MRI: Opening a can of wiggly worms?

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.

 

You pretty well answered your own question. If the MRI shows any normal anomalies--or "grey hair of the spine" as the Good Doctor terms it, you will continue in doubt, probably get suggested to do surgery, and suffer a mental confidence set-back from pursuing TMS as a solution. I would get the imaging but have the report interpreted by a TMS practitioner who knows how to separate "gray hair" features from what needs treatment, but that's me.

I just had another x-ray and the answer from the ortho's PA was to get a THR--I've got a file full of "the best" surgeons. Since you don't have any TMS physicians and you don't trust the opinion of the TMS PT you have you will be back to TMS?/is it real? square one. Maybe you can send your imaging to a TMS doc in the states but that may be a hassle. Try Sopher or Gwotz.

So, if you get the "all clear", will your sub-C pick out another pain spot for a symptom imperative--or will you be "cured"?

G'luck!
tt

 

Your MRI will show degeneration considering you're over 40. I believe at that age over 80-90% will show something. I've had 3 mris over the years and believe they are important to rule out fractures, tumours or any other very rare disease that can cause pain. Sarno would want to see one before officially diagnosing Tms. Don't be afraid of the standard disc bulge etc that will show up, chances are that's not what is causing this. An MRI can help with accepting Tms in your mind once you see that apart from normal wear and tear for your age, your spine is normal.

 

Hi Huckleberry. Have you read "Back in Control" by Dr Hanscom? I highly recommend it. I had an MRI on my back 20 years ago. It showed a ruptured disc. I had severe sudden pain and a lot of sciatica. I could not raise my leg 90 degrees. I had back surgery(cost $20,000) and afterwards, the pain was less but I was still in chronic pain for several years. Now it is quite clear that I have been suffering from TMS this whole time. About a year and a half ago I was in exactly the same position you are now. I had pain, severe spasm in the right side of my neck/shoulder/head. I also had numbness in my hands. The MRI revealed several bulges and a herniated discs in my neck. Because of my earlier experience, I was hesitant to have surgery. Dr Schubiner looked at my MRI on-line and wrote me a nice email telling me it could be TMS. Doctors here said that I needed surgery, and my physical therapist also strongly recommended surgery. Here I am 18 months later and I am fine. I know the MRI diagnosis slowed my recovery. At the same time, it was what I needed to do. I'm not saying that the MRI is a bad idea. Having surgery won't kill you. It might even cure your pain. I have known several people that it has worked for. I do recommend reading Dr Hanscom's book though. He is a neurosurgeon and back surgeon with lots of experience and it is very informative. He also suffered from chronic pain.

 

Dr. Sarno says surgery is our BEST PLACEBO!

 

Thanks for the replies chaps. Weird thing happened in that whilst I have been deliberating over getting the private MRI done a letter arrived yesterday from the hospital telling me my NHS MRI referral had come through for the procedure on 17th Oct...this was actually first ordered August 2013, gotta love the UK NHS. I'm still in two minds as to the best way forward.

Anne, yep I have read the Hanscom book...interesting stuff regarding surgery and the like but I did fin his approach somewhat confusing as he seemed to be in a halfway house between physiological and structural. Like you said happened with you I am concerned an MRI result may knock me back but maybe it is whats required.

Oh TT, had to laugh at the quote about surgery being the best placebo...I think its actually Hanscom who points that sham/placebo surgery is actually statistically more successful than the correct surgery. go figure hey.

 

WOW! And the citizens of the USA are being forced under Obama kare to implement a system that makes sufferers wait in pain for over a year for imaging. You keep hearing about how advanced the European and Canadian socialist health care systems, are when in reality they are anything but. When Canadians get serious diseases they cross the border to the USA for speedy private treatment. When I need an MRI I get it immediately at my doc's office on their machine or at an imaging center. For example when I had my Ludwig's Angina a few years back I went to a maxio/facial specialist's office and he had an MRI right there and sent me immediately to a hospital while calling the head of the department telling her I was on my way in. I went immediately into surgery. If I had needed to wait over a year for an MRI I would likely have been dead since a L.A. is usually fatal, named after Dr. Ludwig who died of it. I can foresee a silver lining if this brave new world system gets implemented, many new pain sufferers may discove TMS KNOWLEDGE on the shelves of the "Health" section of their bookstores--if there are any left?--or googling the internet, while being forced to wait their turn in the new health-kare queue.

I am impressed with your postal system though, otters delivering the post sounds quite innovative--maybe you limeys are more advanced then we here in the USA, we still have the USPS that you sometimes have to wait a day or even two for a human to bring us our mail--but the private delivery companies can often deliver the Zappos or the Slazenger tennis balls the same day!

 

Otters, lol...damn Apple auto correct for you there. Now amended.