Chronic Pain and TMS – the hidden cause

When, in my mid-thirties I became struck by a mystery illness which rendered me incapable of more than 3 hours work a day, I feared the worst. The symptoms were very varied but began with incredible fatigue. Then my joints swelled up so that walking became painful. I had unexplained rashes and itching, dizziness and headaches, it went on and on. I went back and forth from the GP and various hospital and blood tests. They could find nothing organically wrong with me and left me with a 6 months prescription for painkillers telling me it would probably get better of its own accord!

So, I determined I would find out more about chronic pain and fatigue and see if I could unlock whatever it was with alternative methods. I tried acupuncture (which was helpful), homeopathy (which was not – for me anyway). Then I tried massage and chiropractic and finally some Chinese herbs which were incredibly effective as they detoxified my body and enabled it to begin to heal. I started to see that health and wellbeing was more than curing myself of disease. It was about bringing my body back into balance.

Fast forward 15 years and I am now a fully qualified therapist specialising in Chronic pain, specifically TMS or Tension Myositis Syndrome (which is closely related to Chronic Fatigue syndrome although they may manifest differently). It is a stress-related illness – by which I don’t mean necessarily due to an obvious stressor but it can be accumulated, low-level stress like being in the wrong job, relationship for you, or by burying your emotions of loss, grief or anger. Men and women are different in this respect as their emotional landscapes are different which may explain the huge preponderance of women with CFS/ME as compared to men. Men on the other hand may get unexplained back pain, or auto-immune diseases. Modern medicine calls these conditions different illnesses, and attempts to treat them symptomatically. This doesn’t work as the central cause isn’t in the affected part but in the brain.

Now, here’s where this gets tricky as people in pain do not like being told ‘it’s all in the mind’. That isn’t what I’m saying at all. The pain is very real and there is real physical disturbance in the tissue causing that pain. However, the ultimate causation is in the imbalance in the nervous system which comes from undischarged emotion. It is a simple biological fact that we are hardwired for emotion – the two most primitive are fear and defensive anger (rage). In the animal kingdom (of which we are part from an evolutionary perspective) animals will display these emotions as a survival tactic. If we didn’t have fear we would be incautious and perhaps get eaten, if we didn’t have rage we couldn’t stand up to our attackers with the same result. The part of the nervous system that controls this is the autonomic nervous system and it is composed of two parts; the sympathetic and the para-sympathetic. They are like the accelerator and brakes respectively that modulate the body’s responses to outside stimulus. But they also response to internal stimuli – our feelings and emotions.

So, if we are afraid, our heart rate increases, our breathing is rapid, we are geared to the so-called  ‘fight or flight’ response which involves the brain and endocrine (hormone) system. If we have a situation where neither of these is possible we can exhibit a freeze response where our body is in perpetual slow motion – lacking energy and vitality. This is probably the basis for Chronic Fatigue syndromes – much more common in women whose nervous systems tend to freeze more than they fight. [i]That our mind can create this may seem nonsensical until you begin to understand our evolutionary heritage. As animals, our mind is incredibly complex and designed to deal with threat- it cannot differentiate between real threat and perceived threat – perception is everything! So, for instance we can get anxiety because our mind is interpreting a situation as threatening even when it is relatively innocuous. This is because the brain is a pattern recognition machine and it links certain events together by their associated senses or emotions. So, for instance a certain smell will evoke a memory as will feeling fearful – but the associations may be unconscious, so for instance your boss may remind you of someone you once feared so they trigger that response in you causing unconscious stress.

TMS is the physical response of the body to that cumulative, low-grade stress. It inhibits blood flow to the tissues casuing local ischaemia (or oxygen deprivation). The tissues become hypoxic, lactic acid builds up and pain and fatigue is the result – especially in muscles and tendons. There only needs to be a small amount of reduction too to have serious effects. If the nerves are affected then the pain may be accompanied/replaced by tingling or odd feeling sensations. But because the root cause – stress – is never addressed all physical approaches be they massage, physio, pain killers and surgery will never work. It has been noticed of instance that in people with Fibromyalgia most pain killers are ineffective.

There has been a lot of research into TMS but the main author who first coined the term was Dr john Sarno[ii]. He was in rehabilitation medicine for 30+ years and began to notice patterns of trauma in his patients that, if he encourage them to highlight and address their unprocessed emotions, they were able to reduce or remove their pain altogether. He hypothesised that the mind was creating pain as a diversion to these uncomfortable emotions – in the mind’s view physical pain is less damaging! He also noticed  that the pain could shift and move around when these feelings were addressed. Combined with his research into normal pathology of the spine and tissues with ageing, he came to the conclusion that the root cause was not physical but emotional.his work has since been furthered by clinicians such as Dr James Alexander[iii] who being a psychologist, was able to hypothersise how this mechanism might be mediated.

I have written extensively on this in other blogs and won’t repeat here, but mindbody medicine which acknowledges that we are both mind AND body is really the only logical way forward to solve the epidemic of mindbody disorders that we are currently seeing. These include in no particular order; CFS/ME, auto-immune disease, IBS, anxiety/panic disorders, headaches/migraines, insomnia, etc. In my practice I work with people on a mindbody level - we investigate the whole person not just the physical symptoms.  I use massage and Reiki to stimulate the body and rebalance the energy system, and then various psycho-somatic techniques such as EFT (tapping ) and EMDR within a hypnotherapeutic framework (which emphasises safety and self-empowerment).

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[i] Peter Levine:  ‘In unspoken voice- how the body releases trauma

[ii]Dr john Sarno: ‘The Mindbody Prescription’ and ‘Healing Back Pain’

[iii] Dr James Alexander; The hidden Psychology of Pain’

Medical contributions to psycho-genic pain

Further to my first blog on reading The Hidden Psychology of Pain by Dr James Alexander, I thought I'd add some more thoughts. I thoroughly agree with his contention that the medical establishment contributes in no small part to the perpetuation of the notion that pain can only have a physical cause. The idea that emotions can cause pain is dismissed in the main, especially since both physician and patient make the mistake of thinking that this means the pain is 'all in the mind' and therefore not real!. Psychogenic pain is completely real - it has a physical manifestation - which can be due to lack of oxygen supply to the tissues or over-contraction (spasm) but the over-riding cause is an emotional memory which has not been released and continues to replay the motor action that was in place at the time that the encoding traumatic event first occurred. So, in simple language the body holds the trauma in memory and, as this is never discharged, chronic pain ensues.. This may take the form of back pain, shoulder pain or in very severe cases, fibromyalgia and other chronic fatigue-related syndromes. There is usually complex childhood trauma at the heart of these syndromes.

The brain is able to create physical symptoms via the combination of limbic system (deep brain) which triggers the Hypothalamus, Pituitary, Adrenal (HPA) axis mediated by the autonomic nervous system; the body is flooded with stress chemicals (mostly cortisol from the adrenal glands) and the stress cycle begins. Cortisol will cause most of the symptoms seen, especially if it is released continuously.

Unfortunately, when a person is misdiagnosed with a physical cause of this (via increasingly sophisticated technological scans which reveal 'pathology' of the various tissues), the belief that there is indeed something physically 'wrong' is corroborated. What you are not told is that many people who are not in pain have the same 'pathology', but since they do not consult their doctors, this is rarely appreciated. However, there are many reliable studies that have confirmed this, it just does not fit the current model. If the pain was caused by the structural abnormalities then why doesn't everyone who has these abnormalities have pain? It just doesn't make sense.

With some chronic pain/fatigue syndromes like CFS/ME the symptoms are so varied that it is hard to see how they relate at all. They can range from cognitive disorders, digestive issues, cold hands and feet, postural hyptension (low blood pressure when standing up), etc, etc. The brain lies at the heart of all of these symptoms via, as we have said, the HPA axis and excess cortisol but for someone suffering it is hard to believe this.

I recently had  a client tell me that she has finally got a diagnosis of Menieres disease, a disorder of the inner ear that affects hearing and balance. It causes sudden attacks of vertigo (a spinning sensation), tinnitus (a loud ringing in the ears), and a temporary loss of hearing. She seemed relieved that at last there is an explanation for the very disabling symptoms she has been experiencing. However, I am not convinced that this 'disease' is not simply another manifestation of the autonomic nervous system imbalance. Sadly, it is hard to contradict the medical view as it is so supported in our culture, and, for someone in pain, they need to have an explanation or they fear that people will think they are making it up or 'swinging the lead' as it used to be called. Being told by a doctor that you have 'x disease' and then, worse, being told it is bad enough to merit investigation, usually by tests (in this case MRI), further traumatises the patient and ensures the symptoms will continue and usually get worse. For traumatisation to occur requires that the person be helpless. There is nothing like being subject to medical investigation with complex interventions by 'experts' to make a person feel helpless. They are totally disempowered from their bodies, their self-determination and become stuck in the anxiety loop.

Unless they are able to work with a trusted holistic/mindbody practitioner who can demonstrate the real meaning of these symptoms and give them tools to alleviate the stress, the likely prognosis is poor. We have seen people die from these chronic fatigue related diseases, and most live a thoroughly reduced quality of life. It takes a lot of courage to break free of the medical model, with its round of tests and specialists who each corroborate the view that this is lifelong and nothing much can be done. And the social care model, that only pays disability payments to those with defined conditions simply adds to the burden that these people feel. If they then get better does that mean they never had it in the first place?? how will they live while they are recovering but are still not well enough to work? This places such a pressure on people that they are unlikely to step outside the system, especially since this means losing the little certainty they had.

It is a very challenging field in which to work. But I have no doubt medical science and psychology will eventually unite and prove that this psycho-genic model is the correct one. We will in the future be able to understand our emotional fallibility without blame - and have a collaborative healthcare team to work with us to re-write the programme and release us from pain.