Hi all, just for a bit of background I've had a chronic wrist pain for about 7 years but only started treating it as TMS since I discovered this forum 3 months ago. I worked through the education program and I'm definitely improved, but not pain-free.
I've been reading a few books on TMS too. One thing in all of these case studies that I read is that it's so clear this person's pain is TMS because there is a clear connection between some emotional trigger and a flare in their pain (e.g. pain returns at a particularly stressful time for the person).
My pain isn't like that (as far as I can tell). It's very consistently tied to the activity of sitting at my desk. I wake up feeling no pain, I have my breakfast, I sit down at my PC to start my day and like clockwork within a few minutes I feel the wrist pain.
This makes me wonder if there are completely different camps of pain, and if they should be treated differently? Alan Gordon talks about neural pathway pain and that "neurons that wire together fire together". Could my pain be almost like a Pavlovian response? That whenever I perform this action, sit at the desk and reach for the mouse, my brain automatically responds by creating pain because it's been so reinforced over the years?
Curious to hear what others here have experienced because I get this feeling we are meant to be looking for this revelation, to unearth some deep emotional issue that is responsible for creating pain, but for me I'm really not sure it's that deep. I don't seem to get as much out of the journaling that others seem to, maybe I'm doing it "wrong" or maybe my efforts are better spent taking a different approach, I don't know.
The heading of this post is brilliant, and it's a great question (my answer is under the assumption that you have TMS).
I think it depends what the trigger is. If it's clearly emotional (like I speak with this person who stresses me out and I get symptoms), then it's more clear. In this case, it's more of a physical conditioned response (I mean physically triggered not the way it's felt, all conditioned responses are felt in the body), but that doesn't mean there isn't emotion attached to it, which I'll address at the end (actually, all conditioned responses are emotion based because they're all built on fear).
This conditioned response (as they all are when physical like this) was built and created during the time you thought something was wrong with you (that's the only reason the position or movement got tagged as dangerous and in turn paired with pain), so there is an element of it's just catching up with your belief and that can take a bit of time (it shouldn't take forever though - and it doesn't necessarily mean it's correlated to how long you've had pain - I've seen conditioned responses that have been there for decades vanish in 5 minutes - Alan Gordon has some examples of that - I don't want that to scare you).
How strong is your belief in the TMS diagnosis? That's the first thing I'd focus on. If it is very strong (it will be a lot easier to do this if it is), then what you need to do to me is start questioning the conditioned response. Act as if it's an illusion, because it is. You've spent years confirming to your brain through both your anticipation and your reaction that sitting at your desk causes pain (both through anticipating and fearing the sitting beforehand, and then basically saying to yourself afterwards "see, it did cause that pain" - prior guilt at sitting, as in "I wish I hadn't have done that because it caused pain", is one of the main ways that you convince yourself as to the causative effect - you convince yourself it causes it so it does - because if it didn't cause it, there's no reason to regret or feel guilty for engaging in the activity). I know that because if you hadn't (and I did the same thing), then the conditioned response wouldn't exist - so to undo it you need to do the opposite.
The truth is that it's not causation. I thought for six years that bending over caused my pain, it was so obvious that it did, but it didn't. How do I know? Because it doesn't hurt at all to bend now and nothing has changed physically, it was an illusion because it was TMS. It never actually caused it, it was just a conditioned response. If I were you I'd completely change how I look at it - before I have to sit if my mind goes there (which it probably will - it's not a problem that it does as your reaction to it is more important now - if you improve your reactions eventually it will stop saying it) I'd call it out for the rubbish that it is. It say "absolutely not, I know it's rubbish and that it doesn't cause it, and I'm not going to get sucked into that". Sit down and then even if it does hurt say "no, I am not getting sucked into blaming it for the pain, it may seem like it caused it but it didn't, sitting at my desk is completely safe". Your brain will take notice as you're telling it a completely different story to what it is used to. It is missed because it's counterintuitive, but it's very powerful.
In addition, clearly, I would at least look at what I was doing at the desk and if that plays a part based on stress. For example, given you work at the desk it seems (which can be stressful), then I would instead do a very enjoyable activity at the desk. If the latter leads to less pain, then part of this may also be doing some emotional work and the conditioned response is actually distracting you from things you really need to face and address. I'd also test it at other desks if I can, because if it's different then that might suggest more of an emotional element. The other thing is that if you start to become more appreciative of the fact that it's actually the work stress that is putting me on high alert (if that resonates and makes sense), you have a different understanding of what's causing the pain and that will make you more confident that it actually has nothing to do with the sitting (I started to appreciate with my sitting conditioned response - that it was more to do with who I was with than the type of chairs - people I was more comfortable with I could sit on a hard stool with less issue compared to a comfier chair with people I'd just met, just as an example).
To answer your question, it's hard to say so I would cover both things (they do overlap). The emotional work here to me doesn't need to necessarily be unearthing anything deep, it could purely be acknowledging your work stress and putting things into place to reduce it
