Pain and the Fear of Pain

Most of the people I talk to who have chronic pain often talk about the fear of pain and all of the things they have had to give up doing.  They also talk about listening to their bodies.

About 2 years ago I wrote a blog post about the problem of listening to your body.  I need to tread carefully here.  I may be the only yoga teacher who tells people that maybe they shouldn’t listen to their bodies.  But I have to explain.

First, if you have broken your leg, or tore a hamstring or have been sick with the flu, you should listen to your body and you should rest and recuperate.  But sometimes when we think we are listening to our body, we are really listening to our mind.  Our minds can deceive us, it may make us feel sluggish and lazy.  And we think it is our body when it isn’t.

Before I go any further, I want to strongly recommend that if anything that I am talking about in regard to chronic pain resonates with you, then you should see a physician who specializes in Mind/Body medicine to make sure that you have TMS and not something serious.  In my area, I strongly recommend Dr. Paul Gwozdz in Somerset, NJ.  If you need resources in other areas, please see my resource page.  I cannot tell you for certain that your pain is due to TMS and it has a psychological cause.  But, it might, as it did for me. 

Dr. Schubiner, a prominent mind/body specialist, describes the difference between chronic pain and acute pain.  Acute pain is due to a fracture, infection or cancer.  Chronic pain is something that persists for longer than the 12 weeks or so that an injury would take to heal.  Chronic pain is what I am talking about in these posts about TMS.

A lot of people with chronic pain begin to limit their lives saying that they cannot play tennis anymore, or play golf, or ride a bike or a horse, run, or pick up their kids (or their grandkids), or sleep on a soft mattress or sit on a hard chair as these things bring on pain.  But none of these things actually cause pain, the mind has just been conditioned to experience pain during these activities.  In the treatment of TMS, Dr. Sarno talks about resuming any and all physical activity.   This has to happen once there is a reduction of pain.  But sometimes you may have to work through the pain. 

In Healing Back Pain, Dr. Sarno tells the story of a patient of his, an attorney in his mid-thirties:

He went through the treatment program uneventfully and in a few weeks was free of pain and was doing everything – except one thing.  He was afraid to run.  It had been drummed into his head that running was bad for his back and he simply could not get up the courage to try, though he could do many things more strenuous than running.  After almost a year, he decided that this was silly and he was going to run.  He did, and his pain returned.  Now he was at a crossroad; should he continue to run or back off?  He called Dr. Sarno for advice, but unfortunately the doctor was on vacation and he had to make his own decision.  Wisely, he decided to bull it through.  He continued to run and he continued to hurt.  Then one night he was awakened from sleep with a very sharp pain in his upper back, but his low back pain was gone.  Knowing that TMS often moves to different places during the process of recovery, he decided that he had probably won, and he had.  Within a couple of days, the upper back pain was gone, too and he hasn’t had a recurrence of either upper or lower back pain since that time.  – Dr. John Sarno, Healing Back Pain, page 80.

The Role of Fear in TMS

“Severity of TMS is measured not only by the intensity of the pain, but by the degree of physical disability that exists.  What things is the person afraid of or unable to do?  Disability may be more important than pain because it defines the individual’s ability to function personally, professionally, socially and athletically. 

In the long run fear and preoccupation with physical restrictions are more effective as a psychological defense than pain.  A severe attack of pain may be over in a few days, but if the person is afraid to do things for fear of inducing another attack or because they have found that the activity will invariably bring on pain, even it is not an acute attack, then the preoccupation with the body is continuous and the defense is working all the time…

Most patients are afraid of physical activity, which tends to perpetuate the problem by inducing further anxiety and often leads to depression as well. “ - Healing Back Pain, Page 52.

In my personal experience, I was experiencing extreme back pain.  It was so bad I bought slip on sneakers because I could not bend over and tie my shoes.  I had stopped riding my bike because I could not bend over the handle bars.  I went to see Dr. Gowzdz who examined me and looked at my MRI’s.  He reassured me that there was nothing wrong with me and that the findings on my MRI’s (herniated disks, arthritis, spinal stenosis and spondylthesis) were normal findings for someone of my age, activity level and genetic history.  He said that there was nothing wrong with me and that I should resume all physical activity, especially as physical activity helps to reduce stress, which is what TMS is a reaction to. 

One of the things I used to love to do the most was to disappear on my bicycle.  I loved the freedom of riding, but it had become too painful for me. I decided that it was the thing I needed to do to help me get over my back pain. 

I started to ride my bike, even though it was painful.  I could barely ride to a nearby stop sign, which was about a half a mile away.  (This is from someone who had ridden the MS City to Shore Ride which is over 75 miles!)   I set a goal for myself to ride three times a week and to be able to ride a 10-mile bike ride in the span of two months.  Which I did.  Every time I rode I told myself that the pain was due to a psychological reason, not a physical one.  Dr. Gwozdz also told me that everything I did was going to help me heal faster, that it would provide proof to my subconscious mind that my pain was not physical.  If I sat at home and “listened to my body” I would not have gotten better.  The fear of pain would have kept me partially disabled.  My mind was creating a physical symptom to keep me distracted from unwanted and deeply buried emotions which I had to learn to uncover and process. 

Because of the fear of pain Dr. Sarno stated that chronic pain can be more debilitating than paralysis. Which means that sometimes you shouldn’t listen to your body!