Dr. Zafirides How Our Thoughts Play a Critical Role in Pain Relief

[Peter Zafirides]

Hi everyone,

I came across this study last night as I was reviewing some recent health news. I thought it was especially relevant for all of us in the PPD/TMS community. Essentially, the researchers discovered that mental distractions - thoughts! - decreased pain signals BEFORE they hit the brain. Here are the details:

http://www.thehealthymind.com/2012/05/18/distraction-plays-a-critical-role-in-pain-relief-study/

Our thoughts are so critically important as it relates to our health - emotional AND physical. Science is only now beginning to understand how this happens.

Keep moving forward in your PPD/TMS program!!

Never doubt how truly powerful you are!!

- Dr. Zafirides

 

[BruceMC]

I think I mentioned this somewhere else on the TMSwiki, Dr. Zafirides, but I think it's worth recounting in the light of this article. When my sciatica and lower back pain were really bothering me about 2 years ago, I noticed an interesting phenomenon. If I was hiking on a trail, the pounding of my feet seemed to make my back and legs hurt more and more. However, when I stopped, set up my DSLR on a tripod and started setting the variables for a photo shoot in the onboard menus and submenus, my pain level dropped down until I couldn't feel it. Like the article says, distraction. Yet the effect seemed to continue after I disassembled and stored my photo gear because when I started walking again, it was as if the TMS pain had disappeared. IOWs: Distracting my attention from the pain in my back and legs created a pain-free space that continued after the distraction ended. Perhaps, focusing my attention on the intellectual activities associated with setting up my Nikon to take a picture shifted my center of awareness away from the part of my brain that was activating the neotransmitters that were sending the pain messages and relocated it in my more rational neocortex? Don't know!

 

[Forest]

This is a really interesting article. The articles on the Healthy Mind website show some really interesting developments, and I always love to see reports of when medicine begins to realize what we've known all along. I was a lot like MorComm. The more I focused on other stuff, especially the task at hand, the more my symptoms faded away. Of course I couldn't do this without knowing about PPD. It is a little shame that the article suggests that the evidence may support some CBT methods to combat chronic pain because it does not mention uncovering repressed emotions. I do think that some CBT techniques, especially mindfulness, may draw our attention away from our symtpoms and help us be more in the present, but there seems like we need to still learn about TMS.

In the interivew Howard Schubiner did for the wiki he described this as "During my sixteen years of teaching mindfulness, very few people had dramatic recoveries from TMS-like symptoms. It was only when I started to fully understand TMS and educate people about it that mindfulness became an approach that helped to create dramatic recoveries. The combination of education and interventions is powerful, while only one of the two is often not enough....it is generally not enough to engage in the therapeutic tools for PPD (such as mindfulness, expressive writing, affirmations, and counseling) without the understanding about PPD. I think that people need to understand that they have PPD rather than a medical disease and that they can recover."

I always intepreted this as CBT techniques can assist us in recovering, but we still need the knowledge. In my own case, I know that if I didn't know about PPD there would be absolutley no way I could say to myself, there is no reason to focus on your pain, because it is a psychological problem, not strucutral.

I still find myself interested in how to relate CBT with TMS/PPD treatment. Dr. Zafirirdes, I would love to hear your thoughts on this. What sort of CBT techniques are helpful or effective at treating TMS?

 

[chumba]

The article supports something I have always intuitively done. Through all the pain I have always kept working and sometimes I have found that throwing myself at work or some project was the best medicine.

 

[BruceMC]

"'Our findings strengthen the role of cognitive-behavioral therapeutic approaches in the treatment of pain diseases, as it could be extrapolated that these approaches might also have the potential to alter the underlying neurobiological mechanisms as early as in the spinal cord,' the researchers say."

True, TMS therapy does seem to fall into the broader category of CBT approaches described here. But I'm sure Dr. Sarno would object to the idea of using them to treat what the article defines as "pain diseases". Pain in and of itself is not a "disease", but rather an indicator that something is amiss either with soft tissue (a real 'disease') or else, as Sarno insists, a symptom due to repressed emotionality, a psychological condition resulting in bio-chemical changes in the brain that in turn cut down on the flow of oxygen to nerves, tissues and tendons, resulting in the experience of real physical pain.

It seems to me that the article misses the point that the patient could take an active role changing the underlying psychological causes behind his or her pain symptoms. Or as Chumba puts it above, just choosing to immerse yourself in a project can short-circuit the whole TMS/PPD process without hooking the patient up to a MRI scan and having the "little men in the white coats" monitor the neurological functions in his or her spinal column. The results, while extremely interesting, seem to only confirm what Dr. Sarno was saying all along.

 

[BruceMC]

Funny, Chumba, it was the pain of a so-called 'herniated disk' I experienced about 6 months after my mom's death in January 2001 (no coincidence I'd say) that led me into 1/35 fine-scale armor modelling. When I was just sitting there "hurtin'" I didn't know what to do, so I found a couple of plastic models downstairs and started clipping the sprues, sanding the parts, and gluing them together. What I noticed was that as long as I stayed focused on the model building process, totally absorbed in it, that is, I wouldn't notice the pain in my back nearly so much. I'm sure that it was modeling that distracted me enough from what I now know was TMS pain that I began to break the cycle. Sounds as though focusing all my attention on building a kit functioned in much the same way as concentrating on breath cycles during parayama meditation. Two kinds of mindfulness! Also, building the kits allowed me to obsess about modeling instead of obsessing about the pain symptoms. Then, I started winning prizes and I was hooked!

 

[BruceMC]

Which reminds me of another time when I was really "hurtin'" following my herniated disk in 2001-002. I remember being afraid to get under my old van to work on tightening up a transmission pan so it wouldn't leak. I thought sure I would "hurt myself". However, while I was lying on my back on the hard asphalt, checking socket sizes, and sorting out tools to replace the tranny modulator, I noticed something really, really interesting. While concentrating on the task at hand (an intellectual activity involving muscular coordination and making choices about procedures), the pain in my back disappeared completely. Again, shifting my center of attention to the intellectual part of my brain, short-circuited the whole TMS pain cycle. Now that I'm thinking about it, I can think of many other occasions where being mindful caused my TMS pain to disappear or diminish. Bet if the "little men in the white coats" hooked up a monitor to my spinal cord while I was flat on my back under the old Ford, they'd notice that the pain messages had subsided.

 

[Forest]

While concentrating on the task at hand (an intellectual activity involving muscular coordination and making choices about procedures), the pain in my back disappeared completely. Again, shifting my center of attention to the intellectual part of my brain, short-circuited the whole TMS pain cycle.

This is why I have always felt it is so important for people to return to being active. When we can do things that we enjoy or that require our full attention, we do not focus on our symptoms and they will fade away. This is probably one of the reasons why being active can help people accept the diagnosis. Part of what you are mentioning is a great example of mindfulness, but the other side is just going on with our lives.

I think a lot of people have these experiences/stories. When they happen we need to use them as a reminder that we have TMS/PPD.

 

[BruceMC]

Looking backwards, Forest, I also notice how my sciatica began - not exactly when my mother died in January 2001 - but six months later after I walked on a onsite technical writing contract that was absorbing a lot of my energy. The contract ended in June and I started running to use up my energy. That's when I first noticed my sciatica (which I thought was a ham string pull) coming on. Then, the contract started up again in July, and my TMS symptoms (i.e. the sciatica) went away. However, that fall, when the contract finally REALLY ended and I started running full time, often alone at night, is when the sciatica started getting worse and worse until I had a really major back attack (herniated disk) in November. IOWs: Although the trauma and repressed emotions associated with my mother's death probably changed the biochemistry of my brain in January 2001, the sheer amount of obsessive attention I was pouring into the tech writing contract distracted me enough to keep my symptoms from increasing and becoming catastrophic. However, once the contract ended (rather abruptly!) at the same time I inherited the new responsibilities of my parent's house, my symptoms grew in intensity until I had a major back attack. I guess my obsessive work ethic was functioning as a "distraction" that kept me from dealing with the feelings of rage and sorrow I had successfully repressed at the time of my mother's death. Stiff upper lip and all that sort of rot!

 

[Peter Zafirides]

Perhaps, focusing my attention on the intellectual activities associated with setting up my Nikon to take a picture shifted my center of awareness away from the part of my brain that was activating the neotransmitters that were sending the pain messages and relocated it in my more rational neocortex? Don't know!

MorComm,

From an existential perspective, it is interesting that when you were fully engaged in your work (existential purpose and meaning), the pain was at bay. There was no reason for it to distract you from anything, as your work provided fulfillment and purpose. During the times in between however, you began to feel the pain. It is as if the pain had to fill the existential "void", if you will, of the passing of your mother and also now being in between work.

FYI, this has been a very common scenario in the TMS/PPD individuals I treat. Keep doing the TMS work and never doubt your strength!!

-Dr. Z

 

[Peter Zafirides]

IOWs: Distracting my attention from the pain in my back and legs created a pain-free space that continued after the distraction ended. Perhaps, focusing my attention on the intellectual activities associated with setting up my Nikon to take a picture shifted my center of awareness away from the part of my brain that was activating the neotransmitters that were sending the pain messages and relocated it in my more rational neocortex? Don't know!

Perhaps.

But I will also offer a possible psychological explanation as well for your consideration. It could also be that the hiking prior to setting up the camera represented the work you HAD TO DO to be able to set up the camera and do the thing you really WANTED TO DO, which was to take the photos. Often time the pain of TMS is in response to things we HAVE to do, the "good child" obligations we take on. Once you began to do that which you wanted, the pain went away. I would imagine shooting photos for you (for all of us) is a also an exercise in mindfulness, as we have to give all of our attention to the moment in order to get "the right shot". It may also be that you continued free of pain because you actually had just done something you really WANTED TO DO, and that was very emotionally reinforcing.

Just some thoughts for your consideration. Never, ever doubt how truly powerful you are!!

Dr. Z

 

[BruceMC]

Interesting what you say about hiking as something I "HAD TO DO" because when I got my so-called herniated disk in November 2001, my late mother's old doctor, the late Jim Buckley, told me to start walking and increase my distances gradually. Dr. Buckley functioned as a kind of surrogate father figure during the 5 years I was caring for my mother following my dad's death in 1997, so the walking-superego connection is (was) very strong. Maybe when I walk I feel like the "good child" pleasing my absent father (and mother)?

"From an existential perspective, it is interesting that when you were fully engaged in your work (existential purpose and meaning), the pain was at bay. There was no reason for it to distract you from anything, as your work provided fulfillment and purpose".

This is very interesting too because when I had a TMS relapse in 2008, it coincided with my completing a new guidebook to Castle Rock State Park that had totally consumed all my intellectual, creative and physical resources for over a year. And when I wasn't working on the book I was doing hill climbs for time on my road bike. The pain came back almost the exact same moment as the publication of the book. I'd always thought I took a fall on my butt out running and then the tingles of the sciatic pain started coming back gradually until I had a bout of back spasms a couple of months later around X-mas. But now I see that my TMS started to return after the book was safely published and I didn't have any all consuming activities to distract me from my own existential predicament following the deaths of my father and mother. The book project ended, my hill climbing stopped, my running stopped, and my obsessive/compulsive relationship with a ballet dancer in San Francisco all ended at about the same time that the TMS pain in my back returned. All my self-imposed distractions ended at about the same approximate time, and there I was, facing the same problem I had confronted at the time of my mother's death in January 2001 when I originally developed TMS symptoms.

Thanks for your analysis Dr. Zafirides. You've made me more aware of how my TMS may have developed.

 

[BruceMC]

Another interesting phenomenon associated with my TMS relapse in 2008 is that how much better I started to feel when I accidentally was bidding on a 2000 BMW Z3 that was offered for an incredibly low price on Amazon and which I was surprised to have won. Felix culpa! I'd wanted one of those cars for over 10 years! When the car arrived by transporter from Back East I was amazed to find that it was in absolutely perfect condition. Well, good TMSer that I am, I became totally obsessed with restoring it to the last detail and upgrading it with racing packages. When I first climbed into the driver's seat I was so stiff with sciatica I could hardly get in and out. However, as the car claimed more and more of my attention, my sciatica began to subside. At first it hurt to sit in the racing seat, but when I started driving the Bimmer up to Yosemite and Tuolumne Meadows my pain went down more and more. The little Bimmer obviously served as a big distraction that was so all-consuming it kept me from obsessing on my TMS pain. I guess it is like Dr. Sarno suggests: TMSers invariably have perfectionist personality types that predispose them for getting pain syndromes.

 

[Peter Zafirides]

Thanks for your analysis Dr. Zafirides. You've made me more aware of how my TMS may have developed.

I appreciate your kind words, MorComm, but is is more appropriate that I thank you for taking the time to share your thoughts and experience with all of us in the forum. Real stories can be so meaningful to others going through their TMS/PPD journey. Through this forum (and the community that develops because of it) all of us can help to instill hope in each other. We can remind each other how very powerful we are in making true change happen in our lives - for the better.

The "true nuggets" of experience that are shared here have the capacity to be so very healing to others. I know this is true because my patients have told me so. If you are a regular poster here, keep writing! If you are new and are wondering if you should write something in the forum - do it! Beyond getting the answers you need, your words really do have the potential to help someone by: validating their symptoms or knowing they are not alone or learning from your words as they free themselves of pain.

All of us are critical in this forum... all of us.

Kindly,
Dr. Z

 

[nowtimecoach]

just listening to the podcast this morning. I love your enthusiasm Dr. Z! You exude hope and optimism. I think that is one of the greatest takeaway gifts I've gotten from exploring, acknowledging and accepting TMS - that I have been given my optimism back. There is a sense of empowerment in telling my brain to knock sending those signals - that I wasn't going to be limited or bullied by the pain anymore. The other day I had a massage and the gal was telling me I needed to go to a chiropractor to get my atlas adjusted. I just laughed to myself with glee that I no longer have to go see anyone for the health of my body. I just need to pay a little more attention to what is going on psychologically and my body will take care of itself. YES!

 

[Peter Zafirides]

Thank you so much for your kind words. I am so happy to know you are enjoying my podcasts. It makes it all worthwhile. Don't ever doubt your strength...ever. So often, we allow the negative thoughts to dominate our mindset. This results in anxiety and an overall decrease in belief our potential.

BUT THESE ARE SIMPLY THOUGHTS - AND THEY CAN BE CHANGED!

We believe that who we "are" is fixed and unchangeable, something we must learn to accept.

Fight these thoughts with all of your being! We have the freedom to change our thinking at any point. I am not saying the road is easy, but it is absolutely possible for everyone who reads these words. Only our fear and self doubt limits our ability to change.

Refuse to allow your fears to dominate. Put them on notice and REFUSE TO LET THEM WIN!!

You are stronger than you can possibly imagine - all of us are. Never doubt this, ever.

 

[Dahlia]

Don't ever doubt your strength...ever. So often, we allow the negative thoughts to dominate our mindset. This results in anxiety and an overall decrease in belief our potential.

BUT THESE ARE SIMPLY THOUGHTS - AND THEY CAN BE CHANGED!

We believe that who we "are" is fixed and unchangeable, something we must learn to accept.



Refuse to allow your fears to dominate. Put them on notice and REFUSE TO LET THEM WIN!!

You are stronger than you can possibly imagine - all of us are. Never doubt this, ever.

Thank you for the reminder of strength. It would be easy for me to think of myself as weak as evidenced by years of debilitating TMS pain. But it has taken strength to continue to live as well as possible through 7 years of pain, to continue to search for healing and not give up, and finally now to accept that it is TMS and to do the work associated with healing.

And the reminder that everything can change: certainly everything changed for me the day I learned of TMS. And more can change all the time. Thanks for this as well.