New Program Day 3: Identifying the Source

[Alan Gordon LCSW]

Day 3: Identifying the Source

Over the past couple of days, we've talked about how and why neural pathway pain develops. This begs the question - how do you know if you have it?

Not all chronic pain is caused by learned neural pathways in the brain. Some people have structural issues that need to be addressed medically.

Often though, structural abnormalities in the body are incidental, and not the source of physical symptoms. For example, 64% of people with no back pain have disc bulges or herniations. 61% of middle aged-adults with no knee pain have meniscal tears. Wear and tear is a normal part of life.

Don't Guess. Assess.

I’ve done many intakes with pain patients, and one of the first things I do is assess whether their symptoms are likely to be structurally caused or due to learned neural pathways.

These are some of the questions I ask:

Do you have multiple symptoms?
Do you have a history of anxiety?
Did the pain come on during a stressful time in your life?
Was there an initial injury or did the pain come out of nowhere?
Are the symptoms inconsistent?
What other diagnoses have you been given?

Here’s an assessment I did with a woman at the 2017 Pain Conference. We were able to help her determine that she has neural pathway pain despite having been diagnosed with disc bulges, scoliosis, spinal stenosis, and arthritis:

So, do you have neural pathway pain? Probably. Chronic pain caused by neural pathways is more common than structurally-caused chronic pain. But it’s always important to be thorough.

The best way to confirm that your pain is not structural is to meet with a physician who specializes in identifying and diagnosing neural pathway pain. Here’s a list of doctors state by state who have this specialty:

http://www.tmswiki.org/ppd/Find_a_TMS_Doctor_or_Therapist (Find a TMS Doctor or Therapist)

The Belief Paradox

As we talked about yesterday, pain is a danger signal...and to overcome neural pathway pain, it's important to teach your brain that the pain you're feeling is not dangerous.

But if you believe that there's something structurally wrong with you, it can be very hard to feel safe. How can you communicate a message of safety to your brain if you think you're causing physical damage every time you sit, or walk, or type?

Accepting that your pain is not structural is a key part of recovery.

Here comes the paradox part:

I’ve been telling you that the best way to eliminate your pain is to convince yourself that it’s not structural. The paradox is that the best way to convince yourself that your pain is not structural is to eliminate your pain. Once you’ve seen that your brain has power over your pain, it’s much easier to accept that it’s caused by neural pathways.

This is a chicken-and-egg situation. But don’t worry, you can beat the paradox by taking small, incremental steps. The more evidence you get that you're structurally sound, the easier it is to believe, the more you believe, the easier it is to get evidence. It becomes a positive feedback loop.

In tomorrow’s post, "Breaking the Pain Cycle," we'll take the first step down this path, by addressing the driving force behind neural pathway pain.

​

 

[Paul Naj]

In spite of believing strongly in the concept of TMS, I think acceptance has been a challenge for me. The funny thing is that when I was first introduced to the concept 8 years ago it was easy for me to believe because I suffered from lower back pain, neck pain, etc. I knew I hadn't injured myself and never accepted a physical diagnosis as the cause. I was able to heal myself of most symptoms including gastro intestinal issues for several years. The problem for me lately is that my issues aren't always pain, they are more TMS equivalents.

The one I've been suffering from since January was diagnosed as vestibular neuritis. It started as extreme vertigo, hospitalization, etc. I still struggle with dizziness, brain fog and tinnitus. An ENT Specialist did testing and said that the balance system in my left ear was hypo-functioning. When I asked him what caused it he said "probably from a virus". He told me that my brain will learn to recalibrate my balance function without that data point. It could take months or longer. The "probably" caused me to think that maybe it wasn't physical. So here I am 6 months later still dealing with the issue and finding it hard to accept that this is TMS.

The timing of this program couldn't be better. Thank you so much for doing it. I can't wait to learn more and finally accept that I'm dealing with TMS even if it isn't physical pain.

 

[Eugene]

Thanks alan. I have read sooooo much about TMS in numerous excellent books, but it isn't until recently that some things have really started to resonate with me, and have had a noticeable impact on the discomfort levels. Hopefully this 21-program will help to push me through to the other side.

 

[Laleah Shoo Shoo]

Hi Paul, I suffered incredibly many, many years ago...with complete loss of balance, falling down unexpectedly, floors and ceilings spinning, the list goes on.
It felt like a nightmare, as i also had panic attacks and when the balance was so precarious, almost all of the time, it triggered panic immediately.
To get to the point, i saw ENT doctors way back then, was told it was vertigo and it would go...someday.
Years later, after i had been free of it, finally, after two years of living that way......it returned. This was after an incredibly stressful time and back then i
didn't know how to walk into those feelings and overcome. And so ~ i then saw an ENT doctor who was a wize elder gentleman, looked at my records from years before and said "You didn't have an inner ear infection" What was going on at your life at that time, may i ask? Well, i told him i had just given my baby to adoption, had married right afterwards to the father, travelled overseas and boom.....all balance was gone. And so began a hellish couple of years.
(short version ;-)
This doctor and i too, knew for certain that enormous stress and hidden and powerful emotions unattended to.....had manifested in the vertigo.
Also in panic.
In the last 3 years in debilitating pain, which i am so thrilled is dissipating, Bravo! I do understand how TMS works and i do still see how the pain arises, when the brain is threatened i am telling it to 'give up it's role of protecting me'. Not a straight line, this healing, for some of us. And it acts up when
i feel a danger in expressing all of what i feel, with very specific situations and people. And i'm a spiritual/pshychological counsellor, ha! But so what.
This gives me the compassion, understanding and ability to provide a 'safe' place for anyone i facilitate. Plus, i know this journey firsthand.
ah well, i didn't mean to go on this much! ;-)
That elder doctor said...years ago now, it was 1982 ~ that when i move through emotional problems that have kept me stuck, the balance in my body will return to where it is meant to be.

Wishing you the best and hopes for your speedy recovery...or however long it takes ;-) Trust trust trust xoxoxo

 

[Bodhigirl]

Acceptance is never the first step in any treatment or process, is it? It's a gradual coming to ourselves, to a new reality. A slow enlightenment that requires daily practice.
I feel as if each day needs to begin with "I have TMS even when I am symptom free." The unconscious defense of oxygen deprivation can arise in any moment.

Loved the video! Love how we laugh when our cognitive distortions are evident to us. I always think there is a good prognosis when we burst out in giggles over the good news: TMS not spinal stenosis, etc.

Nice work.

 

[RozieHolland]

• TMS pain is the brain’s belief that you’re in danger of causing tissue damage.

• The way to turn off these danger signals is to reduce your fear around the pain.

• It’s difficult to reduce your fear around the pain if you believe that there’s something structurally wrong with you.

• Accepting the TMS diagnosis is an important part of recovery.

This is so true.
The more I believe it's TMS, the stronger I feel.
The more I believe, the less the pain becomes.
The more I believe, the less the fear becomes, here right now in my chair.

Thanks Alan.

 

[LEW]

I believe firmly that it is TMS and have read numerous books as well. I've practiced some of the techniques will quick relief then spiraling down again. But I know this is not a straight path and remind myself to be patient. I say multiple times a day.... " you're ok and won't hurt yourself... TMS will pass. That's all it is." I am excited to hear what others do and what's more in store for the 21-day program.

 

[sio]

Great news here

I.e Many pain sufferers have the following belief: “I have to be 100% certain I have TMS in order to get rid of my pain.” This couldn’t be further from the truth. In fact, almost no one believes this 100% until they get rid of their pain.

I have been really struggling and almost beating myself up because I could not believe 100% that it is TMS. Only probably at 90%. It is a relief and seems like the above is just common sense. Thank you.

 

[Click#7]

I am somewhat confused about the difference between structural pain and neuropathic pain after watching this video so I hope Alan can clear this up. If someone has lower back pain and hip pain all the time with MRI's that show herniated discs, stenosis, bulging etc then because the pain very rarely changes, or doesn't move around much than it's structural ? Sometimes my pain is less, or it is worse on one side versus the other. Sometimes my pain will lighten up, or doesn't bother me at all at night or when I am sleeping...it just gets worse during the day with increasing activity. I realize you will say please see a TMS doctor as I have, but I was confused when Alan spoke with the gal in the video regarding her symptoms. Sometimes lower back pain, hip pain, feet pain or whatever can go on for years and plants itself in the same areas. SteveO had severe back pain for years, but he still had TMS. As he began to heal the pain shifted around or he had other symptoms. John Stossel and many others complained of strictly LBP and never really spoke much about how pain can shift around, or coming and going ? I really want to embrace my TMS diagnosis, but now it's confusing.

 

[Forest]

Yeah, I totally didn't believe the diagnosis until I started to heal. I don't think I believed it completely until I had pretty much overcome the symptoms.

For me it worked like this: when I did certain activities, I would hurt, and if I did them a lot, I'd have a relapse and my body would remain sensitive for days or weeks. When I learned about TMS by reading success stories online, it helped me overcome my fear. I started resuming activities and just enjoying my life. Sure, it hurt more, but I didn't worry about it because I was safe. Eventually, the pain levels stopped increasing and eventually started dropping. It wasn't until I had pretty much overcome them completely that I started reading books. That was when I decided to make a wiki about TMS where people could share success stories.

Bottom line: I totally didn't believe the diagnosis completely until I was already healed. I just overcame my fear and lived my life.

I do think that TMS healing is primarily a mental game. When you get your head in the right place, that is when you start to heal. You don't have to believe 100%, but an authentic meditative mindset helps. Mindbody healing starts with the mind and progresses to the body.

 

[shmps]

In spite of believing strongly in the concept of TMS, I think acceptance has been a challenge for me. The funny thing is that when I was first introduced to the concept 8 years ago it was easy for me to believe because I suffered from lower back pain, neck pain, etc. I knew I hadn't injured myself and never accepted a physical diagnosis as the cause. I was able to heal myself of most symptoms including gastro intestinal issues for several years. The problem for me lately is that my issues aren't always pain, they are more TMS equivalents.

The one I've been suffering from since January was diagnosed as vestibular neuritis. It started as extreme vertigo, hospitalization, etc. I still struggle with dizziness, brain fog and tinnitus. An ENT Specialist did testing and said that the balance system in my left ear was hypo-functioning. When I asked him what caused it he said "probably from a virus". He told me that my brain will learn to recalibrate my balance function without that data point. It could take months or longer. The "probably" caused me to think that maybe it wasn't physical. So here I am 6 months later still dealing with the issue and finding it hard to accept that this is TMS.

The timing of this program couldn't be better. Thank you so much for doing it. I can't wait to learn more and finally accept that I'm dealing with TMS even if it isn't physical pain.

Paul, I hear you. I have the same not so TMS symptoms. Although, I didnt go that far in getting them diagnosed medically. I just somehow accepted and believed that its TMS or my brain's way of telling me about the danger. I have ringing in my ear, too.

 

[Sonic]

After getting tests such as MRIs, water flushed down my ears and cameras up my privates which all came back clear, along with TMS knowledge from a few books. I have accepted the TMS diagnosis 99%. There is always that little doubt that springs to mind now and again but I just say I have all these crazy symptoms yet the docs say they can't find nothing so it must be TMS.

Funnily enough, it was the Physios who charged £40 a shot who were the only ones who could find something wrong with me. Muscle knots, one leg bigger than the other, muscle imbalance etc.

It's hard overcoming the fear of pain though and I appreciate this site and its advice for guidance. It's how I stumbled on TMS in the first place, looking for success stories.

 

[Click#7]

Yeah, I totally didn't believe the diagnosis until I started to heal. I don't think I believed it completely until I had pretty much overcome the symptoms.

For me it worked like this: when I did certain activities, I would hurt, and if I did them a lot, I'd have a relapse and my body would remain sensitive for days or weeks. When I learned about TMS by reading success stories online, it helped me overcome my fear. I started resuming activities and just enjoying my life. Sure, it hurt more, but I didn't worry about it because I was safe. Eventually, the pain levels stopped increasing and eventually started dropping. It wasn't until I had pretty much overcome them completely that I started reading books. That was when I decided to make a wiki about TMS where people could share success stories.

Bottom line: I totally didn't believe the diagnosis completely until I was already healed. I just overcame my fear and lived my life.

I do think that TMS healing is primarily a mental game. When you get your head in the right place, that is when you start to heal. You don't have to believe 100%, but an authentic meditative mindset helps. Mindbody healing starts with the mind and progresses to the body.

Forest,

I think I am exactly where you were....I just want to heal and I am starting to (I think), but ever so slowly. I feel and experience the pain and like today I wasn't afraid of it. I increased activities because I want to be part of the living again. TMS gives me hope as the stories like you offer to share. Thank you so much.

 

[Celayne]

Paul, I hear you. I have the same not so TMS symptoms. Although, I didnt go that far in getting them diagnosed medically. I just somehow accepted and believed that its TMS or my brain's way of telling me about the danger. I have ringing in my ear, too.

I didn't go that far with medical diagnoses, either. As soon as I would say, "I hurt everywhere", they would prescribe drugs, or say 'there's nothing wrong with you'. I even had one doctor ask me what I wanted to see happen. It was so frustrating and I think part of me suspected it all had an emotional basis, even though I didn't know about TMS. And yes, I have the ear ringing as well. It seems worse when I am having muscle pain but it may be that I just notice it more when I am already dissatisfied with how I feel.

 

[Alan Gordon LCSW]

Hi Click,
That's a good insight. Pain that is incredibly inconsistent points toward TMS, but that doesn't mean that pain that isn't inconsistent isn't TMS. Wow, let me try that again. Pain that is very consistent can very well be TMS. You just need to find other pieces of evidence to back it up. #triplenegatives

 

[Jaxson]

Okay Alan...I'm beyond the hope/disappointment cycles...now it's why bother or how do I make peace with it (defeated)....But..I'm willing to give this a try ..though it'll be difficult to keep doing a "replace all" every time I see or hear the word "pain"since my TMS involves numbness - and Sarno mentions this as well as many other "equivalents". It would be great if you could use a different word (or pain/symptoms, signals, condition, manifestations, etc.) to help the rest of us TMS sufferers move past the doubt and really GET this..... Plz...Just a request because my mind wants me to believe that since it's not pain it's not TMS.

 

[birdsetfree]

I do think that TMS healing is primarily a mental game. When you get your head in the right place, that is when you start to heal. You don't have to believe 100%, but an authentic meditative mindset helps. Mindbody healing starts with the mind and progresses to the body.

This was basically my first experience with the miraculous effect of hope endorphins on the body. After 15 years without a break in the pain, being able to resonate with the content in Alans recovery programme, gave me that hope and a direct powerful release of all pain and tension in my body as I was engaging in a highly triggering activity. This was great luck for me at the beginning of my tms recovery journey and something I am so grateful for as it solidified from the start a strong belief in the syndrome.

 

[Ines]

I never had doubts it was TMS. It was always clear. The doubt that would creep up would be "can TMS work?" That's the doubt I have to struggle with. But, I know it's my brain trying to scare me and keep the fear alive. I've seen so many improvements already that I have to squash that little voice when it tries to scare me.

 

[Ollin]

Glad to know we don't have to be 100% certain.

While I strongly believe the roots of my pain are psychological (i.e. no injury or structural defect), but then...
being in pain for a long time changes our movement patterns which can result in muscular imbalances and trigger points, but on the other hand...
when I had my triggers treated it only made my pain worse. ... but then again...
some specialists know that treating triggers in pain-sensitized tissues has to be done very very gently... and I did have some improvement with self treatment... But then again....
some of my painful areas "feel different" and don't respond to trigger point treatment... And also...
often my pain gets worse after "emotional work", or improves a couple of days later, so sorry but I don't see a clear correlation.... But then again
when I have a really good day the pain either subsides or doesn't bother me despite being quite significant... But then it can be the chicken or egg problem... i.e. having less pain makes my day...

 

[James59]

Okay Alan...I'm beyond the hope/disappointment cycles...now it's why bother or how do I make peace with it (defeated)....But..I'm willing to give this a try ..though it'll be difficult to keep doing a "replace all" every time I see or hear the word "pain"since my TMS involves numbness - and Sarno mentions this as well as many other "equivalents". It would be great if you could use a different word (or pain/symptoms, signals, condition, manifestations, etc.) to help the rest of us TMS sufferers move past the doubt and really GET this..... Plz...Just a request because my mind wants me to believe that since it's not pain it's not TMS.

I wholeheartedly agree with Jaxson. My symptoms have little in common with most people's TMS symptoms, so when the discussion centers around "pain" I feel out of place here. I have severe muscle tension, limited range off motion, neck pain and stiffness, and most of the time my whole body feels like it's being squeezed in a vise. Sometimes I feel dizzy, off-balance (as in uneven weight distribution), or mentally foggy. Acute pain is relatively rare. In fact, for many years I often had acute lower back pain, but since the current crop of symptoms came along several years ago I've had almost zero lower back problems.

Though they never completely go away, the intensity of my symptoms waxes and wanes. I tend to go to bed feeling half-way decent, but often wake up feeling like I've been hit by a truck. The slightest anxiety or time constraints greatly magnifies the symptoms, but if I feel a genuine sense of urgency I can usually move freely if only for a few seconds. Getting involved with a good movie or TV show also lessens the symptoms. So because my mental state usually governs how I feel, I'm as convinced as I can be (90-95%) that I'm dealing with some variety of TMS. Would you all concur?

Question for Alan: It's reassuring to know I don't need to be 100% convinced it's TMS, but does one need 100% faith in the treatment for it to be effective?