March 08th, 2021
This Might Hurt is a documentary describing the work of Dr Howard Schubiner. Viewers follow the moving stories of a group of chronic pain patients for whom conventional medicine had little to offer other than opiates and other drugs or potentially harmful unnecessary surgery. Most of them found significant relief using a structured program examining the underlying emotions contributing to their physical symptoms.
This approach has been used at our office for many years.
Fibromyalgia is a common long-term condition, affecting 2-4% of the population, more commonly women than men, that causes pain all over the body along with many other symptoms. People with fibromyalgia often have:
Books and articles often say that the causes of fibromyalgia are unknown. It may be that it is the final destination arrived at from a variety of different starting points. For some people it occurs after an illness such as influenza; for others after an accident or other traumatic event. For many it develops gradually after an overwhelming incident or as the culmination of years of accumulated stressful events, often dating back to childhood. Numerous studies have found that between 50 and 63% of patients with fibromyalgia also meet the criteria for post-traumatic stress disorder, frequently reporting adverse childhood events or subsequent physical or emotional trauma. Adverse childhood events (such as the loss of a parent, abusive or chaotic households, early hospitalizations, accidents, neglect etc), and later traumas all can prime the nervous system's fight/flight/freeze response, giving rise to a sense of being unsafe in the world, and cause the body to respond with physical symptoms. Chronically elevated stress hormones change the way our glucose metabolism and digestive function work, cause increased muscular tone (tight muscles), and affect our immune system function.
There is a complex inter-relationship between our nervous systems, our hormones, immune systems, gastrointestinal system, and our muscular function, including how the energy powerhouses (mitochondria) in our cells function. In other words, although it is a very real physical condition, the pain is being produced in the nervous system in response to (usually prolonged and cumulative) internal (such as the demands or expectations we place on ourselves) and external sources of stress. It can also be triggered by sleep deprivation in some people.
For this reason, it is possible to turn the pain down or even off, by means of techniques that address past trauma, anxiety, stress, beliefs and expectations, as well as by optimizing nutrition, sleep and general well-being through regular exercise (while avoiding extreme of activity). Coming to an understanding of the condition reduces fear, which in turn can substantially reduce pain intensity.
Fibromyalgia can be best thought of as a central nervous system condition in which the brain and spinal cord are sensitized and therefore respond to sensations which are perceived as much more painful than the same sensation would be experienced by someone without fibromyalgia. It is sometimes referred to as a Central Pain Amplification Disorder. Similarly, people with irritable bowel syndrome will perceive the same degree of gaseous intestinal distension as being much more painful than someone without IBS would do. It is as though the pain ‘thermostat’ or dial has been turned up to a very high level.
Unlike rheumatoid arthritis or lupus, fibromyalgia is not an autoimmune or inflammatory condition. It can co-exist with arthritis but it is not primarily a joint condition. It does not lead to any ilife-threatening disease.
Fibromyalgia may run in families to some extent but whether this is genetic or due to a common environment (similar stresses) or a learned response to adverse circumstances is not clear. A small subset of people with symptoms suggestive of fibromyalgia have been found on skin biopsy to have an abnormality of small nerve fibres. Genetics alone cannot explain fibromyalgia. Symptoms tend to be worse with stress, over-work, excessive exercise, or sleep deprivation.
1. symptoms as mentioned above, present for more than 3 months with no other explanation
2. pressure at certain common soft tissue points on physical exam can be helpful to detect tenderness and to exclude other causes of muscle pain.
There is no specific blood test or X-ray that can diagnose fibromyalgia. Commonly tests will be ordered to exclude other conditions, for example, sleep apnea, an underactive thyroid, or polymyalgia rheumatica, anemia, iron-deficiency, rheumatoid arthritis or lupus.
While there is no one specific cure for fibromyalgia, approaching it from a number of different angles – certain medications, carefully structured aerobic exercise within one’s capabilities, and mind-body approaches such as relaxation, stress-reduction, Cognitive Behavioural Therapy, mindfulness, Tai Chi, and clinical hypnosis or guided imagery, can be helpful. Ensuring adequate sleep is essential. Some people have co-existent anxiety, depression, PTSD, panic disorder, all of which can also be treated. Proper nutrition is also important. Anecdotally, some patients report a correlation between pain intensity and diet, such as refined carbohydrates, gluten, nightshades, or meat. This may be an individual response.
A number of medications are often tried to reduce symptoms. Most of these are “off-label”.
Low doses of an antidepressant called amitriptyline (Elavil) or related medications (such as nortriptyline or trazodone) can often be very helpful for pain, sleep, and to reduce migraines.
A muscle relaxant such as cyclobenzaprine (Flexeril) can be helpful. This is structurally similar to tricyclic antidepressants (TCAs) such as amitriptyline.
A newer SNRI medication, duloxetine (Cymbalta) can sometimes help.
Additional medications include pregabalin (Lyrica) and gabapentin (Neurontin) can be used.
Another off-label medication is low dose naltrexone.
Opioid narcotic medications are best avoided as they have significant side-effects, are largely ineffective, addictive and can lead to a conditions known as opiate-induced hyperalgesia, a parodoxical increase in pain the more opiates one cosumes. Of the opiates Tramadol may be better than the others but shares all the same risks as other opiates and interacts with other medications.
Acetaminophen and anti-inflammatories (such as ibuprofen) are generally not effective for fibromyalgia but may help other co-existing pain. Sleeping tablets such as Zopiclone and benzodiazepines are not recommended.
One small study published in December 2018 suggested that some patients with fibromyalgia may respond to treatment with a diabetes drug called metformin if their average sugar level (HBA1C) was in the high normal or elevated range.
Gaining an understanding of fibromyalgia, engaging in self-care, ensuring good sleep, reducing stress, modifying behaviour, counselling, dietary modifications and supplements, and a judicious exercise regimen can all be helpful.
In my own practice a combination of tender point injections, counselling, relaxation techniques, clinical hypnosis, medication and nutritional advice, and patient-education (which may include recommended reading and journalling) can lead to a significant reduction in symptoms, periods of remission, or even resolution.
Psychophysiologic Disorders - a new book
Experts in managing stress-induced illness and pain have produced a new book titled Psychophysiologic Disorders. It is available from Amazon in paperback and Kindle formats and free to subscribers of Kindle Unlimited. It is a comprehensive, in-depth, and up to date approach, reflecting the latest in neuroscience.
It describes a host of different stress-induced conditions and how they can be managed.
Psychophysiologic Disorders: Trauma Informed, Interprofessional Diagnosis and Treatment Paperback – Nov. 13 2019 by David Clarke MD, Howard Schubiner MD, et al.
Physicians and allied mental health professionals have created an App that you can use gradually over time to help both educate yourself and manage the symptoms you have, once your condition has been properly evaluated medically. The Curable App can be downloaded from the appropriate App Store for your device and requires an annual subscription.
Here is some info from the TMS Wiki. Please note: Myositis is not a good term for this condition as there is no inflammation present.
An Introduction to Tension Myositis Syndrome (TMS)(Redirected from An Introduction to TMS)
Have you struggled with chronic pain or another medically unexplained symptom for a long time? Have you tried everything to alleviate your pain, but nothing worked? Have you had doctors tell you they "just can’t find anything wrong?"
Then you may have Tension Myositis Syndrome (TMS). TMS is a condition that causes real physical symptoms that are not due to pathological or structural abnormalities and are not explained by diagnostic tests. In TMS, symptoms are caused by psychological stress.
You may be at your wits end. However, there is hope. We know this because the authors of this wiki struggled with chronic pain for many years, and that is exactly how we felt: hopeless. We're not doctors so, of course, we can't diagnose you, and everyone is different, but we are here to tell you what worked for us and how it did so without surgery, needles, or drugs. We found relief from pain through TMS.
Tension Myositis Syndrome (TMS), also known as Tension Myoneural Syndrome, is a condition originally described by John E. Sarno, MD, a retired professor of Clinical Rehabilitation Medicine at New York University School of Medicine, and attending physician at the Howard A. Rusk Institute of Rehabilitation Medicine at New York University Medical Center. TMS is a condition that causes real physical symptoms, such as chronic pain, gastrointenstinal issues, and fibromyalgia, that are not due to pathological or structural abnormalities and are not explained by diagnostic tests. In TMS, pain symptoms are caused by mild oxygen deprivation via the autonomic nervous system, as a result of repressed emotions and psycho-social stress. This is not to say that the pain is “all in your head” or that it is not real. TMS symptoms are very much real, and we should know. All of the people who wrote and developed this website had debilitating chronic pain and other symptoms. We know, first hand, what it is like to have back pain, sciatica pain, RSI, fibromyalgia, chronic fatigue syndrome, migraines, irritable bowel syndrome, and a wide array of other symptoms. We visited doctors and were told the same things you probably heard: "you have a degenerative disc disease, a herniated disc, you type too much, it is due to overuse, or that you are just aging." Even though we were told this, when we applied the ideas first promoted by Dr. Sarno we became pain free and regained our lives.
For more info on TMS watch The 20/20 segment on John Sarno and TMS.
How TMS Develops: At the heart of the development of TMS is our desire to be good people, loved by those we care about. This desire leads us to strive for perfection, and to put the needs of others above our own. We will cook a three course family meal after working a 10 hour day, because that is what a good mother would do. We will be the first person to volunteer to work on the weekend, because that is what a good employee would do. We will stay up all night making sure our homework is perfect, because if we don't, we won't get a good job. Our beliefs of what a good and perfect person will do directly influence our behavior on a day-to-day basis.
But sometimes, as more and more external stress is added and our desire for perfection increases, we develop a very deep seated resentment toward these tasks. There are some nights when you come home from working a double shift and are angry that you have to cook a meal for your family, while your husband has been watching TV all night. Part of us hates telling our friends that we can't go out on Friday night, because we have to read and study for a class the next day. When our newborn baby wakes us up at 3 am for the fourth night in a row, some part of us has rage at the child, for waking us up yet again. These are all normal feelings and emotions to have. However, when a person has an emotion that goes against their belief of what a good and perfect person would do, the only option available to them is to repress that emotion. If we admit that we are angry at our family, our boss, or at doing homework, we fear that we would be considered a bad person and will be rejected by those we love or who we want to respect us. If we are not perfect, we will be unworthy of being loved. So instead of admitting that we are angry at our spouse for never cleaning up or doing the dishes, we repress it deep in our unconscious.
Another repressed emotion might be guilt. Some of us have to care for a loved one who is injured or aging. Being a caretaker is not an easy task. If we aren't able to provide the necessary care, or the care the person not only desires but may demand of us, we may feel guilt. If we repress that feeling, especially if we are the type of person who wants to please very much, it can cause us TMS pain.
As we continue to repress these emotions, we create an immense amount of emotional tension which only increases as more and more stress is added to our lives. In order to keep you from recognizing that you have these powerful emotions of anger and rage or guilt, your unconscious creates physical symptoms, such as back pain, neck pain, plantar fasciitis, acid reflux, anxiety, depression, Dizziness, and irritable bowel syndrome. These symptoms serve as a way to distract you from the unwanted emotions by having you focus on your back hurting instead of your anger, rage, or guilt. We develop TMS because we are unable to accept and/or process these emotions.
David is a fan of books and no doubt will be sharing some good reads here.