The popular phrase “you are what you think” couldn’t be more relevant than in the field of chronic pain. Sadly, this phrase has become so mundane that we hardly ever give it much thought. Not only that, but strangely, as egocentric human beings, we have the tendency to think that ‘generalities’ that apply to others somehow do not apply to us - because we know better already.
But today, it’s about time I discussed the power of thoughts, specifically in relation to TMS and Neuroplastic Pain. It’s normal to think that a fleeting thought is harmless (and it may be if you’re simply catastrophizing about an unlikely scenario), but from experience, I can say that if you’re trying to recover from chronic pain, then controlling specific thoughts is an essential part of the puzzle.
Our beliefs shape our thoughts
Chronic pain sufferers tend to have developed certain beliefs about their condition. These beliefs sometimes stem from inaccurate diagnoses (their pain is blamed on a structural cause, when in reality that structural ‘damage’ or abnormality is not really to blame). Even when they don’t get a specific diagnosis, most chronic pain patients are given all sorts of advice: ‘don’t lift’, ‘don’t overdo it’, ‘be careful, you should quit sports’, and so on and so forth.
Naturally, such ‘advice’ is likely to lead to the formation of various beliefs, namely along the lines of ‘my body / back, etc. can be easily re-injured’, ‘physical activity can make things worse’, ‘sitting down is bad for me’, etc, etc.
These beliefs then lead to a new class of thoughts which will arise in our day to day lives. If you suffer from chronic pain, you’re probably familiar with some of them:
“This activity might be too much for me”
“I cannot do this without pain”
“I hope I didn’t overdo it this time…”
“What if I keep getting a flare-up each time I do X or go to ‘Y’"?
“What if my pain will last forever”? (because after all, they said it was ‘chronic’…)
You get the gist of it. Most sufferers get hundreds of similar thoughts every day, as they go about their day with caution and trepidation, trying to avoid a flare-up or regression.
The typical thought to self-fulfilling prophecy scenario
We might think that worrying is one thing, but actually experiencing the subject of your worries is another. You might argue that if you get pain shortly after a thought, that pain is there because you were right - you really might have overdone it.
This is where it gets tricky. We love being right, don’t we? Deep inside, there’s this perverse ‘need’ to be right, even though we’d rather not experience what we’re experiencing.
But let me introduce you to an alternative explanation. What if the pain manifests due to the thought itself? Here’s how a typical TMS flare-up scenario would play out:
Mary is having a busier day than usual. She decided to invite her parents and in-laws for dinner. A part of her regrets this decision (there are some unresolved conflicts with her father in-law, and she feels she’s doing this just to appease her husband). To make matters worse, her back is giving her trouble lately. Her doctor told her not to lift anything heavy, because maybe it would make things worse (10 years ago she’d been diagnosed with a herniated disk). Part of her is also furious that her husband is not at home to help with the preparations.
She ends up carrying a bag full of groceries up the stairs. As she does this, she gets the fleeting thought; “What if this worsens my back? What if this lifting and standing up will cause a flare-up similar to what I had last year?”
As she prepares the dinner, the pain gets worse. In reality, she has been scanning her back for pain, evaluating the sensations, labelling them as sensations that ‘do not bode well’. Her memory of last year’s flare-up doesn’t help (after all, it’s memories and associations that contribute to the process of conditioning). Every second of the day, she is expecting the pain to get worse. Naturally, this creates some level of anxiety and fear. She is both afraid of the pain, and anxious that she will not be able to be a good host that evening.
The anxiety and fear create more tension in the body. As stress levels rise, pain perception increases. In short, by the time her guests are about to arrive, she is in agony. Her husband gets home, and she has not choice but to tell him to take over because she needs to sit down (at least the pain managed to give her a break in the end…). The next day, the pain is even more intense, because she ‘knows’ or ‘thinks’ that she’s definitely overdone it. And it only fades away once she ‘thinks’ that she’s rested enough.
It’s NOT just a thought!
Can you see how many factors were at play following a simple thought? First of all, Mary was already frustrated in the first place (deep down, she didn’t really want to be hosting the dinner - this makes it more likely for pain to surface as a way to try and prevent her from it, but in this case, it was too late). When we feel relaxed and happy with what we’re doing, it’s less likely for pain to resurface.
Secondly, Mary had negative memories of back pain, which she associated with lifting and housework in general. These memories created the belief that lifting may re-injure her back.
Thirdly, following her fearful thought as she carried those groceries up the stairs, she became hypervigilant. She gave her back more attention than usual, and as soon as she felt an uncomfortable sensation, her anxiety spiked. She judged that sensation as bad, and expected the pain to get worse. And so it did. As it did, she was flooded with fear and disappointment, and was unable to ignore the pain - and so it got worse and worse.
The above scenario is typical, and in no way an exaggeration, and is what happens when our brain’s neuroplasticity starts to work against us - when we learn how to generate pain. And yet, if you were to explain it to Mary, who has never been educated about TMS, you would probably get a rather hostile - or, at the least, dismissive - reaction.
This is because we don’t really like to take responsibility for our thoughts. If we did, then we’d be admitting that we’re also responsible for some of the negative things that are ‘happening’ to us. Who would want to admit that they are indirectly causing pain to themselves? There is likely to be some resistance, even if we already know something about conditioned pain - let alone if we don’t!
How can we stop negative thoughts?
I always like to say that the best way to prevent such a scenario is to nip things in the bud. It all starts with being aware of what kind of thoughts we’re having. What do we believe about our pain and our body? What are we thinking as we engage in movement or physical activity? What scenarios are we envisioning or worrying about?
The next time you get a negative thought in relation to your pain, you need to prevent it from giving birth to a chain of other related thoughts and expectations. I like the idea of ‘catching’ it early. It is so much easier to redirect a thought if we’ve just had it, than it is to stop the conditioning process once it’s properly kicked in. This is because as we indulge in our thoughts, we give rise to feelings and expectations that make it very hard to reverse the process (though not impossible).
In my related video, I explain a technique for rejecting an unhelpful pain-related thought from the outset, through self-talk. The attitude with which we reject or redirect a thought is vital. In fact, ‘attitude work’ is what’s really needed in the majority of cases of TMS, and a fundamental component of my Coaching practice.
If you have problems controlling your thoughts, or if doubt tends to get in the way of your recovery (doubt in itself consists of a series of negative thoughts), then it is crucial that you cultivate mindset shifts and new patterns of thinking that will halt the conditioning process.
I also encourage you to check out my Intensive Recovery Program if you feel that this is the sort of thing you need to work on. For $199, you get all the lessons, resources and tools needed to break those thoughts, habits and behaviours that are preventing you from TMS recovery.
Whatever approach you decide to take, just watch your thoughts. Think of this as the first step to recovery.