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inflammation?

inflammation?

by Seth Wilson -
Number of replies: 2

Hello,

I haven't been around for quite a while.  Let me first say I understand that some questions are unanswerable on the internet and need to be answered by a tms aware physician in person.  That said, I am going to ask anyway : ).  But first I will give some history to hopefully make things a little more clear.

Around 10 months ago I was entrenched in the unlearn your pain program when I was contacted out of the blue by an individual who had a similar set of symptoms as me.  At the time I was diagnosed with "Pudendal neuralgia" a scary and debilitating pelvic pain diagnosis.  The man that contacted me had discovered (with the help of his doctor) that his "pudendal neuralgia" was actually referred pain from between t10 and L2.  One day, he popped his back and within a week he was completely pain free.  Anyway, he reached out to me and I dismissed the information as I was confident in my tms diagnosis.  After all, how on earth could I have entrapped a completely random nerve on both sides of my body? However, at my wife's urging we explored the possibility and sure enough every symptom I have ever had is reproducible by palpating the t12/L1 vertebrae. This includes the symptoms that I have that were never linked to my so called pudendal nerve entrapment.  Also, prior to the onset of my symptoms I had injured that area of my back while squatting with free weights.  I was squatting 300 lbs at the time.  The back injury was never treated. 


After some research and some doctors appointments I was diagnosed with "thoracolumbar syndrome" which is essentially the irritation of the nerves as the leave the thoracolumbar junction.  Objectively, I have a textbook case of thoracolumbar syndrome. According to the physical therapists.  So I have been treating this spine problem for the last few months and have seen some improvement.  I can now sit as long as I want and am back to work in a light duty capacity (I am a firefighter).  Over the last month or so my progress has plateaued.  This has caused me to explore the possibility that this is in fact tms and the structural issues at the thoracolumbar junction are not physically causing pain as my MRIs are relatively normal. BUT... here is my hang up.  Part of the diagnostic criteria for thoracolumbar syndrome is that there is "cellulagia" in the corresponding dermatomes.  It is essentially neural inflammation. On me, this so called neural inflammation is palpable and corresponds directly to the correct dermatomes.  The tissue appears swollen as well. I had this "cellulagia" long before I was aware of the thoracolumbar syndrome diagnosis.


Now to my question... finally... Can tms cause physical changes throughout a nerves dermatome?  Can tms cause inflammation?  I practice a lot of the principles that I learned here but also understand that I will not get the full benefit of the program until I accept the tms diagnosis which as of right now I have not.  Mostly because of the physical changes in my tissue in the thoracolumbar dermatomes.  The fact that pressure over the vertebrae reproduces my symptoms is also a hang up for me.  Any insight into this issue would be greatly appreciated.


Thank you,

Seth

In reply to Seth Wilson

Re: inflammation?

by Howard Schubiner -

HI Seth.

I'm a bit confused from your post.  It seemed that you were diagnosed with pudendal neuralgia initially, which I don't think is a specific diagnosis anyway, usually a term for pain in the groin/pelvic area of unknown cause.  But then you were told it's thoracolumbar syndrome, which as far as I can tell is a chiropractic diagnosis for pain originating in the lower thorax (T11-12) or upper lumbar (L1-2) areas.  It doesn't seem that this would be any different from pain originating from any other area of the spine.  However, pain coming from the lower thorax and upper lumbar areas would not go to the groin/pelvic area.  It would be limited to the back area, maybe to the buttocks as well.

So, if you could clarify where you have pain, that might help.  Pressure over the vertebra can cause pain in just the same way that muscle pressure or skin pressure can cause pain in people with TMS.  This is because that area have become sensitized, or is now a "trigger" for pain and that pressure causes the brain to activate pain.

I hope this makes sense and helps.

Best, Howard

In reply to Howard Schubiner

Re: inflammation?

by Seth Wilson -

Hi Howard,

Sorry for such a delayed response.  I understand my previous post was a bit confusing.  I have pain in the groin, testicle and pelvic area.  I have been told that the L1 nerves are being irritated.  Specifically the ilioinguinal, genitofemoral and cluneal nerves. I was previously diagnosed with pudendal neuralgia but as my pain is reproducible at the L1 and L2 vertebrae the diagnosis was changed to "thoracolumbar syndrome" which is as you say a chiropractic diagnosis. Some of the pain is believed to be "sympathetically mediated".

The nerves have become sensitized to the point that when someone palpates the area of the nerves it sends referred pain that is identical to my symptoms.

I have started running and weight lifting again for the first time in 18 months and am journaling but I would not say I have completely accepted the diagnosis.  I am trying though and would very much like for this to be tms.

I guess my only hangup is the sensitivity of the nerves to palpation but as you say this really isn't any different than someone with a sciatica diagnosis. 

In your experience have you seen nerves become this sensitized due to the tms process?

Running does not make my pain worse.  In fact it seems to help.  It would seem to me that a mechanical issue would get worse with physical activity right?

Although my pain is constant, it is definitely made worse when I am feeling down.  I am never pain free but it is much more tolerable if I am in a good place mentally.  Seeing as I have exhausted all conventional medicine has to offer I don't know why I am unable to make the leap into believing completely that this is tms.  I suppose it is natural to have doubts.  Thank you for being such an excellent resource.