Accepting the diagnosis, dealing with doubt

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I regularly deal with skepticism about the diagnosis of TMS. I deal with worry that something else is wrong. I deal with a reluctance to give up a structural model for chronic pain.

Today, with one patient, I could tell with the first sentence that doubt remained. I knew that if I didn't help the patient extinguish this doubt it could burst into full fledged rejection. Doubting the diagnosis of tension myositis syndrome / tension myoneural syndrome is toxic to the treatment. Doubting poisons the ability to move forward with hope and calmness. Doubt drives anxiety (and vice versa). Doubt must be addresed by the physician caring for the patient. It's harder for the psychotherapist, if one is involved, because although an emotion, doubt can be grounded in specfic structural comments or diagnoses that the patient hangs on to. Therefore the physician can most effectively address the rational basis for a new diagnosis, a diagnosis that is not bio-mechanical, but mind/brain based.

Doubt--- the roadblock that must be passed through to succeed in treatment.

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