Day 6 Doubts about TMS self-diagnosis

[If 6 was 9]

Since reading Dr Sarno's Healing Back Pain and starting this program I've changed my approach to the back pain and stopped all preventative measures I used to do to minimize my pain.

I used to sit as upright as possible while at work and when I came home I would do 40 squats in front of the TV while watching something on Netflix, and occasionally some stretching if my back was particularly bad. The pain never disappeared but these things kept it fairly manageable. That said, I have avoided sports that have twisting in them such as tennis and squash and golf, though the latter is no great loss, I was hopeless at it!

Anyway, now in this post-TMS world I sit whatever way is comfortable which of course involves slouching. I also haven't done one exercise or stretch to strengthen or relieve my back. And I've largely ignored pain medication that I often took while at work to get relief.

So now my back is in a horrible way. It's constant pain when sitting, especially if I don't sit bolt upright. When I bend to pick something up or I get up out of my seat it's like I'm an old man and I do it very gingerly. I try to tell the pain that it's got nothing to do with anything structurally wrong with my back, or anything I've done to exacerbate it. And that it's my brain trying to divert my attention away from emotional pain. And I tell my brain it's ok to reveal this emotional pain to me. I can handle it.

But this self-talk doesn't help and I'm still left with the pain which affects my mood - forget repressed anger of the unconscious, I've got it in spades in the conscious mind!

So my whinge today is that whereas I had small doubts about the pain being related to psychological rather than physical issues when I first embraced the TMS theory, these doubts still have logic on their side of the argument. I.e. After taking away the physical measures to protect my back and guard against pain, my back has responded by getting worse.

Also, Dr Sarno doubts that inflammation in a bad back even exists. I found this a bit hard to swallow when I read it. Has he or anyone else tested this theory? Why would anti inflammatory drugs work on it? Before you say "placebo", I took indomethacin (a strong anti inflammatory) for something unrelated to my back - it was reactive arthritis which affected me in the ankles which both swelled up. The drugs reduced the swelling and as a side effect, my back in those few months was the best it had been in years. I wasn't even thinking of my back when I was taking it.

I've also asked a radiologist friend of mine about it and he said inflammation is evident in an MRI if it's very bad or at the very least at the microscopic level - if you're looking for it.

Sorry to be so negative...I don't want to put anyone off their progress

But having said that, it's not all doom and gloom. The other day at work I raised a straight leg while sitting at my desk which always brings on excruciating pain at my lower back. I did it deliberately and kept it there and told myself I don't care about the pain! You don't frighten me and you can't hurt me beyond the pain (if you know what I mean). Strangely it stopped hurting and I could push my leg even further. I tried standing up and I felt I could bend more before the pain caught. I was quite excited as this was the first time I had evidence that the mind interplayed with the body.

However since then doubts have crept back in and I found that when I sit up in bed, if I hold the position when the pain hits rather than shrink away from it like I've just touched a hot plate, the pain tends to disappear and I can complete the motion (i.e. Sitting right up rather than having to roll onto my side first). So I started to think this is just a physical phenomenon, that you just need to not shrink away from pain, and it weakens.

Or do you think the mind is at work here too?

One more argument on the side of TMS. Since not doing the exercises, not consciously trying to sit up straight and challenging the source of my pain, I've gotten these new really nasty pains down the front of my thighs when I'm sitting down. I used to get occasional pains of these before, not nearly as strong, which I attributed to tightness in my thighs after doing squats. Now that I haven't done the squats in weeks these pains are even stronger, so I'm wondering whether this is TMS from my brain that may feel threatened by my challenging it.

 

[Andy Bayliss]

Hi If 6 was 9,

You are clearly challenging the patterns, and with some very direct successes. Yes, the pain may very well increase when you don't "pamper it" with physical treatments. This is because of conditioning about what does or does not cause, or also, relieve pain. Please remember that this is a process, and you are gathering evidence which supports your own TMS diagnosis. Yes, the pain will bring doubts. This is part of the process and natural. You are gaining ground, not losing it, even though the fear speaks loudly.

I cannot answer the technical question about anti-inflammatories/inflammation except to say that I would not get too hung up on particulars with regard to this.

Andy B

 

[If 6 was 9]

Thanks Andy for your encouragement - it means a lot.

As a post script for anyone who might be having similar doubts, after posting the above I went out and moved a lot of rubbish out to the front of the house for council collection. To my horror (!), my back had little trouble as I was bending and carrying all the junk in the many trips I had to make. I wondered at the time whether the act of expressing these doubts to people who will listen and take it seriously may have even helped it. Just a thought.....

 

[MindBodyPT]

Hi If 6 was 9,

Glad you are starting to realize the inconsistency of the pain! If you can bend and carry objects with minimal pain there is some evidence for your TMS hypothesis. Andy is right, it takes some time to challenge patterns. Conditioning is very powerful and it makes sense you might still be having pain with certain movements and positions that brought you pain for so long. Even two months into this process, I get a bit of inconsistent back pain in the mornings and occasionally bending forward...I just try not to give it any attention if it happens and it goes away. I think it's good you stopped back-specific exercises to address your pain. If you're feeling sedentary or desire more exercise, try doing squats or any other exercise for "general health" purposes rather than to decrease your pain.

On the topic of inflammation- it is certain that tissue inflammation occurs for any acute injury. This has been obvious in my work as a PT with post-surgical patients or people with new injury or reactive arthritis, like you mentioned. If you have an acute back injury such as a newly herniated disc or muscle tear, some mild inflammation could occur. I think Sarno's point is that this would only occur in the initial stage of the injury and would not be chronic in nature. A person who has back pain for months or years with no acute injury would not have tissue inflammation visible either to the naked eye or on imaging. Indometicin, an NSAID, addresses pain from both inflammation and non-inflammatory conditions like muscle cramps and migraines. It make sense it would have also helped your back pain (doesn't require your back to have inflammation to work). Hope that clears things up!

 

[If 6 was 9]

Thanks MindBodyPT, yes it does make sense what you say. It was just one of those nagging doubts but now I'll cross it off the list

Glad you've made a lot of progress in two months - there's hope for me! All the best.