central censitization vs TMS?

I'm curious if there is a real difference between the two, and if Alan Gordon could chime in? For those who dont know what CS is, there is plenty of info online about it, but in a nutshell, CS is the emerging theory by neurologists that the central nervous system is jacking up the sensitivity of nerves, so that you "feel" more (sometimes even smell more, taste more, hear more, etc.) basically turning up the volume knob of your senses, and this usually happens after repeated stresses on tissue, particularly an injury, surgery, infections, etc. There's a lot more medical terminology that explains it more deeply that i dont quite understand, but that's the short explanation.

Central sensitization seems more grim of a diagnosis though, doctors act like once these changes happen in the brain/spinal cord level, it is more or less permanent. But at the same time, they do say that some relief can be obtained if you can "calm down the nervous system". I am glad however, that they are (meaning, regular doctors) at least coming to conclusions that this type of chronic pain is BRAIN BASED, and that probably most chronic pain is CS.

Dr. Shubiner has said in a blurb he thinks that TMS and CS are the same. I think that they most certainly overlap, though, traditional doctors sort of scoff at the idea that CS has a psychological component. Many doctors havent even caught up to the CS theory yet, and they're still trying to mess with the painful tissue, chasing a problem that isnt there.

The more i read about CS, the more it seems to resonate with me, since my pain came from repeated trauma, but at the same time, i HAVE made some strides using mind-body approaches. I seem to have a mix of CS and TMS. In my case, my baseline pain is the same, but my flares/spikes have reduced. In other words, my pain still hovers around a 5-6 like it always has, almost like my brain has adjusted to pain being the "new normal" (which is the problem that CS creates) but the flareups that my brain was creating whenever my brain feared an activity, has been drastically reduced. I just cant seem to bring down that daily 5-6 pain. That's what i'm really stuck on. I dont want to get too stuck on the idea that i have the dreaded incurable central sensitization pain that i've read about. Does anyone know anything about this?

 

I am a patient with Alan's clinic, and this is something we are working with at the moment. Also I've just come across the brain neuroplasticity work of Dr. Moskowitz (http://www.neuroplastix.com/ (Home | Neuroplastix)) and it is very interesting to see how this can be applied to my TMS (and as per your description CS) symptoms. Would love to lower the baseline pain as well.

 

I don't have too much knowledge about CS, but this is what I think about it...
Both are all about anxiety in my mind. The brain feels it is in danger and therefore it becomes more sensitive to all kinds of input (receptors in the body, smell, taste, sound, sight, touch, and last but not least: emotion triggering events or thoughts). I also wonder if the CS doctors explain why muscles can spasm, swelling can occur, joints start to grind and pop etc.. In my mind CS is a typical regular medicine approach and they will do anything to not have to implement emotions in the mix.
Doctors telling you that CS can't be improved are basically giving a nocebo which is based on prejudice and ignoring the progress people can make using mindbody techniques: There are many people here including myself who improved enormously using the TMS approach. That road isn't always straight, levelled or hardened. Sometimes it seems you are making no progress, but this is often temporary.

 

I also didn't read much about CS, but I'm sure I could easily relate to the theory these medical professionals are creating. I have been a walking catalogue of Symptom Imperative nerve stuff. Seriously, thank goodness I found TMS because my brain is PacMan on trying to distract me with this stuff.

I'm not going to read about CS because I think it's one more of those "illness of the year" things that the medical industry has defined because they have no answer to it. If "permanent" damage is the diagnosis, outside of say a deep physical wound from an accident, I am going to say NO.

Think of all the trauma, physical hardships, and even childbirth our ancestors went through. Where was all the CS then? You would think the human race would expire if all of this sensitization were actually the nerves being damaged. It's our brains. It's our anxieties and fears revving up our nervous systems. It's our constantly checking to see what is wrong. (trust me, I have to really TRY to not constantly look at my symptoms).

The internet is loaded with people trying to find an answer to why they began with one type of nerve pain and now it has "spread" to another area, etc.
Everyone is scrambling for a physical answer. I think Sarno has it exactly right. The answer is in the emotions and letting ourselves be honest with our feelings. It's also accepting that we have looked to the physical for a long, long time...and so the ship might be slow to turn. I just know we can.

 

This is beautiful.
I'd only add that we would also benefit from letting negativity go and turning our hearts and minds towards nurturing and nourishing practices.

Our brain is an extremely sensual organ and responds very well to the tender, loving care of the body. Those of us who have been frazzled or burned out (which was the lingo in my day) and have recovered (The Phoenix from the ashes) know this.

Care for your 'ship' as well as changing course and it'll be plain sailing all the way. Just be sure you have an emotionally savvy Captain at the helm.

 

I have just been given a diagnosis of central sensitisation from a neurologist for arm/leg nerve symptoms. The way I am choosing to interpret it is, basically there's nothing wrong with me physically, which can only be a good thing! However, doubts are still creeping in as new symptoms come. I recently went to see a physio who specialises in thoracic outlet and also mind body pain, and he told me I will make a full recovery, he says he has seen people recover so often. He just recommended slowly building up my activity levels. In the article about Neuroplastix I posted a while back there are also so many people who have reduced or eliminated pain, even when there is still some physical damage in their body, so it is definitely possible no matter what the cause of the pain.

 

Just a my quick two cents- I fully agree with Dr. Schubiner and others above that CS equals TMS. It’s just a halfway house that traditional medicine acknowledges without going all the way of exploring why the sensitization has occurred.

 

Interesting...have you see people get better by just increasing their activity ?

 

Click, a prominent CS pain researcher is Lorimer Moseley. He is both a physical therapist and neuroscientist. He and his co-author (also a physical therapist) advocate increasing one's activity but only gradually (what they call "graded exposure"). However, they do not view increasing one's activity as sufficient by itself. They say one also should understand why central sensitization occurs and, closely related to that, why the pain does not mean you are damaging or about to damage your body.

If you would like to learn more about their perspective and have a spare $36, I recommend purchasing their book The Explain Pain Handbook Protectometer from Amazon. They get into technical neurological details regarding CS in their book Explain Pain (2nd edition), also available on Amazon at a pricey $95. And they get super technical in their latest book, Explain Pain Supercharged, which I would not recommend unless you really enjoy neuroscience.

 

Personally (not from a research perspective)-no. It requires an understanding of some kind or at least the clinician telling the patient not to be afraid and setting the mind at ease in some way, taking down the fear component.

 

This is very true. I had a conversation with an ER doctor and an ER nurse about this very topic. It's all about recognizing that constant pain signals can indeed be quieted by embracing the neuroplasticity of your brain, as well as heightening your consciousness as an individual and fully integrating your physical, mental, and emotional health care in a positive way. It may take time, but please don't lose hope. It is possible to heal, and don't let anybody tell you otherwise! Central censitization is just the brain getting stuck in a loop after experiencing traumatic or substantial circumstances (physically, mentally, and/or emotionally) - the loop can be broken.

As an example of neural retraining, my internist and neurologist gave me some advice when I was diagnosed with Ehlers-Danlos (which is closely tied to autonomic dysfunction). According to them, I had to learn how to retrain my brain and how it processes continuous pain signals from my hyperactive nerves. Another neurologist assigned biofeedback and meditation to me as well. And guess what... IT ALL WORKED! My internist specifically warned me to not log onto online message boards and read horror stories from other patients with negative attitudes all day, as they said that would absolutely seal my fate as a hopelessly sick patient with no future. They asserted that my condition lies on a spectrum and some people do have worse situations than me, but they also said that many people could better themselves and their situations if they truly wanted and knew how to (for what it's worth, better doesn't have to mean perfect). I went from having pain that averaged from being an 8 to 10 out of 10, to pain that is now a 1 to 2 out of 10 at the most (with 1 being almost no pain and 10 being extremely unbearable pain). Despite having structural issues, I was still able to calm my autonomic nervous system down, and anxiety, depression, and stress were indeed the driving forces behind the issues. Similarly, central sensitization also requires some retraining of the brain. I was fascinated with the idea of central sensitization, so I had to inquire!

It must be noted that central sensitization has been said to not have a high rate of recovery, but that's only because a lot of medical professionals and patients aren't aware of the neuroplasticity of the brain. The medical world instead tries to "help" patients by simply prescribing them medications like Cymbalta and Lyrica, and then telling them to go home and hope the medications will scramble some of the stronger pain signals. These medications may work for some individuals, but they aren't actually addressing the root of the central sensitization problem - the pain loop still continues in the background. Additionally, similar to how Jeff Goldblum's character famously says "life finds a way" in Jurassic park, pain signals within the body eventually find a way to make it back to the brain (they want to be heard!), so the medication's effectiveness often reduces over time. This is why patients frequently say a medication stopped working and need multiple dosage increases. The good news? As members of this forum who deeply understand and believe in the mind-body connection (and it's critical to our own success that we do truly understand and believe), we do recognize that neuroplasticity is real, so we can beat the "pain brain."

At the end of the day, a lot of these "separate" conditions really aren't so separate from TMS - it all boils down to the mind-body connection and ending that pain loop/cycle.

Some good reading material: http://www.theaustralian.com.au/news/health-science/training-the-brain-to-beat-pain/news-story/45ad7b7daaaf3c4bbbab6c76b0190ac7 (Nocookies) (Nocookies)

 

Brilliant post Caulfield. You mention using meditation and biofeedback, and I wondered if you would be prepared to give more detail about exactly how you overcame your symptoms, and also what was involved in the biofeedback? Thanks. My main problems seem to be that my nerves are making noticeable inflammation in the surrounding tissue, plus my muscles are incredibly tight.

 

This gives me hope. i'm in a horrific flare right now after i was doing well, i was mostly doing physical activity and learining not to fear that activity....and i almost stopped getting activity-based flares.

however that's as far as i got. I still cant dull down the daily pain. The pain that happens on my commute and at my desk job. So yes, as i said above, i have some evidence it works, i just cant seem to apply it to my daily life. I've tried meditation but only half-heartedly. I tried guided meditation thru youtube. Can you recommend a better way? And how did you do the biofeedback? I'm always worried i need to take an expensive class or something, also i work late, so i probably couldnt get to a class easily.
I believe these things work, i just need a good link or video or something to start. Thanks.

 

Hi! I can for sure provide some more detail; let me know if you have any questions.

My biofeedback and meditation techniques: http://www.tmswiki.org/forum/threads/neuroplasticity-and-thought-reframing.17849/#post-94689 (Neuroplasticity and Thought Reframing)
My strong belief in the diagnosis: http://www.tmswiki.org/forum/threads/tms-or-structural-out-of-hope-don%E2%80%99t-know-who-to-believe-anymore.17857/page-2#post-94688 (*** TMS or Structural? *** Out of hope; don’t know who to believe anymore. :()
My thought reframing and neuroplasticity techniques: http://www.tmswiki.org/forum/threads/neuroplasticity-and-thought-reframing.17849/#post-94551 (Neuroplasticity and Thought Reframing)
My getting off Cymbalta and avoiding a relapse during this time:
- http://www.tmswiki.org/forum/threads/effect-of-food-on-physical-issues-placebo.12170/page-2#post-94303 (Effect of food on physical issues - placebo?)
- http://www.tmswiki.org/forum/threads/effect-of-food-on-physical-issues-placebo.12170/page-2#post-94309 (Effect of food on physical issues - placebo?)

 

Interesting discussion this is. I am not sure if the following is helpful or contributes to confusion: I think that TMS as Sarno has developed it is working with a 'humanistic' vocabulary of emotions, trauma, self etc. The explanation for pain is: there is an emotion which is repressed, we feel pain and can get rid of the pain by not repression emotions (very much simplified). In between the repressed emotions and the pain happens a process that goes something like this: repressed emotions, brain, nerves and the blood circulation react, that has consequences for the way particular areas of the body are felt, more specific, the result is pain. We need to know that it is a harmless reaction of the body, but we do not need to know all the particular scientific theories and models in order to heal.

Now, compare this with a vocabulary that is strictly naturalistic: there is an impulse in the brain (which in the humanistic language was called emotion), which leads to nerve impulses, influences blood circulation etc, and then the nerves in particular areas of the body are sensitized and lead to a central sensitization. (I am not a medical doctor - but I know that this is a very simplistic model). Emotions, pain etc. are all framed as physical-chemical processes within the brain and the body.

My point is simple: when we talk about emotions and feelings etc. we are using a language that takes us as the centre of our feelings. It's the first person perspective we use when we relate to the world of feelings and emotions, to our self and personality. And it is only other humans who would understand us because they also are familiar with the first person perspective (though one human being is not able to have the same first person perspective as the other). Talk about nerves and impulses is talk from outside - here we talk as an observer. Usually as a scientist as neutral observer.

The point is that these two ways of talking/vocabularies/perspectives might be compatible. When I say I feel angry then an observer would be able to see something happening in my brain. But, we are not scientists and not doing research. I think it is important to be very clear that the medical vocabulary is distancing us from our symptoms. It makes it objective, something out there, nothing really to do with us. In my perspective TSM and CS might be compatible to a certain extend. But I must say I doubt that the CS vocabulary is helpful for us TMS people. It might be just another invitation to TMSing ....

I am myself are very curious about scientific explanations for TMS, but I really have to controll myself not overdo and suddenly ending in a situation where reading about CS makes me anxious. What helps me is to tell me that there are not two entities, my brain and then me. We are the same. And when I am taking care of myself, being aware of my emotions, then this is actually also my brain doing that. I don't need to take extra care of my brain ...

 

Sorry it has taken me a while to reply, but just wanted to say thank you Dorado for posting this - so helpful!

 

MindBodyPT, I listened to the latest podcast of 'Like Mind, Like Body', which is an interview of PT Tim Flynn and this is what he says too. I thought of you while listening to the podcast and how fortunate people are you to find a physio that marries typical physio with mind body healing.

 

Yes! I heard it too, he does a lot of things similarly to what I do, i'm so glad there are some others out there too.