The Symptom Imperative - your biggest TMS clue?

You might have terrible knee pain, but sometimes you get this neck pain too. Or your other knee may also start getting a bit cranky. Then, you go down with a very bad case of the flu, and your knee pain seems to have nearly disappeared - until you recover from the flu and in all comes back in full force!

What is happening here? According to TMS practitioners, this would be a case of the Symptom Imperative, or Symptom Substitution. The Symptom Imperative occurs when pain changes location, or when it’s replaced by another condition, which may also become chronic. A lot of people who have started to see improvement in one pain area - whether it’s because they have been following a TMS program or because a drug or surgery has produced a successful result (or placebo effect) - start to experience pain in another location, which seems to be totally unrelated to the original pain area.

Who gets Symptom Substitution?

Symptom Substitution can kick in when the original chronic pain symptom has started to subside, and when it’s no longer working as a successful distraction. For certain people, the ‘new’ pain can get so bad, that they forget about the original symptom altogether, or they find that it no longer bothers them so much. The severity of this new symptom may very easily lead us to believe that there’s something really wrong with us this time round.

Now that we’ve stopped fearing or caring so much about the old symptom, we start fearing this new pain, because it’s so obviously very distressing, and we may also start a new cycle of conditioning, as the mind and body learn to reproduce the new symptom repeatedly.

One other vital thing that’s been discovered by Dr Sarno himself is the fact that symptom substitution doesn’t have to result in another chronic pain symptom, but may manifest in a range of other chronic symptoms. Some people may completely ged rid of chronic pain, only to start feeling severely depressed, getting migraines or develop an allergy. In this case, it is the depression/migraine/allergy that has replaced chronic pain as a new distraction to keep certain emotions from resurfacing. If the new symptom suddenly has our full attention and we start feeling helpless about it, then it’s succeeded in keeping us stuck in the TMS cycle.

The most obvious proof of the symptom imperative at work is when we have a real accident or go down with the flu or another virus, and our chronic pain suddenly disappears. I can still remember my shoulder pain being completely gone for a day once, just because I had a bad stomach ache. My attention had been diverted by the stomach pain that day! But fortunately, you don’t have to wait for one of these circumstances to notice the symptom imperative at work. If you tend to get different chronic symptoms that come up now and again, in addition to other chronic pain areas, then this is often a good indication that TMS is at work.

Symptom substitution is therefore a way for our minds and bodies to tell us that something is still not quite right - there may still be some emotional repression or too much stress building up in our lives, OR we may still be fearing that something is bound to go wrong with our bodies.

Rejoicing at the Symptom Imperative

Although this whole Symptom Imperative thing seems very annoying, it is actually something you should be glad to experience. This is because if it kicks in as you’re working on healing yourself from tension myositis syndrome, it is one of the best clues that what you are experiencing is all TMS. If your back pain has suddenly subsided and you get terrible wrist pain out of nowhere, that’s very good proof for you that you’ve got TMS, and gathering this evidence is very important to healing (I provide tips on how to gather TMS evidence in my coaching sessions).

I can recall one very obvious case of the symptom imperative as I was healing from my leg and shoulder pain. I simply woke up one morning to find that I couldn’t turn the palm of one hand to face upwards, because it hurt so much. I’d done no activity to justify this pain, and, having been prepared for this, I soon concluded that it was none other than symptom substitution.

So how do you get rid of Symptom Substitution?

The answer to this is simple: you simply treat it as TMS. If the symptom is severe and lasts long, you should of course get it checked out by a doctor; but if you find that the doctor has no clue what it may be, or you get a diagnosis related to ‘strain’, ‘tense muscles’, a torn muscle or another pinched nerve (and you know you didn’t do anything stupid to cause such damage), then it would soon become very obvious that it’s just TMS.

The same things that applied when treating your other symptoms are valid here as well; you shouldn’t react to this new symptom in fear, or start catastrophizing about the possibility of never getting better. If the pain doesn’t make much anatomical sense, you could also start challenging it by using the affected area normally, instead of trying to protect it or avoid using it. And of course, it’s also worth reflecting or journalling about any issues that may be causing you stress or worry, in case there’s something that you still haven’t admitted to your conscious mind.

That is the beauty of Tension Myositis Syndrome - it can take so many forms, and manifest in so many symptoms, but the underlying principles are always the same. Don’t allow the Symptom Imperative to block your progress - use it to learn more about yourself and your beautiful mind, and you’ll get even further ahead!