Alan G. How do I know if I have TMS?

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Question

I've had low back pain on and off for nearly 10 years now. My MRI showed degeneration and herniationat L4/L5 and L5/S1. This last Monday I read Healing Back Pain and I've started practicing the Structured Educational Program on the TMS wiki. I believe I have TMS and also believe I am experiencing an extinction burst because my pain has been as bad as ever to the point of not being able to walk at times since reading Dr. Sarno's book.

I'd like some advice about what kind of doctor I should visit to make sure that there is nothing else that could be physically causing my back pain. I live in Las Vegas, and according to the wiki, there are no TMS physicians in the area. Can you also advise about how to communicate with a doctor in this scenario who doesn't come from a TMS background?

Thank you,

Melody

 

Answer

Hi Melody,
Thanks for your question. I'm often asked by people in states without a TMS physician how they can go about determining whether or not they have TMS.

Here's a basic guideline:
If you've been told by non-TMS physicians that they can't find anything wrong (persistent back pain without any structural abnormalities, etc.) it's a pretty safe bet to assume you have TMS.

If you've been diagnosed with fibromyalgia, and your work-up has come back clean (no auto-immunes, etc.), you can assume you have TMS.

It becomes tricky when you have musculoskeletal pain and that pain is validated by findings on an MRI. Now, having findings on an MRI certainly doesn't mean that you don't have TMS. In fact, a study in the New England Journal of Medicine found that 64% of people with NO back pain have disc bulges or herniations. Most findings on back MRIs are incidental and not the cause of physical pain.

I personally have a 5 mm disc herniation and two 4 mm disc bulges. A physical therapist once looked at my MRI and asked if I'd fallen out of out of a third story window. Despite these structural findings, I eliminated my symptoms through a TMS approach.

That being said, we can't just assume that everything is TMS, because some people have musculoskeletal pain that is structurally caused.

I'd be careful about going to an orthopedic specialist who isn't familiar with TMS or the psychogenic component to many forms of chronic pain. It's kind of a crap shoot. They may tell you that your MRI abnormalities are pretty normal, or they may give you a diagnosis that reinforces the belief that your symptoms are structurally caused.

This can potentially set you back. Accepting that the pain is psychologically caused is one of the most important components of recovery, and a structural diagnosis from a respected physician can be a barrier to that (I had to get past the diagnoses of herniated discs, disc desiccation, and hyperkyphosis. It would have been a lot easier if I didn't have those images swirling around in my head.)

One TMS physician I know is currently working on getting approval to practice telemedicine to patients in different states. This would be a game changer, but unfortunately isn't currently an option.

In your case Melody, given that you've previously had MRIs and a back specialist indicated that your pain was the result of structural issues, I'd make an appointment with David Schechter and road trip it out to LA for a day. It may cost you more time and money than you'd like to spend, but the psychological value of getting a diagnosis of TMS from a TMS doc is priceless.

Alan

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Any advice or information provided here does not and is not intended to be and should not be taken to constitute specific professional or psychological advice given to any group or individual. This general advice is provided with the guidance that any person who believes that they may be suffering from any medical, psychological, or mindbody condition should seek professional advice from a qualified, registered/licensed physician and/or psychotherapist who has the opportunity to meet with the patient, take a history, possibly examine the patient, review medical and/or mental health records, and provide specific advice and/or treatment based on their experience diagnosing and treating that condition or range of conditions. No general advice provided here should be taken to replace or in any way contradict advice provided by a qualified, registered/licensed physician and/or psychotherapist who has the opportunity to meet with the patient, take a history, possibly examine the patient, review medical and/or mental health records, and provide specific advice and/or treatment based on their experience diagnosing and treating that condition or range of conditions.

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Alan, I'm in a similar boat to Melody but have the added feature of pulmonary emboli that were found "accidentally" during my full body bone scan... which found nothing.

Any suggestions for me as both a Canadian with limited TMS specialists locally AND someone with PEs? Which they cant find the source or cause of.

FA