緊張肌膜炎發作史
制約
Essential to an understanding of this subject is knowledge about a
very important phenomenon known as conditioning. A more
modern term meaning the same thing is programming. All animals,
including humans, are conditionable. The phenomenon is best known
by the experiment reported by the Russian physiologist Pavlov,
who is credited with the discovery of conditioning.
制約是緊張筯膜炎最重要的現象。所有動物包括人類是可制約的。此現象是由俄國生理學家帕夫洛夫的實驗發現的。
His experiment
demonstrated that animals develop associations which can produce
automatic and reproducible physical reactions. In the research study
he rang a bell each time he fed a group of dogs. After repeating
this a few times he found that the dogs would salivate if he rang
the bell even without the presentation of food. They had become
conditioned to have a physical reaction at the sound of the bell.
The process of conditioning, or programming, seems to be very
important in determining when the person with TMS will have pain.
For example, a common complaint of people with low back pain is
that it is invariably brought on by sitting. This is such a benign
activity one is mystified by the fact that it initiates pain. But
conditioning occurs when two things go on simultaneously, so it is
easy to imagine that at some point early in the course of the TMS
experience the person happens to be having pain while sitting. The
brain makes the association between sitting and the presence of
pain and that person is now programmed to expect pain with sitting.
In other words, the pain occurs because of its subconscious
association with sitting, not because sitting is bad for the back.
That is one way a conditioned response may be established. There
must be others I am unaware of since sitting is such a common
problem for people with low back pain. Car seats have a bad
reputation, so a person expects to have pain when he or she gets
into a car.
人們常會被醫生曾告訴他的事情而進入疼痛模式。
醫生常勸病患腰椎必須保持直立，才不會受傷，這使得病患在某次彎腰時因心理作用開始發作疼痛，而病患往往忘了以前從未因彎腰而疼痛。
專家說久坐會壓迫下脊椎，這使得病患在一次久坐時，開始感覺脊椎受傷了。
單腳站立、舉重物，等不良聲名的動作，快速的讓病患心理進入描述的疼痛模式。
很多人說走路會緩和疼痛，但其它人說走路會增強疼痛。有些人晚上痛到睡不著。某案例整天搬重物，從未感到刺痛，但每晚3:00會有刺痛持續到起身為止，這很明顯是腦被束縛。
有些人睡得很好，但起床後疼痛開始發作，且疼痛會在白天越來越嚴重。
基於病史及理學檢查證據，這些人都有緊張肌膜炎，但他們被制約相信是被某種事件弄傷了。這可由這些病患經由我的療程(主要是上課)後，幾周內疼痛便解除了。若是生理上的問題，疼痛是不會解除的。教育破解疼痛制約模式。
制約對緊張肌膜炎來解釋這些病患無意識的反應是相當重要的。若某人說我不能舉超過5嗙的東西，否則會引起疼痛，這個痛肯定不是生理性的。
如此案例，一婦人可以前彎的把手掌碰到地板而不病，但是若把腳放上來則一定會感到痛。
這些束縛反應源自人們開始有背痛時所生出的恐懼，特別是下背痛。他們被告知背部是非常脆弱、易受傷的，所以當他們試著作一些稍微激烈的活動，像是健行、游泳或拿吸塵器吸地板，他們的背便開始受傷。他們已習慣連結活動到疼痛。他們預期，所以發生，這就是大腦被束縛。
引起疼痛的特定姿勢或活動本身不重要，重要的是要暸解這是緊張肌膜炎的束縛反應，且心理因素大於生理因素。
Common Patterns of TMS
緊張肌膜炎一般模式
Perhaps the most common pattern is for the person to have
recurrent acute attacks of the kind described earlier. These may
last from days to weeks or even months, with the most acute pain
subsiding after a few days.
最一般的模式是人們有再發急性症狀，這可能持續幾天、幾星期或幾個月，而最急性的痛可能在幾天後平息。
They are traditionally treated with bed
rest, painkillers and anti-inflammatory drugs, administered by mouth
or by injection. If the patient is hospitalized, traction is often
employed, though its purpose is to immobilize the patient and not to
pull the spinal bones apart since this could not be done with the
weights used.
傳統會建議病患臥床休息，止痛及抗發炎藥，口服或注射。若病患住院，牽引常會用，雖然它的目的是固定病患而不是把脊椎骨拉開，因為使用的重量無法達到拉開的目的。
I do not instruct my patients what to do for an acute
attack, for it is the goal of this program to see that the attacks
don’t occur—to prevent them. However, occasionally I am called
upon to advise someone having an acute attack; as stated earlier
in the chapter, it’s essentially a question of waiting it out.
我不會指示病患如何處理急症，因為本療程的目的要顯示症狀不會發生來預防本身。
我可能會開立止痛藥但不會開立抗發炎藥，因為沒有炎症。
The irony of the usual experience with one of these attacks is
that most patients would be better off if they consulted no one.
諷刺的是，病患通常在急症發生時，若不去求取任何幫助，症狀則會好一點。
This is unwise, however, because every once in a while there may
be something physiologically important going on and so one must
be examined by a physician. Assuming nothing truly serious, like a
tumor, is present, the usual diagnosis is some spinal structural
abnormality. A scary diagnosis (degenerative disc disease, herniated
disc, arthritis, spinal stenosis or facet syndrome) plus the dire
warnings of what will happen if the patient doesn’t take sufficient
bed rest and cautioning about never again jogging or using a vacuum
cleaner or bowling or playing tennis is the perfect combination for
multiplied and persistent pain.
But the human spirit is more or less indomitable and eventually
the symptoms fade, leaving someone who is essentially free of
pain but permanently scarred, not physically but emotionally. Except
for the very brave few, most people who have had such an attack
never again engage in vigorous physical activity with an easy mind.
They have been sensitized by the experience and all that it is
supposed to imply and they see themselves, to a greater or lesser
degree, as permanently altered. They fear another attack and
eventually it comes. It may be six months or a year later but the
prophecy is fulfilled and the dreaded event occurs again. As before,
the person usually attributes the attack to some physical incident.
This time there may be leg pain as well as back pain and now
there is talk of surgery should a herniated disc be found on MRI or
CT scan. (CT, or computed tomography, is an advanced X-ray
technique that can, like the MRI, give information about soft tissues
as well as bone.) This further increases anxiety and the pain may
become even more severe.
This pattern of recurrence of acute attacks is very common.
As time goes on the attacks tend to come more frequently, to be
more severe and to last longer. And with each new attack the fear
increases and there is an increased tendency to limit physical
activities. Some patients become virtually disabled as time goes
The Manifestations of TMS 25
on.
In my view physical restrictions and the fear of physical activity
represent the worst aspect of these pain syndromes. They are
ever present, though the pain may come and go. They have a
profound effect on all aspects of life: work, family, leisure time.
Indeed, I have known patients with TMS who were much more
disabled in terms of their daily lives than patients who were
paralyzed in both legs. Many of the latter go to work every day on
their own, raise families and in every way lead normal lives, except
that they are in wheelchairs. The severe TMS patient may have to
stay in bed most of the day because of the pain.
Eventually most people who have recurrent attacks will develop
a chronic pattern. They will begin to have some pain all the time,
usually mild, but exacerbated by a variety of activities or postures
to which they have become conditioned. “I can lie on my left side
but not on my right”; “I must always have a pillow between my
knees in bed”; “I never go anywhere without my seat cushion”;
“My body corset (or neck collar) is absolutely essential if I am to
remain free of pain”; “If I sit for more than five minutes I get
severe pain”; “The only chair I can sit on has to have a hard seat
and a straight back”; and on and on.
And to some the pain becomes the primary focus of their lives.
It is not uncommon to hear people say that the pain is the first thing
they are aware of when they awaken in the morning and the last
thing they think about when they go to sleep. They become
obsessed with it.
There is great variety in the manifestations of TMS. There
are those who have a little pain all the time with varying degrees of
physical restriction. Others have occasional acute attacks but live
essentially normal lives in between with little or no restriction.
What I have been describing are the more common
manifestations of TMS and the most dramatic, those in the low
back and legs. However, a severe episode involving the neck,
shoulders and arms can be very dramatic too—and just as physically
26 Healing Back Pain
restricting. Here is a typical example.
The patient was a middle-aged man who had been having
recurrent attacks of pain in the neck and shoulders and pain,
numbness and tingling in his hands for about three years prior to
the time I saw him. The episode that brought him to me had begun
about eight months previously with pain in the left arm. He saw
two neurologists, had a variety of sophisticated tests and was told
that the pain was the result of a “disc problem” in the neck. There
was debate whether he should have immediate surgery; he was
warned that he might become paralyzed if he didn’t. Not
surprisingly, the pain spread from his arm to his neck and back; he
was unable to ski or play tennis, two of his favorite sports. He was
very frightened.
My examination disclosed that he had TMS and that there
were no neurological abnormalities. Fortunately, a third neurologist
concluded that there was no structural basis for his pain so he was
able to accept the diagnosis of TMS with an easy mind. He went
through the program and in a few weeks was free of pain and able
to resume his usual athletic activities. He has not had a recurrence.
Sometimes the shoulder is the site of the trouble or the knee.
To anyone who tries to be physically active, knee pain can be very
debilitating. I have had such an episode and can attest to the fact
that it can be scary, persistent and restricting. Any of the tendons
and ligaments in the arms and legs and any of the muscles and
nerves of the neck, shoulders, back and buttocks can be involved
in TMS.
Though we must identify the structures involved in each case,
this is the least important part of the consultation. Each encounter
with a patient is an excursion into that person’s life. After we have
established which body parts are involved that information must
be put aside, for we do not work on the muscles, nerves and
ligaments directly. Something in that person’s emotional life that
might have played a role in producing the symptoms must be
addressed.
個案：一個人在年輕時便獲得經濟上成功，並從職場退休，不久便產生疼痛症候群。與他談話的過程中，明顯發現他由於家庭的問題而心事重重。
有幾個家族成員都死了，他也擔心由他親戚所經營企業的健全，並開始思考現在他退休後的生命是什麼，及第一次思考老化及死亡的問題。
他有意識或無意識的關心這些事已產生足夠的焦慮、憤怒來促成緊張肌膜炎。一般醫學關注於他老化的脊椎，並試著治療他，自然地，無效。
他有緊張肌膜炎，他問題不在脊椎，因為脊椎問題已存在很久了。總結，緊張肌膜炎可能與姿勢肌肉、其周圍之神經及臂部及腿部之肌腱及韌帶等，這些部位會讓病患感成痛、刺及無力。痛有不同的模式及部位，且嚴重程度範圍很大，從輕微的干擾到近乎失能 。
反覆發作，恐懼於再發作及物理活動，及找不到成功治療方法的挫折感，形成了緊張肌膜炎。
疼痛、麻木、刺痛及無力等症狀是大腦有意要建議我們生理上有問題。
對多數人、醫療人員及外行人等等，生理問題意指受傷、虛弱、不完美及退化等問題。
更進一步人們會把疼痛與某次激烈活動連結，使病患不禁推論某些部位可能受傷或錯位。我的脊椎錯位是常見的病訴。
人們有強烈傾向束縛於恐懼各式各樣簡單、日常事物，如久坐、單腳站立、彎腰及舉重物，這也是強化人們感覺自已生理結構失能的重要因素。
症狀、恐懼、生活形態及日常活動改變，使人們開始影響極度關注身體。這些症狀的目的是用來避免不舒服的情緒。這看來似乎是很高的代價，且對心靈的內部運作我們仍不是確切暸解，只能猜測是對恐懼及疼痛感覺的深層厭惡。
Essential to an understanding of this subject is knowledge about a
very important phenomenon known as conditioning. A more
modern term meaning the same thing is programming. All animals,
including humans, are conditionable. The phenomenon is best known
by the experiment reported by the Russian physiologist Pavlov,
who is credited with the discovery of conditioning.
制約是緊張筯膜炎最重要的現象。所有動物包括人類是可制約的。此現象是由俄國生理學家帕夫洛夫的實驗發現的。
His experiment
demonstrated that animals develop associations which can produce
automatic and reproducible physical reactions. In the research study
he rang a bell each time he fed a group of dogs. After repeating
this a few times he found that the dogs would salivate if he rang
the bell even without the presentation of food. They had become
conditioned to have a physical reaction at the sound of the bell.
The process of conditioning, or programming, seems to be very
important in determining when the person with TMS will have pain.
For example, a common complaint of people with low back pain is
that it is invariably brought on by sitting. This is such a benign
activity one is mystified by the fact that it initiates pain. But
conditioning occurs when two things go on simultaneously, so it is
easy to imagine that at some point early in the course of the TMS
experience the person happens to be having pain while sitting. The
brain makes the association between sitting and the presence of
pain and that person is now programmed to expect pain with sitting.
In other words, the pain occurs because of its subconscious
association with sitting, not because sitting is bad for the back.
That is one way a conditioned response may be established. There
must be others I am unaware of since sitting is such a common
problem for people with low back pain. Car seats have a bad
reputation, so a person expects to have pain when he or she gets
into a car.
人們常會被醫生曾告訴他的事情而進入疼痛模式。
醫生常勸病患腰椎必須保持直立，才不會受傷，這使得病患在某次彎腰時因心理作用開始發作疼痛，而病患往往忘了以前從未因彎腰而疼痛。
專家說久坐會壓迫下脊椎，這使得病患在一次久坐時，開始感覺脊椎受傷了。
單腳站立、舉重物，等不良聲名的動作，快速的讓病患心理進入描述的疼痛模式。
很多人說走路會緩和疼痛，但其它人說走路會增強疼痛。有些人晚上痛到睡不著。某案例整天搬重物，從未感到刺痛，但每晚3:00會有刺痛持續到起身為止，這很明顯是腦被束縛。
有些人睡得很好，但起床後疼痛開始發作，且疼痛會在白天越來越嚴重。
基於病史及理學檢查證據，這些人都有緊張肌膜炎，但他們被制約相信是被某種事件弄傷了。這可由這些病患經由我的療程(主要是上課)後，幾周內疼痛便解除了。若是生理上的問題，疼痛是不會解除的。教育破解疼痛制約模式。
制約對緊張肌膜炎來解釋這些病患無意識的反應是相當重要的。若某人說我不能舉超過5嗙的東西，否則會引起疼痛，這個痛肯定不是生理性的。
如此案例，一婦人可以前彎的把手掌碰到地板而不病，但是若把腳放上來則一定會感到痛。
這些束縛反應源自人們開始有背痛時所生出的恐懼，特別是下背痛。他們被告知背部是非常脆弱、易受傷的，所以當他們試著作一些稍微激烈的活動，像是健行、游泳或拿吸塵器吸地板，他們的背便開始受傷。他們已習慣連結活動到疼痛。他們預期，所以發生，這就是大腦被束縛。
引起疼痛的特定姿勢或活動本身不重要，重要的是要暸解這是緊張肌膜炎的束縛反應，且心理因素大於生理因素。
Common Patterns of TMS
緊張肌膜炎一般模式
Perhaps the most common pattern is for the person to have
recurrent acute attacks of the kind described earlier. These may
last from days to weeks or even months, with the most acute pain
subsiding after a few days.
最一般的模式是人們有再發急性症狀，這可能持續幾天、幾星期或幾個月，而最急性的痛可能在幾天後平息。
They are traditionally treated with bed
rest, painkillers and anti-inflammatory drugs, administered by mouth
or by injection. If the patient is hospitalized, traction is often
employed, though its purpose is to immobilize the patient and not to
pull the spinal bones apart since this could not be done with the
weights used.
傳統會建議病患臥床休息，止痛及抗發炎藥，口服或注射。若病患住院，牽引常會用，雖然它的目的是固定病患而不是把脊椎骨拉開，因為使用的重量無法達到拉開的目的。
I do not instruct my patients what to do for an acute
attack, for it is the goal of this program to see that the attacks
don’t occur—to prevent them. However, occasionally I am called
upon to advise someone having an acute attack; as stated earlier
in the chapter, it’s essentially a question of waiting it out.
我不會指示病患如何處理急症，因為本療程的目的要顯示症狀不會發生來預防本身。
我可能會開立止痛藥但不會開立抗發炎藥，因為沒有炎症。
The irony of the usual experience with one of these attacks is
that most patients would be better off if they consulted no one.
諷刺的是，病患通常在急症發生時，若不去求取任何幫助，症狀則會好一點。
This is unwise, however, because every once in a while there may
be something physiologically important going on and so one must
be examined by a physician. Assuming nothing truly serious, like a
tumor, is present, the usual diagnosis is some spinal structural
abnormality. A scary diagnosis (degenerative disc disease, herniated
disc, arthritis, spinal stenosis or facet syndrome) plus the dire
warnings of what will happen if the patient doesn’t take sufficient
bed rest and cautioning about never again jogging or using a vacuum
cleaner or bowling or playing tennis is the perfect combination for
multiplied and persistent pain.
But the human spirit is more or less indomitable and eventually
the symptoms fade, leaving someone who is essentially free of
pain but permanently scarred, not physically but emotionally. Except
for the very brave few, most people who have had such an attack
never again engage in vigorous physical activity with an easy mind.
They have been sensitized by the experience and all that it is
supposed to imply and they see themselves, to a greater or lesser
degree, as permanently altered. They fear another attack and
eventually it comes. It may be six months or a year later but the
prophecy is fulfilled and the dreaded event occurs again. As before,
the person usually attributes the attack to some physical incident.
This time there may be leg pain as well as back pain and now
there is talk of surgery should a herniated disc be found on MRI or
CT scan. (CT, or computed tomography, is an advanced X-ray
technique that can, like the MRI, give information about soft tissues
as well as bone.) This further increases anxiety and the pain may
become even more severe.
This pattern of recurrence of acute attacks is very common.
As time goes on the attacks tend to come more frequently, to be
more severe and to last longer. And with each new attack the fear
increases and there is an increased tendency to limit physical
activities. Some patients become virtually disabled as time goes
The Manifestations of TMS 25
on.
In my view physical restrictions and the fear of physical activity
represent the worst aspect of these pain syndromes. They are
ever present, though the pain may come and go. They have a
profound effect on all aspects of life: work, family, leisure time.
Indeed, I have known patients with TMS who were much more
disabled in terms of their daily lives than patients who were
paralyzed in both legs. Many of the latter go to work every day on
their own, raise families and in every way lead normal lives, except
that they are in wheelchairs. The severe TMS patient may have to
stay in bed most of the day because of the pain.
Eventually most people who have recurrent attacks will develop
a chronic pattern. They will begin to have some pain all the time,
usually mild, but exacerbated by a variety of activities or postures
to which they have become conditioned. “I can lie on my left side
but not on my right”; “I must always have a pillow between my
knees in bed”; “I never go anywhere without my seat cushion”;
“My body corset (or neck collar) is absolutely essential if I am to
remain free of pain”; “If I sit for more than five minutes I get
severe pain”; “The only chair I can sit on has to have a hard seat
and a straight back”; and on and on.
And to some the pain becomes the primary focus of their lives.
It is not uncommon to hear people say that the pain is the first thing
they are aware of when they awaken in the morning and the last
thing they think about when they go to sleep. They become
obsessed with it.
There is great variety in the manifestations of TMS. There
are those who have a little pain all the time with varying degrees of
physical restriction. Others have occasional acute attacks but live
essentially normal lives in between with little or no restriction.
What I have been describing are the more common
manifestations of TMS and the most dramatic, those in the low
back and legs. However, a severe episode involving the neck,
shoulders and arms can be very dramatic too—and just as physically
26 Healing Back Pain
restricting. Here is a typical example.
The patient was a middle-aged man who had been having
recurrent attacks of pain in the neck and shoulders and pain,
numbness and tingling in his hands for about three years prior to
the time I saw him. The episode that brought him to me had begun
about eight months previously with pain in the left arm. He saw
two neurologists, had a variety of sophisticated tests and was told
that the pain was the result of a “disc problem” in the neck. There
was debate whether he should have immediate surgery; he was
warned that he might become paralyzed if he didn’t. Not
surprisingly, the pain spread from his arm to his neck and back; he
was unable to ski or play tennis, two of his favorite sports. He was
very frightened.
My examination disclosed that he had TMS and that there
were no neurological abnormalities. Fortunately, a third neurologist
concluded that there was no structural basis for his pain so he was
able to accept the diagnosis of TMS with an easy mind. He went
through the program and in a few weeks was free of pain and able
to resume his usual athletic activities. He has not had a recurrence.
Sometimes the shoulder is the site of the trouble or the knee.
To anyone who tries to be physically active, knee pain can be very
debilitating. I have had such an episode and can attest to the fact
that it can be scary, persistent and restricting. Any of the tendons
and ligaments in the arms and legs and any of the muscles and
nerves of the neck, shoulders, back and buttocks can be involved
in TMS.
Though we must identify the structures involved in each case,
this is the least important part of the consultation. Each encounter
with a patient is an excursion into that person’s life. After we have
established which body parts are involved that information must
be put aside, for we do not work on the muscles, nerves and
ligaments directly. Something in that person’s emotional life that
might have played a role in producing the symptoms must be
addressed.
個案：一個人在年輕時便獲得經濟上成功，並從職場退休，不久便產生疼痛症候群。與他談話的過程中，明顯發現他由於家庭的問題而心事重重。
有幾個家族成員都死了，他也擔心由他親戚所經營企業的健全，並開始思考現在他退休後的生命是什麼，及第一次思考老化及死亡的問題。
他有意識或無意識的關心這些事已產生足夠的焦慮、憤怒來促成緊張肌膜炎。一般醫學關注於他老化的脊椎，並試著治療他，自然地，無效。
他有緊張肌膜炎，他問題不在脊椎，因為脊椎問題已存在很久了。總結，緊張肌膜炎可能與姿勢肌肉、其周圍之神經及臂部及腿部之肌腱及韌帶等，這些部位會讓病患感成痛、刺及無力。痛有不同的模式及部位，且嚴重程度範圍很大，從輕微的干擾到近乎失能 。
反覆發作，恐懼於再發作及物理活動，及找不到成功治療方法的挫折感，形成了緊張肌膜炎。
疼痛、麻木、刺痛及無力等症狀是大腦有意要建議我們生理上有問題。
對多數人、醫療人員及外行人等等，生理問題意指受傷、虛弱、不完美及退化等問題。
更進一步人們會把疼痛與某次激烈活動連結，使病患不禁推論某些部位可能受傷或錯位。我的脊椎錯位是常見的病訴。
人們有強烈傾向束縛於恐懼各式各樣簡單、日常事物，如久坐、單腳站立、彎腰及舉重物，這也是強化人們感覺自已生理結構失能的重要因素。
症狀、恐懼、生活形態及日常活動改變，使人們開始影響極度關注身體。這些症狀的目的是用來避免不舒服的情緒。這看來似乎是很高的代價，且對心靈的內部運作我們仍不是確切暸解，只能猜測是對恐懼及疼痛感覺的深層厭惡。
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