Part 2

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

(Page 2 of 2)

If structural abnormalities don't cause pain in the shoulder, back and buttocks, what does? Studies and clinical experience of many years suggest that these common pain syndromes are the result of a physiologic alteration in certain muscles, nerves, tendons and ligaments which is called the Tension Myositis Syndrome (TMS). It is a harmless but potentially very painful disorder that is the result of specific, common emotional situations. It is the purpose of this book to describe TMS in detail.

The ensuing sections of this chapter will discuss who gets it, in what parts of the body it occurs, the various patterns of pain and the overall impact of TMS on people's health and daily lives. Following chapters will talk about the psychology of TMS (which is where it all begins), its physiology and how it is treated. Conventional diagnosis and treatment will be reviewed and I will conclude with a chapter on the important interaction between mind and body in matters of health and illness.

Who Gets TMS?

One might almost say that TMS is a cradle-to-grave disorder since it does occur in children, though probably not until the age of five or six. Its manifestation in children is, of course, different from what occurs in adults. I am convinced that what are referred to as “growing pains” in children are manifestations of TMS.

The cause of “growing pains” has never been identified but physicians have always been comfortable in reassuring mothers that the condition is harmless. It occurred to me one day while listening to a young mother describe her daughter's severe leg pain in the middle of the night that what the child had experienced was very much like an adult attack of sciatica, and since this was clearly one of the most common manifestations of TMS, “growing pains” might very well represent TMS in children.

Little wonder that no one has been able to explain the nature of “growing pains” since TMS is a condition that usually leaves no physical evidence of its presence. There is a temporary constriction of blood vessels, bringing on the symptoms, and then all returns to normal.

The emotional stimulus for the attack in children is no different from that in adults - anxiety. One might say that the attack in a child is a paranightmare. It is a substitute for a nightmare, a command decisions by the mind to produce a painful reaction rather than have the individual experience a painful emotion, which is what happens in adults as well.

At the other end of this spectrum, I have seen the syndrome in men and women in their eighties. There appears to be no age limit, and why would there be? As long as one can generate emotions one is susceptible to the disorder.

What are the ages when it is most common, and can we learn anything from those statistics? In a follow-up survey carried out in 1982, 177 patients were interviewed as to their then current status following treatment for TMS. (See page 87 for results of the survey.) We learned that 77 percent of the patients fell between the ages of thirty and sixty, 9 percent were in their twenties, and there were only four teenagers (2 percent). At the other end of the spectrum, only 7 percent were in their sixties and 4 percent in their seventies.

These statistics suggest very strongly that the cause of most back pain is emotional, for the years between thirty and sixty are the ages that fall into what I would call the years of responsibility. This is the period in one's life when one is under the most strain to succeed, to provide and excel, and it is logical that this is when one would experience the highest incidence of TMS. Further, if degenerative changes in the spine (osteoarthritis, disc degeneration and herniation, facet arthrosis and spinal stenosis, for instance) were a primary cause of back pain, these statistics wouldn't fit at all. In that case, a gradual increase in incidence from the twenties on would occur, with the highest incidence in the oldest people.

To be sure, this is only circumstantial evidence, but it is highly suggestive.

So the answer to the question “Who gets TMS?” is “Anybody.” But it is certainly most common in the middle years of life, the years of responsibility. Let's now take a look at how TMS manifests itself.

Copyright © 1998 by John E. Sarno, M.D.

About the Author

John E. Sarno, M.D., is Professor of Clinical Rehabilitation Medicine, New York University School of Medicine, and attending physician at the Howard A. Rusk Institute of Rehabilitation Medicine, New York University Medical Center.