The TMS Wiki has an extensive list of questions and answers from medical practioners here.
1. Are you saying the pain is just “in my head?”
Absolutely not. The pain of RSI or back pain is as real as the pain of a broken leg. The restriction of blood flow to the affected limbs causes very real physical pain. The difference is that the underlying cause is not structural, but as a result of the unconscious control of the autonomic system.
2. If my pain is not structural how can it be triggered by physical activity?
TMS pain occurs in order to distract you or remove you from a situation that is harmful at an unconscious level. This can be a stressful situation, negative emotions or a job you hate. Common manifestations of TMS like RSI effectively remove you from those stressful or miserable work environments and force you to significantly change your life. Therefore by targeting the back and lower limbs, the unconscious control of the autonomic system can often most effectively achieve its goal.
3. But my chronic condition was initially triggered by a physical event.
There are undoubtedly physical strains and pulls which we all suffer. The difference is primarily in the recovery from those strains. Your RSI symptoms may have been triggered after a really prolonged bout of typing, your back pain from heavy lifting, but if you are still in pain months later it is likely that it is no longer the physical strain that is causing the pain. That will have healed a long time ago. Added to this is the positive feedback of pain conditioning. Something causes pain so the next time you do that activity you expect pain again, heightening sensitivity, and making the pain sensation worse. This increases the fear stress response next time you do the activity and so on.
4. But I have a structural diagnosis from my doctor.
This is a tough one. It is absolutely essential that anyone with chronic pain goes through the correct medical channels. It is possible that your symptoms are indeed caused by a serious structural condition which needs diagnosis. However, there is also an important caveat to be aware of – these structural diagnoses may not always be correct.
In the case of RSI, the term is somewhat of an ill-defined catch all. There are few tests for the condition. You might be given a nerve conduction study – though a positive test here does not preclude the possibility that TMS might be the root cause.
In the case of back pain, there have been a number of studies (referred to in more detail in the “medical evidence” section) which demonstrate that the frequent diagnosis of back pain due to spinal abnormalities is questionable. Many healthy people with no reported back pain also have “spinal abnormalities” show up on MRI scans. For many cases of back pain therefore these abnormalities may not have a causative pain effect.
Ultimately you have to use your judgment on this one. I would recommend doing your own reading on the subject, and ideally getting a second opinion from one of the doctors listed on the “links/resources” page.
5. So, if the pain is not structural, does that mean I can just ignore it and it’ll go away?
Unfortunately not! That’s not how TMS works. You have to genuinely believe that the pain is a result of a non-structural cause. This will allow you to re-program your brain’s control of the autonomic system to get your blood flowing again normally. If you just try and ignore the pain whilst still believing it to be physical, it will not get better.
6. How do I journal?
Read the “How to cure TMS” section. It’s simply a case of writing for 10 minutes a day about things which cause/have caused you stress or pain or anger etc etc. You’ll find it provides a really interesting introspective into your psyche!
7. You only concentrate on RSI and back pain on this website, what about other chronic pain conditions?
The majority of case studies are from RSI and back pain sufferers because these seem to be the most common. However the TMS Wiki contains a pretty comprehensive list of chronic pain conditions that Dr. Sarno believes may be manifestations of TMS. These include sciatica, groin pain, migraines and neck pain.
8. Isn’t this just the placebo effect?
Firstly the placebo can’t cure structural conditions – no matter how much you believe in a cure it won’t mend a broken bone, so if this was just the placebo effect then that on its own would be enough to show that the chronic pain of RSI and back pain don’t have a structural root. But in any case, the numerous success stories all follow the same pattern – success after first trying an d failing with a whole host of other treatments. In my own case I had tried two courses of physio, acupuncture, posture awareness, stretches, rest and ergonomic changes. All of these failed to have any placebo despite my optimism of their efficiency.
9. You do know the plural of anecdote isn’t evidence don’t you?
It’s true that the case studies of individuals who have recovered from chronic back pain and RSI do not constitute empirical evidence. Maybe the odds of seeing significant improvements after adopting a TMS approach are 1000-1, but the other 999 don’t write about their experiences. The only way to really refute this idea is to examine the retrospective studies which have been done by Dr. Sarno and others (referenced in more detail in the medical section).
In my case, it wasn’t simply a case of chance that I happened to improve after reading Dr. Sarno’s book. I would still have been letting my RSI dominate my life without that prompting. Overcoming the fear conditioning was a massive part of my recovery. To recover I needed to actually sit down in front of a computer again and start typing. The first time I did this I had to start deep breathing for about 5 minutes to calm myself – such was my conditioned stress response to the idea of typing again. I simply wouldn’t have done this without being exposed to the concept of TMS. So, at the very least these individual stories do demonstrate that at least for a subset of chronic pain sufferers, their pain is not structural in nature – because it was cured by a mindbody approach.
10. Why have you made this website? What’s in it for you?
I have absolutely no financial interest in promoting TMS – indeed, as a concept there’s remarkably little money to be made out of it – everything you need for a full recovery is available for free online. I suffered debilitating RSI for three years which had a massive impact on my quality of life. I recovered after stumbling across the TMS Help forum and TMS wiki, so I feel an obligation to do my bit to spread awareness of TMS.