RLS and TMS

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RLSLES
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Joined: Fri Oct 18, 2019 1:27 am

RLS and TMS

Post by RLSLES »

Hi all,

So I came across this site tmswiki.org (see https://www.tmswiki.org/w/index.php?pag ... drome_Wiki), and am curious to know if other RLS folks have gone down this rabbit hole as well. It's almost a shrine to this New York-based pain doctor (Dr Sarno), who promoted emotional-based rather than physical-based explanations of pain. He is no longer alive but there are a number of practitioners who continue his work. He was not well loved by his more traditional medical colleagues but had a dedicated cadre of patients and sold a LOT of books.

There is some decent science to back up the Sarno-like ideas that, in chronic pain states: (i) pain does not correlate with physical injury (back pain with no slipped disc in one person; no back pain despite slipped disk in another person, etc) and (ii) descending (brain to tissue) pain pathways can be learned and self-reinforce, in the absence of a "problem" in the tissues -- so potentially such pathways could also be "unlearned". Of course, how this all applies to RLS (or not) is a whole other question.

I think Sarno's idea of detachment from the pain is very useful -- basically just mindfulness in different wording. On a slightly lower tier for me, the idea (badly paraphrased by me) that you can manifest less pain by rejecting that there is a physical explanation and thus thinking your way out of it -- I'm open to that part, though somewhat skeptical and I think it can easily slide into victim blaming. Finally, the more psychoanalytical stuff leaves me a bit cold (i.e., I don't think my pain is driven by unresolved conflict).

I'm curious if others with RLS have looked into TMS or Sarno as a way of coping with their symptoms, and whether you have had any positive (or negative) experiences related to it. Or if you have other suggestions on how to cope mentally with symptoms. I seem to be somewhat stable in terms of a drug regimen now (gabapentin + Mirapex), so am looking more seriously into any useful mental / non-pharmaceutical coping strategies.

all the best,
William

Rustsmith
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Re: RLS and TMS

Post by Rustsmith »

William, I have not looked into TMS for RLS, but I have used something like the approach to manage my migraine headaches when they become so severe that my normal meds are not effective. I have learned to be able to mentally block the pain, which allows me to fall asleep if I be in a quiet, dark place. The headache is usually gone when I wake up many hours later. Unfortunately, the same technique has proven to be useless for my RLS. I suspect that it has something to do with the underlying neurochemistry of RLS. I envision it sort of like RLS stepping on the accelerator when I need the brake pedal and my migraine mental techniques are just not strong enough to even slow things down a bit.

With that said, if my RLS isn't too severe then mental distraction seems to help. I like to play Suduko, so I try working on a very difficult while standing. Standing seems to help reduce my RLS and the distraction seems to help calm the attack. This approach (without the standing part) is something that I have used on airline flights to keep my RLS in check. But if my RLS is really bad, none of this helps and all I can resort to are hot baths or walking for hours on end.
Steve

https://www.mayoclinicproceedings.org/a ... 0/fulltext
Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

badnights
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Re: RLS and TMS

Post by badnights »

It sounds (from your post) like what this Sarno guy was saying is similar to David Butler's explanation of pain in the wonderful book Explain Pain. That book was recommended to me by one of my doctors a number of years ago. I ended up reading a couple of books and reading reviews and summaries of a few more. Only this one was not condescending and judgmental. It explains how our bodies interpret stimuli as pain, and how that system can go out of whack, and how we can put it back on track.

I shouldn't try to summarize it because I won't do it justice, but the important points: A stimulus cannot be painful until the message hits the brain; and even then it will not be painful unless the brain decides that the stimulus represents a danger to you. So if you feel pain, it's because your brain thinks you're in danger. If you don’t know the cause of the pain, your brain might elevate the level of threat and therefore the degree of pain. If your brain perceives you to have taken action to eliminate the threat (for example, by going to an Emergency clinic because of a severe gut pain) then it might remove the pain before the doctor even looks at you.

In other words, thoughts are just neuronal impulses, and they can affect the brain the same way that signals of danger from sensory nerves can. Once you fully understand that there is no tissue damage associated with the pain you’re feeling and that the pain is due to a faulty alarm system, that faulty alarm system can begin to fix itself. But it's not a matter of just thinking yourself better; you'll still feel pain if you just try to think your way out of it, because you're not doing anything to change the neuronal pathways being used.

Butler shows how graded exposure to stimuli – at a lower level than will cause pain – can re-train the brain, over time increasing your pain threshold back to a normal level. With chronic pain, moving makes it worse, so people gradually move less and less, therefore the pain starts at a lower and lower threshold of movement. When they have a good day, they overdo it with too much movement, which makes the pain comes on twice as strong. Butler's solution is to do only small amounts of movement even if you feel good, gradually training to be able to handle more movement without triggering the pain response.

This approach to treating chronic pain is appealing because the pain isn't being caused by injury - it's being caused by overly sensitized pain signalling in the nervous system. To heal it requires organic changes to the nervous system - growth of new neural connections and abandonment of old ones.

But I wondered how we could relate that to WED/RLS. We have the equivalent of pain when we don't move - not when we move. How can I "train" my neurons so that movement is not required? Move less and less each day? :lol: And on a good day, if I felt I could lie still for longer, don't overdo it, only lie still a bit? :lol: :lol:

Distraction works the same as movement, so maybe there is an answer there. Sleepdancer, a member of this board, used a TENS machine regularly for a long time to control her PLMD, and now almost never needs it anymore. This seemed to me a possible example of someone re-wiring themselves, causing the WED/RLS circuits to be abandoned thru dis-use.

Anyway I didn't succeed in applying the Explain Pain premises to WED/RLS, but I think there's something important there. I felt like writing to the authors and asking them to turn their attention to WED/RLS :twisted:

If anyone's interested (it's expensive, unfortunately): Explain Pain by David Butler and Lorimer Moseley.

(I just googled it and it seems they have created more books on the topic since then, but this one is the useful one, I think).
The book also does a really good job of explaining the things that can go wrong physiologically to lead to chronic pain (eg. peripheral nerves grow more branches toward the main danger-signalling nerves in the spinal cord, meaning that normal stimuli like touch can trigger a danger/pain response). It's actually really interesting.
Beth - Wishing you a restful sleep tonight
Click for info on WED/RLS AUGMENTATION & IRON
I am a volunteer moderator. My posts are not medical advice. My posts do not reflect RLS Foundation opinion.

badnights
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Re: RLS and TMS

Post by badnights »

arghk
that was a long post :(
Beth - Wishing you a restful sleep tonight
Click for info on WED/RLS AUGMENTATION & IRON
I am a volunteer moderator. My posts are not medical advice. My posts do not reflect RLS Foundation opinion.

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