FREQUENTLY ASKED QUESTIONS
I recommend taking five minutes to watch the very informative video below before exploring the in-depth FAQs that follow.
I'm having a hard time buying into this whole mind-body thing. My pain is severe and it is REAL.
Yep, I understand that your pain is severe and I agree that it is 100% real. But here's the thing: ALL pain (and all sensation, for that matter) is created by the brain. All pain, including yours, is an output FROM the brain, not an input TO the brain.
At any given moment, there are literally millions of bits of raw data streaming into your brain from your body. Your brain takes that data and makes sense of it in light of information that comes from your environment, thoughts, emotions, beliefs, and a vast storehouse of memories. Only then does your brain make a determination about whether or not pain is an appropriate response. In acute pain, when there is clear damage to the body, danger signals coming from tissues typically (but not always) provoke the brain to produce pain until the damage heals.
When pain has persisted for more than a few months, however, things become much more complicated. Factors other than the condition of tissue start weighing more heavily as the neural networks involved in the pain experience shift and expand to areas in in the brain involved in emotional processing, memory, and beliefs. Persistent pain literally rewires the brain -- just like tasks that once required deliberate, focused effort (like reading, writing with a pen or pencil, driving a car, riding a bike, or typing on a keyboard) become effortless and automatic if they are repeated enough, the brain also learns pain.
So you're saying my pain is all in my mind?!
What I am saying is that ALL pain (and all sensation, for that matter) takes place in the brain. If you are experiencing pain, it is because your brain is receiving raw data from your body, weighing it in light of a vast amount of other information (regarding your emotional state, your beliefs, your expectations, your memories, etc.) and determining that pain is a necessary or appropriate response. Pain is an output FROM the brain as opposed to an input TO the brain.
What is neural pathway pain?
There are two causes of chronic pain:
- Structural pain due to ongoing tissue injury, tumor, fracture, or nerve damage. When imaging reveals a fracture, a tumor, an inflammatory condition, or severely herniated discs with evidence of nerve damage, a structural disorder is likely to be the cause of pain. These conditions are the cause of persistent pain in only a small minority of patients.
- Neural pathway pain (also called brain-induced pain or centralized pain). Studies show that approximately 85% of patients with chronic neck or back pain do not have a clearly identifiable, structural cause for their pain. Of the millions of individuals experiencing tension and migraine headaches, only about 5% have an identifiable structural cause. Other studies show that very few people with irritable bowel syndrome, fibromyalgia, and many chronic pelvic pain syndromes have tissue damage to account for their pain. These data suggest that the majority of patients presenting with chronic pain do not have a structural cause. In these cases, pain is caused by the activation of neural circuits that create real pain in the absence of tissue damage.
What is TMS?
TMS is an acronym coined by Dr. John Sarno and originally stood for Tension Myositis Syndrome. This acronym was later revised to Tension Myoneural Syndrome or The Mindbody Syndrome when Dr. Sarno realized that there was no “itis” (inflammation) involved in the condition and tissues other than muscles (myo) were involved.
Pain is a hiding place for nervous tension
This phenomenon is described in great detail in Dr. Sarno’s books, but the gist of it is this: pain is a ploy on the part of the psyche to keep a person distracted from unconscious emotions that are so shameful or overwhelming or socially unacceptable that they would threaten a person’s whole sense of self and ability to function in the world if they were to bubble into consciousness. According to Dr. Sarno, when unconscious emotions threaten to emerge into consciousness, the autonomic nervous system causes blood vessels to constrict (a phenomenon that can happen as quickly as a person blushes when they are embarrassed). This constriction deprives muscles and nerves of oxygen and causes pain, pain serves as a very effective distraction, and difficult emotions remain safely locked away in the unconscious mind.
So you're saying I'm a head case?!
No, I am saying that you are human. There is a primitive, childish part of the brain (which Freud called the id) that exists in each of us, without exception. TMS is an effort on the part of the conscious mind to keep the primitive brain in check.
At one point in time, everyone suffers from TMS. It is part of being human. It is just that certain personality characteristics (more on this below) make some people more likely to suffer from TMS.
I've never heard of this before -- is this a new idea?
Although Dr. Sarno's theory is very insightful, it is actually not new. An ancient Chinese medical text (written around 200 BCE) says “bu tong ze tong, tong ze bu tong” which translates roughly to “if there is no free [blood] flow, there is pain; if there is free [blood] flow there is no pain”. There has long been an awareness among the sages of Chinese medicine that "unresolved" emotions are a primary cause of this lack of free flow. According to Chinese medicine, chronic pain is often caused not by a physical problem but by “crystalized emotion”, which results from familial issues that have been swept under the rug, early childhood abuse forgotten by the conscious mind but remembered by the body, and/or refusal to face one’s own shadow side and trying to be “all goodness and light” while denying deeper layers of emotion. In these cases, the treatment is to “dare to shine the light of awareness into the dark death sleep of a denied truth” (Lorie Eve Dechar, in her book Five Spirits: Alchemical Acupuncture for Psychological and Spiritual Healing).
Are you saying that pain always has a psychological cause?
Please understand, I am not saying that pain should not be taken seriously and should not be thoroughly investigated when it occurs. Women in particular already have a hard time getting taken seriously when they seek medical care for pain, which can have life-altering or even life-threatening consequences.
Before proceeding with the recommendations on this site, you must get a thorough medical exam. If your neck or back pain is new; if it is getting worse, not better; and/or you have any of the red flags listed below, do not pass go, do not collect $200, go to your doctor.
- Weight loss without dieting.
- Unexplained fevers or chills.
- Light tapping on the spine is painful.
- Incontinence and/or true numbness around the groin and buttocks in a “saddle” pattern.
- Any accident with forces that may have been sufficient to fracture your spine.
- A fierce headache, and/or an inability to bend the head forward, and/or fever, and/or altered mental state.
- Severe headache that comes on suddenly and/or “the worst headache you’ve ever had”.
- Pain that grows steadily worse and is mostly unaffected by position and activity, is worse with weight bearing and at night, and comes with other signs of being unwell.
- Poor hand coordination; weakness, “heavy” feelings, and atrophy; diffuse numbness; shooting pains in the limbs (especially when bending the head forward); an awkward gait.
- Symptoms that spread equally into both legs, especially numbness and/or tingling and/or weakness, and especially if it is aggravated by lifting. The same symptoms limited to one side are also a concern, but less so.
- Difficulty urinating, incontinence, numbness around the groin, foot drop (a toe that drags), and significant weakness in the legs are all potentially serious signs of a neurological problem.
- Back pain that throbs in sync with pulse.
- Unexplained episodes of dizziness and/or nausea and vomiting may indicate a problem with stability of the upper cervical spine.
- Steroid use, other drug abuse, and HIV are all risk factors for a serious cause of neck pain.
- If you are feeling quite unwell in any other way, that could be an indication that neck pain isn’t the only thing going on.
- The main signs that neck pain might caused by autoimmune disease specifically include: a family history of autoimmune disease, gradual but progressive increase in symptoms before the age of 40, marked morning stiffness, pain in other joints as well as the low back, rashes, difficult digestion, irritated eyes, and discharge from the urethra.
It is also important to understand that acute injuries cause pain. It is when pain does not resolve within a reasonable period of time that it starts to become appropriate to seek a psychological as opposed to physical explanation. A good example is the pain that I experienced after a major car accident. There were three people in the car that day and we all had significant pain afterward. The other two people experienced resolution of their pain within a few weeks (normal). I, on the other hand, got worse in the months following the accident and went on to develop chronic pain that lasted nearly a decade (not normal).
Surely I need a MRI!
According to guidelines published in February of 2017 by American Academy of Physicians and the American Pain Society, only a small percentage of patients require MRI or CT evaluation of neck or back pain.
This excellent article explains why are you actually probably better off avoiding imaging procedures if you have neck or back pain.
Also see Scans for Back Pain are Ineffective.
Lastly, as it turns out, a large percentage of people with NO PAIN have abnormal MRIs, meaning that there's not a clear relationship between what shows up on a scan and whether or not you have pain.
But my doctor says that my pain is from herniated discs/degenerative changes/spinal stenosis/spondylolysis/spondylolisthesis?
A large body of scientific evidence shows that the vast majority of adults, even people who are completely free of pain, have abnormal MRIs, suggesting that these “abnormalities” do not necessarily cause pain. Because this is such an important topic, I have devoted an entire blog post to it.
Here is a brief video of Dr. Sarno addressing this question.
But my pain is so bad -- surely I need surgery!
If you are considering spinal surgery, particularly fusion surgery, it is very important for you to be aware that the scientific evidence that surgery will fix your problem is tenuous at best. In a recent study, back pain patients were followed for 11 years after either fusion surgery, exercise therapy, or cognitive behavioral therapy. The study authors found no difference among the three groups, meaning that patients who subjected themselves to the risky surgery and lengthy recovery process were no better off than patients who exercised or underwent psychological counseling.
If you are seriously considering spinal surgery, I would strongly recommend that you read Back In Control: a Surgeon's Roadmap Out of Chronic Pain (which is written by a spinal surgeon who suffered from TMS himself) and Crooked: Outwitting the Back Pain Industry and Getting on the Road to Recovery first.
- When Evidence Says "No" But Doctors Say "Yes"
- Study Questions Need to Operate on Disc Injuries
- A Knife In the Back: is Surgery the Best Approach to Chronic Back Pain
- Why Useless Surgery is Still Popular
- With Costs Rising, Treating Back Pain Seems Futile
Surgery for Other Painful Conditions
Check out this recent meta analysis of 25 scientific studies of 2,000 patients with conditions including lower back pain, arthritis, angina, abdominal pain, and endometriosis which found that "surgery is a prime example of over utilization of healthcare services" and that it's benefits clearly do not outweigh its risks.
But I have fibromyalgia/central sensitization syndrome and my doctor says I'm incurable!
Yep, so did I.
According to fibromyalgia expert Dr. Nancy Selfridge, fibromyalgia/central sensitization syndrome is "the quintessential mind body disorder" and is very responsive to the approach taken in The Meter Method. Dr. Sarno says that fibromyalgia is "TMS plus".
Each time I get over one problem, another one pops up to take its place!
This is what Dr. Sarno referred to as the Symptom Imperative and is a pathognomonic sign that you have TMS.
I see this very commonly among the patients in my practice who refuse to consider the emotional underpinnings of their suffering and insist instead on a treatment approach that is strictly focused on physical or structural causes (an approach that I am becoming less and less willing to participate in, given its dismal chances of long-term success). If the consequences were not so devastating it would almost be humorous -- we fix a person's migraines and then they develop frozen shoulder. We fix the frozen shoulder and then their IBS flares up. We get the IBS to settle down and then they develop debilitating low back pain. It is a cycle that can go on indefinitely. This happens because the root cause of the problem is going unaddressed.
But I'm not an angry person, in fact I'm really quite nice!
There is a primitive, childish part of the brain (which Freud called the id) that exists in each of us, without exception. The sole goal of this part of the psyche is immediate gratification of every impulse. The id does not take kindly loss, hardship, sacrifice, or any internal or external pressure to delay gratification, behave responsibly, take care of other people, and/or resist sexual, violent, and selfish impulses. In fact, it reacts to all of these things with seething, volcanic rage.
The conscious brain, also called the ego, makes the determination that the feelings and impulses of the unconscious mind are unacceptable and that it must to do whatever is necessary to keep these feelings from exploding into the consciousness. The threat posed by these emotions seems mortal to the psyche, which is why it stimulates the production of physical symptoms to keep the attention of the conscious mind on the body.
People who are perfectionists, do-gooders, and/or have a strong need to be liked have a particularly urgent need to confine the feelings of the id to the unconscious mind. You need to understand that the more you think of yourself as a nice person, the more internal tension is necessary to confine the workings of your id to your unconscious mind and hence the higher the risk that you will develop TMS.
How do I know if I have neural pathway pain/TMS?
After you have had a thorough medical exam to exclude the possibility of a serious condition that requires immediate treatment, take this quiz, which will help you to determine whether you have neural pathway pain (aka TMS) and whether The Meter Method is likely to be helpful to you.
The Thank You Dr. Sarno website and the TMS Wiki Success Story Forum are also an excellent resources. There you will find hundreds of stories from people who had neural pathway pain/TMS and became pain-free using a process similar to The Meter Method. If you type the diagnosis you have been giving into the search fields on those sites, you are likely to find many stories from people with a similar situation who were able to overcome their pain.
How do I know if I have a highly sensitive personality (HSP)?
According to Dr. Sarno, perfectionism and "goodism" are the two most common personality characteristics among individuals with TMS. Dr. Sarno later acknowledged that individuals with Highly Sensitive Personalities are also apt to develop TMS and are at particularly high risk for developing fibromyalgia, a concept that was further developed by fibromyalgia expert Dr. Nancy Selfridge.
The highly sensitive temperament has four defining characteristics, according to Elaine Aron, Ph.D. Those with highly sensitive personalities are:
- Deep thinkers
- Easily overstimulated/overwhelmed
- Sensitive to subtleties
Dr. Elaine Aron developed a brief questionnaire to help people to determine whether or not they have a highly sensitive personality (HSP).
Experts believe that the HSP trait exists in over 100 species of animals and that approximately 20% of humans (regardless of culture or race) are HSP. These individuals process everything more thoroughly than others do before acting and brain research indicates that they respond more strongly to their experiences and perceive more subtleties. They have stronger emotional reactions are more sensitive to caffeine, pain, beautiful music, and others' moods.
It is important to recognize that the HSP trait is not pathological. It is normal variation, sort of like blond hair or fair skin. If you are a HSP it does not mean that you are broken or fragile, it just means that you need to take steps that others don't have to take in order protect yourself from becoming overwhelmed or from developing TMS, just like a blond-haired, fair-skinned person has to wear sunscreen in order to avoid getting sunburned.
Why haven't I ever heard this before?
The reality is that the clinical practice of medicine has always lagged significantly behind leading-edge science. This is definitely true when it comes to the field of pain management, where most health care providers -- well-intentioned as they may be -- are locked in a struggle to identify a structural cause for pain and to manage symptoms with a set of tools that have recently become very limited (as the risks associated with opioid medications have become more clear and so these medications have become very tightly regulated). This approach leaves millions of patients with chronic pain in a pretty hopeless situation.
Fortunately, however, pain scientists have recently discovered that there is cause for hope. According to pain expert Dr. Howard Schubiner, the vast majority of persistent pain is brain-induced (as opposed to caused by structural problems) and that brain-induced pain is reversible because of the brain's ability to adapt and change. Mainstream media coverage of this information has become more common and there is even a popular app now available based on these insights.
The other thing to take into consideration is that pain management is big business and there are a lot of powerful interests that stand to lose a great deal of money if patients are empowered with the knowledge needed to resolve their own pain without medications, surgery, or other procedures like injections or chiropractic care.
“It is extremely difficult to alter the potentially disabling belief among the lay public that low back pain has a structural mechanical cause. An important reason for this is that this belief continues to be regularly reinforced by the conditions of care of a range of ‘hands-on’ providers, for whom idiosyncratic variations of that view are fundamental to their professional existence.” - Max Zusman
Cathryn Jacokson Ramin has written an excellent book on this topic called Crooked: Outwitting the Back Pain Industry and Getting on the Road to Recovery, which I highly recommend.
Ok, I'm willing to entertain this possibility -- what do I DO to get rid of my pain?
I’ve dedicated the past fifteen years to caring for patients suffering from chronic pain at my clinic in Texas. Through the experience of working with these courageous individuals, as well as the experience of overcoming my own stubborn chronic neck and back pain and fibromyalgia, I developed a transformational step-by-step process — based on the intersection between the ancient wisdom of Chinese medicine and modern neuroscience and psychology — for overcoming the root cause of persistent pain without medications or surgery. After dozens of requests from people unable to travel to my clinic but desperate for help, I have distilled my method into a step-by-step online course. Now you can have all the advantages of working one-on-one with me at a fraction of the cost and from anywhere in the world!
Learn more here.
This information is being provided to you for educational and informational purposes and as a self-help tool for your own use. It does not constitute medical or mental health advice or treatment. Do not delay in seeking medical care or discontinue treatment recommended by a physician or other health care provider because of what you have read on this site. Readers suffering from pain or any other symptom should undergo appropriate medical examination to exclude serious injuries or illnesses that may require immediate or aggressive treatment before initiating the self-treatment approaches described on this site. This information is to be used at your own risk based on your own judgment. Please refer to my full disclaimer here.