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 Why does it hurt more at night?

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sdiddy Posted - 06/03/2013 : 16:19:56
I have been working on TMS therapy for my shoulder (see my other posts for background) for almost 2 months now and have seen a lot of pain reduction during the active hours of the day. However, at night, the pain increases a lot and keeps me up and wakes me up.

Just curious as to why this is happening? It hurts most probably first thing in the morning, but then shortly after seems to dissipate quickly.

I am trying to figure out if this is TMS, or if I really do have a tear, inflammation, etc that is exasperated at nighttime for some reason.
20   L A T E S T    R E P L I E S    (Newest First)
sdiddy Posted - 06/18/2013 : 20:42:07
i honestly have changed the way i think about it for the last couple months. i dont worry about it, touch it, give it attention, and even have stopped letting it get in the way of my enjoyment of life (playing basketball etc). and although ill say the symptoms and pain are much less, the pain is still there. it doesnt actually hurt when im sitting around and not using it, but if i move it in a wierd way or lift my arm in certain positions, it will "seize" up, sending me a sharp pain.

like today i played some basketball and the whole time it didnt hurt until i shot one particularly long 3 pointer and i got a sharp pain in the shoulder, and then one other time when i sort of bent my arm backward i got a very sharp pain. its strange because i have sort of reconditioned my brain to not expect pain anymore, so when i actually DO experience pain like those instances, it comes as a shock and surprise and feels like a setback. I know the pain is there, but those reminders are very discouraging.
jaya Posted - 06/17/2013 : 10:57:08
you have conditioned yourself to "expect" more pain at night
Dave Posted - 06/12/2013 : 08:53:38
quote:
Originally posted by sdiddy
...Its just frustrating that its taking so long.

It is counterproductive to monitor your progress or put any kind of timetable on recovery.

You must undergo a life-long change in the way you think about and react to the symptoms. You must recondition yourself. You must break bad habits that formed over decades. It is only logical that it will take time.

It's not unlike losing weight. Who is going to have a better chance of lasting success -- the one who goes on a certain diet and weighs himself every morning, or the one who decides to make a life long change in the way he approaches eating and exercise?
sdiddy Posted - 06/11/2013 : 12:15:06
Interesting update - it has stopped hurting as much at night in the last couple weeks. I have also went and played basketball (just shooting around) 3x in that time span and surprisingly it hasnt hurt afterwards like I thought it would, based on my past experiences. There was one instance when i reached out sort of backwards for the ball and got a shooting pain, but that was it.

It is definitely improving, but the deep pain is still there if I do a weird movement or touch it (I try to never touch it anymore). Its just frustrating that its taking so long.

I am worried still though, because in january when it felt fine I started lifting weights and playing basketball and the pain came back very strong and took me out of sports for a few months. I was scared I retore it or something because I might have pushed a little too hard with the weight lifting. This time around I am trying to take it slow but its hard.
art Posted - 06/08/2013 : 11:51:55
I have almost no pain at night, which makes sense for me because it's when my stress levels are at their lowest for the most part...

I think what matters is the connections we can make, and the understanding we can bring to bear that if we have a genuinely bad knee say, it should pretty much be bad (that is hurt) all the time. Periodic pain, situational pain...both of which is to say conditioned pain...is cause for celebration and a renewed commitment to a TMS diagnosis...
Dave Posted - 06/08/2013 : 08:16:33
quote:
So then I ask myself....what to do?

1. To try and heal with TMS therapy I must truly 100% commit to TMS and not just sit around and hope the pain goes away, but actually use my shoulder, play basketball, golf, etc and not give the pain a second thought.

2. I can assume its a small tear or inflammation, leave my shoulder alone, not play sports, then when it heals and the pain is gone, start up physical therapy again to strengthen it and prevent any future injuries.


That's it in a nutshell. You have two paths from which to choose. There is no in between.

If you are not at a point where you can truly accept that the pain is not due to a structural issue, and you cannot banish the fear that you may injure yourself, then your mind is simply not at a place where you can treat the pain as TMS. As long as you allow this doubt to occupy your thoughts, baby yourself and/or seek physical treatments, there is no chance of successfully treating the symptoms as psychogenic.

To recover from TMS you must be truly ready to take path #1. Even if you do not believe 100%, you must act as if you believe 100% and commit fully to treatment. If not, then you have no choice but to take path #2. Perhaps one day you will be ready to take the other path and commit fully to the TMS diagnosis. It seems you are not there yet.
sdiddy Posted - 06/07/2013 : 17:31:46
Balto, I was playing sports and lifting weights without much pain in january and february, but then (perhaps I pushed too hard), the pain starting to creep in around march. I stopped playing sports and lifting as the pain worsened.

Since then I have let it completely rest, not doing anything strenuous with it. The pain DID dissipate quite a bit, and about 8 weeks ago I started "TMS therapy", which seemed to decrease the pain too. Now, I dont feel much pain except at night, morning, and during specific movements. But like I said, I am not using it much.

This week I got tired of sitting around and only running on a treadmill and went and shot a basketball a couple times. The shoulder felt stiff and sore, but not terribly bad after.

I think partially the doctors make things worse by saying things like "some tears and bursitis wont heal by themselves and require surgery because the tendon keeps rubbing against the bone" etc etc. Maybe its true...I dont know....but things like that are what allows me to have the nagging fear that something is physically wrong. I am sure you know what I mean.

To answer your other question, although I am not depressed or have severe insomnia or anything, I AM under a bit of stress and anxiety about having a baby with my wife. We are getting old and there is a fair amount of pressure (self imposed) to "do the right thing" and start trying, even though we dont feel 100% ready. The truth is, we will never will. That is the problem with type A people like us who ALWAYS want to do the right thing and make everything perfect...if I cant control the outcome of every circumstance, its scary for me. So YES I will admit its a nagging fear in the back of my mind...but truly I am not sitting around stressing like a maniac...I am trying to approach it pragmatically and with a healthy perspective, but still...its the scariest thing I have ever had to do or decide.

Not sure if this matters, but I also have not had a sip of alcohol in 60+ days (cleansing the system prior to trying to conceive). I would think this would actually help "heal" my shoulder faster too.

Anyways, thank you
balto Posted - 06/07/2013 : 11:39:19
S, the human body is an amazing machine. Any physical wound will heal in less than 2,3 months time. If after resting your shoulder 2,3 months and you still have pain then it is very very likely is tms. Also, if the pain level goes up and down, then it is also could very well be tms. Pain level from real injury don't go up and down. And do you notice your pain level go up and down in sync with your stress level? If it is then it also tell you it is tms.

Do you also have other "telltale" sign of tms, like insomnia, anxious, depress, stomach trouble....

The normal advice here is go have your shoulder check by an MD to rule out any thing serious. Take it easy for a couple months if you're not sure. Then if it doesn't improve then go the tms way 100%.

Another thing you can try is do whatever you can to stop worrying about your health and stop fearing your symptoms. You don't have to go back to all your normal physical activities, just work on eliminate your fear and health worry. If you're able to do that then you will be cure for sure.

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No, I don't know everything. I'm just here to share my experience.
sdiddy Posted - 06/07/2013 : 11:03:33
I hear what you guys are saying...I really do...but I guess my response would be....what if you are wrong??

If you are, and I resume basketball, and it was a tear, bursitis, inflammation, whatever, then it WILL get worse and potentially set back my healing another 6 months or so? This is my honest and open fear.

The pain doesnt bother me...its the fear of what the pain might be an indication of. I did shoot some baskets for the first time in a long time this week, and I will admit my shoulder is sore and hurts a bit more since then....I played gingerly and carefully, so who knows.

So then I ask myself....what to do? SInce neither you, nor me, nor even a doctor can say with 100% certainty as to what is wrong with my shoulder....After hearing your advice I am left with 2 choices I suppose:

1. To try and heal with TMS therapy I must truly 100% commit to TMS and not just sit around and hope the pain goes away, but actually use my shoulder, play basketball, golf, etc and not give the pain a second thought.

2. I can assume its a small tear or inflammation, leave my shoulder alone, not play sports, then when it heals and the pain is gone, start up physical therapy again to strengthen it and prevent any future injuries.

What do you think? Is my reasoning sound? I dont know what to do.
Dave Posted - 06/06/2013 : 10:28:49
quote:
Originally posted by sdiddy
...if I stretch both my arms back...the "injured" one...hurts during a rare specific movement...throbbing chest and left arm pain...its a very "in your face" throbbing or shooting pain...I might re-tear my rotator...

Do you see a pattern here?

I believe you are "running up into your thoughts" and allowing obsession about the physical symptoms to continue. You are looking for some evidence or proof that the pain is TMS. None will be forthcoming. The more you focus on the physical aspects of the pain, the more the pain will continue, because it is working.

You are stuck and not allowing yourself to accept the benign nature of the symptoms. It is almost as if you are looking for reasons to prove that this particular pain is not TMS. The doubt has evolved into obsessing about the pain and that in and of itself is a distraction. It is a vicious cycle.

You have to try your best to stop thinking in the physical realm, accept the pain as benign, and resume physical activity. As long as you allow the fear to dominate your thoughts, the pain will continue, because its purpose is being fulfilled.
balto Posted - 06/05/2013 : 19:39:16
sdiddy, your mind is filled with nothing but fear thoughts. You constantly scanned your body for symptoms, your analyze your pain and trying to figure out what is wrong.... How do a worrier like yourself expect to get well? :)

There could be many reasons for your pain and why you feel the pain is worst at certain time or during specific movements. Like Darko said above, tension from everyday life's difficulties can have very negative effect on your tms symptoms. Or It could be conditioning like I've said earlier... Whatever it is, it happened because of FEAR.

According to Sarno's theory, that Fear is what keep your attention and distracted you from some strong negative emotion deep in your subconscious mind.
That Fear is what Claire Weekes call the second fear and is what keep you in a fear - symptoms - fear loop.
That Fear is what Dale Carnegie said we must laugh at to get rid of it.
That Fear is what the Buddha called the second poison dart. We doubted our self, we doubted our ability to be well.
That fear is what Steve O tried to defeat by doing and keep doing physical activities.

tms/anxiety can not stay exist without you fearing it. When all fear thoughts end, the body automaticly reset itself and calm itself down, and pain symptoms just melt away.

So try to find way to eliminate your fear, all of it, and you will be well again.


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No, I don't know everything. I'm just here to share my experience.
Darko Posted - 06/05/2013 : 16:50:28
Sdiddy,
I always get the pain at night.....If I have a stressful fight with my other half this can also give me pain at night. It doesn't sound like you have a physical issue......as they get better, and generally are painful all the time.

I almost sent myself crazy trying to figure out the conditioning theory.....might be true but wasn't for me in this application. It's really simple, if I'm "seeing" too many threats in my day to day life, or in the future I start to generate deep tension. You'll notice when your mind is occupied you'll start to tense a part of your body, like back area or shoulders.

The tension is deep in the unconscious because one keeps thinking negatively or fearing everything OR it could be an anger thing for you.....or all of the above!

I have to get my day to day thinking and focus under control. Ultimately I need to feel secure....and this gets me calm. It's mainly a money thing for me.

When the lights are out, then the tension sets in because consciously I know its all BS......

take a look at what is going on in your life and how you're thinking about it all....and change your perspective. Then it could take a little while for your system to calm down.

Good luck
D
sdiddy Posted - 06/05/2013 : 14:46:17
I suppose you are right and this is very helpful info. I didnt realize that conditioning might really be a factor here. What then is the reason that if I stretch both my arms back, then the right one (the "injured" one) hurts? It seems that the goal of TMS is to initiate pain as a means of detracting or distracting me from dealing with my real stress and fears, but if the pain only generally hurts during a rare specific movement, then it doesnt seem similar to my other TMS issues in the past. Curious your thoughts on this?

Another TMS issue I have had (and still have off and on) is a throbbing chest and left arm pain....it stems from stress and my long-time fear of having a heart attack, despite my general good health. I have had above avg cholesterol for some years though, mostly genetic, (I dont eat fried food, red meat, sweets, etc) and have a generally active and healty lifestyle and below avg BMI, but having high cholesterol has really scared me. But when I get those pains, its a very "in your face" throbbing or shooting pain at ANY time of the day or night. I can usually take deep breaths and say "this is just TMS" and the pain goes away.

What I am experiencing with my shoulder is completely different, so I am trying my best to overcome it, but still have this nagging fear that if I try and do some light weight training or play golf or basketball again, I might re-tear my rotator (assuming that this was a physical injury), and then set me back another year or so. I dont know if I can handle that, but on the flipside, I dont know that I can live not knowing either.

Perhaps I should take your advice and take baby steps and see what happens? I am really trying to think back to how I cured my lower back TMS years ago, and I am pretty sure I just threw caution to the wind and went for, playing sports, etc and not caring about the pain. I cured myself VERY quickly of that 6 year long pain. But this shoulder thing is taking much longer. I think the primary difference was that with my back, after reading "healing back pain" I KNEW for certain that this was TMS. The book detailed everything I had been through exactly, but I havent seen nearly as much info or evidence on shoulder TMS, and I dont know what to think. Plus the multiple doctors I saw in the past about my shoulder all claiming a small tear and wanting to do exploratory surgery didnt help my confidence.

It feels good knowing you guys are here to offer your help and advice...dunno what I would do without this community. Thanks


quote:
Originally posted by balto

sdiddy, I think your pain level increase during specific movements or at night is due to conditioning. Your body use implicit memory to increase the pain level at night or during specific movements. Let me try to explain it as best I can.

When you accidently touch a boiling pot of water, what do you do? Your hand would automaticly pulled back right away. You don't hold on to the boiling pot and think in your mind that: "hey, this pot is hot, if I don't pull my hand back it will burn and I will be in pain..." . That's your implicit memory at work. Old experience help instruct your body to perform a task without any awareness from you at all. It is a kind of conditioning.

Sometime in the past you experience a tms pain attack at night. Your body just remember the time (at night), the place (in the bedroom), the environment (the bed, the sheet...),... when that happened. Your mind "wrongly" associate "the time, the place, the environment..." as a sign of danger to you and it produce the necessary changes in your chemistry and physiology to produce the increase in pain level.

Some people have pain increase a suffer a panic attack each time they go thru a tunnel or over high bridge. Just about anything can be a "conditioning object", we just have to acknowledge that and eliminate our fear of it or try to loose any concern about it, the conditioning effect will lessen and be gone in time.

Pavlo's dogs stopped salivating at the sound of the bell after they don't get any food for a while.

About the fear of starting doing more sport, why don't you just start out slow. Just do light activities at first and increase the intensity as you feel more comfortable using your body again. When confidence come and fear is gone you will be cure. Goodluck.

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No, I don't know everything. I'm just here to share my experience.

balto Posted - 06/05/2013 : 12:35:13
sdiddy, I think your pain level increase during specific movements or at night is due to conditioning. Your body use implicit memory to increase the pain level at night or during specific movements. Let me try to explain it as best I can.

When you accidently touch a boiling pot of water, what do you do? Your hand would automaticly pulled back right away. You don't hold on to the boiling pot and think in your mind that: "hey, this pot is hot, if I don't pull my hand back it will burn and I will be in pain..." . That's your implicit memory at work. Old experience help instruct your body to perform a task without any awareness from you at all. It is a kind of conditioning.

Sometime in the past you experience a tms pain attack at night. Your body just remember the time (at night), the place (in the bedroom), the environment (the bed, the sheet...),... when that happened. Your mind "wrongly" associate "the time, the place, the environment..." as a sign of danger to you and it produce the necessary changes in your chemistry and physiology to produce the increase in pain level.

Some people have pain increase a suffer a panic attack each time they go thru a tunnel or over high bridge. Just about anything can be a "conditioning object", we just have to acknowledge that and eliminate our fear of it or try to loose any concern about it, the conditioning effect will lessen and be gone in time.

Pavlo's dogs stopped salivating at the sound of the bell after they don't get any food for a while.

About the fear of starting doing more sport, why don't you just start out slow. Just do light activities at first and increase the intensity as you feel more comfortable using your body again. When confidence come and fear is gone you will be cure. Goodluck.

------------------------
No, I don't know everything. I'm just here to share my experience.
bryan3000 Posted - 06/05/2013 : 12:28:58
My symptoms have always been 10x worse in the morning/late morning and considerably better at night. For many of use, this is pretty easily attributed to daily cortisol and gaga/serotonin patterns.

I agree with Balto and others here, though... if your symptoms are at night, when your body should generally be more relaxed... it seems a good chance that conditioning or general thought patterns/anxiety are the culprit.
Dave Posted - 06/05/2013 : 12:18:58
quote:
Originally posted by sdiddy
Its actually concerning to me that my shoulder only hurts during very specific movements, or like at night when I spend quite a bit of time sleeping on my arm, because this seems to indicate that the pain isnt stress induced but rather a physical issue.

Again, please read, re-read, and re-read Dr. Sarno's explanation of conditioning.

It's not about your thoughts or expectations. TMS is more clever than you think. The fact that you believe "the pain isn't stress induced but rather a physical issue" is the precise goal of the symptom.

It seems you are overthinking things. Ignore the symptoms as best you can. Accept them as benign. Explore the potential psychological triggers. Resume normal activity. Trust that the symptoms will fade as long as your are diligent in your efforts to diffuse the power they have to preoccupy your thoughts.
sdiddy Posted - 06/05/2013 : 11:27:34
Balto, thanks for your thoughts....

I guess that is the confusing part for me. I TOTALLY understand that at night and in the morning it would hurt because i have a habit of thinking deep thoughts at night, life planning, career, family, stress, etc....I know its not healthy but I havent learned how to let go and pass out like my wife does. It has kept me up many nights of my life. SO that part makes sense.

The part that DOESNT make sense is what you mentioned, which is other times when I EXPECT pain or am sitting and even thinking and worrying about my shoulder and pain (during the day), and it doesnt hurt. For example...I will be sitting on the couch motionless, watching tv, and start stressing about my shoulder, wondering when it will get better and when I can play sports again, and normally this type of high level stress would have caused throbbing or shooting pains or something, but nowadays it doesnt do anything. Its actually concerning to me that my shoulder only hurts during very specific movements, or like at night when I spend quite a bit of time sleeping on my arm, because this seems to indicate that the pain isnt stress induced but rather a physical issue. It used to hurt all the time, but after letting it rest and doing TMS therapy, it now only hurts during specific movements or at night.

I am not sure what to think....Do I test it and start to play sports again? I am scared to do that and cause it more damage (if it IS in fact physical and not mental). I am just getting so fed up of babying it and not being able to do what I want, and its affecting my overall mood, stress, and health.
balto Posted - 06/04/2013 : 16:20:24
While you're awake your mind is occupied with many other things and you focus less on the pain symptoms. At night and early morning your mind is free so you focus more on the symptoms. The pain level is the same all day, you just think is it worst when you're focus on it. But the symptoms will get worst if you "expecting" it. You somehow condition your body to expect the pain to get worst at night and early morning.

for some people the symptoms get worst when they bent down to tie their shoes or when they brush their teeth or walk to the mailbox... Sometime in the past they experience a symptoms attack at a particular time or while doing something, after that their mind just associate that "time" or while doing that "thing" with an increase in symptoms. Their mind "think" that "time" and "thing" as a sign of danger and produce the corresponding symptoms. (fight or flight respond)

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No, I don't know everything. I'm just here to share my experience.
Dave Posted - 06/04/2013 : 10:13:22
quote:
Originally posted by sdiddy
I have been working on TMS therapy for my shoulder (see my other posts for background) for almost 2 months now and have seen a lot of pain reduction during the active hours of the day. However, at night, the pain increases a lot and keeps me up and wakes me up.

Just curious as to why this is happening?

Suggest that you re-read the portion of Dr. Sarno's book that discusses conditioning. It is one of the most important concepts of TMS.
tmsjptc Posted - 06/04/2013 : 09:19:33
NA, other than a little yawn and stretch, I never had this kind of pain in the morning before the chronic TMS started. Also, while going through the healing phase, I've had symptom substitutions. One of these was foot and heel pain that I had NEVER had before and it was most prevalent in the morning when I got up but continued all day to a lesser degree. Also, sometimes I would go to bed without pain but wake up with a tension headache. What kind of movement and circulation wasn't happening at night that you think would cause these things to sometimes happen?

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