Alan G. Overcoming the symptom imperative

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Question

I have a question that sounds like criticism of Sarno’s theory, but honestly it’s not. I genuinely want to know the answer so that I can heal and I hope your replies help others who may struggle with this.

I’m re-listening to The Divided Mind right now, and I guess I’m not listening well enough, because I still have one seemingly fundamental question that I can’t understand. Dr. Sarno says that some of his patients get better just by acquiring the knowledge that the thing that ails them is originated in the mind, rather than a pathological problem. So if the brain is trying to protect us from unwanted feelings, why would it just stop producing symptoms in that case? Doesn’t it still have something it wants to hide from us? Why wouldn’t the symptom imperative start happening?

Contrast that with a situation like mine, where I do have symptom imperative going on; After each symptom crops up, I have a brief period of worry, but then I realize that the symptom is mind-body in origin, and it loses its power – but instead of being completely healed, it just produces a symptom somewhere else.

I don’t understand why when I pull the curtain back on what my brain is trying to do, it just keeps going. And yet others, it knows the jig is up?

 

[Alan Gordon LCSW]

Answer

Great question! The symptom imperative is often sneaky, and can occur even without being recognized.

Psychogenic pain is serving a purpose. The purpose of the pain for most people is to serve as a vessel of preoccupation, primarily in the form of fear. So put more directly, the purpose of the pain is to scare you (ultimately with the unconscious motive of helping to protect you...)

So when you neutralize the fear associated with one symptom, it usually subsides, as it's no longer serving its purpose. But the pain came up for a reason. Maybe there are emotions that you're not consciously able to tolerate, or maybe you treat yourself poorly (criticism, pressure, etc.)

If you plug up a leak in a dam, it'll be fine for awhile, but if you don't address the water pressure, it'll just spring another leak. This is why people have symptoms crop up in other areas.

But it doesn't have to be replaced with another physical symptom, any vessel of fear will do. I've had patients where the pain went away, and several weeks later it was replaced with OCD, or body dysmorphic disorder, or specific phobias, or generalized anxiety, or even obsessing about their job or relationship.

Many people categorize overcoming TMS as just getting rid of their physical symptoms, but often the new "leaks" in the dam can just as uncomfortable, even if they're less obvious.

I look at beating this thing as getting to the root of what's going on so that you no longer need the defense mechanism; you're not just neutralizing the fear associated with one symptom, but you're eliminating (or significantly reducing ) your overall need to exist in a state of preoccupation and fear.

When you've achieved this, the mind no longer has a need to elicit new symptoms - physically or psychologically. It's like achieving TMS enlightenment.

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.

 

[chickenbone]

This is an excellent explanation of the symptom imperative - the best I have seen yet - Thank-you, Alan. This helped me also. Even though I am mostly recovered from TMS, the symptom imperative still follows me around. It seems like each time my mind needs some outlet for anxiety, I get one of my many TMS symptoms, but usually for short periods because I know why this is happening. However, I don't believe this is because of things that have happened in the past. I tend to be a non-stop worrier. When I can't find anything personal to worry about, I tend to worry about existential stuff.

 

[colls100]

This explanation is super helpful!

 

[Buckster]

100% agree colls100!

 

[Syl]

Actually, I find the symptom imperative is almost impossible to overcome. Please bear with me now as I explain: For 10 years I've suffered from pudendal neuralgia (PN), which pretty much wrecked every area of my life with pain and horrible sensations in all female parts, including vagina and bladder, plus a whole host of other symptoms I won't bore you with. When I discovered Dr Sarno's books, I started to see some slight improvement in PN--to the point where I lost much of my fear of PN. But you know what my brain did? It varied the symptoms of PN, just to make me feel afraid again, which worked!

Not only this, I've had IBS for 30 years on and off, and all my symptoms used to be pretty much below the belly button, but in the last couple of years my symptoms switched to symptoms above the belly button; symptoms like what they now call functional dyspepsia (FD): namely dysmotility (pressure bloating), burping, early satiety, nausea, and pharynx-to-esophagus-to-stomach spasm (or you could call this globus that goes all the way down to your stomach). At the same time, to make matters even worse, I developed what they call silent reflux or laryngopharyngeal reflux (LPR): no heartburn, but namely mucus at throat, voice hoarseness or croaky voice, post-nasal drip, etc.

Since Alan Gordon's TMS program, I found more strategies to help me cope with four conditions--all with changing symptoms, that is: PN, IBS, FD and LPR. I lost 12kg (112 pounds) thanks to a low acid diet--so at least I'm eating healthy--and I saw some improvements in the LPR symptoms for a while. But last and most definitely the worst thing of all--I suffer from chronic anxiety, and have done so since age 14. I am now 56 years old. My first panic attack was at age 14. So I'd say that anxiety/fear creates the perfect storm for all my other four conditions. The moment I relax about one thing, something else pops up, or whatever I'm dealing with changes its symptoms in order to create more fear and anxiety.

I refused all invasive tests as they would have been numerous, and as this is all doctors know how to do these days. The only good doctor I came across was an older guy who was about to retire, and he actually knew how to diagnose by asking questions and being interested in my personal history. He had been taught to diagnose (a lost art now) by his mentor. So after a long talk and getting to know me better, he palpated my tummy and listened to all the bubbles gurgling away in my tummy, etc, etc. After all this he said that these days "over testing" is the "method du jour" in modern medicine. I have to agree with this. If younger doctors didn't send their patients to all sorts of invasive (and sometimes risky tests) they'd be out of a job in five minutes, but patients would at least feel more understood and nurtured if they had a doctor like the older guy I saw.

Anyway, what this doctor said was that I should submit to testing if I saw blood eg. spit up blood or blood coming from the other end. Not every one will agree with me about whether to have invasive tests or not, but I was traumatised by an invasive test gone wrong many years ago, and this is why I will not submit to an invasive test if I can help it. But back to what the older doc said, this went a long way to reassuring me, especially since the test of time (living with IBS for 30 years) proved that I must really have IBS, otherwise I'd be dead by now. As for the FD and LPR, well, diet and natural herbs helped a lot (I work with a great naturopath), and for a few months I was symptom-free from the FD and LPR symptoms (but if it was something serious there would have been other signs of things getting worse). As for PN, after 10 years I've gotten so used to it that I'm sure I'll live (as long as the brain doesn't start playing silly buggers with it by changing my symptoms). By the way, I diagnosed myself for PN and then went to a specialist in this area to confirm my diagnosis. After this, no one seemed to know what to do except physical therapy, acupuncture, etc, etc, none of which worked, so you end up pretty much alone and trying different things in the hope you'll find something that helps.

Sorry to waffle on, but you needed to have the whole picture before I can make my point. And my point is this: ANXIETY seems to be the common denominator in this scenario of conditions changing around, jumping from one to another, or improving and then returning, or of having to juggle four conditions at once, etc.

Re the "symptom imperative" the only thing I want to know is this: How can we journal our way to what's in our "unconscious mind" when even Dr Sarno (and others) say this is impossible? We can only write or talk about what we remember (what we are conscious of), and I know writing often brings up a lot of what's in our subconscious, but whatever is in our "unconscious" is pretty much unreachable, except in a few rare cases I read about. So does this mean we are all doomed to keep battling through one condition after another?

And finally: From a neuroplasticity perspective, the more we talk or write about our emotions, pains, fear, etc, etc, aren't we just reinforcing already existing brain maps instead of building new brain maps that are only made up of healthier and more other positive thoughts and beliefs?

If you got this far, reading my post, and you can come up with an answer to all my questions, I'll give you $5M if and when I win the Lottery

 

[Allissa RS]

Answer

Great question! The symptom imperative is often sneaky, and can occur even without being recognized.

Psychogenic pain is serving a purpose. The purpose of the pain for most people is to serve as a vessel of preoccupation, primarily in the form of fear. So put more directly, the purpose of the pain is to scare you (ultimately with the unconscious motive of helping to protect you...)

So when you neutralize the fear associated with one symptom, it usually subsides, as it's no longer serving its purpose. But the pain came up for a reason. Maybe there are emotions that you're not consciously able to tolerate, or maybe you treat yourself poorly (criticism, pressure, etc.)

If you plug up a leak in a dam, it'll be fine for awhile, but if you don't address the water pressure, it'll just spring another leak. This is why people have symptoms crop up in other areas.

But it doesn't have to be replaced with another physical symptom, any vessel of fear will do. I've had patients where the pain went away, and several weeks later it was replaced with OCD, or body dysmorphic disorder, or specific phobias, or generalized anxiety, or even obsessing about their job or relationship.

Many people categorize overcoming TMS as just getting rid of their physical symptoms, but often the new "leaks" in the dam can just as uncomfortable, even if they're less obvious.

I look at beating this thing as getting to the root of what's going on so that you no longer need the defense mechanism; you're not just neutralizing the fear associated with one symptom, but you're eliminating (or significantly reducing ) your overall need to exist in a state of preoccupation and fear.

When you've achieved this, the mind no longer has a need to elicit new symptoms - physically or psychologically. It's like achieving TMS enlightenment.

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.

Alan,
I like this eliminating need of fear...
I m starting to find it helpful to say I am are engaged in practices that make deep emotions feel safe for my brain. Creating an environment of trust? Rather then focusing on ...I must get rid of fear!!!
Hmmmm hard to explain but tis a subtle difference

 

[zclesa]

Re the "symptom imperative" the only thing I want to know is this: How can we journal our way to what's in our "unconscious mind" when even Dr Sarno (and others) say this is impossible? We can only write or talk about what we remember (what we are conscious of), and I know writing often brings up a lot of what's in our subconscious, but whatever is in our "unconscious" is pretty much unreachable, except in a few rare cases I read about. So does this mean we are all doomed to keep battling through one condition after another?

And finally: From a neuroplasticity perspective, the more we talk or write about our emotions, pains, fear, etc, etc, aren't we just reinforcing already existing brain maps instead of building new brain maps that are only made up of healthier and more other positive thoughts and beliefs?

If you got this far, reading my post, and you can come up with an answer to all my questions, I'll give you $5M if and when I win the Lottery

Have you read Steve O's book The Great Pain Deception? He gives you some great ways to reach your unconscious mind, including dream programming and visualisation. You can also do it through hypnosis. I used dream programming yesterday. I got myself into a relaxed and slightly sleep-deprived state to make my mind more suggestible, then asked my unconscious kindly to tell me what was bothering it. Well, it told me alright! I had the most horrific nightmare involving my mother mutilating my private parts with a knife and then following me around threatening to do it again. At some point in the dream, I actually offered for her to it. The unconscious mind works in symbols. I grew up with a Narcissistic mother who used me to fulfil her own needs. As I child I learned to capitulate and put my mother's needs before my own, and that continued into my adult life with my needs coming below everyone else's. The dream was clearly telling me that my inner child is very upset at how my mother frightened me, took away my true identity and soul (what could be more symbolic of such intimate things than the genitals?) by making me suppress them, and how I offered up myself as a sacrifice to my mother's needs. Extremely powerful stuff!

2nd question: Look at Alan's TMS program again. You must teach your brain that it's OK to feel emotions - all emotions are "normal". We have taught ourselves that they are not safe, which is why we repress them. Have the attitude while journalling or whatever that it's OK that you feel or felt these emotions. Use Somatic Tracking when you feel anxious to let your body know it's safe to feel anxious. It is also important to be positive though. The greatest healing power of all is forgiveness. Dr Dan Siegel said that once you can understand the story of those who hurt you in the past, then you can heal. I understand that my mother must have suffered great trauma herself that made her become a Narcissist. It was what she had to do to survive. Once I understood that, it was easy to forgive her. Obviously my adult self has forgiven her, but my child self is still raging and fearful. I will need to get that out somehow. Bodywork is good for this, as well as journaling. We keep trauma trapped in our bodies, and bodywork can release it.

And yes, be positive in your life now. While you write about those painful feelings, you are releasing them. But balance out all the focus on pain with writing a gratitude list every day, being loving and caring to others every day (although NOT at the expense of yourself). Do things that make you joyful every day. That will give your brain some strong positive neural networks.

Read The Great Pain Deception if you haven't already. I claim my $5m

 

[Syl]

Have you read Steve O's book The Great Pain Deception? He gives you some great ways to reach your unconscious mind, including dream programming and visualisation. You can also do it through hypnosis. I used dream programming yesterday. I got myself into a relaxed and slightly sleep-deprived state to make my mind more suggestible, then asked my unconscious kindly to tell me what was bothering it. Well, it told me alright! I had the most horrific nightmare involving my mother mutilating my private parts with a knife and then following me around threatening to do it again. At some point in the dream, I actually offered for her to it. The unconscious mind works in symbols. I grew up with a Narcissistic mother who used me to fulfil her own needs. As I child I learned to capitulate and put my mother's needs before my own, and that continued into my adult life with my needs coming below everyone else's. The dream was clearly telling me that my inner child is very upset at how my mother frightened me, took away my true identity and soul (what could be more symbolic of such intimate things than the genitals?) by making me suppress them, and how I offered up myself as a sacrifice to my mother's needs. Extremely powerful stuff!

2nd question: Look at Alan's TMS program again. You must teach your brain that it's OK to feel emotions - all emotions are "normal". We have taught ourselves that they are not safe, which is why we repress them. Have the attitude while journalling or whatever that it's OK that you feel or felt these emotions. Use Somatic Tracking when you feel anxious to let your body know it's safe to feel anxious. It is also important to be positive though. The greatest healing power of all is forgiveness. Dr Dan Siegel said that once you can understand the story of those who hurt you in the past, then you can heal. I understand that my mother must have suffered great trauma herself that made her become a Narcissist. It was what she had to do to survive. Once I understood that, it was easy to forgive her. Obviously my adult self has forgiven her, but my child self is still raging and fearful. I will need to get that out somehow. Bodywork is good for this, as well as journaling. We keep trauma trapped in our bodies, and bodywork can release it.

And yes, be positive in your life now. While you write about those painful feelings, you are releasing them. But balance out all the focus on pain with writing a gratitude list every day, being loving and caring to others every day (although NOT at the expense of yourself). Do things that make you joyful every day. That will give your brain some strong positive neural networks.

Read The Great Pain Deception if you haven't already. I claim my $5m

Hi, thanks for your post. I've read many books on trauma and releasing it and feelings/emotions associated with it; additionally, I've done a course at uni on the subject plus I've tried many techniques, including counselling, relaxation, meditation, mindfulness, journaling, and expressive writing to name a few. Being a writer, I can write till the cows come home, and have done so over the last ten years to express my feelings, explore the traumas of both childhood and adulthood, etc. I've had some improvement in my condition, but the brain is still playing its sneaky tricks. One big thing I've been working with recently is neuroplasticity and changing brainmaps in combination with Qigong (or medicinal Qigong as some call it, which is a more ancient form of Tai Chi but solely focused on balancing the body and mind so the person can heal from within). I've had a major breakthrough as a result, and in less than four weeks I've seen much improvement in the pelvic condition and upper back pain. Plus I'm now getting better at stopping the brain in its tracks, before it goes on to give me pain in different area, etc. I am now following this method as it seems to be workng for me. Therefore, you may have to wait to claim that $5m, but if I win the lottery I may still give it to you just because you cared enough to reply to my post, and you're obviously a person who wishes to help. So I thank you, and I won't forget you if I win the "big one"!

 

[zclesa]

Hi Syl, How wonderful. I'm so glad you've found something that's working for you. I've only done Qigong a couple of times (and that was several years ago before I got TMS). I had no idea it could really be so powerful. That's great! I assume you've read Bessel Van der Volk. I did my first ever yoga lesson this week as a start in this bodywork. It was great as it was at a Buddhist Centre and I'm a Buddhist (so if you did give me some of your lottery winnings, I'd probably donate it to charity anyway ) and the teacher was brilliant. She made a really safe space for everyone and talked about "inhabiting the body" and stuff. So I'm going to go every week. If that doesn't work then I may have to try more directly trauma-focused releasing therapies, but for the meantime I'm really happy to go there anyway.

I'm a writer too, though I've never journalled until yesterday (which had me bawling my eyes out). I used to be a journalist, but now I write self-help books. I have always written creatively, from appalling poetry in my teens to short stories as an adult. I actually didn't think journalling would help at this stage, as I intellectualise and detach so much from my emotions that I thought I'd block myself from feeling them. But I ended up closing my eyes as I wrote and that helped for some reason. I guess because I had to "go inside" more and wasn't looking at what I was writing and trying to edit it!

So happy that you've had some major breakthroughs. Go, Syl!

 

[Syl]

Hi Syl, How wonderful. I'm so glad you've found something that's working for you. I've only done Qigong a couple of times (and that was several years ago before I got TMS). I had no idea it could really be so powerful. That's great! I assume you've read Bessel Van der Volk. I did my first ever yoga lesson this week as a start in this bodywork. It was great as it was at a Buddhist Centre and I'm a Buddhist (so if you did give me some of your lottery winnings, I'd probably donate it to charity anyway ) and the teacher was brilliant. She made a really safe space for everyone and talked about "inhabiting the body" and stuff. So I'm going to go every week. If that doesn't work then I may have to try more directly trauma-focused releasing therapies, but for the meantime I'm really happy to go there anyway.

I'm a writer too, though I've never journalled until yesterday (which had me bawling my eyes out). I used to be a journalist, but now I write self-help books. I have always written creatively, from appalling poetry in my teens to short stories as an adult. I actually didn't think journalling would help at this stage, as I intellectualise and detach so much from my emotions that I thought I'd block myself from feeling them. But I ended up closing my eyes as I wrote and that helped for some reason. I guess because I had to "go inside" more and wasn't looking at what I was writing and trying to edit it!

So happy that you've had some major breakthroughs. Go, Syl!

Hey there. No I didn't read the book you mentioned. I've read so many books now that I lost count, and I'm still reading. I could never do yoga; even as a young person I found it didn't suit me for some reason. I guess we're all different. Instead, I turned to the martial arts when I was young (I was doing a high impact style, Tae Kwon Do). As for Tai Chi, although it's considered a martial art (but in slow motion), Qigong is the medicinal side of the Eastern healing arts. I practise under a grandmaster who is very well known in Australia (where I live). He has worked with doctors and surgeons, too, in order to get patients up and moving so they can heal. Qigong is very much tied in with neuroplasticity, only in the West not many people, especially in the medical/healing field, have explored this.

Yes, journalling can be powerful. I've cried many times when writing, but I find expressive writing is working a lot better with me nowadays. I simply write whatever emotions or feelings come up, and I write fast and without worrying about spelling or grammar. It's kind of like writing from whatever comes through the unconscious. After I finish I shred whatever I write. This gives me a huge sense of release. Some people tear up the paper in bits or burn it or whatever. I love shredding, for some reason I find it very therapeutic.

Like you, I've been writing since an early age, but I've always stuck to fiction; the only non-fiction I've done was for business (my professional background was in human resources, and learning and development, so I did a lot of writing of policies, procedures, contracts, training programs, etc). I've given up the HR side of things about four years ago as it was very stressful and I hated the politics, so these days I do the odd writing gig now and then. In the meantime, I've published seven novels--three of which are part of a mystery series--and I tell you, there is nothing more healing than a fictional murder (and think of someone who has hurt you in real life while you're writing). I get so involved in murder and mayhem and it's not only safe (because it's fictional) but healing as well. LOL. I find creativity is also very healing and it distracts the brain from making pain.

I'm now exploring a project where I may get to work with my Qigong grandmaster. He published several books many years ago and has asked me if I'd be interested in updating and rewriting some of his books. He's really into neuroplasticity, and we make a good team because I've been researching neuroplasticity for such a long time and practising it too. So I'm keeping fingers crossed that this will come about. If so, it'll be a big non-fiction project for me. We shall see. But if it doesn't pan out I have a fourth murder mystery awaiting my attention, and I'll have to find some victims to do away with

I hope you get results with yoga. If not, try Shibashi Qigong (which is considered to be the medicinal Qigong style) and hopefully you will see results. We are on a journey of healing and I'm sure we will take many turns along the road until we find the right one. Happy healing to you!

 

[zclesa]

That all sounds wonderful. Thanks for the good wishes and happy healing to you too

 

[Syl]

Thank you!

 

[Viridian]

Answer

Great question! The symptom imperative is often sneaky, and can occur even without being recognized.

Psychogenic pain is serving a purpose. The purpose of the pain for most people is to serve as a vessel of preoccupation, primarily in the form of fear. So put more directly, the purpose of the pain is to scare you (ultimately with the unconscious motive of helping to protect you...)

So when you neutralize the fear associated with one symptom, it usually subsides, as it's no longer serving its purpose. But the pain came up for a reason. Maybe there are emotions that you're not consciously able to tolerate, or maybe you treat yourself poorly (criticism, pressure, etc.)

If you plug up a leak in a dam, it'll be fine for awhile, but if you don't address the water pressure, it'll just spring another leak. This is why people have symptoms crop up in other areas.

But it doesn't have to be replaced with another physical symptom, any vessel of fear will do. I've had patients where the pain went away, and several weeks later it was replaced with OCD, or body dysmorphic disorder, or specific phobias, or generalized anxiety, or even obsessing about their job or relationship.

Many people categorize overcoming TMS as just getting rid of their physical symptoms, but often the new "leaks" in the dam can just as uncomfortable, even if they're less obvious.

I look at beating this thing as getting to the root of what's going on so that you no longer need the defense mechanism; you're not just neutralizing the fear associated with one symptom, but you're eliminating (or significantly reducing ) your overall need to exist in a state of preoccupation and fear.

When you've achieved this, the mind no longer has a need to elicit new symptoms - physically or psychologically. It's like achieving TMS enlightenment.

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.

Hello Alan,

What would your suggestion be for getting ‘to the root of what’s going on’?

I feel like I’ve tried everything...and though I’ve been successful in vastly reducing my pain for long stretches, I simply live in a state of high anxiety instead.

I know there are obvious answers for our pain - living in a stressed state etc - but we can’t ever truly know the cause and what the best course of action is can we?