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plainchant
41 Posts |
 Posted - 12/03/2004 : 06:18:38
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| I am sure that many members of this forum would be interested to find this out. You must have had to look beyond a lot of what you were taught in medical school. |
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Dr. Fatteh
USA
16 Posts |
Posted - 12/04/2004 : 01:29:59
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Plainchant,
That is a very good and revealing question. My original plan did not involve the world of chronic pain. I completed my residency in Physical Medicine and Rehabilitation (the same specialty as Dr.Sarno), and planned on primarily treating musculoskeletal disorders such as industrial injuries and sports injuries. However, more and more chronic pain patients came my way, since PM & R docs tend to see patients who have made the rounds with all the other specialties already. And, I started to notice something. I spent time actually talking to my patients, probably to the detriment of staying on schedule, but I actually got to know the personalities of my patients. And, it became clear, that their personalities affected their pain and in turn their level of impairment. Also, by working with a population of worker's compensation patients I got further insight into the effects of emotional baggage on pain. Now, I by no means am implying that worker's comp patients are duplicitous. I would say that 99.9 % of my patients are genuinely in pain. It's just that I could plainly see the effects that extraneous factors had on their pain and disability: anger towards a supervisor who left them shorthanded leading up to an injury, paranoia about the insurance company sending private investigators to spy on them, anxiety over what will happen with their career, worry over their financial situation (disability payments don't come close to paying the bills), embarrassment over being a former breadwinner who now cannot bring home the bacon, etc. And, I would also see the sense of calm, and resultant reduction in pain and disability, that came when a case came to a resolution and a career plan (such as vocational rehabilitation) was established.
In the midst of all this, I would see patients who got no benefit from various medications, injections, or even surgeries. But finally it took a near-tragedy to open my eyes regarding TMS. A patient of mine made two suicide attempts, before finally turning her life around after someone else gave her Fred Amir's book. That was the crystallization of the patterns that I had seen coming together. Ironically, to further answer your question, the academic world of pain management is surprisingly disjointed. Plenty of pain treatments are thought to POTENTIALLY provide benefit, but surprisingly few are PROVEN to benefit. This fact is continually brought to light by insurance companies when they seek to deny treatment. So it hasn't been a matter of looking beyond the teachings of medical school. Rather, it has required that I look beyond the compulsion to find patterns amongst loosely scattered anatomical lesions and test results, and simply look at the patterns of behavior that are plain as day. I think that doctors deep down inside have always had a hunch that emotions and personality played a strong role in the manifestations of pain, but we haven't had the time (during a 10 minute visit), the public relations confidence ("You think the pain is in my head?! Well, I shall find a new doctor!"), or the legal backing ("Dr.Fatteh, your claims of psychosomatic illness are damaging my client's case!") to follow our hearts. Besides, it requires too much time, guts, and actual compassion to make the effort to communicate these issues to a chronic pain patient. And that, at the end of the day, is what makes the difference: communicating with the patient. Connecting with the patient. Talking to or with the patient, not talking at them. Simple concepts that us dumb doctors historically have been too egotistical to understand. That is why we as a profession have struggled with these concepts, and that is why patients have continued to suffer.
Parvez Fatteh, M.D. |
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plainchant
41 Posts |
Posted - 12/04/2004 : 02:08:41
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Thank you for your long and revealing post. I hope that it will convince several recent "Doubting Thomas" posters about the existence of TMS. You also bring up an excellent point about the monstrous "personal injury" lawyers. They undoubtedly have a huge part to play in the epidemic of modern pain syndromes. By playing on people's greed to satisfy their own greed they condition clients' minds to want to be in permanent pain in order to collect compensation.
In the book I just completed, "Take Off Your Glasses and See", an eye doctor, Dr. Jacob Liberman, realized a non-physical cause for poor eye sight after years of practicing. In medical school he was taught that naturally improving eye sight is impossible, and was trained to simply provide stronger and stronger glasses and contacts as the years go by. Dr. Liberman saw a correlation between deteriorating eye sight and patients' need to "block out" emotional aspects of their lives that they found to painful to deal with. And that this situation could be addressed, and eye sight improved.
In any case, I salute doctors like you, because you really do help people, and you have the strength of character not to follow the herd. |
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UK james
United Kingdom
37 Posts |
Posted - 12/04/2004 : 03:20:55
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I find it so hard to believe that I was never intoduced to TMS theory earlier in my life. It can help so many people it is unbelieveable. I wasted so many years and so much money searching for the cause of my pain. The problem lies in the fact that TMS does not show up on a scan or X-ray - it is not quantifiable.
In the UK no-one has heard of TMS - all the posts on this site are from the USA. Massive shame. |
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plainchant
41 Posts |
Posted - 12/04/2004 : 03:58:24
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Actually there are some posts on this site from Europe, Canada, New Zealand and some other places. In fact, it is striking that TMS seems most prevalent in Western countries.. I gave the "Mindbody Prescription" to a Mexican friend of mine, and he believed strongly that TMS type symptoms are very rare in Mexico. I remember being in a Mexican town called Cuetzalan. I was observing how old tiny Mexican women were carrying huge packages on their heads. And they were doing this for their entire lives with NO chronic back, shoulder, or neck pain. And yet, a muscular 6 foot man in America can get life-altering pain one day while bending over to tie his shoe laces!
And also, a German friend of mine who lives in Mexico, also told me a TMS-confirming story. He had classic TMS back pain in Germany which caused him to seek out all sort of treatments which did not work. When he moved to Mexico the pain disappeared completely and never came back (he knew nothing of TMS until I told him about it years later). So Western society with its stresses, lawyers, and a horrible media that constantly conditions people with non-existent things such as "carpal tunnel syndrome" is a festering ground for TMS. |
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Baseball65
USA
734 Posts |
Posted - 12/04/2004 : 08:36:07
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WOW
You sound like a lot of the doctors I fired(LOL!)
I was seeing one of the top Neuro-surgeons in Los Angeles.I felt uncomfortable in his waiting room ,as sometimes children with grave neurological/brain disorders were there as well......and me and my sciatica.
His name was Dr. Pablo Lawner.Unlike all the fastfood MD's I had seen,He would spend TIME with me.He was a very insightful and patient man,and I sensed he truly cared whether or not I recovered.
He was THE ONLY Md I saw who said "Marc....these symptoms your having just don't match up with the NORMAL amount of degeneration you have in your spine" (herniation/congenital fusion/Tilted hips/Long leg)
Consistent with TMS theory,I improved under his care...even tried going back to my job(which I Hated)...but the underlying issues were still left undealt with.
He refused to operate on me....he was certain it would go away with therapy....so...I FIRED HIM !
I ran off to the first Dr who would cut me open....Funny...Dr. Lawner was probably the most honest and insightful one of the whole parade of Md's I had!!
My hat is off to you Dr. Fatteh. You are truly courageous in your field to go with what you believe rather than what is accepted!
"Wrong is wrong, even if everybody is doing it, and right is right, even if nobody is doing it."
- Bishop Fulton J. Sheen
Peace
Marc a.k.a. Baseball65
Baseball65 |
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tennis tom
USA
4749 Posts |
Posted - 12/06/2004 : 12:19:32
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Dear Dr. Fatteh,
Thank you so much for joining the board and contributing your valuable knowlege. I play tennis with a very nice, retired doctor. He has had two hip-replacements and does OK on the courts in doubles. He mentioned to me, when he was a "young and idealistic" new doctor, he would try to steer patients away from surgery and prescribe less invasive therapies. He soon found his patients canceling future appointments and request there records be sent to doctors who would "cut". The message was clear, his ex-patients wanted the quick-fix of surgery. He got his hip-replacemtns when he was in great pain from standing on his feet from doing hours of surgeries.
I'm certain that TMS pain is endemic to western culture because we can AFFORD it. The third world could not tolerate such nonsense because they would STARVE if they could't move. |
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MRosenthal
USA
30 Posts |
Posted - 12/06/2004 : 12:38:35
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| I miss playing tennis. When I play tennis I get pain. |
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tennis tom
USA
4749 Posts |
Posted - 12/06/2004 : 13:32:02
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Dear Matt,
I know the feeling--I've been playing tennis for goin' on a decade now with pain of various degrees--but I just show up. When I go to tournaments, almost every player has a bandage on some body part. One of Sarno's great messages is pain is not to be FEARED.
Somewhere, it seems that you learned that pain = damage. Your subconscious has conditioned your body to lock-up. It's that Pavlovian thing, hear a bell and salivate. With psychogenic, TMS pain, it's become, "feel pain, stop moving". Everytime you don't move your body part because you fear doing damage, you reinforce the autononmic process. You need to decondition yourself by moving and proving that after about ten minutes the locked up body part will "juice" up and function like the good old days.
I proved this to myself by walking after playing tennis. I would take a 45 minute walk and after 10-20 minutes my "locked-up, frozen, limping, painful right butt muscles would "thaw" and I finished my walk with NO PAIN and a normal gait. Recently, I have been able to use this vision while competeing on the tennis court which is exceedingly more difficult to do because sports competion is an alagory for war, thus, a potentialy very stessful enviornment.
I have extrapolated TMS theory to the physiolgy of my hip. I had erroneously, condiitioned my hip, after years of x-rays, MRI's and very bad medical advice to believe that with every step I took, that I was wearing away the cartlege in my hip joint--this is a very damgaging and fearful mode of thinking. Is it any wonder that my hip muscles would lock up in an unnecessay process to protect the joint and prevent wearing away what little valuable cartelge that remainded. Fortunately, I was never told that my hip was "bone on bone". Therefore I believed that I could eventually fix it through various therapies and resting it. But the pain always returned and the FEAR and frustration cycle started all over again. Always looking for the latest snake-oil and new-age therapy--all placebo.
About a year ago after a significant pain shift, I was able to more fully accept, that what was wrong with my hip, was TMS. My present view of the pain is that it is TMS, blood flow restriciton to the butt region. The joint is locked up and the synovial fluid, needed to bathe the joint in nourishing and cushioning fluid, is not being produced by the bursae, because the autonomic nervous system has thrown the "off" switch due to TMS.
Matt, hope this helps, "use it or lose it". |
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seanf
21 Posts |
Posted - 12/06/2004 : 15:17:07
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plainchant,
I've also thought a lot about the prevalence of TMS in Western societies vs. other parts of the world. Last year I was in India for two months, fighting knee pain every day, looking around at 70-80 year old men carrying piles of suitcases on their heads, and 70-80 year old women with backs bent over 90 degrees from decades of sweeping with tiny brooms. I was 22 at the time and I couldn't comprehend how I was in pain and they weren't. |
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Dr. Fatteh
USA
16 Posts |
Posted - 12/07/2004 : 01:43:18
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Tom,
You make a couple of very good points. First, in regards to surgery and other invasive treatments, not only do people want a quick-fix (which they soon realize is not a fix at all), but they also want the satisfaction that someone is "taking them seriously" by proposing an involved treatment. The simpler the treatment proposed, the more dismissive the doctor is perceived as being. This points to a sense of validation that is craved by many chronic pain patients. While this is human nature, it is incredibly out of whack for this need for validation to outweigh the need for appropriate treatment, and to outweight the overall societal need for cost-effective medicine. And, yes, those with money demand more involved treatment, because "gosh darnit, only the best will do!" Ego and stature get in the way of actually wanting to get better. Imagine that.
Parvez Fatteh, M.D. |
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Dr. Fatteh: How did you come to believe in TMS?
