Harnessing the power of the mindbody approach
Understanding acute and chronic pain
Acute, subacute, and chronic pain are different. With acute pain, for example an injury, you may hurt for up to six weeks while you’re healing. This might be a sprained ankle, a contusion like a bruised arm, a shoulder injury from playing sports, or something similar. Most acute injuries, whether they affect the knee, the back or other areas of your body, will typically go away often regardless of how they are treated.
In fact, data and research on back pain has shown that if a physician does nothing and simply tells the patient to go about their usual activities as best they can, the vast majority of injured people get better during that acute phase. Subacute pain might be experienced for six weeks to three to six months. Chronic pain lasts longer—more than three to six months—and is more of a challenge when it comes to breaking the cycle of pain.
What’s the science on chronic pain?
We now have access to functional MRI imaging. This technique scans the brain with an MRI scanner that looks at blood flow as well as structure. Unlike the standard MRI you might get when you injure your knee or you have a headache, these MRIs are more for research purposes. What they show is that acute pain is experienced in the part of the brain that’s connected to sensation: the somatosensory cortex. It’s no surprise that sensations are experienced in the part of the brain that deals with sensations!
However, based on the blood flow studies of functional MRI imaging, we can see that chronic pain—which is another kind of sensation—is experienced in different parts of the brain called the prefrontal cortex and the amygdala. Chronic pain is more intimately connected with the emotional centers of the brain. Over the last 20 years or so, the science has corroborated some of the work that I studied based on the empirical observations of chronic pain pioneer Dr. John Sarno and from my own experience: acute pain and chronic pain are different animals.
It’s very important that we don’t treat the two the same, yet many conventional and alternative practitioners sort of lump everything together and say, oh, you’re in pain, we should treat you for your pain. But what is the cause of the pain? With acute pain, it’s often either something mechanical, an injury or soft tissue problem that will typically go away. According to what we’ve observed in these functional MRI imaging studies, the cause of chronic pain is more likely to be found in the nervous system: it’s related to the brain and to emotions.
What is TMS?
The term that I use for chronic pain that I feel is related to the mind, brain, and emotions is Tension Myoneural (formerly Myositis) Syndrome, or TMS. Alternative terms include Psychophysiologic Disorder (PPD), Mindbody Syndrome, Distraction Pain Syndrome (DPS), and Central Pain Syndrome.
Let’s go back to the acronym that I prefer, TMS. What is TMS? It involves real physical pain, or, in some cases, other symptoms—such as tingling, nausea, or dizziness—that are less related to physiologic damage or a structural change in the body, and more to a functional change in the body that is triggered and amplified by the nervous system. The ultimate cause of TMS is related to emotions, and therefore to how our personality responds to different events and situations.
We find that a “type T” personality is common in people who suffer from TMS. What are some of its characteristics? Being hard on yourself—being self-critical is one of the key features. Perfectionism is not unusual; it may not be perfectionism in everything, but it could be perfectionism in some things that end up dragging you down or worrying you in some sense. Being a people pleaser—someone who is sensitive to how others perceive them—can also be a factor in TMS. Feeling very responsible for others and tending to be more focused on caring for them than yourself is a very nice characteristic to have, but it creates a lot of tension internally. Finally, Dr. Sarno used a term called “goodism,” which refers to people who are really focused and passionate about changing the world and making it a better place—another fine quality to have, but it puts a lot of pressure on you.
The reason we’re speaking about the characteristics that are common in TMS is because it helps people and physicians identify who might be a good candidate for the TMS diagnosis and treatment approach. It also helps such a person understand that slight modifications and dialing things down just a little bit can be greatly beneficial. If you’re a 9½ out of 10 perfectionist, you don’t have to become a 3 out of 10 to get pain relief, but you might need to become an 8¾. Just a little tweak can make a big difference. And if you are a kind and wonderful person who is always caring for others, add yourself to the list of people that need to be cared for. Type T is a common personality type by the way. Certainly I have it, Dr. Sarno had it, and maybe you have it as well.
What is the treatment for TMS?
First off, be sure to get your medical condition examined by a suitable practitioner to make sure there’s nothing going on structurally. If nothing serious is found and you’re a type T personality, you’re at a much higher risk for TMS and related disorders.
The treatment starts with education, which means learning more about the condition. It means reading a book, listening to a podcast or an interview about the subject. Simply evaluating this information begins the process of neural change or neuroplasticity. Regarding treatment of TMS, Dr. Sarno would say to me that education is the penicillin for this condition.
The other thing is accepting and believing the diagnosis. It’s very natural to doubt this— the idea that the mind, brain, and emotions are so central to the pain you’re experiencing is very different from what you may have heard about back pain and other health conditions. Changing your belief system, trying to internalize the message, and changing your attitude is key.
I spoke to someone the other day who said that after he left my office and was driving back to his home several hours away he started talking to himself in the car. “You know what, there’s nothing seriously wrong with me. Dr. Schechter looked at my examination, we reviewed my MRI, he went through the evidence in favor of this diagnosis, and nothing strongly opposes it. And now it’s clear to me that this is what I’ve got.” And he kept repeating this to himself in the car. “It’s TMS. There’s nothing seriously, structurally wrong with me.” And he noticed that he could drive for hours. Usually, he was in pain within an hour or so of sitting in a chair or car, but this time he drove for hours and didn’t have any problems.
The treatment for tension myoneural syndrome, or TMS, begins here. We rely on the power of attitude, belief, information, knowledge, and evidence. And they all contribute to a successful outcome.