas desaparecen cuando se empieza a creer que son psicosomáticos, que los síntomas cambian de lugar, que las úlceras disminuyen y el dolor de espalda aumenta, etc.), pero también podría haber otras explicaciones para estos fenómenos. Personalmente, no creo en la idea de que "el dolor se crea deliberadamente para distraerte y evitar que los sentimientos subconscientes negativos se vuelvan conscientes" con tanta convicción como en la de que "los sentimientos subconscientes negativos de alguna manera causan dolor", y también en la de que el condicionamiento (haber experimentado dolor en una circunstancia particular durante un tiempo) causa dolor.
4) Gracias, pero no te preocupes por mi corazón. Al menos no por caminar. Caminar solo me sube el ritmo cardíaco a 100 o 110, creo que es correr lo que lo pondría en riesgo, cosa que no estoy haciendo actualmente (aunque me da mucha rabia).
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That makes sense, I appreciate the advice and your take! I'll try my best to do my regular activity without focusing on the pain and see how it goes.

Definitely agreed with that last part about Sarno.
 
Just following up here, the pain ended up totally going away in late april, about a month after this discussion. So it ended up lasting about 2.5 months in total (1 month not realizing it was TMS, and 1.5 months realizing it was and actively trying to get over it).

I basically followed the usual process--reread the mindbody prescription and healing back pain a number of times, and went for walks nightly despite the fact that this was causing me significant pain and numbness in my left leg. Admittedly, I wasn't able to make myself fully ignore the pain and would ocassionally pause to squat while walking because that caused the pain to stop temporarily. I did this even though I figured that squatting was presumably just a conditioned response to make the pain go away, and that continuing to do so might subconsciously add weight to the theory that my symptoms might not be physically caused. But it just hurt too much for me to completely ignore it all the time. I did reduce the squatting frequency over time though and increase the walking as well. I didn't see much change almost for the first month of doing this, which was pretty frustrating, and definitely made me doubt whether or not the pain was pyschosomatic. It also didn't help that my friends/family that I told about it were pretty much convinced that sciatica is a non-psychosomatic condition, and I should probably take it easy. Although I guess this is pretty much par for the course dealing with this kind of issue--usually no one believes you so you just have to get used to ignoring that.

About one month in I remember there was one day where I did the same walk and my pain was significantly reduced. It definitely wasn't gone, but was maybe ~halved, so that was fairly encouraging. Then, a couple of weeks later, I went on a one week business trip to china, during which I did A TON of standing, walking, exactly the kinds of things that were causing me pain and leg tingling. And then, on the way back to the US, I realized that my leg hadn't hurt once the whole time I was there. Since then, I've had basically 0 pain or recurrence and basically stopped thinking of it. Apologies for taking so long to write this followup, just it naturally is no longer top of mind as the pain goes away I guess.

Also, I had a heart procedure for the PVCs, and saw further doctors about the potential for heart disease, which they now think I don't have. So all that has been improving as well, although it's worth noting that my TMS symptoms got better long before the

Here are some observations from this time that I think may be helpful to others attempting to recover from similar issues:
1) Be very patient and try not to be worried if you don't see improvement in the first couple of weeks, because improvements may not be linear. In fact, they may be extremely non-linear. Obviously, if you tried the TMS methods for some period of time without success, eventually you'd probably have to conclude they weren't working, and I'm not sure what the cutoff for that length of time should be, but in this case, if I had given up after a month, that would have been a terrible decision.
2) Try to do things that shake you out of your routine. I have no proof, but I suspect that this helps avoid the self-reinforcing nature of conditioning. My trip to China is what made this occur to me, although I hadn't planned it to deliberately try to solve the leg pain issue, it was unrelated.

Good luck to anyone else trying to recover! Let me know if you have any further questions about my experience or any way I can help.
 
Congratulations on your progress! And thanks for coming back to update us and share your insights.
 
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