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

[melodyr]

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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

 

[Alan Gordon LCSW]

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

---

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.

The general advice and information provided in this format is for informational purposes only and cannot serve as a way to screen for, identify, or diagnose depression, anxiety, or other psychological conditions. If you feel you may be suffering from any of these conditions please contact a licensed mental health practitioner for an in-person consultation.

Questions may be edited for brevity and/or readability.

 

[Francis.Antonius]

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

 

[Carokitty]

I'm in the same boat as well. I've had chronic back, neck, shoulder, leg, knee and foot pain for 3 years. Also burning headaches on one side of my head. IBS symptoms started 2 years ago I think. I was diagnosed with Barrett's Esophagus a year ago. No one's given me an actual diagnosis except maybe Fibromyalgia and a misaligned neck and spine. I've gotten so many treatments tho and continue to have pain so it's hard to not think it's mindbody. However, I'm still unsure since Chiropractor and massage helps a little. Once I stop going tho, the pain gets worse. I'm just wondering how you can tell the difference between structural and mindbody pain.

 

[Baseball65]

I'm just wondering how you can tell the difference between structural and mindbody pain.

I am 55, been recovered from TMS for 20 plus years and have payed careful attention to the stories of my friends, family and team mates. I play sports and work in the trades, so if 'structural' stuff was 'real' , I ought to know a lot of people with it....

But I don't. Of the friends and family and co-workers and what not, I have rarely , if ever met a person with a 'condition' that was NOT TMS. There are several proofs of this.

1. They have a 'condition' that never responds to any treatment
2. Their condition flairs in situations that are frustrating or aggravating Mentally
3. They go and get numerous diagnoses from different professionals and after a period of time 'settle' for the one that is 'permanent'. Usually with gobs of prescriptions and therapy.
4. Even when their symptoms aren't flaring, they are constantly 'careful' about it and always reminding me they have a 'condition'.

I have had (at different times)Herniated discs, torn shoulder and knee stuff, Jaw pain, Hip pain,neck pain, teeth problems, wrist pain, foot pain and even the chronic skin/insect bite problems.....all of them served as a distraction and I 'needed' them, and none of them were 'real'. They have all gone away by doing the TMS work....without any structural repair.

Whenever one of these appeared it always scared me and occupied my attnetion obsessionally. THAT is proof of it being TMS. When I have had the odd 'real' issue, there is no obsessional component .This includes , but is not limited to broken arms, severed my thumb, broke vertebrae in my back, get drilled by pitches playing baseball, bone chips,etc. There is pain for a couple of days MAX and then it heals. Sarno pointed this out , and the man was extraordinarily on point.

I too thought I needed a TMS 'diagnosis' but , I started treating my problem as TMS because the evidence was overwhelming, and by the time I could finally see the doctor, I didn't need to, because I was 100 per cent cured.

99.5% of stuff is TMS/Mindbody...

 

[Carokitty]

always scared me and occupied my attnetion obsessionally. THAT is proof of it being TMS. When I have had the odd 'real' issue, there is no obsessional component .This includes , but is not limited to broken arms, severed my thumb, broke vertebrae in my back, get drilled by pitches playing baseball, bone chips,etc. There is pain for a couple of days MAX and then it heals. Sarno pointed this out , and the man was extraordinarily on point.

What if I obsess about everything whether it's structural or not?

It's really hard to wrap this around my head, even though the evidence is there. I'm still unsure if this is 100% me. And the fact that TMS techniques haven't worked so far makes me doubt it even more. How did you convince yourself that it was mindbody? What helps when starting an evidence list?

 

[Baseball65]

How did you convince yourself that it was mindbody?

I didn't convince myself. The truth of my experience convinced me.

What helps when starting an evidence list?

#1. What was going on in your life when the symptoms began... Family, Job, deaths, responsibilities, school, changes.
2. When are my symptoms particularly bad? What's going on THEN
3.What does it keep me from doing? Feeling and concentrating on?
4. WHY would a distraction be useful right then, or right now?
5. Have I always been an obsesser? Is this just a new manifestation of OCD like distraction?

But the clincher is ; Which makes more sense and explains my experience... The crap the medical world told me or the text in Dr. Sarno's Book?

 

[Carokitty]

I didn't convince myself. The truth of my experience convinced me.

#1. What was going on in your life when the symptoms began... Family, Job, deaths, responsibilities, school, changes.
2. When are my symptoms particularly bad? What's going on THEN
3.What does it keep me from doing? Feeling and concentrating on?
4. WHY would a distraction be useful right then, or right now?
5. Have I always been an obsesser? Is this just a new manifestation of OCD like distraction?

But the clincher is ; Which makes more sense and explains my experience... The crap the medical world told me or the text in Dr. Sarno's Book?

What did you mean by "I didn't convince myself. The truth of my experience convinced me." ?

It's hard to say what makes sense and what doesn't. Both are equally important and evidence based. It's just finding what works for me.

 

[Baseball65]

What did you mean by "I didn't convince myself. The truth of my experience convinced me."

It just makes a circle with my last statement

Which makes more sense and explains my experience... The crap the medical world told me or the text in Dr. Sarno's Book?

I evaluated my experience quietly from MY point of view, not the tainted one that had trusted the Doctors. I have always been a question asker. When I used to ask questions to the Doctors, none of their answers set well;

Why are you saying this is a back problem when the symptoms are focused around my hip and butt?
Why did it move to the right side, when you say the herniated whatever is in my left?
Why do I feel so good sometimes and not good others?
Why do the pain killers not work?
How come the epidural only lasts for half a day?
Why do you blame this on my core not being strong when I was in boxing kind of shape when the pain came?
If my birth defect has been there since my mothers womb, why did it only start hurting a year ago?

and many others like that. In spite of being indoctrinated into THEIR way of thinking, I still remembered my own thoughts on the matter...many times their answers didn't sit well. Two of the doctors I had consulted with while I was in pain (out of a half dozen or more) did NOT want to operate because they didn't think the symptoms and the diagnosis matched closely enough..... they were the only ones being ethical.

I believe anybody desperate enough to get here has just as many 'Why?'s as I did.

 

[Balsa11]

Instead of wondering is this physical, use the psychological to recover.

 

[Carokitty]

Instead of wondering is this physical, use the psychological to recover.

I wish I could. It's just hard when my pain seems to bother me when doing physical things like sitting, looking at my phone, or playing videogames. Those are all things that have been said to make back, and neck pain worse. Should I ignore that pain or is my brain sending the right messages? I know my pain hasn't been relieved but there's nothing wrong with good posture. I'm just confused and don't want to assume I have TMS if it's an easy fix. For the past 2 years I think, I've been sitting on a rocking chair cause everything else is uncomfortable. I'm afraid to use the computer because I don't want to worsen my pain by slouching. The computer chair was uncomfortable since day one. I just wonder if I got a comfortable chair, I'd feel better.

 

[Baseball65]

You still believe in all of the Medieval Medical Structural Model?... have you read any TMS texts? Sarno?
Believing in ridiculous stuff like posture, and something as benign as sitting causing pain is ironically , at the root of your pain. If you still believe this:

worsen my pain by slouching.

you might want to read or re-read Sarno.

There is no way to get well from TMS holding on to these beliefs... it is a mutual-exclusivity principle.

 

[Cwoolworth56]

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

---

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.

The general advice and information provided in this format is for informational purposes only and cannot serve as a way to screen for, identify, or diagnose depression, anxiety, or other psychological conditions. If you feel you may be suffering from any of these conditions please contact a licensed mental health practitioner for an in-person consultation.

Questions may be edited for brevity and/or readability.

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

---

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.

The general advice and information provided in this format is for informational purposes only and cannot serve as a way to screen for, identify, or diagnose depression, anxiety, or other psychological conditions. If you feel you may be suffering from any of these conditions please contact a licensed mental health practitioner for an in-person consultation.

Questions may be edited for brevity and/or readability.

I am struggling with whether my pain is structural or mind/body. Had a terrible back spasm over a year ago where I couldn’t move for 12 or so hours. I have had these before but usually the pain would go away after two weeks. Had an MRI that showed a 8-9mm disc protrusion at l5s1. I have some intermittent foot tingling and numbness on the left side. My back pain is usually concentrated on the left side but can vary in intensity. What freaks me out is that most people say that disc herniation don’t cause pain and I’ve gotten very hopeful and have been doing more physically as well as the somatic tracking outlined in “the way out”. But the pain hasn’t gone away I’ve just cared less about it. I’ve recently been freaked out because DR Schubiners content says “large herniations” can cause structural pain, which mine would qualify as. I live in Nashville TN

 

[Jimmy Todd]

I relate a lot to your story, @Baseball65, and I enjoy reading your posts. Are you still physically active?

 

[Baseball65]

I still Play Baseball, work in construction and lift weights and run when I feel like it..so yes, pretty active for turning 60 this summer

 

[Jimmy Todd]

That's awesome and very inspiring! Stories like yours are more valuable than gold, in all seriousness. Thank you.