Q&A: Can TMS/PPD cause swelling?

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I was curious if anyone has had a TMS diagnosis which was blamed on a herniated or extruded disc, AND they noticed swelling in the area of the disc. In other words, if you looked at your back in the mirror, has anyone noticed "puffy" or swelling along the spine? There seems to be some support for the idea that TMS can even cause swelling. However, in HBP Sarno talks about how inflammation has nothing to do with the pain or other symptoms. Swelling and inflammation aren't exactly the same thing, but swelling can be a sign of inflammation. I noticed swelling in the L4-L5 location before I had surgery. After surgery almost 3 weeks ago, the swelling is still there. I'm guessing most TMS doctors would attribute any swelling to a structural concern, not TMS. I didn't want to get more nerve issues than I already have, so I had surgery. If I didn't see the swelling before surgery, I would have attributed it to the surgery. However, it was there before, and it is still there after. Dr. Sarno seems to believe that TMS can manifest itself even to some extremes, like extreme muscle weakness and so on. Maybe even swelling. On the other hand, Dr. Schubiner doesn't believe TMS causes extreme motor issues. Diagnosis is a problem when symptoms get extreme. Sometimes surgery is necessary.

Answer by Howard Schubiner, MD

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Howard Schubiner, MD

Dr. Schubiner's Profile Page / Survey Response / Bio / Psychophysiologic Disorders Association (PPDA) Board Member / Website

You're asking an important question that often arises. At its core, the question probes the relationship between PPD/TMS and structural changes in the body. In general, PPD/TMS does not cause structural changes in the body. It produces symptoms, such as pain, fatigue, diarrhea by activating nerve pathways that act on the body. These nerve pathways are real and produce real symptoms, but typically they do not cause structural changes which I am defining as some kind of tissue damage, as seen by swelling or inflammation. However, it is well known that at times, the mind (PPD/TMS) can cause tissue damage. There is a rare condition known as “broken heart syndrome” in which an emotional event or shock leads to tissue damage in the heart sending the unfortunate person into a cardiac care unit, often with low blood pressure and inability of the heart to pump as powerfully as it usually does (fortunately, this is almost always reversible). Another condition that crosses the line between “pure” PPD/TMS without any structural changes and PPD/TMS with structural changes in called Chronic Regional Pain Syndrome (CRPS, formerly known as RSD or reflex sympathetic dystrophy). Here the affected body part gets swollen, red or purplish in color, and very painful. I think that CRPS is another form of PPD/TMS, but apparently one that includes some tissue damage.

With regard to back pain, PPD/TMS does not cause inflammation in the back so that swelling would not result from that process. We know that PPD/TMS can cause muscle tightness, contractions and spasms in the back. The back muscles have been shown to do this in response to emotions, such as anger. See research by John Burns (Burns JW. Arousal of negative emotions and symptom-specific reactivity in chronic low back pain patients. Emotion. 2006, 6: 309-19.) for details. The swelling that is sometimes noticed in the back is probably due to muscles of the back tightening, shortening and “balling up” so to speak, which is interpreted as swelling. So-called “degenerative disc disease” cannot cause swelling seen on the surface as those structures are much deeper inside the body. When one approaches a patient with back pain, it is obviously crucial to rule out a structural cause for the pain such as a fracture, tumor, or inflammatory disease. However, when those are not identified, back pain usually fits into the pure PPD/TMS category of illnesses, i.e. there are no structural changes in the body and the pain is caused by activation of nerve pathways triggered by stress and emotions.


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