Curing Chronic Pain in 21 Days: Part 2

What type of rager are you? 

If you haven't already read it, check out Part 1 to understand the hypocrisy of back pain and how I cured mine in 21 days. I know what you’re thinking: that it makes no sense for your brain to cause debilitating, chronic physical pain just to avoid confronting some previously unconscious rage. To fully understand this, we’ll need to go back to some of the roots of this work. Freud conceived of three components of the emotional mind, later labeled as the parent, adult and child. The parent and adult are found in both the conscious and unconscious mind and play a role in TMS, but it is the child that is key here. Just like an actual child, this part of the unconscious is self-involved, dependent, charming and very often illogical and irrational. Unlike a real child, it is also endlessly angry. This angry, irrational part of your unconscious would opt for you to face this incredibly painful distraction than what it deems to be an intolerable amount rage. 

So what kind of people are subject to this kind of unconscious rage? Pretty much all of us. Sarno believes most of it comes from three different sources:

  1. Rage that was generated during the time of infancy and childhood. 
  2. The daily rage that comes from the pressure we put on ourselves to stay driven or be perfectionists. 
  3. The rage that results from all of the little unacknowledged pressures of everyday life. 

Although we’re all subject to repressed rage from these sources, certain personality types have been shown to be more susceptible to TMS. Here are some of the traits that often tend to cause symptoms: 

  • Perfectionists: Projects have to be done perfectly, always needing to complete one task or another. Ignores own needs and feelings to complete tasks and putts well over 100% into everything they do. A clear picture of how everything should be and always has too much on their plate. 
  • People Pleasers: Usually adhere to what social, cultural or religious norms deem to be as “good” spouses, parents, children, employees, friends, etc., while failing to address their own needs. Often attempt to be the peacemakers during arguments, don’t speak their mind in confrontations and usually go along with others to avoid disagreements. 
  • Legalists: Always feel their view is right and tend to think the world would be better if more people thought like they did. Takes them a long time to make a decision because they are so worried about making the wrong choice. 
  • Stoics: Have a hard time expressing their emotions so they often hold them in. Embarrassed to cry in front of friends or family and feel a sense of control in their life when able to control their emotions. 
  • Driven by Anxiety & Fear: Always worried that a situation might yield the worst possible outcome. Nervous meeting new people, afraid people will reject them if what they were really all about were discovered. Fearful of the worst possible outcome of doctor's visits. 
  • Low Self-Esteem: Question their ability to do things competently, get anxious in crowded rooms or when meeting new people. Do not feel like they are as well liked as others and do not feel like they deserve praise or compliments. 
  • Hostile and Aggressive: Low tolerance for those who make mistakes, easily subject to road-rage, little events make them react in an extreme manner. When involved in a conflict they are always convinced the problem is someone else’s as opposed to theirs. 
  • Dependents: Like it when other people make decisions for them. Being alone is frustrating and upsetting for them, prefer others to take the lead when making plans, avoid jobs that they know will be a challenge. End up in relationships where they are the one being taken care of. 

Creating the cure

So now you know why it happens and how it works. So how do you fix it? Well, you actually just started to. The foundation of a TMS cure is knowledge. The biggest pill to swallow is that you don’t have a physiological problem, you have a psychological one. The only thing harder to believe is that accepting this diagnosis begins to pull the veil back from the ploy of the unconscious, thus making the distraction of pain ineffective. It’s like you’re saying to your brain, “Sorry, buddy. I know what you're doing and the jig is up.” Many people, like myself, were cured just by reading the book. Others require a bit more work and benefit greatly from psychotherapy. 

There are many factors that play into how hard TMS might try and hang on. The amount of repressed rage has a lot to do with it as does one's willingness to mentally let go of the idea that there is something physically wrong with them. If you have lived with chronic pain for months, years, or even decades, this can be an incredibly difficult thing to reconcile. The pain and all the routines around it have become part of your identity. Some people’s pain comes out of nowhere, but more often there is what Sarno calls a “trigger”. This is the occurrence that mentally anchors the original cause for the ongoing chronic pain. Some triggers make no sense at all. Why would the strongest bundle of muscles in the human body get “thrown out” from the act of picking up a child or lifting a box? Other triggers are more believable such as car accidents and sports injuries. In my case, I was totally convinced that lifting 315 lbs from a vulnerable position on a cold morning could absolutely crush one of my discs and cause pain for the rest of my life. 

However, the fact remains that even if the lift did herniate my disc, the symptoms that resulted made no medical sense in relation to that specific injury. Actually, it is much more likely that the herniation was already there, along with all the degenerative discs that the scan revealed. The MRI only psychologically validated that I had a crippling injury, reinforcing the efficacy of the brain’s distraction tactic. The truth is that most people have disc protrusions but never have symptoms. A study at the University of Copenhagen compared X Rays of 238 patients that complained of back pain with those of 66 other patients that had no pain at all. The difference in the X Rays? None. Every single one had degeneration of the discs and the presence of spondylosis (bone spurs). In 1994, the New England Journal of Medicine published a report that showed disc bulges and protrusions on MRI’s in 64 out of 98 men and women who had never had back pain. 

I’m in no way saying that it isn’t possible to physically injure your back, but it is very important to remember that the body has an amazing capacity to heal itself. My wife was back to walking on the fibula that had a transverse fracture only five weeks earlier, and was sleep-deprived while taking care of a one year old during the entire healing process. When months or years go by without relief after stepping off of the curb wrong way or sleeping on that soft mattress at your in-laws’ house, there is most likely a psychological cause at hand. 

Aside from the reading and therapy, there are some other actions you can take. Most of them have to do with refraining from anything that cements the idea that you have a physiological problem. Have you stopped exercising for fear of re-injuring yourself? It’s time to start back up. Are there specific stretches and exercises you do for your back injury? Stop them all. Do you have a special lumbar support seat for your car or office chair? Get rid of it. Do you wear support belts or braces? Take them off. Dr. Sarno even eventually stopped recommending any physical therapy for his patients because he felt it was doing more harm than good by validating the idea of a physical problem. 
Here are a few important things to try:

  1. Contemplate Your Rage: The bummer about dealing with the unconscious is that you’ll never really know what’s lurking in there. However, you can make some good guesses and start to really be with those things that make you angry. This isn't so easy when you're in pain. The greater the pain, the harder it will be to concentrate on feelings, but that’s all part of the brain's strategy. 
  2. Self-Talk: This is a matter of your conscious mind addressing your unconscious mind. Don’t be afraid to speak out loud and tell your brain that you are on to its shenanigans. Demand that it increases the oxygenated supply of blood to the areas that are in pain. Be forceful and even try yelling out loud. Remember, you are dealing with a selfish and irrational part of your emotional mind. 
  3. List it Out: Get all that rage out on paper. Make a list of all the pressures you feel and manifestations of the personality traits I listed earlier. Life is beautiful, but it is also often infuriating. Your partner and children might be the greatest source of joy in your conscious life, yet the greatest causes of rage in your unconscious mind. It’s hard to admit you might resent your own children to the point of rage, but its much more common that you’d believe. 
  4. Journaling and Meditation: Are you too busy to write for a few minutes each day or just sit in silence? Then this one is especially important for you. The alleviation of TMS is based on your ability to think your way out of it. If you do not have the mental space in your life for a little introspection, this will be incredibly difficult to achieve. Create some protected time for you to work through this and it will pay dividends. 

Whack-a-mole of the mind

Over the years, I’ve had some reoccurrences of back pain, some worse than others. Some people never experience pain again after fully embracing the cause of TMS, but I seem to need some gentle reminding now and then. This last holiday break, I was at the gym just hours before flying out to spend time with family. It was going to be a long trip in order to cover my wife’s family and my own in two different parts of the country. My wife was in a cast after breaking that ankle, and we were traveling with our baby and daughter. I didn’t finish all the work that I had intended to before leaving, and I get stressed out as it is when going home to visit my family. As I contemplated all of this during my first set of deadlifts, I felt a sharp spasm in my low back. By the time I arrived at my in-laws, it hurt to breath. I spent all night unable to sleep, drenched in a painful sweat. For three days, I popped muscle relaxers and pain pills and even tried lying in the snow to relieve the spasming. I was so convinced that I hurt myself deadlifting, that I forgot all about TMS. But the pain started shifting into all sorts of weird places that didn’t make physiological sense. That night, I opened up my Kindle and decided to download Sarno’s more clinical dive into the syndrome. I got 33% into the book that night and in the morning, the pain was gone. 

I just can’t describe how insane of an experience it is to go from that level of pain and then have it just turn off. The transformation was just as mind blowing as it had been twenty years prior. As fate would have it, I ended up marrying a psychotherapist who specializes in pain psychology. Just a few weeks later, I started getting spasms in my my left gluteus and oblique after a challenging workout. I insisted to my wife that it was TMS, and she began leading me through a series of questions when I yelled, “I’m just so damned angry that I understand what is causing this, yet it still happens! I know there’s nothing physically wrong with me, yet I keep falling for this trick that my brain plays on me!” I immediately felt the warm rush of blood into the spasmed area and the pain vanished. I actually felt it, like someone opened up a valve. This experience really validated how valuable talk therapy can be for this syndrome. 

In Sarno’s later work, he identifies many other medically mysterious chronic disorders that are most likely varieties of TMS, operating under the same psychological premise. Some chronic ailments on that list include shoulder, neck and arm pain, gastrointestinal disorders, arthritis, chronic fatigue syndrome, carpal tunnel syndrome, plantar fasciitis, migraine headaches and even some skin disorders. If the cause and effect of your problem is murky in medical logic and wrought with contradicting remedies, it’s worth examining TMS as the possible culprit. Location substitution is fairly common with tougher TMS cases. This is when pain stops in one area only to start in another. This is the brain’s attempt at continuing to distract you from the unconscious rage by moving the pain to another area or even spinning up a completely new malady. Some patients speak of how they underwent a shoulder surgery only to have pain appear in their “good” shoulder shortly afterwards. Others report to be free of their chronic back pain only to get an ulcer later in the year. After my most recent experiences, a psychological cause for a physical ailment is now my default consideration as opposed to my last. 

The back pain economy

The financial momentum behind back and neck pain remedies alone is staggering. Between 1997 and 2005, treatment costs increased 65%, reaching $86 billion a year. The larger category of chronic pain affects over 100 million American adults. This is more than the number affected by the combined cases of heart disease, cancer and diabetes. If the work around mind-body practices and self-healing gained even incremental traction, the suffering of millions of people could be eliminated. If you have suffered from chronic low back pain, I sincerely hope this helps you as much as it did me. Keep in mind that everybody’s recovery looks different. Don’t give up if it is taking a while. Although it’s very hard to believe while in severe pain, TMS and its many equivalents are essentially harmless. Don’t take a diagnosis as the final word of your fate. It has now been proven without doubt that structural abnormalities in the spine are massively common, yet seldom painful. Things can and will get better. You can be free of pain again. 

-Elijah Szasz


Healing Back Pain (the original book I read in the late 90s)
The Mind Body Connection (the more in-depth clinical book I recently read)
Danielle Szasz (my wife and practicing pain psychotherapist)