Healing Back Pain: The Mind-Body Connection - by John E. Sarno

The Manifestations of Tension Myositis Syndrome (TMS)

The primary tissue involved in TMS is muscle, hence the original name myositis (as mentioned, myo stands for "muscle"). The only muscles in the body that are susceptible to TMS are those in the back of the neck, the entire back, and the buttocks, known collectively as postural muscles. They are so named because they maintain the correct posture of the head and trunk and contribute to the effective use of the arms.

Why does the pain begin when it does? Remember, the physical incident, no matter how dramatic, is a trigger. The answer, of course, is to be found in one's psychological state. It is not the occasion itself but the degree of anxiety or anger which it generates that determines if there will be a physical reaction. The important thing is the emotion generated and repressed, for we have a built-in tendency to repress unpleasant, painful or embarrassing emotions. These repressed feelings are the stimulus for TMS and other disorders like it. Anxiety and anger are two of those undesirable emotions that we would rather not be aware of, and so the mind keeps them in the subterranean precincts of the subconscious if it possibly can.

The Psychology of TMS

The word tension will be used here to refer to repressed, unacceptable emotions.

The personality characteristics of which we are aware represent only a part of our emotional makeup and may be less important than that which is unconscious. It is likely that the majority of emotional reactions occur in the unconscious. Feelings that remain there do so because they are repressed and it is these that are responsible for the sequence of events that causes TMS. This condition begins and ends in the unconscious.

The pain of TMS (or the discomfort of a peptic ulcer, of colitis, of tension headache, or the terror of an asthmatic attack) is created in order to distract the attention of the sufferer from what is going on in the emotional sphere. It is intended to focus one's attention on the body instead of the mind. It is a response to the need to keep those terrible, antisocial, unkind, childish, angry, selfish feelings (the prisoners) from becoming conscious.

The Physiology of TMS

The physiology of TMS begins in the brain. Here repressed emotions like anxiety and anger set in motion a process in which the autonomic nervous system causes a reduction in blood flow to certain muscles, nerves, tendons or ligaments, resulting in pain and other kinds of dysfunction in these tissues. This is clearly highly unusual but suggests that there must be some pressing need for the reaction. As we have suggested earlier, that need is to deflect the person's attention away from those very unpleasant, often painful emotions that the mind is trying to keep repressed. It is as though the mind had decided that a physical pain is preferable to an emotional one.

The Treatment of TMS

The most important factor in recovery is that the person must be made aware of what is going on; in other words, that the information provided is the "penicillin" for this disorder. If I can convince the conscious mind that TMS is not serious and not worthy of its attention, better yet that it is a phony, a charade, and that rather than fear it one should ridicule it, that most of the structural diagnoses are not valid and that the only things worthy of one's attention are the repressed feelings, what has been accomplished? We will have made the TMS useless; it will no longer have the ability to attract the attention of the conscious mind; the defense is a failure (the cover is blown, the camouflage is removed), which means the pain ceases.

I suggest to patients that when they find themselves being aware of the pain they must consciously and forcefully shift their attention to something psychological, like something they are worried about, a chronic family or financial problem, a recurrent source of irritation, anything in the psychological realm, for that sends a message to the brain that they're no longer deceived by the pain. When that message reaches the depths of the mind, the subconscious, the pain ceases.

Talk to Your Brain. What one is doing is consciously taking charge instead of feeling the helpless, intimidated victim, which is so common in people with this syndrome. The person is asserting himself, telling the brain that he is not going to put up with this state of affairs--and it works. Patients report that they can actually abort an episode of pain by doing this.

Resume Physical Activity. This means overcoming the fear of bending, lifting, jogging, playing tennis or any other sport, and a hundred other common physical things. It means unlearning all the nonsense about the correct way you are supposed to bend, lift, sit, stand, lie in bed, which swimming strokes are good and bad, what kind of chair or mattress you must use, shoes or corset or brace you must wear, and many other bits of medical mythology.

Discontinue All Physical Treatment. The principle is that one must renounce any structural explanation either for the pain or its cure, or the symptoms will continue. Manipulation, heat, massage, exercise and acupuncture all presuppose a physical disorder that can be treated by some physical means. Unless that whole concept is repudiated, the pain and other symptoms continue.

Review the Daily Reminders. This is an important strategy but one must be careful that it does not become a ritual. Patients are given a list of twelve key thoughts, and it is suggested that at least once a day they set aside fifteen minutes or so when they can relax and quietly review them. They are called daily reminders.

  • The pain is due to TMS, not to a structural abnormality.

  • The direct reason for the pain is mild oxygen deprivation.

  • TMS is a harmless condition, caused by my repressed emotions.

  • The principal emotion is my repressed anger.

  • TMS exists only to distract my attention from the emotions.

  • Since my back is basically normal there is nothing to fear.

  • Therefore, physical activity is not dangerous.

  • And I must resume all normal physical activity.

  • I will not be concerned or intimidated by the pain.

  • I will shift my attention from the pain to emotional issues.

  • I intend to be in control--not my subconscious mind.

  • I must think psychological at all times, not physical.

The Traditional (Conventional) Treatments

In a textbook chapter on the treatment of back pain, I once wrote that therapeutic eclecticism is a sign of diagnostic incompetence. The fact that there are so many different treatments for the common neck, shoulder and back pain syndromes suggests that the diagnosticians are not really sure what the problem is.

Mind and Body

The study of psychoneuroimmunology is highly scientific and will play an important role in our understanding of many serious disorders, such as cancer and the autoimmune diseases (like rheumatoid arthritis and diabetes), but in my view it is but one segment of a larger study of how emotions may influence any of the organs and systems of the body. TMS is an example of a mind-body disorder mediated through the autonomic nervous system; the immune system is not involved. I suspect the immune system does not participate in the interaction of emotions and the cardiovascular system. Once more, one is intrigued by the fact that the brain crosses boundaries in responding to its psychological needs. Thus patients with the same psychological diagnosis (though differing in severity) may develop TMS, autonomically mediated; allergic rhinitis, immune system mediated; or psychogenic regional pain, direct action on the sensorimotor system.