Can this still be TMS/neuroplastic pain? (Had doc appointment today and have questions)

[Polydactylkat]

Hi all,

I have low back pain, had it for about 7 years now. (Also some upper back/neck pain as well, but this post focuses on the low back stuff). I saw an ortho today for a follow up that I had on the books before I started my TMS journey. I know the TMS programs/guidance says to get things checked out to rule out a definite physical cause as a part of determining whether pain is TMS. It also says that the presence of things like disc degeneration, bulging discs, and osteoarthritis doesn’t mean that the pain isn’t TMS.

When I was talking to the ortho, we reviewed my MRI from last year and I asked some additional questions. She said that my pain most likely was from the disc degeneration, but at the same time confirmed that many people have these abnormalities with no pain and that these types of changes are expected as we age. That she doesn’t know why some people get pain and some people don’t.

Now, the MRI showed some pressing on a nerve and she said that could be the cause of some shooting leg pain I was having. I think the TMS guidance says to get checked for nerve issues, so perhaps that part is structural; however, I’m no longer having that particular pain.

My question is whether this counts as “ruling out” structural causes. There’s nothing immediate or acute going on with my spine, and while the doc says the changes are most likely the cause of my pain, she also said not everyone with those changes gets pain.

Is it still possible that my pain is TMS? It and I do fit many of tje characteristics of TMS pain/people likely to get TMS. I’m just getting stuck on whether a structural reason has been “ruled out” enough.

I think it’s worth mentioning that the first person I saw about my spine, a surgeon, did say that the changes he saw didn’t stand out to him as necessarily the cause of my pain. I can’t remember if that was before I got my MRI or after, if that matters. He at least had an X-ray of my spine when he said that.

I hope it can still be TMS and I think it could be, but what do you all think? Let me know if you need more information. Thanks!

 

[Cactusflower]

Truly, only you and your Doctor can tell you if this is absolutely TMS pain. I think that the best way for you to discover what is going on is to use the free tool: https://www.symptomatic.me/quiz (Neuroplastic Symptoms Self-Assessment Quiz | ATNS)
Your "nerve pain" sounds like it might be a form of sciatica, and yes, sciatica is considered a neuroplastic condition.
Question: who else would you see if you've been to your doctor and they are suspecting your pain is not something they would be treating, and did not give you a referral to anyone else?
What exactly do you categorize as ruling out something "enough" - ruling out beyond a doubt (I'm not sure who would provide this for you, a great question to ask yourself).
As for asking about your personality or asking us if you have TMS characteristics - please use that quiz. I personally don't feel you've given enough information for anyone here to know you, and it's always best if you can begin to identify the characteristics within yourself. The fact that you are here on this page certainly does point to the fact you are very aware something else is going on.
Instead of asking someone else to take responsibility for figuring out where you are at with all this, I think it's a big step to do that for yourself. It will help you get a better idea of where you are at now, and how you think you'd like to proceed. If you need more information, any book by Dr. Sarno is a great start!

 

[Duggit]

I hope it can still be TMS and I think it could be, but what do you all think?

It is not enough to think it "could be" TMS. Dr. Sarno said that his TMS patients did not "get better" unless they "understood and accepted" that the cause of their pain was not structurual but rather was psychological. Dr. Schubiner says much the same thing in his 2026 version of Unlearn Your Pain. He calls it a "click moment," which he defines (p. 250) as "[y]ou know for sure that you have a neuroplastic condition." Schubiner was a cofounder of the ATN, and I agree with Cactusflower that its neuroplastic assessment self-help quiz is a good place to start. If you need more advice about how to get to a click moment, I recommend Schubiner's new book.

 

[Polydactylkat]

Truly, only you and your Doctor can tell you if this is absolutely TMS pain. I think that the best way for you to discover what is going on is to use the free tool: https://www.symptomatic.me/quiz (Neuroplastic Symptoms Self-Assessment Quiz | ATNS)

I did take the quiz and got a 12/12 (I answered yes to both having tests that did not show a direct cause of my pain and for structural issue that has lasted longer than expected because they both kind of apply depending on the doctor). I’ve also gone through the FIT assessment and looked at the characteristics listed by Sarno and Gordon, and my pain and my personality definitely fit TMS.

Your "nerve pain" sounds like it might be a form of sciatica, and yes, sciatica is considered a neuroplastic condition.
Question: who else would you see if you've been to your doctor and they are suspecting your pain is not something they would be treating, and did not give you a referral to anyone else?

I started talking to my mental health therapist about it. I knew (before reading about TMS/neuroplastic pain) that stress can lead to muscle tension which can lead to pain, and that the body holds trauma, so I came to her with that. When I became aware of TMS, it seemed to expand on that idea and give more of an explanation of the mind body connection.

What exactly do you categorize as ruling out something "enough" - ruling out beyond a doubt (I'm not sure who would provide this for you, a great question to ask yourself).

I think this is my question, and you make a good point that no one is going to tell me this, because doctors that look at my spine and hear my pain are trained to connect pain to structural issues (other than a specialist in TMS/neuroplastic pain, I assume). I don’t think they are going to say “no, your back pain isn’t at all related to your spine abnormalities” for that reason and probably for liability purposes as well.

As for asking about your personality or asking us if you have TMS characteristics - please use that quiz. I personally don't feel you've given enough information for anyone here to know you, and it's always best if you can begin to identify the characteristics within yourself. The fact that you are here on this page certainly does point to the fact you are very aware something else is going on.
Instead of asking someone else to take responsibility for figuring out where you are at with all this, I think it's a big step to do that for yourself. It will help you get a better idea of where you are at now, and how you think you'd like to proceed. If you need more information, any book by Dr. Sarno is a great start!

You’re right. I didn’t include a lot about me, but suffice to say I do have a lot of characteristics associated with TMS. I’m a perfectionist, a goodist, have a low sense of self-worth and self-esteem, have experienced trauma, I’m anxious all the time and depressed some of the time, and I’m really hard on myself, for starters. My pain started after a traumatic child birth (low back) and after a period of significant emotional stress (upper back). It’s spread to my shoulders.

Maybe I was just looking to hear that even if a doc has said “these abnormalities are present and might be causing your pain” it doesn’t rule out TMS/neuroplastic pain.

I think Alan Gordon mentions a client with anxiety that came in thinking he would be the “one patient” that didn’t do this right and get better (something along those lines) and I guess I’m getting into the “I’m going to be the one person where the normal abnormalities actually are the cause of my pain.”

But Sarno lists the things I have (disc degeneration, bulging disc and some arthritic changes) and says the pain can still be and is often TMS, so I’m thinking that even if a doc says it “probably” is the source of my pain, the fact that it’s not “definitely” the cause of my pain and that research has found these changes in lots of people without pain (and vice versa) that it’s enough to rule in TMS?

I have read MindBody Prescription, most of Healing Back Pain and I’m working my way through The Way Out. I’m also working the SEP here.

 

[Polydactylkat]

It is not enough to think it "could be" TMS. Dr. Sarno said that his TMS patients did not "get better" unless they "understood and accepted" that the cause of their pain was not structurual but rather was psychological. Dr. Schubiner says much the same thing in his 2026 version of Unlearn Your Pain. He calls it a "click moment," which he defines (p. 250) as "[y]ou know for sure that you have a neuroplastic condition." Schubiner was a cofounder of the ATN, and I agree with Cactusflower that its neuroplastic assessment self-help quiz is a good place to start. If you need more advice about how to get to a click moment, I recommend Schubiner's new book.

Thanks, I’m trying to get to that click moment. I believe, logically, that this pain is TMS but I can’t seem to get over that internal hump. My mind is looking for little excuses to convince me it is not TMS, and I’m trying not to let it convince me.

I’ll look for Schubiner’s book. I’ve got Healing Back Pain, The Way Out and The Body Keeps the Score on my nightstand, alternating between them. It’s a lot to read! There’s a lot of good stuff out there. I’m working the SEP here as well.

Oh, I just checked and I’ve got a hold request on Unlearn Your Pain through the library. I guess I’m ahead of myself.

Also I took that quiz and my score was 12/12.

 

[Adam Coloretti (coach)]

That she doesn’t know why some people get pain and some people don’t.

She would if she knew about TMS I wouldn't be concerned about the disc degeneration if I were you, assuming other indicators point towards TMS (and assuming no nerve issues, as discussed below).

Maybe I was just looking to hear that even if a doc has said “these abnormalities are present and might be causing your pain” it doesn’t rule out TMS/neuroplastic pain.

I'm happy to tell you that if it helps, that's foundational TMS theory If this wasn't true (if abnormalities were always the cause of pain) then not enough people would have TMS (both now and historically) for this forum to exist!

My question is whether this counts as “ruling out” structural causes. There’s nothing immediate or acute going on with my spine, and while the doc says the changes are most likely the cause of my pain, she also said not everyone with those changes gets pain.

According to my reading of Dr Schubiner (that could be wrong) the answer to this would be yes assuming that the neurological exam is normal (no loss of reflexes, sensations etc.). The fact that you don't have the symptom anymore may mean that isn't necessary - but from my reading I think that would be the only tick off you might need if you haven't had that already (this exam can still be normal despite nerve compression, Dr Schubiner's book makes it clear that they aren't the same in the success story examples he uses - i.e. many of his success stories someone had nerve impingement on MRI but their neurological examination was clear, and it was TMS).

I’ve also gone through the FIT assessment and looked at the characteristics listed by Sarno and Gordon, and my pain and my personality definitely fit TMS.

You've also seemingly ruled in TMS, not just ruled out a structural condition (which is important - they are different also - ruling out a structural condition is more for your medical safety). Does this not hit home? I am curious about you being at a "could be TMS" still despite all of this. Doubts are normal, but even still that does surprise me. Do you believe in/understand the concept of TMS itself or are you still skeptical overall (not just when it comes to you personally)?

What I would do is focus on the elements of the FIT criteria that basically leave you no logical choice but to accept it's TMS (assuming they are present, it's no issue if they aren't and doesn't necessarily mean it isn't TMS - use your own logic to convince yourself). These are factors which Dr Schubiner says can be enough in and of themselves (just one factor present) to rule in TMS.

For example, pain that goes away on vacation. Assuming that the physical activity isn't radically different, that makes absolutely no sense if it were a structural issue (why would pain caused by a structural issue just disappear for a few weeks? It's not like the structural issue vanishes in that period, only to return once you get home). Pain that is triggered by innocuous stimuli (that has nothing to do with the supposed structural issue) could also be sufficient, such as if your pain was triggered by the wind. There are more, so that isn't exhaustive but just some examples.

I assume this would be ok (happy to be told if not), but if you want to list your evidence here I'm happy to comment on it if that would help

 

[Polydactylkat]

She would if she knew about TMS I wouldn't be concerned about the disc degeneration if I were you, assuming other indicators point towards TMS (and assuming no nerve issues, as discussed below).



I'm happy to tell you that if it helps, that's foundational TMS theory If this wasn't true (if abnormalities were always the cause of pain) then not enough people would have TMS (both now and historically) for this forum to exist!



According to my reading of Dr Schubiner (that could be wrong) the answer to this would be yes assuming that the neurological exam is normal (no loss of reflexes, sensations etc.). The fact that you don't have the symptom anymore may mean that isn't necessary - but from my reading I think that would be the only tick off you might need if you haven't had that already (this exam can still be normal despite nerve compression, Dr Schubiner's book makes it clear that they aren't the same in the success story examples he uses - i.e. many of his success stories someone had nerve impingement on MRI but their neurological examination was clear, and it was TMS).



You've also seemingly ruled in TMS, not just ruled out a structural condition (which is important - they are different also - ruling out a structural condition is more for your medical safety). Does this not hit home? I am curious about you being at a "could be TMS" still despite all of this. Doubts are normal, but even still that does surprise me. Do you believe in/understand the concept of TMS itself or are you still skeptical overall (not just when it comes to you personally)?

What I would do is focus on the elements of the FIT criteria that basically leave you no logical choice but to accept it's TMS (assuming they are present, it's no issue if they aren't and doesn't necessarily mean it isn't TMS - use your own logic to convince yourself). These are factors which Dr Schubiner says can be enough in and of themselves (just one factor present) to rule in TMS.

For example, pain that goes away on vacation. Assuming that the physical activity isn't radically different, that makes absolutely no sense if it were a structural issue (why would pain caused by a structural issue just disappear for a few weeks? It's not like the structural issue vanishes in that period, only to return once you get home). Pain that is triggered by innocuous stimuli (that has nothing to do with the supposed structural issue) could also be sufficient, such as if your pain was triggered by the wind. There are more, so that isn't exhaustive but just some examples.

I assume this would be ok (happy to be told if not), but if you want to list your evidence here I'm happy to comment on it if that would help

Sure, I can list my evidence. I’ll use the FIT criteria if that works. I only listed the criteria that seem to fit:

Functional


 Symptoms begin without a physical precipitation (often occurring with no injury, upon waking up in the morning, or during a time of stress) - no injury this time around for upper or lower back.

 Symptoms persist after an injury has healed (all injuries heal within 3 months & scars do not cause pain) - I had a lower back injury maybe 15-20 years ago, but obviously that has healed. The current pain stated about 7 years ago with no injury at that time.

 Symptoms are in a distribution pattern that is symmetric in the body, mirror image on the left andright side (this rarely occurs with structural pain) - upper back pain and the dull, constant ache on my lower back are symmetrical on both sides.

 Symptoms spread over time to different areas of the body - started with lower back, then upper back about 18 months ago, then shoulder pain about 6-9 months ago.

 Symptoms radiate to the opposite side of the body or down a whole leg or arm (unlike a nerve pain thatwould only affect the part of the arm or leg where that nerve is located) - the leg pain, when present, goes down my whole leg on the left.

 Symptoms occur in many different body parts at the same time - yep.

 Symptoms that have the quality of tingling, electric, burning, numb, hot or cold (these are
commonly MBS, especially when there is no evidence for actual nerve damage) - often my lower back pain feels like a burning sensation.

 Symptoms occur from a prior injury that has healed - if it’s from my previous back injury, that has healed. I’ve been told my shoulder pain is from tendinosis but that was about 6 months ago, so that should have healed by now too.

Inconsistent

 Symptoms are more or less intense depending on the time of day, or occur first thing in the morning or in the middle of the night (this is due to subconscious brain activity) - first thing in the morning my pain is always bad. It usually gets a little better in the morning and then worse in the afternoon/evening.

 Symptoms occur after, but not during, activity or exercise (a structural injury hurts when used and is better when rested) - yes this happens, but not for every activity or exercise. If I go for a hike, for example, I’m alright until afterwards. Or it’s a combination like if I stand for a bit I’m okay at first and then start to hurt after 30 min or so.

 Symptoms occur when one thinks about them or when someone asks about it - I think so? I’m trying to pay more attention to this.

 Symptoms occur when stress is increased or one thinks about stressful situations - same as above, I think so but I’m trying to pay more attention to confirm.

 Symptoms are minimal or non-existent when engaged in joyful or distracting activities, such as when on vacation or when not thinking about the symptoms - It definitely doesn’t go away on vacation, I just had one and it was bad; however, I was focused on it because I wanted it to go away. If I am distracted the pain is still there but I think I notice it less.

Triggered

Symptoms are triggered by things that are not related to the actual symptom, such as foods, smells, sounds, light, computer screens, menses, changes in the weather (weather has been shown in research to not increase pain, despite what most people think) or specific movements - only to specific movements like sitting, bending and twisting. Sitting in my work chair or in the car. Bending to get something from the floor. Twisting while holding something with weight, for example.

 Symptoms are triggered by the anticipation of stress, such as prior to school, work, a doctor’s visit, amedical test, a visit to a relative, or a social gathering; or during those activities - I think so. If I know I have a stressful workday I feel like my pain will be worse, if I am anticipating a trip (and the stress here comes from worrying about the pain) then the pain is worse. My upper back got bad when I was anticipating doctor visits/tests for my lower back. The symptoms do not start with these triggers, but they do seem to get worse.

I think I may have been confusing neurological disorder with the nerve pain. There were no indications of any neurological issues on my tests.

Seems like TMS to me? I did have a couple of better days after I started learning about TMS but then I think my brain is trying to sabotage me and it got worse again, but the fact it improved for a bit is encouraging.

I think I just need to get over myself lol!