Tension myositis syndrome (TMS), also known as tension myoneural syndrome or mindbody syndrome, is a name given by John E. Sarno to what he claimed was a condition of psychogenic musculoskeletal and nerve symptoms, most notably back pain. Sarno described TMS in four books, and stated that the condition may be involved in other pain disorders as well. The treatment protocol for TMS includes education, writing about emotional issues, resumption of a normal lifestyle and, for some patients, support meetings and/or psychotherapy. The TMS diagnosis and treatment protocol are not accepted by the mainstream medical community.

Conceptual basis

According to Sarno, TMS is a condition in which unconscious emotional issues (primarily rage, though other practitioners include other subconscious emotional issues such as anxiety, past trauma, and fear) initiate a process that causes physical pain and other symptoms. His theory suggests that the unconscious mind uses the autonomic nervous system to decrease blood flow to muscles, nerves or tendons, resulting in oxygen deprivation (temporary micro-ischemia) and metabolite accumulation, experienced as pain in the affected tissues. Sarno theorized that because patients often report that back pain seems to move around, up and down the spine, or from side to side, that this implies the pain may not be caused by a physical deformity or injury. Sarno stated that the underlying cause of the pain is the mind's defense mechanism against unconscious mental stress and emotions such as anger, anxiety and narcissistic rage. The conscious mind is distracted by the physical pain, as the psychological repression process keeps the anger and rage contained in the unconscious and thereby prevented from entering conscious awareness. Sarno believed that when patients recognize that the symptoms are only a distraction, the symptoms then serve no purpose and subsequently go away. TMS can be considered a psychosomatic condition and has been referred to as a "distraction pain syndrome." Sarno was a vocal critic of conventional medicine with regard to diagnosis and treatment of back pain, which is often treated by rest, physical therapy, exercise and/or surgery.

Symptoms

Back pain is frequently mentioned as a TMS symptom, but Sarno defined TMS symptoms much more broadly:

Diagnosis

Below is a list of criteria for diagnosing TMS, according to Schechter and Sarno: Schechter and Sarno state that if a patient is unable to visit a medical doctor who is trained in TMS, then the patient should see a traditional medical doctor to rule out serious disorders, such as fractures, tumors and infections.

Treatment

Sarno recommended ignoring chronic muscular-skeletal pain, and living everyday life as if there was none.

Notable patients

Notable people who have been treated for TMS include the following:

Reception

The TMS diagnosis and treatment protocol are not accepted by the mainstream medical community. Sarno himself stated in a 2004 interview with Medscape Orthopaedics & Sports Medicine that "99.999% of the medical profession does not accept this diagnosis." Although the vast majority of medical doctors do not accept TMS, there are doctors who do. Andrew Weil, an alternative medicine proponent, endorses TMS treatment for back pain. Mehmet Oz, a television personality and Professor of Surgery at Columbia University, includes TMS treatment in his four recommendations for treating back pain. Richard E. Sall, a medical doctor who authored a book on worker's compensation, includes TMS in a list of conditions he considers possible causes of back pain resulting in missed work days that increase the costs of worker's compensation programs. Patients typically see their doctor when the pain is at its worst and pain chart scores statistically improve over time even if left untreated; most people recover from an episode of back pain within weeks without any medical intervention at all. The TMS theory has also been criticized as too simplistic to account for the complexity of pain syndromes. James Rainville, a medical doctor at New England Baptist Hospital, said that while TMS treatment works for some patients, Sarno mistakenly uses the TMS diagnosis for other patients who have real physical problems.

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