what is TMS/mindbody syndrome?

Have you……?

  • struggled with chronic pain or another medically unexplained symptom for a long time?
  • tried everything to alleviate your pain, but nothing worked?
  • had doctors tell you they “just can’t find anything wrong?”
  • noticed your symptoms intensify at times and drop off at others?
  • experienced the symptoms or pain shift, or move to another part of your body?
  • had a period of no pain, only for the symptoms to suddenly reappear?
  • been told that your pain is due to ageing or overuse?

Then you may have Tension Myositis Syndrome (TMS). TMS is a condition that causes real physical symptoms that are not due to pathological or structural abnormalities and are not explained by diagnostic tests. In TMS, symptoms are caused by psychological stress.

TMS (sometimes also referred to as Tension Myoneural Syndrome) is also known as mindbody syndrome, or psychophysiological disorder (PPD). Essentially, they all mean the same thing*.

TMS is a condition originally described by John E. Sarno, MD, a retired professor of Clinical Rehabilitation Medicine at New York University School of Medicine, and attending physician at the Howard A. Rusk Institute of Rehabilitation Medicine at New York University Medical Center. TMS causes real physical symptoms, such as chronic pain, gastrointenstinal issues, and fibromyalgia. In TMS, pain symptoms are caused by mild oxygen deprivation via the autonomic nervous system, as a result of repressed emotions (**see below for examples) and psycho-social stress.

This is not to say that the pain is “all in your head” or that it is not real. TMS symptoms are very real, and can be extremely debilitating.

They can include: back painsciatica painRSIfibromyalgiachronic fatigue syndromemigrainesirritable bowel syndrome, and a wide array of other symptoms.

I visited many medical practitioners to be told the same things you have probably heard yourselves: “you have a degenerative disc disease, a herniated disc, you type/run/hike too much, it is due to overuse, or that you are just aging.” Even though I was told this, when I applied the ideas promoted by Dr. Sarno we became pain free and regained our lives.

How TMS Develops

(Adapted from source: TMS Wiki) At the heart of the development of TMS is our desire to be good people, loved by those we care about. This desire leads us to strive for perfection, and to put the needs of others above our own. We will cook a three course family meal after working a 10 hour day, because that is what a good mother would do. We will be the first person to volunteer to work on the weekend, because that is what a good employee would do. We will stay up all night making sure our homework is perfect, because if we don’t, we won’t get a good job. Our beliefs of what a good and perfect person will do directly influence our behavior on a day-to-day basis.

But sometimes, as more and more external stress is added and our desire for perfection increases, we develop a very deep seated resentment toward these tasks. There are some nights when you come home from working a double shift and are angry that you have to cook a meal for your family, while your husband has been watching TV all night. Part of us hates telling our friends that we can’t go out on Friday night, because we have to read and study for a class the next day. When our newborn baby wakes us up at 3 am for the fourth night in a row, some part of us has rage at the child, for waking us up yet again. These are all normal feelings and emotions to have. However, when a person has an emotion that goes against their belief of what a good and perfect person would do, the only option available to them is to repress that emotion. If we admit that we are angry at our family, our boss, or at doing homework, we fear that we would be considered a bad person and will be rejected by those we love or who we want to respect us. If we are not perfect, we will be unworthy of being loved. So instead of admitting that we are angry at our spouse for never cleaning up or doing the dishes, we repress it deep in our unconscious.

Another repressed emotion might be guilt. Some of us have to care for a loved one who is injured or aging. Being a caretaker is not an easy task. If we aren’t able to provide the necessary care, or the care the person not only desires but may demand of us, we may feel guilt. If we repress that feeling, especially if we are the type of person who wants to please very much, it can cause us TMS pain.

As we continue to repress these emotions, we create an immense amount of emotional tension which only increases as more and more stress is added to our lives. In order to keep you from recognizing that you have these powerful emotions of anger and rage or guilt, your unconscious creates physical symptoms, such as back pain, neck pain, plantar fasciitisacid refluxanxietydepressionDizziness, and irritable bowel syndrome. These symptoms serve as a way to distract you from the unwanted emotions by having you focus on your back hurting instead of your anger, rage, or guilt. We develop TMS because we are unable to accept and/or process these emotions.

No two people are exactly alike, and likewise, no two TMS recoveries are exactly the same. Different pain-healing techniques work for different people, and one of the keys to TMS treatment is identifying what techniques work best for you. People have reported using a variety of approaches to get better. Regardless of the specific technique, TMS treatment is based on two principles, which Dr. Sarno stated in Healing Back Pain:

1. The acquisition of knowledge, of insight into the nature of the disorder.
2. The ability to act on that knowledge and thereby change the brain’s behavior.

All of the standard treatments for TMS seek to help people address one or both of these pillars. The following is a list of techniques that many people have reported being helpful in their own recovery from chronic pain. As a reminder, Sarno says, “It is important to see a medical professional before starting this treatment approach to rule out any serious medical condition.”

  • Think Psychological: As previously mentioned, TMS serves as a distraction mechanism to prevent unwanted emotions to surface to our consciousness. The idea being that you will focus on your symptoms instead of your emotions. Think of how much time you spend thinking about your symptoms, worrying about when they will come next, or if they will ever go away. Thinking psychologically involves turning your focus from your symptoms to your emotions. Instead of thinking “When is my back going to stop hurting?,” ask yourself “What am I stressing about now?,” or “How do I feel emotionally right now?”
  • Educate yourself: As the first pillar of TMS recovery states, learning about this condition will give you the knowledge you need to recover. Read a TMS bookforum postssuccess storiesThank You, Dr. Sarno messages, and the TMS Wiki site, along with watching the 20/20 Segment, to gain a better understanding of Tension Myositis Syndrome and how to recover.
  • Resume Physical Activity: In Healing Back Pain, Dr. Sarno writes: Perhaps the most important (but most difficult) thing that patients must do is to resume all physical activity, including the most vigorous. It may seem odd to become active when you are still in pain, but it can be extremely beneficial in TMS treatment. By being active you are sending messages to your unconscious that you do not have a physical problem, and will no longer think physical.
  • Stop all physical treatments: In order to fully accept the diagnosis it is important for people to stop using physical modalities to treat their symptoms, once a medical professional has cleared them for any serious medical conditions. There are a wide variety of physical therapies people in chronic pain use. Whether it is massage, heating pads, chiropractic manipulation, or acupuncture, all of these techniques keep people focused on their physical symptoms, instead of their emotional health. If you wear orthopedics, use ergonomic devices, or any other device to prevent or help reduce your symptoms, it is recommended to stop using them. If possible, stop taking pain-killers of any kind or strength. Full recovery can only happen when a person has full belief in the TMS process.
  • Affirmations: Many people have reported how helpful saying affirmations are in recovering. Essentially this involves talking to your brain. While it may feel slightly odd to talk to yourself, people have reported that it allows them to gain control over their thoughts and take a more active role in their recovery. Affirmations are like mantras, and examples are “I am calm,” “I am at peace,” “Every day I am feeling better.”
  • Interact with Other TMS Peers: Hearing how other people recovered from TMS can be very helpful in your own recovery. Learning from people who have been there will help you gain a better understanding of this syndrome.
  • Journal/List making: Identifying and understanding what factors are fueling your symptoms is key. Many people have reported that writing about past and present events, as well as their emotions, has been particularly helpful in reducing their symptoms. Simply making a list of events and circumstances that may be creating repressed anger and rage has been enough for some people to recover. Dr. Sarno says you don’t even need to solve a problem you have repressed. It is enough to identify it and tell your unconscious mind that it is what you have repressed and that is causing your pain.
  • Psychotherapy: For some people, identifying and processing their repressed emotions is challenging. This could mean that they simply have a higher level of anxiety or a more traumatic past. In these cases, a trained TMS professional can be helpful in guiding the person through their TMS treatment. Just because you need to see a therapist to get better, does not mean that you have failed.

Medical Evidence

Research in the field of mindbody medicine is quickly developing. Up to this date, most of the research has focused on understanding the causes of chronic pain symptoms. This research has found that most chronic pain conditions lack a clear structural cause. One study by Jensen, MC in the New England Journal of Medicine found that MRI tests do not accurately depict when a person has back pain. Of the 98 symptomatic people in this study 52% had a disc bulge, 27% had a protrusion, and 1% had an extrusion. This study shows that there is no correlation between spinal abnormalities and back pain. This is one reason why Dr. Sarno called spinal abnormalities the “grey hair of the spine,” referring to a harmless physical change in our body, such as having grey hair when we age.

* The acronym TMS was first coined by Dr. John Sarno for Tension Myositis Syndrome, and later turned into Tension Myoneural Syndrome. The term refers to tension in the muscles (myositis), because initially Sarno diagnosed people with TMS who only had pain. However it soon became clear that muscles were not the only part of the body being affected, but that nerves could also be part of TMS (hence the term Tension Myoneural Syndrome). The term TMS has been met with multiple challenges and oppositions arguing that it does not adequately address all of the manifestations it can be responsible for such as: dry eyes, gastrointestinal disorders, tooth pain, tendinitis, and dermatological conditions. Because of this reason several other doctors and authors developed different terms for the same condition (source: https://www.tmswiki.org/).

**Dr. Sarno states that each patient should try to list out all issues that might contribute to the patient’s repressed emotions. He suggests looking in the following areas:

  • (a) certain childhood experiences, such as abuse or lack of love,
  • (b) personality traits such as perfectionismconscientiousness and a strong need to be liked, approved or validated by everyone,
  • (c) current life stresses and pressures,
  • (d) aging and mortality and
  • (e) situations in which the patient experiences conscious but unexpressed anger.

Dr Sarno 12 daily reminders

  1. The pain is due to TMS, not to a structural abnormality
  2. The direct reason for the pain is mild oxygen deprivation
  3. TMS is a harmless condition caused by my repressed emotions
  4. The principal emotion is my repressed ANGER
  5. TMS exists only to distract my attentions from the emotions
  6. Since my back (replace with whatever pain you’ve got) is basically normal there is nothing to fear
  7. Therefore, physical activity is not dangerous
  8. And I MUST resume all normal physical activity
  9. I will not be concerned or intimidated by the pain
  10. I will shift my attention from pain to the emotional issues
  11. I intend to be in control-NOT my subconscious mind
  12. I must think Psychological at all times, NOT physical.

PLUS! Please also read my blogs ‘Could my personality be contributing to my chronic pain? ,How to turn off the stress response and How to write your way out of chronic pain’ for more information on how to heal yourself, and please do get in touch if you feel coaching would help. I know I needed a little extra help in the early days, and it helps so much to talk to someone who really understands.