Dr. Schechter's book Think Away Your Pain

Heya, Branson,

I've noticed that when Dr. Sarno sometimes "highly recommends" and sometimes just "recommends" a book. He highly recommended this book, writing "I highly recommend Dr. Schechter s book. It is readable, accessible, and insightful, and based on his long history in the diagnosis and treatment of Tension Myoneural Syndrome (TMS)." I agree and think it's a terrific book. Of all of the TMS doctors out there, Dr. Schechter is probably the one who has been treating TMS the longest.

Since Dr. Schechter was one of the first people to make a TMS website (perhaps the first - he first put it up in 1997), I used a bunch of his materials in my own recovery. In fact, our Structured Educational Program was largely inspired by Dr. Schechter's workbook and Dr. Schubiner's program. Both of those programs are actually materials that the doctors developed to use with their own patients if I remember correctly, so I figured that was a great foundation.

Medicine has been making some tremendous progress in the last ten years in their understanding of pain and Dr. Schechter includes many of these advances in his book. These new developments can explain TMS pain and other symptoms in terms of learned nerve pathways or "central sensitization." This just means that our pain nerve pathways become sensitized, which leads to us feeling constant real pain that can even be excruciating. It's a pretty simple model and the science is piling up to support it.

Anyway, I agree. I think it is terrific to see different ideas out there.

 

I just did a bit of Googling, and found a free podcast interview with Dr. Schechter in case people want to learn more:
http://straightshothealth.com/would-you-rather-have-pain-management-or-cure-your-pain/

There is also another video below, which looks interesting.

 

Hi Branson, The fatigue is just pure TMS, too. It's amazing the wide variety of symptoms that TMS can create and fatigue is definitely one of them. Mindbody doctors have healed many cases and some have healed simply by reading books.

In terms of mechanisms, Dr. Schubiner recently sent out an explanation for how this would work to the mailing list for TMS therapists and doctors. The idea is that sometimes our body needs to slow us down so that we can heal. When this happens, our body is said to "promote quiescence" - i.e. it makes us inactive. Fatigue is a perfect example of promoting quiescence.

Here is what Dr. Schubiner wrote:

In the attached article, Gracely and Schweinhardt introduce the concept of how the brain promotes quiescence (PQ). I explain it this way to patients.

When our brains developed, the dangers or threats to our well being centered on predators attacking us. When one of our ancestors was being threatened by a lion, they would go into immediate fight or flight reaction. This is a highly activated state of being and allows one to use all available resources, including muscle activation and mental focusing, to protect oneself. During these episodes, which are generally relatively brief (as one can’t sustain this state for very long), individuals generally feel no pain or fatigue (even if injured).

The outcomes of this state were being killed, escaping or being injured. Escaping leads to a return to homeostasis as the counter-regulatory mechanisms in the brain turn off the fight or flight reaction. However, being injured leads to the need for rest and recovery. The brain activates this state in a powerful way, just as it activated the powerful fight or flight reaction. This state can be called a PQ state, and is useful for the individual as their brain enforces a time for healing and inactivity. How does the brain enforce this rest? By producing pain with movement, fatigue, cognitive dysfunction (think “brain fog”), depression, fear of going out (anxiety), and any other symptoms that will be effective to prevent the “patient” from getting out of the cave or home. This state would last for a few days or weeks to allow full healing and will then be turned off as the individual returns to full activity.

However, in the modern world, the threats and dangers that cause TMS are often chronic and we carry them with us for months or years, due to programmed learning and a number of cognitive and emotional mechanisms. The PQ state can become chronic and the brain tries to enforce a state of rest and recovery, even though there is no actual physical injury. The symptoms of pain, fatigue, depression, cognitive dysfunction, etc. are all produced by the brain, just as in hitting the wall during an athletic event. The required response for alleviating TMS symptoms is the same as for dealing with Noakes’ central governor: understand the facts about the situation that there is no actual damage or danger and that the brain is causing the symptoms as a warning signal, ignore the symptoms and fight back against them, alleviate the fear that is associated with them, and activate your brain and body out of the enforced, maladaptive rest and recovery state.

Patients have responded very well to this explanation since I’ve started using it.

Let me know what you think.

Best, Howard

PS Here’s an amazing quotation from Noakes about this. Italics added by me.

"This new understanding of fatigue brings together all the different models of exercise physiology. In fact, the findings of the separate models can all be explained by the action of a central governor that regulates exercise to ensure that internal body homeostasis is maintained and bodily damage avoided. Fatigue is merely the emotional expression of the subjective symptoms that develop as these subconscious controls wage a fierce battle with the conscious mind to ensure that the conscious ultimately submits to the superior will of the subconscious."

Timothy Noakes, MD, DSc, The Lore of Running, 2001​

I think this makes a lot of sense. It makes sense that our bodies would have a way of slowing us down so that we can heal and recover. A researcher named Richard Gracely explains it for pain like this:

But why exacerbate pain? The answer was emphasized by Wall [33] with an example of a dog struck by a car. The dog first experiences the pain of injury, accompanied by vocalization and fleeing the site of the injury. Pain serves to avoid or minimize injury, adding conscious withdrawal to reflexive withdrawal. This is followed by a second phase in which the dog lies curled and unmoving. CS [Central Sensitization] has exacerbated pain and inhibited movement. It promotes behaviors (or lack of behaviors) that protect and immobilize the injured area, promoting natural healing. CS is recuperative, it maximizes the chance of survival
under natural conditions.​

The article that Dr. Schubiner mentioned attaching in the first sentence was the original article that introduced promoted quiescence. This article had previously been sent out by one of the psychologists closest to Dr. Sarno for a number of decades. This person is truly brilliant, and while that doesn't necessarily mean that they endorse the explanation, it presumably at least means that they find it worthy of consideration.

A number of other mindbody therapists and doctors seemed to like the idea, so I suspect that we'll be hearing more about it. What I like about it is that it shows another way that things like brain fog, fatigue, or pain that gets worse with movement can actually be our body's way of protecting us. Our body wants us to be "quiescent" so that we can heal.