Can I just journal my way out of chronic pain?
There are so many ways to work with chronic pain, and there’s research to support many different modalities. Expressive arts therapy, acupuncture, listening to music, meditation, and spending time in nature, all have studied benefits for reducing chronic pain.
If you’ve been in chronic pain long enough, at some point or another, you may have come across a well-known and controversial book, Healing Back Pain by John E Sarno. Sarno theorizes that folks with chronic back pain who, after repeated testing, have no discernible pathologies, are suffering from what he calls Tension Myositis Syndrome, also known as TMS. Sarno suggests that chronic pain is a manifestation of the subconscious mind in response to repressed emotions, especially anger. The pain is meant to distract you from feeling these intensified emotions. This results in an autonomic nervous system response that slightly deprives oxygen to the tissues, contributing to the feeling of pain.
TMS healing protocol involves some degree of education about how pain is processed (aka pain is created by the brain, not the body). It involves a return to “normal activity,” encouraging mindset shifts around the psychological nature of pain. And a large part of the healing is…journaling.
Sarno and his proponents think that your pain will only resolve when you deal with your unprocessed and unresolved emotions. There seem to be a few TMS-based journaling techniques, but many involve writing a list of all the things that cause stress or anger in your life, past or present, and taking the time to write about them. Others just suggest writing about your day, and about the challenges and emotions associated with the day. The point is to find a safe space to express unprocessed emotions.
So if you’re asking, is TMS an evidence based theory? The answer is…no. I found one study that showed a positive effect when 51 patients used a TMS protocol, but that’s too small of a study from which to glean large scale conclusions. Is there evidence to support expressive journaling for chronic pain? Most certainly. Do we know that the mind-body connection contributes to the perception of pain? Definitely! But I don’t buy the physiological underpinnings of Sarno’s theory, and I don’t buy a one-size-fits-all pain resolution approach.
Is it for everyone? Why the vast appeal?
From my research, it seems like a lot of folks who are interested in TMS are now applying the concepts to research around pain neuroscience. So even if the theory in and of itself is ~off~, people are justifying it in certain ways by talking about biopsychosocial approaches to pain, and nocioception (see past newsletters if you’re not sure what I’m talking about!). The Curable App, which many of my clients have found useful, is founded on principles of TMS.
Ableism and self-healing
There’s this certain strand of ableism that can be embedded within TMS theories, where if you just work hard enough, you can cure yourself. This doesn’t take into account many social determinants of health, how bad healthcare is in this country, and how hard it might be to work on healing your trauma if you live in an environment without clean water, air, food, and relative safety and stability. The rugged individualism of ~self-healing~ leaves so many folks out of the equation. Healing is relational, and most of us need more support in order to develop more skills for working with pain, chronic stress, and illness.
No one size fits all approach
Do you love to journal? Maybe you should do it then! It’s associated with decreased stress and pain scores. But do you open a notebook and feel dread, guilt, fear, boredom? Then let’s try something else that maybe fits your needs better. To prescribe a one-size-fits-all approach to healing chronic pain only further isolates folks for whom these these protocols don’t work. I encourage my clients to do the kind of nervous system work that brings them pleasure. I enjoy writing, but I certainly don’t want to wake up every morning and spend 20 minutes writing about the worst and most stressful parts of my life, as some TMS experts suggest. Doesn’t feel very trauma-informed to me.
Expectations matter
So why do so many people swear by TMS? EXPECTATIONS MATTER. Evidence shows an association between expectations around treatment and treatment results.
When you’re in chronic pain, and a very confident person tells you they know EXACTLY what’s going to make you feel better, what do you have to lose by buying in?
I prefer living in a murkier world, where we can hold the complexity of the mind-body connection without reducing it to something as simple as TMS. Everyone could benefit from some nervous system resilience, sure, and also unions, fair wages, more time off, and more connection to supportive people and the earth, etc. I’m never going to tell a client that I know precisely why they have chronic pain, and I know exactly how to fix it. Let’s honor the fact the healing is often a windy journey of trial and error, and that you get to discover what works best for you.
