TMS FAQ and Answers
Getting Started | Understanding TMS | Treatment Approach | Finding Care |
Resources | About Dr. Schechter
GETTING STARTED {#getting-started}
Can I get an appointment with Dr. Schechter?
Appointments are typically available on Mondays and Thursdays for 45-minute consultations for your chronic pain or other symptoms that may be neuroplastic. Often you can be scheduled within 1-2 weeks if you wish. You will be sent forms to complete to make the visit more effective. You will be briefly interviewed by Dr. Schechter's trained medical assistant before the visit. The doctor will listen to your concerns, examine you (if in person) and develop a customized treatment plan for you in that session. Follow-up visits are encouraged, in-person or virtually, and typically last about 15 minutes. Dr. Schechter is the most experienced physician in this field who continues to practice.
What if I have a specific medical question about my condition?
Due to ethical and legal issues, Dr. Schechter is unable to answer specific diagnostic and treatment questions about your condition via email unless you have become a patient by being seen and examined in his office or virtually (California only). General issues are answered in his blog, educational materials, etc.
Are there any options if I live in California but can't come to Dr. Schechter's office due to pain or distance?
For follow-up visits, phone or telehealth is a great option. Outside of the United States, telehealth visits are possible. Virtual visits in California are also permissible.
What can I do if I can't come to Los Angeles and I don't live near any of the other doctors?
First, see a qualified physician in your local area. Consider a neurologist, physical medicine and rehabilitation doctor, sports medicine or orthopedist. Have that doctor examine you and see if they are comfortable with a "conservative" or non-surgical program. If so, ask if you can include a TMS or mindbody program in that plan. Then read the books available on the subject, consider my new online program, and use the workbook. Continue to have that local doctor monitor your progress.
UNDERSTANDING TMS / NEUROPLASTIC PAIN {#understanding-tms}
Are Tension Myositis Syndrome and Tension Myoneural Syndrome the same?
Yes. Both terms describe the condition popularly known as TMS, where emotional stress creates physical pain, and consulting a qualified tension myositis syndrome doctor can help patients understand and overcome these symptoms.
What should I do if my back pain doesn't go away?See a qualified doctor to ensure that there is no structural or inflammatory reason for your pain.
My back pain has become chronic, how can I get relief?
Consider cutting edge approaches such as Neuroplastic Recovery programs that involve Pain Reprocessing and Emotional Awareness. The brain-body link is very important in chronic pain.
How does mind-body medicine help with chronic pain?
Mind-body medicine, also known as neuroplastic medicine or psychologically integrative medicine, incorporates approaches that help to change neural pathways by education, relationship, journaling, therapy, etc. Emotions play a huge role in pain, as does ignorance or misinformation!
Can my headaches be treated without medication? My migraines?
Many people benefit from a Neuroplastic Recovery Program for headaches, both tension headaches and migraines, as featured on www.MindBodyMedicine.com and elsewhere.
TREATMENT APPROACH & EFFECTIVENESS {#treatment}
Is it really possible to get pain relief from psychology and education?
Studies have shown that a correct diagnosis: Tension Myoneural Syndrome, Neuroplastic Pain, Nociplastic Pain, Central Pain can lead to a successful treatment program that includes education, journaling, psychology and sometimes therapy or coaching.
Is this approach effective?
In properly selected individuals, it is very effective, based upon Dr. Schechter's own research, his vast clinical experience and published research by colleagues of the highest level.
Is there research supporting the approach of Tension Myoneural Syndrome, Sarno's work, and Neuroplastic approaches?
In the past five years there have been several important, randomized controlled trials investigating these approaches. Results have been remarkably good in this non invasive, educational, psychological approach.
What if my doctor just wants to give me injections and medications for my pain?
There are excellent resources to help including Think Away Your Pain, The MindBody Workbook: Volume Two, and The Lessons Doctor Sarno Taught Me that can instruct you about the mind-body or brain-body connection in pain.
Are there alternatives to surgery for chronic back pain?
A small number of patients with chronic back pain can benefit from surgery. Most of these have more leg than back pain actually. Many patients benefit from an educational and psychological approach as featured on MindBodyMedicine.com
If I need guidance for referrals to psychotherapy, PRT, EAET, can I get this at Dr. Schechter's office?
During the consultation, he will make recommendations for a comprehensive home program which may include psychotherapy. If you desire a therapist, he will personalize the referrals to match you with a suitably trained and experienced therapist. Due to the proliferation of education in this field over the past five years, some are willing, but not that experienced. Ideally you get a great fit and someone with experience-- Dr. Schechter can make that happen.
FINDING CARE & SPECIALISTS {#finding-care}
Are there doctors in other cities or countries that I can see regarding TMS?
There are a number of such doctors and the number is slowly growing. See the doctors page for other physicians that have interest in this area.
Other Doctors Therapists & Resources
Should I see a doctor to get neuroplastic pain treatment?
Since the diagnosis is such an important step in relieving chronic pain, you should see a medical doctor if one is accessible to you, ideally in person.
How can I find such a doctor?
MindBodyMedicine.com/medical-doctors has a national and international list. Dr. Schechter in California sees patients in California or who can travel there and some International patients as well.
What if my doctor doesn't know how to treat my chronic pain?
Websites such as mindbodymedicine.com and symptomatic.me are informative and offer resources. Just make sure it's safe for you to use a conservative program that doesn't involve invasive procedures or surgery.
What does a neuroplastic pain doctor in Los Angeles specialize in?
A neuroplastic pain doctor in Los Angeles focuses on chronic pain caused by changes in the brain and nervous system rather than structural injury. They help retrain the brain to reduce pain signals.
Can a primary care doctor in Los Angeles diagnose neuroplastic pain?
While many physicians can identify neuroplastic pain, a primary care doctor Los Angeles CA specializing in mind-body approaches can provide deeper insight and tailored care.
How does a chronic pain doctor in Los Angeles treat long-term pain?
Chronic pain doctors use a combination of education, behavioral therapy, mind-body techniques, and neuroplastic retraining to reduce persistent symptoms, and a chronic pain doctor in Los Angeles can provide specialized care tailored to these approaches.
What conditions does a neuroplastic pain doctor treat?
They treat chronic back pain, neck pain, fibromyalgia-like symptoms, headaches, muscle tension, nerve pain, and pain with no clear structural cause, and a pain relief doctor stress specialist can help determine whether these issues are connected to tension or mind-body factors.
How does a family physician in Los Angeles support preventive health?
A family physician Los Angeles provides preventive care through regular exams, lifestyle guidance, screenings, lab tests, and early detection strategies to help maintain long-term health.
BOOKS & RESOURCES {#resources}
What books can I read on Tension Myoneural Syndrome or Neuroplastic Pain Recovery?
Dr. Schechter's books, Think Away Your Pain or The MindBody Workbook are excellent. Dr. Sarno's books such as Healing Back Pain and The MindBody Prescription are the original works in this field. Alan Gordon's The Way Out is excellent on psychology.
Are Dr. Schechter's educational materials for chronic pain available online?
Yes, on amazon.com; see the Store page. Also available at his office as part of a consultation or separately.
Does he have audible books?
His book Think Away Your Pain is available on audible/amazon. Also The MindBody Workbook Volume Two is available (but write down the answers to the questions or keyboard them separately). Also The Lessons Doctor Sarno Taught Me is an audible book (this one not narrated by Dr. Schechter)
ABOUT DR. SCHECHTER & DR. SARNO {#dr-schechter}
Who learned directly from Dr. John Sarno?
Dr. David Schechter was his first student physician trainee and has continued his work for many decades. There are others including Howard Schubiner, Ira Rashbaum, and Paul Gwozdz.
More Questions:
Diagnosis & Symptoms
What are the symptoms of TMS/neuroplastic pain?
Many symptoms including pain, headaches, fatigue, Long Covid, pelvic pain, low back ache, even chest pain (but get that checked out)
How do I know if my pain is neuroplastic or structural?
Ideally a physician with experience should make that diagnosis, but there are factors like waxing and waning, changing sides, alleviation with calmness or worsening with stress that can help to make the distinction.
What is the difference between acute pain and chronic pain?
Acute is the first six weeks of a painful condition. Chronic pain starts between 3 and 6 months after the onset of pain.
Can neuroplastic pain cause real physical symptoms?
Absolutely! nearly any symptom the body can get from a disease or injury can occur from persistent neural circuit pain.
Why does my pain move around to different body parts?
Movement or migration is common with TMS/neuroplastic.
Treatment Specifics
How long does it take to recover from TMS?
It takes "as long as it takes". I prefer not to specify a duration, because that typically puts pressure on patients and our goal is to reduce pressure.
What is Pain Reprocessing Therapy (PRT)?
This is a system, codified by Alan Gordon, LCSW and team, that focuses on therapy emphasizing safety, non-involved observation, and other methods that reduce fear and increase healing. There is a training program for therapists and research supporting this approach.
What is Emotional Awareness & Expression Therapy (EAET)?
This is a system, codified by Howard Schubiner, M.D. and Mark Lumley, Ph.D., that systematically approaches emotional expression and awareness in a therapy context. There is an extensive manual that they developed and research supporting this approach.
Do I need to see a therapist for TMS recovery?
Many people recover with psychotherapy, but there is a clear benefit to having a team helping you get well. This team ideally includes a physician, a therapist or coach, and you, an active patient learning and working to get better.
Can I recover from TMS without medication?
Medication is rarely used in neuroplastic symptom recovery. One possible indication might be moderate or severe depression coinciding with chronic pain. Typically this approach helps you get off pain medications and other meds for your symptoms.
What is therapeutic journaling for chronic pain?
Journaling or expressive writing was first mentioned in Dr. Sarno's books and developed into a system of guided journaling by Dr. David Schechter, with his original MindBody Workbook in 1999 and other workbooks since. Many practitioners have utilized journaling in their treatment approaches to neuroplastic/TMS recovery.
Insurance & Costs
Does insurance cover TMS treatment?
Depending on the individual practitioner (in-network, out-of-network) and a patient's insurance coverage, health insurance may cover or reimburse some or all of TMS treatment.
What does a TMS consultation cost?
This varies, but experienced physicians may charge $400 to $600 or more for an initial consultation. Psychotherapists may charge $150 to $325 per hour or more. Coaches may charge $100 to $250 per hour or more. But taken in total, this treatment is far more cost-effective than endless PT ($thousands), chiropractic ($thousands), injections ($thousands) or surgery ($10's of thousands).
Is neuroplastic pain treatment covered by PPO insurance?
If the practitioner is in-network, typically yes. If not in network, you may be able to receive reimbursement for out of network coverage as well.
Specific Conditions
Can fibromyalgia be treated with neuroplastic approaches?
In many cases, quite effectively.
Is sciatica a form of TMS?
Sciatica is pain from a nerve going down the leg. It has multiple causes and can be TMS or structural. A careful history, physical examination, and often imaging is needed to understand the cause and design a treatment program.
Can pelvic pain be caused by TMS?
Pelvic pain is often neuroplastic and responds to the TMS program.
Are herniated discs always the cause of back pain?
Rarely a cause of back pain, can be a cause of leg pain in some cases. Careful review of imaging by a skilled physician along with examination can determine if the disc is incidental or causative.
Can anxiety cause chronic pain?
Anxiety and fear can contribute to chronic pain along with other emotions including anger, grief, and sadness.
Success & Outcomes
What is the success rate of TMS treatment?
Multiple studies and clinical experience have shown success rates of 60-85%. Note that the patient plays an active role, so some of these failures are due to the patient's readiness for change.
How many patients recover from chronic pain with this approach?
Hundreds of thousands of patients have recovered from chronic pain with a TMS or neuroplastic approach from practitioner treatment and book "cures".
Is neuroplastic pain recovery permanent?
The human condition is such that our personality and external factors may make us prone to having the same or other symptoms in the future. Some cases recur although the patient is typically more able to manage them when they do recur.
What percentage of back pain is actually TMS?
Acute back pain perhaps 20 to 40%. Chronic back pain, perhaps 60-80%.
Comparison Questions
What is the difference between TMS and fibromyalgia?
Fibromyalgia was codified by a group of doctors, some of whom have come out and stated they wish they never created the diagnosis. Why? Because recovery seems hopeless to FMG sufferers. TMS emphasizes the brain, mind, and emotions as crucial to recovery. FMG treatment focuses more on medications and does acknowledge emotions, sleep, etc. but not with the same emphasis.
How is neuroplastic pain different from neuropathic pain?
Neuropathic pain is nerve pain, can be caused by nerve damage from an injury. Neuroplastic pain is nervous system pain without damage and the "plasticity" or ability to change speaks to its potential for recovery.
Is TMS the same as central sensitization?
No, but TMS is more of a central problem and a central way of approach peripheral symptoms, so there is an overlap. CS implies a damage or pathology that TMS does not.
Dr. Sarno Legacy
What did Dr. John Sarno discover about back pain?
Fifty years ago, Dr. Sarno began treating patients with education and psychology. He began writing about his findings and his conceptualization of back pain as an "autonomic myoneuralgia: in one of his early papers. Later he emphasized a Freudian psychology approach to understanding how emotions, including unconscious ones, drive the perpetuation of symptoms. The work continues to evolve from his pioneering findings.
Is Dr. Sarno's approach still used today?
Yes it is, although, as time goes on, scientific research and empirical explorations of the approach have led to improvements and changes.
Who continues Dr. Sarno's work in Los Angeles?
Dr. David Schechter and a group of skilled psychotherapists and pain coaches, many of whom have grown up around his work and learned from his approach. Los Angeles is one of the clusters of TMS work that have developed nationally. New York is another. Chicago. England, Holland, and Israel are other locations with significant numbers of practitioners in this field.
