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Will Baum, LCSW

Will Baum LCSW

Chronic Pain

Dealing with Chronic Pain

Can psychotherapy help with chronic pain?

Aches and pains are a part of life. But when pain doesn't go away, it can easily become a crisis–ongoing, unwanted, and difficult to live with. Sometimes, repeated doctor visits offer little to no relief. Or just when one pain symptom subsides, another pops up. These may a good times to consider talking to a therapist.

A growing number of therapists count themselves as mind-body specialists, helping people work through tension and stress-related chronic pain, known to some as Tension Myoneural Syndrome (TMS). Many such therapists are gathering in March at the L.A. Mindbody Conference. Alan Gordon, LCSW, a conference presenter, talked to me via email about TMS–how it's identified and how it's treated.

What is TMS and how does someone know if they've got it?

Tension Myoneural Syndrome (TMS) is a term coined by Dr. John Sarno of the NYU Medical Center. Put simply, it means physical pain that's the result of psychological causes rather than structural causes.

Anyone who's ever had a headache or stomachache as the result of stress has experienced TMS. For most, the pain goes away within a day or two, but for some it becomes a chronic condition. Chronic back pain, neck pain, fibromyagia, carpal tunnel syndrome, and many other conditions that are commonly thought of as having structural causes are often TMS.

Many of my clients bounced around from doctor to doctor for years, unable to find relief for their chronic pain. Usually they come upon the TMS diagnosis as a last resort, having exhausted every treatment from physical therapy to magnets to South American shamanism.

In order to be diagnosed with TMS, physical causes of the pain must be ruled out. This can be tricky, as many doctors will diagnose a herniated disc, for example, as the source of back pain, when it's actually an incidental finding. If you have chronic pain that hasn't responded to physical treatment, especially if you're a high-stress or hard-on-yourself type person, you may have TMS.

What's the treatment for TMS?

With TMS, the pain is like a fire alarm that is going off: annoying, distracting, but ultimately it's there to let you know that something is amiss.

One of the primary steps to recovering from TMS is to reframe the meaning of the pain. The physical symptoms, terrible as they may feel, often serve as a signpost to unaddressed issues.

Perhaps you are a perfectionist and put endless pressure on yourself, or perhaps you are your own worst critic and constantly tear yourself down. These behavioral patterns can generate a lot of internal unrest. Addressing these underlying conflicts are essential to recovery.

Many people who recover from the pain come to look at its onset as a blessing in disguise, as it forces them to face issues that otherwise would have gone unacknowledged.

Can you give an example of how that works?

As an example, many of the TMS clients I've worked with were raised to believe that it's not okay to express anger. As they go through life, these powerful feelings get shoved deep down. Avoiding confrontation at all cost, they become "people pleasers" through and through: the perfect friend when you need a ride to the airport at 4:00 AM.

Although they'd like to discard these intolerable emotions, the anger is real and needs to come out. Denied direct expression, the feelings often manifest indirectly as fibromyalgia symptoms, or low back pain, or headaches; anything to take the focus off of these unacceptable feelings.

Mind you, this is all unconscious. Nobody chooses physical pain over painful emotions, our minds simply don't consult on us such matters.

To resolve the pain, one of the most important steps is to find a connection between the physical symptoms and the underlying emotions. Maybe your back flares up when you lend a family member money, or when your baby wakes you up in the middle of the night. These things can generate anger, though it often goes undetected.

Once a connection between these difficult feelings and the phyiscal pain has been established, it's important to become more aware of the feelings when they come up, and gradually learn to better tolerate them. Ultimately, like a lighthouse in the night, the pain becomes a guide: "Okay, my back hurts. Something's going on. How am I feeling?"

In additon to anger, feelings of guilt, helplessness, dependency, sadness, or "not feeling good enough" can lead to TMS.

Because of the emotional tension that results, it is no surprise that many people who develop TMS pain are perfectionistic, self-critical, and put a lot of pressure on themselves. Although these traits lead to success in the outside world, there's often a price to be paid internally.

Just making the connection between unwanted feelings and pain makes pain go away? Really?

For some, making the connection between unwanted feelings and physical pain is sufficient to get rid of the symptoms. For others, more intensive emotional exploration is needed to really flush out the underlying issues.

I've had clients who were able to eliminate their pain after several weeks, while others took several years.

Although the timetable varies, most people recover. In fact, three retrospective studies were conducted at the Rusk Institute (1982, 1987, 1999) measuring the efficacy of TMS treament. Out of 371 randomly selected chronic pain clients, 72% reported being free or nearly free of pain six months to three years after treatment.

Hundreds of individual success stories can be found at the TMS Wiki (

TMS can seem counter-intuitive at first, but it's inspiring to read about how it's helped people overcome everything from back pain to migraines.

For more about Alan Gordon and TMS, visit

X is for 'Xamine Pain in "Crisis Coping from A to Z."

Will Baum, LCSW
Therapy in L.A.