As I'm sure everyone is sick of hearing my issue regarding accepting the TMS diagnosis is the inability to rid myself of the structural doubt and fear. My LBP and sciatica/piriformis pain has been pretty constant now for about 4 years. It does wax and wane and is subject to the typical pattern of being hardly noticeable and then agonising flare ups. Before the LBP began I would suffer from a whole host of other somatised symptoms and physical anxiety symptoms but compared to the LBP these would be far more transient. My GP did offer an MRI on my back a couple of years ago but at the time we both felt that this could possibly do more harm than good due to my ongoing health anxiety and the fact that a previous blood test had highlighted a possible cause for concern issue (which turned out fine) but which had caused me a huge amount of anxiety. Whilst the TMS practioner I see has diagnosed me with TMS this was done without reference to any imaging evidence...he is a qualified physiotherapist and he has examined me thoroughly on numerous occasions and has stated that it is clear in his mind there is nothing structurally amiss with my back and this coupled with my presentation, history, personality traits and history of somatisation makes it a no brainer diagnosis. Even with this diagnosis from the TMS specialist (qualified through sirpa in UK) and also with the evidence I see regarding the inconsistency with the pain patterns I just cannot get to the stage of moving from the intellectual belief in TMS to the guterall and emotional acceptance as to that is what is causing my pain. So, I'm now at the crossroads (well, I've never really moved from it) on having a foot in both camps and committing to neither...I'm well aware that nothing will possibly change in this state of stasis. I am now thinking that getting an MRI would possibly be the only way I can move forward from this point. My main underlying concern has always been that something nasty was going on in my back but as the TMS therapist has suggested after 4 years there would be other issues...further my mobility, functions, reflex etc are 100% he has stated I am much much tighter on my left side and I feel this as a constant tight hamstring but he believes this is from guarding and is all part of the TMS. I do still hike and can hike 10 miles no problem aside from the fact I would ALWAYS be in discomfort and 1 in 10 times I would be in bad pain and very often afterwards as well. My obvious concern is that an MRI could so easily open a can of worms up. If the MRI came back clear I feel that I could really move on with this and make progress but I know that as I'm 47 years old it is highly unlikely it is going to be clear and all those incidental findings will just layer on another entrenched level of doubt...it really does seem like a gamble. This may sound a tad doubt but I (as are many of us) am extremely suspectible to nocebo and I still consider many of my current worries and doubts to have been generated to an osteopath who about 3 years ago diagnosed me with a SI joint dysfunction and twisted pelvis...it took me a long long time to shake this nocebo and it actually is still there to some degree. Anyway, I know this is totally a decision I have to make for myself but would be grateful for any advise and input. Thanks.