The first step is to allow yourself to have the feelings without resisting it, venting it, fearing it, condemning it or moralizing about it.
It means to drop judgment and to just see that it is just a feeling.
The technique is to be with a feeling and to surrender all efforts to modify it in any way let go of wanting to resist the feeling. It is the resistance that keeps the feeling going.
When you give up resisting or trying to modify the feeling it will shift to the next feeling and be accompanied by a lighter sensation.
A feeling that is not resisted will disappear as the energy behind it dissipates over time.
What Exactly is the Weekend Vacation Syndrome?
Today we are continuing our reading of healing back pain, the mind body connection by the legendary Dr John e Sarno. Let’s continue from the weekend vacation syndrome.
It says when we generate anxiety depends mostly on the details of our personality structure.
People will report that they almost always have an attack of pain when they are on vacation or if they already have pain that it gets worse on weekends for some the reason is obvious they are very anxious about their work or business when they are away from it.
What Causes Weekend Vacation Syndrome?
It’s a bit like the delayed reaction.
As long as they are on the job they may be burning up the anxiety, but when they are away from it, supposedly relaxing, the anxiety accumulates.
There are also numerous techniques around for promoting relaxation, like drugs meditation and biofeedback to name a few, however unless the relaxation process succeeds in reducing repressed anxiety and anger, people will develop things like TMS and tension headaches.
How Do We Feel the Weekend Vacation Syndrome?
Despite the attempt to induce relaxation, some people don’t know how to leave their daily concerns behind them and shift attention to something pleasurable.
I remember a patient who said that her pain would invariably begin when she got herself a drink and sat down to relax.
Recently I saw a young man who illustrated vacation syndrome very well. He described having been under a lot of stress for a long time, but without any back pain it wasn’t until he was on his honeymoon that he was awakened one night with a nightmarish dream followed immediately by a severe back spasm in which he said my back went completely out.
Of course it might have been due to the stresses and strains of being newly married but he was an extremely conscious type and I was inclined to connect it with his work.
The examination showed some other reasons
He was still having symptoms when I saw him three months later.
No doubt due to the fact that an amarite has shown a disc herniation on the lower end of the spine and the possibility of surgery had been discussed in parentheses we have an mri or magnetic resonance imaging as an advanced diagnostic procedure that is capable of producing an image of body soft tissue allowing one to detect the presence of such things as tumors or herniated discs; however he read my book on tms and thought that he was typical of the patients described and came in to see me the examination was conclusive for tms.
In fact it showed that his symptoms could not be due to the herniated disc for he had weakness in two sets of muscles in his leg.
Something that the herniated disc could not have caused only involvement of the sciatic nerve as is typical in tms could have produced this neurological picture at any rate. He was delighted to learn that tms was the basis for his back troubles and had a rapid recovery.
The social life issues can also trigger this
Another explanation often difficult for people to admit to themselves it says is that they are great sources of anxiety and anger in their personal lives like a bad marriage trouble with children, having to care for an elderly parent, we have seen numerous examples of this women trapped in bad marriages that they cannot stand and yet unable to break out because of their emotional and or financial dependence on their husbands; the people who feel perfectly competent at what they do for a living but who cannot deal with a difficult spouse or child.
The story of a female patient
I recall a woman with a persistent pain problem who lived with a very difficult brother despite psychotherapy the pain continued.
One day she told me that she had done a very unusual thing.
He had gotten furious at her brother, has shouted and ranted at him and stormed out of the house and with that the pain disappeared.
Unfortunately she could not maintain her strong posture and the pain returned.
I feel like expressing your anger can help to release the pain. So my experience is like when I feel anxious I would go somewhere quiet. After shopping alone I feel more relaxed.
Dr. Sarno find it the main obstacle to healing
Dr Sarno also mentioned some things that are happening in the patient’s personal life and from my experience as a healer and a coach for people who struggle with chronic pain, this is one of the main obstacles.
You know so when I hear people say what are the most common obstacles when it comes to healing.
Unfortunately, for some people they have to choose between setting boundaries expressing their true needs and experiencing relief versus staying with the pain and conserving the toxic environment/relationship that they find themselves in.
People often consider toxic relationships more important than healing
There are some people who have a similar toxic relationship, not necessarily in a marriage, but sometimes it can be a relationship between a son, daughter and parents/family.
For some people conserving the relationship between themselves and their parents is a lot more important than experiencing relief. Why do I mention this?
I mention this because the healing journey can get very personal for some people and there is a lot at stake for some people they are at risk of losing even though it may be toxic, losing their relationship or their marriage.
In this case we have a woman and her brother but these are real life circumstances that we’re talking about here and this is very important to reflect on if you are on the journey.
It’s important to also look at the other people with back pain because believe it or not as Dr Sarno mentioned some people have a hard time admitting to themselves that they’re having difficulties in their personal lives.
Online social groups also play a negative role
The same is true for when we join a support group, especially a support group on Facebook, where it’s just focused on my back hurts and so does yours, etc.
Many of these people will struggle during their journey if they’re not willing to admit or even look at those personal problems, but that’s not the issue.
You know we’re not here to point fingers and say how other people live or how other people should live or how they should go about their healing journey.
I’m sharing this with you just so that you can have an extra alert button with you.
You know that extra red flag to look out for because you can very easily join a support group where the majority of the people there are talking negatively about the healing journey and it’s a very hopeless environment. It’s very pain focused.
There’s no way out of this prison environment and that can definitely play a role.
Negative environment also drags down in the healing journey
It can definitely impact your healing journey in a negative way, if you don’t have personal problems.
You can have an easier time but if you’re in a group of people who do have these personal problems and they’re not willing to admit it it’s very common for them to shine a negative light around the possibility of experiencing belief and in other words their pain-body can drag you down in the healing journey.
Just want to keep that in mind.
Why are holidays more stressful?
Now, moving on the holiday syndrome, one often hears or reads that holidays may be stressful. What should be a time of relaxation and fun often turns out to be unpleasant for some people.
I have been struck by the fact that many patients will report the onset of attacks of tms before, during or shortly after major holidays.
The connection between holiday season and environmental factors
The reason is obvious; big holidays usually mean a lot of work particularly for women who take the responsibility in our culture for organizing and carrying out the festivities and of course society demands that this be done cheerfully with a smile.
Usually the women are completely unaware that they are generating great quantities of resentment and the onset of pain comes on as a complete surprise.
One thing I can also add to that is that big holidays, like Christmas or New Year, the majority of the time especially during new year’s we are celebrating a holiday where many of us are grieving and not only that depending on where you live on the planet, it could also mean that you have less sunlight.
The weather gets cold. There’s less sun and overall when we have this combination of coldness and less sunlight, a lot of people go into a state of seasonal depression. You combine seasonal depression with a holiday that for some it’s the beauty of a new beginning.
A new year and for others another year becomes a grieving thing for many. When we look at the five stages of grief, one of them is anger.
Your anger is very common for people to flare up during that time of the year and just wanted to point that out so it’s not just all the work and all that stuff, most chronic pain sufferers for the most part don’t even celebrate the holidays.
You know there’s a lot of there’s a big chunk of chronic pain sufferers that don’t trust quote unquote the system.
And, a lot of them don’t even celebrate the holidays but they still deal with the seasonal depression and the grief and that can also be a trigger for flare up.
If you have a toxic family and your toxic family, every time they come together there’s some tension in there that could also be the trigger but that’s a whole different conversation.
The phenomenon of conditioning
The natural history of tms; what are the common patterns of tms; what happens all over time if one continues to be played by this disorder conditioning.
The essential thing to understand this subject is knowledge about a very important phenomenon known as conditioning. A more modern term meaning the same thing as programming. All animals including humans are conditionable.
The classic example of conditioning; the experiment of Ivan Pavlov, Russion psychologist
The phenomenon is best known by the experiment reported by the Russian psychologist Pavlov, who was credited with the discovery of conditioning.
His experiment demonstrated that animals develop associations which can produce automatic and reproducible physical reactions.
In the research study he rang a bell each time he fed a group of dogs; after repeating this a few times he found that the dogs would salivate if he rang the bell even without the presentation of food.
They had become conditioned to have a physical reaction at the sound of the bell.
There’s your mind-body connection. So the sound of a bell can make the dogs salivate because they’re expecting food.
The process of conditioning or programming seems to be very important in determining when the person with TMS will have pain. For example a common complaint of people with low back pain is that it is invariably brought on by sitting.
The Brain Makes Association Between Pain & Physical Activity
This is such a benign activity one is mystified by the fact that it initiates pain but conditioning occurs when two things go on simultaneously.
So it is easy to imagine that at some point early in the course of the tms experience the person happens to be having pain while sitting.
The brain makes the association between sitting and the presence of pain and that person is now programmed to expect pain with sitting. In other words, the pain occurs because of its subconscious association with sitting, not because sitting is bad for the back; that is one way a conditioned response may be established.
There must be others I am unaware of since sitting is such a common problem for people with low back pain.
Example 1: The Association of Sitting Posture and Pain
Car seats have a bad reputation so a person expects to have pain when he or she gets into a car.
Often people are programmed to have pain because of things they have heard or been told by a practitioner.
Never bend at the waist means the onset of pain is a surge is a sure thing when they bend from then on although it may never have caused pain before someone says that sitting compresses the lower end of the spine so of course it’s got to hurt when you sit standing in one place, lifting or carrying all have a bad reputation and will quickly be conditioned into a patient’s pattern.
Example 2: The Association of Walking with Pain
Many people report that the pain is relieved by walking up; others say that walking brings it on some have a great deal of pain at night and cannot sleep.
One man worked hard all day long with a fair amount of heavy lifting and pain and never a twinge of pain every night.
He would wake up 3 am with severe pain that persisted until he got out of bed, clearly a conditioned reaction.
Example 3: The Association of Sleep with Pain
Others report that they sleep well but develop pain as soon as they wake up and get out of bed.
In these patients, the pain usually increases in severity as the day goes on based on history and physical examination.
All of these people have TMS but are programmed to believe.
They suffer from something else.
What gives strong support to the idea that these reactions are conditioned is that they disappear within a few weeks as patients go through my treatment program.
If they were structurally based they would not go away after treatment.
It’s Psychological Rather than a Physical Matter
One cannot overemphasize the importance of conditioning and TMS for it explains many of the reactions that patients don’t understand.
If someone says I can lift their lightweight but anything over five pounds will cause pain, the pain can’t be based on structural grounds.
For example, a woman could bend over and touch her palms to the floor without pain but told me she always felt pain when she put her shoes on.
Many of these conditioned responses stem from the fear that people develop when they have back pain especially in the low back.
They have been told and they have read that the back is fragile, vulnerable and easily injured so if they try to do something vigorous like jog or swim or vacuum the floor their backs begin to hurt.
They have learned to associate activity with pain they expect it so it happens that conditioning the specific posture or activity that brings on the pain is not important.
What is essential to know is that it has been programmed in as a part of the TMS and is therefore of psychological rather than physical significance.
The Relationship Between OCD and Chronic Pain
You know the whole conditioning thing also adds to anxiety because then you’re worried, like if I do this activity or if I am sitting or whatever then that’s just gonna add to my pain and so then that adds to the anxiety loop.
It seems like it could be it’s like a little ocd in a way too, like you could get a little bit obsessed, like you know if I hop three times I’ll be fine or whatever you know.
We will also talk about the topic of OCD medication, especially for those who are HLA B27 positive and that’s the genetic marker that a lot of people have heard causes ankylosing spondylitis turns out that HLA B27.
It’s actually more promising according to today’s research; it is more promising for OCD than it is for physical pain and research has shown that it is the OCD that leads to chronic pain and that’s very important OCD – obsessive compulsive disorder.
Obsessive-compulsive disorder is a medical diagnosis so don’t self-diagnose yourself and this is not a diagnosis either but you do need to see a mental health professional, a licensed psychologist, to get diagnosed with it.
Obsessive compulsive disorder is a cognitive mental thinking experience.
We can call it a disease or whatever you want to call it but it’s an experience that gets you to think and behave in certain ways, for example you can find yourself obsessing over and over about how organized something needs to be you can find yourself obsessing about things and worrying about things and thinking too much about things what is this what is that should I organize these cans again.
I need to organize my shoes but wait a minute, did I turn off the stove; maybe I should head back and check if I turned off the stove, did I leave that thing on.
Maybe I should go back and check that I am safe yet I’m not sure if I am safe here.
What if one of my parents died, what if my best friend dies. Oh my god, we could die any second and these thoughts just go on and on and on and on
Self-made Strategies for Coping with OCD
That’s the obsessive part of obsessive compulsive disorder.
Now the compulsive part; it’s the behavior the things that you start to do to cope with those obsessive thoughts so if you have a thought, oh my what if one of my cousins dies like right now and then you decided to do three jumping jacks and all of a sudden you notice that you all of a sudden whenever you get that thought again you’re gonna do those three jumping jacks again and before you know it over time the pattern the obsessions with the compulsions become so obsessed so intertwined with each other that eventually you get to a point where you’re doing those three jumping jacks in order to prevent your cousin from dying as if those jumping jacks were somehow related or connected to your cousin’s life.
So, it’s that type of thing that’s what ocd is and it’s extremely common in the chronic pain community.
So common that we’re gonna read a book about it and no it’s not a diagnosis, I am just here to share information.
I will facilitate it, make your life a little better and make the world a slightly better place or not whatever so that’s what OCD is.
Ways to Snap Out of the OCD
Conditioning also works the other way around when it comes to what Dr Sarno is describing so when we think of programming conditioning there are some things that have programmed us to trigger our anxiety and that’s very important to know because just like we have things that can trigger it we can also have things that can soothe it that can help us soothe and take away that anxiety temporarily.
Usually, when it comes to the chronic pain, touching, massaging, foam rolling, stretching, special exercises, meditation and all of that stuff can somewhat fit into that OCD box.
You can find yourself meditating because you need to take away some of that stress, some of that anxiety, some of that pain and I am not saying there’s a problem with it.
What I am saying is that when you hear someone especially in support groups saying things like hey I am on this diet and this diet has taken away my pain or hey you know I have done these special exercises and these special exercises have taken away my pain.
There’s a really good chance that what that person has created is some form of compulsive behavior that helps them cope with their obsession with their anxiety and their pain.
It’s helping them cope with something and I am not saying there’s anything wrong with that if you need to find an obsession a compulsive behavior to cope with what you’re dealing with.
I don’t see a problem with that if that’s the best you can do and there’s no shame in that but at some point it’s important to feel whatever’s behind that.
So if your mind tells you hey your cousin might die today how do you feel about that.
Scared at some point. You’re gonna have to learn how to just feel that let it pass and disconnect from the identification with those obsessive thoughts and that will get you closer to long-term relief.
The common patterns of TMS
Let’s talk about common patterns of TMS.
Perhaps the most common pattern is for the person to have recurrent acute attacks of the kind described earlier.
Remember what the acute attacks were?
The ones that are just sudden and hurt really bad may last from days to weeks or even months with the most acute pain subsiding after a few days.
They are traditionally treated with bed rest, painkillers and anti-inflammatory drugs administered by mouth or by injection.
If the patient is hospitalized, traction is often employed.
Though its purpose is to immobilize the patient and not to pull the spinal bones apart since this cannot be done with the weights used.
I do not instruct my patients what to do for an acute attack for it is the goal of this program to see that the attacks don’t occur to prevent them; however, occasionally I am called upon to advise someone having an acute attack.
It’s essentially a question of waiting it out. I may prescribe a strong painkiller but not an anti-inflammatory drug since there is no inflammation.
The irony of the usual experiments with one of these attacks is that most patients would be better off if they consulted.
There may be something physiologically important going on and so one must be examined by a physician so pretty much go see a doctor just in case assuming nothing truly serious like a tumor is present.
The usual diagnosis is some spinal structural abnormality, a scary, diagnosis, degenerative disc disease, herniated disc, arthritis, spinal stenosis or facet syndrome plus the dire warnings of what will happen if the patient doesn’t take sufficient bed rest and cautioning about never again jogging or using a vacuum cleaner or bowling or playing tennis is the perfect combination for multiplied and persistent pain.
But the human spirit is more or less indomitable and eventually the symptoms fade leaving someone who was essentially free of pain but permanently scarred not physically but emotionally except for the very brave few.
Most people who have had such an attack never again engage in vigorous physical activity with an easy mind.
They have been sensitized by the experience and all that it is supposed to imply and they see themselves to a greater or lesser degree as permanently altered.
The pattern of recurrence of acute attacks
They fear another attack and eventually it comes. It may be six months or a year later but the prophecy is fulfilled and the dreaded event occurs again as before.
The person usually attributes the attack to some physical incident.
This time there may be leg pain as well as back pain and now there is talk of surgery.
Should a herniated disc be found on MRI or CT scan, this further increases anxiety and the pain may become even more severe.
This pattern of recurrence of acute attacks is very common as time goes on the attacks tend to come more frequently to be more severe and to last longer and with each new attack the fear increases and there is an increased tendency to limit physical activities.
Some patients become virtually disabled as time goes on. In my view physical restrictions and the fear of physical activity represent the worst aspect of these pain syndromes.
They are ever present through the pain may come and go.
They have a profound effect on all aspects of life, work, family, leisure time indeed.
I have known patients with TMS who were much more disabled in terms of their daily lives than patients who were paralyzed in both legs.
That’s pretty serious. Many of the latter go to work every day on their own, raise families and in every way lead normal lives except that they are in wheelchairs.
The severe TMS patient may have to stay in bed most of the day because of the pain. Eventually most people who have recurrent attacks will develop a chronic pattern.
They will begin to have some pain all the time, usually mild but exacerbated by a variety of activities or postures to which they have become conditioned.
I can lie on my left side but not on my right. I must always have a pillow between my knees in bed. I never go anywhere without my seat cushion.
My body corset or neck collar is absolutely essential, if I am to remain free of pain.
If I sit for more than five minutes, I get severe pain. The only chair I can sit on has to have a hard seat and a straight back and on and on.
To some the pain becomes the primary focus of their lives.
How to lower your risks of repeat attacks
I am going to pause right there because I am going to give you guys an exercise.
If you’re reading this and if you’re here with us live, if you use social media, this is the very first exercise that I can share with you.
Just to test yourself on how attached you are to this pain from now on social media, you are no longer allowed to talk about your pain and just think about it.
Take a moment; check with yourself; notice how you feel when I say that if there is any resistance. You know with any fear or any worry, you pay attention to it.
So from this day forward you’re not allowed to talk about your pain anymore on social media. You can talk to your doctor about it; you can talk to your family; you can talk to whoever you want, but on social media no more talking about pain.
If there’s hashtag ankylosing spondylitis, hashtag chronic pain warrior, all of that stuff goes out the window unless you’re a coach and this is what you do for a living like myself. You’re not allowed to use that off out; no more, okay.
Just notice your attachment to that identity, if you don’t have social media but you have these t-shirts and these hats that you know.
Let’s get rid of those shirts.
Let’s give them away for now. You can keep your massagers and you can keep your foam rollers and your special exercise routines and all that stuff but at some point that has to go too.