Can pain be an interplay between neuroplastic/TMS and physical? I’m still relatively new to TMS but am a 100% believer. I have explored my childhood, been journaling, and talked with a mental health professional and I believe my TMS issues are a combination of perfectionism and catastrophizing/fear. The perfectionism runs through most things I do, and I'm working on it, but the fear and catastrophizing are predominantly centered around athletic performance, particularly triathlon. I’ve gotten the impression from several TMS resources that there’s a somewhat absolutist view that you should not attribute anything physical to your TMS pain and that thinking some part of it might have a physical origin will hold you back and suggests you aren’t fully convinced about the reality of TMS. Some example quotes I really like but hint at this absolutist view: • Nicole Sachs “The pain is not in your head but the solution is not in your body” • Monte Hueftle “The very simple and truthful answer is, if you are a TMS person then 99.999999% of all these other aches/pains/strains and other mind body symptoms are TMS.” • Sarno himself “I must think psychological at all times, NOT physical.” In my case, however, I’m wondering if it’s possible that my pain isn’t 100% TMS or 100% physical but an interplay of the two. Like I mentioned, I believe the primary source of my TMS symptoms are because of the high athletic goals I set for myself and my fears that I won’t achieve them. As a result, my TMS pains are any combination of hip, glute, low back, leg, etc. pain that can contribute to fear and worries that I may have an oncoming injury that will set back my training and keep me from reaching my goals. Here’s an example of how I could see this relationship playing out: I really love racing triathlon so I train a fair amount –> training often results in real, though normal and generally harmless sensations of physical pain and soreness –> my brain/subconscious is hypersensitive to these (normal) sensations and interprets them as a danger signal –> this danger signal accentuates the sensations of pain and my conscious mind freaks out because now I worry and fear that I actually have injured myself, and the downward spiral of reinforcement continues the pain-fear cycle. One additional, possibly important, component is that I was diagnosed with ankylosing spondylitis about 15 years ago. Fortunately my case is mild and I have no signs of spinal fusion. With ankylosing my immune system is hyperactive and can begin attacking my own body, typically in the area of my sacroiliac joint/hips/glutes. So the disease can cause an inflammatory response right in the same areas of the body that cause me to freak out, and flare ups can be triggered by stress – just like TMS! So this seems to be another possible contributor to the TMS-pain/fear cycle I’m describing, and I’ve likely conditioned myself for 15 years to worry about glute/low back/SI pain such that my subconscious mind is quick to freak out about normal sensations in those areas and generate pain even though my conscious mind can now know not to worry about them. A TMS analogy I really like here (I think from Alan Gordon?) is that I have trained some of my neural pathways to be like an oversensitive fire alarm that goes off any time you burn toast. In my case legitimate (though non-threatening) soreness from training is my burnt toast, and my subconscious is the oversensitive fire alarm that freaks out with fear and creates pain signals when in reality the physical sensations are a normal and expected adaptation response to training. Does any or all of this seem reasonable? It’s easy to read about TMS and conclude that any thought of the pain sensations having some actual physical reality means I’m setting myself back by not believing it’s 100% psychological. However I’m not so sure it’s that simple and clear cut, especially when a primary driver of my fear–pain cycle has to do with physical training that will inevitably make me sore and fear (subconsciously or consciously) that I’m setting yourself up for injury. Apologies for the long ramble. I’d be curious to hear anyone’s thoughts – thanks!