Tension myositis syndrome causes back pain and other symptoms.
What is Tension Myositis Syndrome?
Tension myositis (myoneural) syndrome was coined by John E. Sarno. TMS syndrome is “characterized by psychogenic musculoskeletal and nerve symptoms, most notably back pain”. While back pain is a common symptom, other tension myositis syndrome symptoms include stiffness, pain, weakness, numbness, and tingling. The location of symptoms can be in the knee, arms, neck, and wrists as well as the back and other body parts. The symptoms can move, and this “movement (is) an important indicator that the pain is from TMS”. Sarno believes that the pain is a defense mechanism against unconscious rage, anxiety, and anger. By repressing the rage, it becomes unconscious, and the pain movement to various other body parts implies that there is no injury or physical deformity. The reason behind the pain is that the “unconscious mind uses the autonomic nervous system to decrease blood flow” to the tendons, nerves, and muscles, “resulting in oxygen deprivation” and “pain in the affected tissues”. The conscious mind becomes distracted by the pain, and the repression keeps the rage in the unconscious mind. Sometimes TMS is called “distraction pain syndrome”.1
Theory and Diagnosis
It is suggested that patients with TMS strive for perfection and begin to resent the tasks. This leads to anger and guilt, creating emotional tension, which increases with additional stress. Physical symptoms may result, including the back and neck pain, acid reflux, plantar fasciitis, dizziness, depression, anxiety, and irritable bowel syndrome. The symptoms are thought to distract from the emotions.2 Diagnostic criteria of TMS includes the idea that the cause is unknown. Of course, imaging and physical examination can rule out serious medical conditions, such as tumors, fractures, and infections. Patients will present with “tender points”. Six tender points are necessary for the diagnosis of TMS, including two from each of the following areas: lateral upper buttocks, lumbar paraspinal muscles, and upper trapezius muscles. Additionally, patients generally will have a history of psychosomatic disorders, such as tension headache and irritable bowel syndrome.3 Healing is believed to come from shifting the focus to the psychological and away from the physical, breaking neural pathways that are dysfunctional, and learning to process emotions in a new way. While the symptoms are real, the cause is thought to be different than what other doctors look for. Dr. David Schechter, who had a long relationship with Sarno, has written about TMS in the book Think Away Your Pain. Schechter was not only a patient of Sarno’s, but he was a research assistant and has treated many patients himself. The mind-body link is important to the treatment program, which is said to be “de-linked” by “Western medicine”. The medical profession is split between psychiatry and medication/surgery. There is an online questionnaire available to patients who want to know if their pain is caused by tension myositis syndrome.4
Tension Myositis Syndrome Treatment
The basic treatment protocol for TMS, according to Sarno, is “education, writing about emotional issues, resumption of a normal lifestyle and…support meetings and/or psychotherapy”. Education includes lectures, audio/written materials, and office visits. Patients can learn that their condition is benign, and their disability is due to “pain-related fear and deconditioning”. Daily, patients should write about a list of issues that might be contributing to their emotional repression (abuse, childhood, personality traits, aging, life pressures, etc.) Long essays can help a patient examine their issues in depth. “The MindBody Workbook”, a 30-day journal, can help patients record events to make the correlation with their symptoms. By being conscious of the issues, repression is combated. Patients must discontinue their physical treatments (physical therapy, spinal manipulation) so that they stop reinforcing “a structural causation for the chronic pain”. Additionally, they can resume a normal lifestyle by engaging in “normal physical activity” and stop “protecting their ‘damaged’ backs”. Support meetings and psychotherapy may be needed for some patients. In a peer-reviewed study, the treatment showed a success rate of 54% for patients with chronic back pain. Additionally, “the study outperformed similar studies of other psychological interventions for chronic back pain”. While the treatment and diagnosis “are not accepted by the mainstream medical community”, there has been national media attention, and there are some famous supporters (Andrew Weil, Mehmet Oz) and patients (John Stossel, Howard Stern, Ann Bancroft, and Tom Harkin). Critics say that TMS and its treatment have not been proven in a “controlled clinical trial”, suggesting “regression to the mean” and “placebo effect” can explain success. There is concern that the diagnosis could prevent patients from seeking help for a real, physical problem.5 There are online resources for finding tension myositis syndrome doctors. Some of the doctors can provide services over the phone or internet, at least in terms of coaching, if there is not a TMS doctor in their area. Diagnosis cannot be performed remotely.6