New member - stubborn pain

Greetings,

I am a long-time TMS patient and first-time poster, but have recently encountered a situation which I can't figure out. I hope that some of you on this forum can offer some advice. Sorry this is so long...

I am 40 years old. I had a major bout with TMS about 13 years ago which forced me to quit my job and left me with chronic arm pain for about 2 years. Once I was diagnosed with TMS, the pain quickly disappeared. I have all the TMS personality traits: perfectionist, people pleaser, worry wart, etc. Over the years, I have had various physical symptoms, some involving my hands and arms, others not, but they all eventually went away and I realized they were TMS. I've also had a number of things in my life that I've obsessively worried about, and I realize that these fears served the same purpose as my pain - to distract me from dealing with my emotions. But I can't say I've ever fully resolved TMS, because I still, to this day, worry about one thing or another. This past year I have been doing a lot of work to figure these things out.

One evening about 6 weeks ago I was sitting at my computer when my right hand suddenly had a very intense spasm. It came out of nowhere and it hurt intensely. I could barely bend my wrist forward and the muscles / tendons on the top of my hand and wrist felt super tight. I figured it was either a weird cramp that would just go away or it was TMS. But it didn't go away. After 5 days I went to see the doctor who originally diagnosed me with TMS and he thought it could actually be a physical injury like a sprain. He gave me a splint to wear and said it should get better in about 5-10 days. Sure enough about a week later it was probably 80-90% better. I stopped wearing the splint and figured the final 10-20% improvement would occur over the next week. Was this because it was an injury and just needed time to heal, or was it because of placebo effect - doctor said it would get better and that made me more relaxed and less anxious?

The other part of the story is that I play piano quite seriously as an amateur. Aside from my family it is the most important thing in my life. It is no coincidence that the TMS symptoms that concern me most relate to my family and my ability to play piano. Over the past year, I have had a variety of pains come up in my fingers, wrists, arms, etc, but they were all TMS and none of them were that threatening and I got over them pretty quickly (i.e. in a matter of days or a week). I have also been taking piano more seriously than at any point in my life since college, and am slowly moving toward a career change so that I can spend most of my time making and teaching music, which has always been my dream, but which I have been afraid for numerous reasons to pursue. I have definitely been putting pressure on myself to make this dream come true, which is probably not the most psychologically healthy approach. So I'm always worrying about practicing too much because maybe I'll injure myself and won't be able to do what I really love.

So after about a week and a half and this pain starting to resolve, I slowly approached playing piano again, but my hand was still slightly stiff and I had some discomfort when playing. Interestingly enough, during the week I was resting my hand, I practiced alone with my left hand and started feeling similar symptoms there (TMS alert) but they were less intense and seemed to come and go like my regular TMS symptoms and while they scare me a little, don't really freak me out. While little pains would pop up elsewhere (upper arms, even my feet) they would disappear within minutes. The right hand pain seems more "real." Playing piano isn't worse than doing other activities throughout the day. Sealing an envelope with my right hand hurts more than playing piano. After playing for about a week and not seeing much improvement (normally with TMS, even if I'm in a lot of pain, the minute I start playing the pain disappears as I focus on the music), I decided to rest again for a little longer to see if it would heal. It didn't really get better and about a week later I went to grab something from the refrigerator and that intense spasm came back. Then several days later I reached for my wallet in my pocket which necessitated twisting my hand and that initial, intense pain came back again. After this I decided to not touch the piano for almost 4 weeks. I saw a hand surgeon just to rule out anything serious. He did an X-Ray and said it was nothing serious and should go away on its own in 6 weeks - maybe it was tendonitis. But he said I could use the splint and use heat packs (I did the former for a week but not the latter) I also revisited the TMS doctor who now thought that while it may be physical it could also just be TMS or maybe a combination. He suggested oral anti-inflammatory medication, but otherwise said I should slowly resume practicing and not worry. And don't wear the splint (which I'm not). Both said I didn't need physical therapy. I've been playing the piano this past week for about 30 minutes a day (normally I'd practice anywhere from 1-2 hours a day).

It's been 6 weeks since the onset of this, and I'm really stuck. At this point, maybe I'm 85-90% better than where I was originally. Playing piano is still a little uncomfortable and I have some tension in my hand, but better than where it was 3-4 weeks ago. I have a major music commitment in 6 weeks that I've been looking forward to all year and need to practice. But I'm afraid I could injure myself if this is physical. It's hard for me to believe 100% in the diagnosis of TMS. Why? Because I haven't had pain in this location before; the pain seems to have come on strong and then slowly resolve / heal like a regular injury would, whereas my TMS pains are completely erratic - they'll be there intensely, disappear, come back, etc, In the past two weeks I haven't had any of the intense initial pain again; sometimes I notice some redness, mild swelling in my hand whereas most of my TMS symptoms don't show any physical changes; although I can't point to something that precipitated the initial symptoms, I keep thinking of different things I was practicing in the days before / of the injury that could have triggered this (was working on a new piece that was technically challenging, experimenting playing with a looser wrist over the past month that could have stressed other parts of the hand, remember a chord that I was practicing 3 hours before the injury that required some awkward stretching, etc), or maybe I did something awkward like lifting my child; I read on some piano websites that tendonitis can come on suddenly and some people notice symptoms *after* a practice session or the following day, and that if you keep practicing through the pain you can cause permanent damage - plenty of horror stories to read online; I had noticed some stiffness in my hands the week or two before which perhaps was not TMS as I had thought but just a prelude to this sudden eruption of pain. Finally, I have tried applying my usual TMS coping techniques, but they don't seem to be working.

Of course, I can come up with as much evidence in the other direction - that the time was ripe for my mind to throw this huge roadblock in my way, right when I was starting to challenge myself to finally stand up for what I wanted and not do things just to please other people, that it makes no sense for grabbing my wallet in my pocket to cause such an intense pain; I remember one day a couple of weeks ago not being able to bend my wrist forward without intense pain and then the next day it seemed much less painful (but maybe I had done something the day before to cause the increased tension and then it naturally relaxed the following day), because two doctors did not seem overly concerned about my condition….

I'm sure this all sounds familiar. What else can I do to believe 100% in the TMS diagnosis? Or should I just take 2 months and COMPLETELY rest my hand and then try to approach this again psychologically? That would mean missing a great musical opportunity and letting other people down. I just don't know how to figure out what's really going on here.

I really appreciate any advice anyone can provide. Thank you so much for reading this.

 

Hi handtms,

It seems to me you should continue to be active. Reading your story you seem to have all kinds of confirmations that this is TMS. It comes and goes, it is severe for no real reason, you've been pressuring yourself, you really want this opportunity, TMS physician saying don't use a brace, etc. You have some evidence that it isn't TMS: some redness and swelling, new location for pain. Both of these are actually weak refutations that it is TMS! Many people have reported swelling that was TMS, or so they thought, because it resolved itself.

Watching you think about this, tell about it, it seems there is concern, fear, and obsessing about it. These things also point to TMS. It may be helpful to practice some mindfulness to observe the fear, the worry, the obsessing about what to do to get better, and keep bringing yourself back to your breath or other target in the "now." Also, I would suggest reading Sarno, journaling as he suggests, or doing one of the free programs: TMS Recovery Program and/or Structured Education Program at the Wiki. You probably need some basic SarnoRx!

Andy B