Dr. John Sarno caused quite a ruckus back in 1990 when he suggested that back pain is all in the head. In his bestselling book, Healing Back Pain: The Mind-Body Connection, he claimed that backaches, slipped discs, headaches, and other chronic pains are due to suppressed anger, and that once the cause of the anger is addressed, the pain will vanish. Relieved readers call this book "liberating" and say "it sounds too good to be true, but it is true." Sarno has returned with The Mindbody Prescription, in which he explains how emotions including guilt, anxiety, depression, and low self-esteem can stimulate the brain to manufacture physical symptoms including fibromyalgia, repetitive strain injuries, migraine headaches, hay fever, colitis, ulcers, and even acne. If these psychosomatic problems all sound a little Freudian, what with the repression of emotions in the unconscious, it's because Sarno unapologetically borrows from Freud for the basis of his theory and cites childhood trauma as a major source of emotional problems. He also says that his program is a "talking cure" of sorts, since patients must be convinced their pain is rooted in their emotions before healing can begin.
CALLED T.M.S.
A special note needs to be made about back pain because it is a very common ailment that unnecessarily costs individuals and the health care system millions of dollars per year. Contrary to popular belief, back pain is usually NOT caused by a structural problem such as a herniated disc, a degenerated disc, scoliosis, spondylolysthesis, a pinched nerve, weak torso muscles, or arthritis. It is almost always caused by tension--not physical tension (like tight muscles) but emotional tension: repressed, unpleasant emotions like anger, anxiety, fear, or feelings of inferiority. This tension leads to a physical process involving the muscles, nerves, tendons, and ligaments of the neck, shoulders and back. The autonomic nervous system (the same system that is responsible for the "fight or flight" response) constricts blood vessels that feed the involved tissues, and it is this blood deprivation, or ischemia, that causes the pain. This condition is called Tension Myositis Syndrome (TMS). It is not only benign, but easily reversed.
The following questionnaire has been designed to help you know if you may have TMS. Answer each of the seven questions and score yourself. Seven or more points is highly probable for TMS, four to six points possibly TMS. Three or fewer points probably NOT TMS. Of course a questionnaire can not replace a detailed medical history, examination, and review of x-rays and MRI scans. Use this as a tool only.
The questionnaire is as follows:
Q. 1) Do you find that your pain level is related to the amount of
tension/stress you are experiencing or to how you are coping with your
feelings?
Definitely_________
Yes, have noticed this, at times_______
Not really__________
Q.2) Would you describe yourself as in general, "very hard on yourself",
"highly responsible for others", or "very thorough, orderly, or
perfectionistic"?
Definitely_____
Yes, have noticed that I have some of these characteristics_____
Not really_________
Q. 3)Have you suffered from other tension-related illnesses such as"
--hives, eczema, rashes brought on by tension
--spastic colon, irritable bowel, gastritis, reflux/heartburn
--tension or migraine headaches
--unexplained prostate trouble or pelvic pain
Definitely, two or more categories______
Yes, at least one______
No_________
Q. 4) Have you been told regarding the cause of your pain that "there's
nothing that can be done surgically", "there's nothing wrong", "it's a
soft tissue problem", or "the cause is degenerative changes"?
Yes____
No_____
Q. 5) Do you spend a great deal of time during the day thinking and
worrying about your pain, looking for an answer, obsessing about its cause?
Yes____
No____
Q. 6)Have you tried several different treatments or approaches for your
pain and received only temporary relief from each or no relief from any of
them?
Yes__________
No_________
Q. 7) Do you find that massage helps your pain significantly OR that you
are quite sensitive to massage in several parts of our back or neck?
Yes_____
No_____
The scoring system is two points for any Definitely answer, one point for
each Yes answer and zero points for any no answers. Total the points
(based on preliminary data, the following scoring system has been developed):
7-10 points--probable TMS
4-6 points--possible TMS
0-3 points--unlikely to be TMS
Conventional Explanations for back pain focus on structural changes such as arthritis, degenerative changes, bulging discs, curvature of the spine and anatomical issues such as a short leg, bad feet, or misalignment.
Problems with this model:
A. many of these structural changes are equally common in asymptomatic people --New England Journal of Medicine article by Jensen, 1994, 52% of people without back pain have bulging discs and other changes.
B.
in many patients pain seems to move around or they may have neck and lower back pain despite normal xrays or MRI scans at one or more levels.
C.many patients who have "successful" surgery by top surgeons still have pain after surgery.
D.many patients note flare-ups may not be associated with any particular physical activity or injury.
All of these facts suggest that the conventional model and diagnostic approach to patients with back pain may be incomplete or inaccurate in some or perhaps many individuals. These individuals are actually suffering from a benign, but painful, soft tissue process called TMS. The treatment is understanding the connection between tension and the pain.
