View source for Tension myositis syndrome

{{Short description|Pseudomedical diagnosis}}
{{Infobox alternative condition}}
{{Alternative medicine sidebar}}
'''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 [[wikt:psychogenic|psychogenic]] musculoskeletal and nerve symptoms, most notably [[back pain]].<ref name="schechter07">{{Cite journal|vauthors=Schechter D, Smith AP, Beck J, Roach J, Karim R, Azen S | title=Outcomes of a Mind-Body Treatment Program for Chronic Back Pain with No Distinct Structural Pathology – A Case Series of Patients Diagnosed and Treated as Tension Myositis Syndrome | journal=Alternative Therapies in Health and Medicine| year=2007 | volume=13 | issue=5 | pages=26–35 |pmid=17900039}}</ref><ref name="medscape1">{{cite web| title = An Expert Interview With Dr. John Sarno, Part I: Back Pain Is a State of Mind | first = Pippa | last = Wysong | url = http://www.medscape.com/viewarticle/478840?src=mp | publisher = Medscape Orthopaedics & Sports Medicine | date = 2004-07-06 | access-date = 2007-09-14}}</ref><ref name="prevention">{{cite web|url=http://www.prevention.com/health/health-concerns/when-back-pain-starts-your-head |title=When Back Pain Starts in Your Head: Is repressed anger causing your back pain? |access-date=2012-04-28 |last=McGrath |first=Mike |date=2004-11-03 |work=Prevention.com |publisher=Rodale Inc.}}</ref>  Sarno described TMS in four books,<ref name="sarno01">{{Cite book| title = Mind Over Back Pain | first = John E. | last = Sarno | author-link = John E. Sarno  | publisher = Berkley Books | year = 1982 | isbn = 0-425-08741-7}}</ref><ref name="sarno1">{{Cite book | title = Healing Back Pain: The Mind-Body Connection | first = John E. | last = Sarno | author-link = John E. Sarno | publisher = Warner Books | year = 1991 | isbn = 0-446-39230-8 | url = https://archive.org/details/healingbackpainm00sarn }}</ref><ref name="sarno2">{{Cite book | title = The Divided Mind: The Epidemic of Mindbody Disorders | first = John E. | last = Sarno | author-link = John E. Sarno | publisher = HarperCollins | year = 2006 | isbn = 0-06-085178-3 | url = https://archive.org/details/dividedmindep00sarn }}</ref><ref name="sarno3">{{Cite book | title = The Mindbody Prescription: Healing the Body, Healing the Pain | publisher = Warner Books | year = 1998 | last = Sarno | first = John E. | author-link = John E. Sarno | isbn = 0-446-52076-4 | url = https://archive.org/details/mindbodyprescrip00sarn_0 }}</ref> and stated that the condition may be involved in other pain disorders as well.<ref name="medscape1"/> 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]].<ref name="schechter07"/><ref name="rashbaum">{{Cite journal|vauthors=Rashbaum IG, Sarno JE |title=Psychosomatic concepts in chronic pain |journal=Archives of Physical Medicine and Rehabilitation |volume=84 |issue=3 Suppl 1 |pages=S76–80; quiz S81–2 |year=2003 |pmid=12708562|doi=10.1053/apmr.2003.50144|s2cid=24357183 }}</ref> 

The TMS diagnosis and treatment protocol are not accepted by the mainstream medical community.<ref name="NYTimes-A">{{Cite news|url=https://query.nytimes.com/gst/fullpage.html?sec=health&res=9B05E3DF1E3AF934A25751C0A96F958260|newspaper=The New York Times|title=Straightening Out Back Pain|first=Liz|last=Neporent|date=17 February 1999}}</ref><ref name="20-20">{{cite episode |title=Dr. Sarno's Cure|series=20/20|series-link=20/20 (US television series)|network=[[American Broadcasting Company|ABC]]|airdate=1999-07-25|url = https://www.youtube.com/watch?v=QUEQHXaMnx0}}</ref>

==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 [[muscle]]s, [[nerves]] or [[tendons]], resulting in [[oxygen deprivation]] (temporary micro-[[ischemia]]) and [[metabolite]] accumulation, experienced as pain in the affected tissues.<ref name="medscape1"/><ref name="rashbaum"/><ref name="ruden">{{Cite journal | author=Ruden RA | title=Encoding States: A Model for the Origin and Treatment of Complex Psychogenic Pain | journal=Traumatology | year=2008 | volume=14 | issue=1 | pages=119–126 | url=http://www.healingthemind.net/Encode3.pdf | doi=10.1177/1534765608315625 | url-status=dead | archive-url=https://web.archive.org/web/20120323072611/http://www.healingthemind.net/Encode3.pdf | archive-date=23 March 2012 | df=dmy-all }}</ref> 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.<ref name = "sarno3"/>

Sarno stated that the underlying cause of the pain is the mind's defense mechanism against [[unconscious mind|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]].<ref name="coen">{{Cite journal|vauthors=Coen SJ, Sarno JE |title=Psychosomatic avoidance of conflict in back pain |journal=The Journal of the American Academy of Psychoanalysis |volume=17 |issue=3 |pages=359–76 |year=1989 |pmid=2530198 |doi=10.1521/jaap.1.1989.17.3.359}}</ref><ref name="enigma">{{Cite book| last = Cailliet | first = René  | title = Low Back Disorders: A Medical Enigma  | publisher = Wolters Kluwer Health  | year = 2003  | isbn = 0-7817-4448-2   | page = 14  | author-link = Rene Cailliet }}</ref> 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."<ref name="schechter05">{{Cite journal | vauthors=Schechter D, Smith AP | title=Back pain as a distraction pain syndrome (DPS): A window to a whole new dynamic in integrative medicine | journal=Evidence-Based Integrative Medicine | year=2005 | volume=2 | issue=1 | pages=3–8 | url=http://www.smi-mindbodyresearch.org/DistractionPain.htm | doi=10.2165/01197065-200502010-00002 | s2cid=70814026 | url-status=dead | archive-url=https://web.archive.org/web/20160408225556/http://smi-mindbodyresearch.org/DistractionPain.htm | archive-date=8 April 2016 | df=dmy-all }}</ref>

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.<ref name="sarno1"/>

==Symptoms==
Back pain is frequently mentioned as a TMS symptom,<ref name="schechter07"/><ref name="rashbaum"/><ref name="ucla">{{cite web |url=http://www.med.ucla.edu/modules/wfsection/article.php?articleid=159 |title=Back Pain: An Unconventional Approach|last=Greenberg |first=Jerome |date=1 February 2000 |work=Proceedings of UCLA Healthcare |publisher=UCLA Department of Medicine |url-status=dead |archive-url=https://web.archive.org/web/20080111220838/http://www.med.ucla.edu/modules/wfsection/article.php?articleid=159 |archive-date=11 January 2008  }}</ref><ref name="coen"/> but Sarno defined TMS symptoms much more broadly:
* ''Symptom type:'' TMS symptoms include [[pain]], [[stiffness]], [[weakness]], [[paresthesia|tingling]], [[numbness]], [[muscle contracture]]s, [[cramp]]s and other negative sensations, according to Sarno.
* ''Symptom location:'' In addition to the back, Sarno stated that TMS symptoms can occur in the [[neck]], [[knee]], [[arm]]s, [[wrists]], and other parts of the body.<ref name="medscape1"/> Schechter states that the symptoms have a tendency to move to other parts of the body.  He considers symptom movement an important indicator that the pain is from TMS.<ref name="schechter07"/>

==Diagnosis==
Below is a list of criteria for diagnosing TMS, according to Schechter and Sarno:
* ''Lack of known physical cause:''  Schechter and Sarno state that a [[physical examination]], tests and [[imaging studies]] is needed to rule out serious conditions, such as tumors.<ref name="schechter07"/><ref name="sarno1"/> Sarno considers [[spinal disc herniation]]s to generally be harmless, because he says the symptom location does not even correlate to the herniation location.<ref name="sarno1"/>
* ''Tender points:''<ref name="schechter07"/> While medical doctors use eleven of eighteen tender points as a diagnostic criteria for [[fibromyalgia]], Sarno states that he uses six main tender points to diagnose TMS:  two tender points in the upper [[trapezius muscles]], two in the [[lumbar paraspinal]] muscles and two in the lateral upper [[buttocks]]. He states that these are found in 99% of TMS patients.<ref name="sarno3"/>
* ''History of other psychosomatic disorders:''  Schechter and Sarno consider a prior history of other psychosomatic disorders an indication that the patient may have TMS.  They list [[irritable bowel syndrome]] and [[tension headache]] as examples of [[psychosomatic disorders]].<ref name="schechter07"/><ref name="sarno3"/>

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]].<ref name="seattle">{{Cite news| url=http://archives.seattletimes.nwsource.com/cgi-bin/texis.cgi/web/vortex/display?slug=4033206&date=20000723&query=john+sarno|date=23 July 2000|newspaper=The Seattle Times|title=Minding the Back|last=Martin|first=Molly}}</ref><ref name="schechter05"/>

== Treatment ==
Sarno recommended ignoring chronic muscular-skeletal pain, and living everyday life as if there was none.<ref name=hh>{{cite web | title=Chronic Pain: A Disease in its Own Right | website=Science-Based Medicine | date=2010-11-09 | url=https://sciencebasedmedicine.org/chronic-pain-a-disease-in-its-own-right/ | access-date=2024-03-12 |first=Harriet |last=Hall |author-link=Harriet Hall}}</ref>

==Notable patients==
Notable people who have been treated for TMS include the following:
* Radio personality [[Howard Stern]] credited TMS treatment with the relief of his "excruciating back and shoulder pain",<ref name="mindbody-back-cover">{{Cite book | title = The Mindbody Prescription: Healing the Body, Healing the Pain | publisher = Warner Books | year = 1998 | last = Sarno | first = John E. | author-link = John E. Sarno | isbn = 0-446-52076-4 | url = https://archive.org/details/mindbodyprescrip00sarn_0 | page = back cover | no-pp = true }}</ref> as well as his [[obsessive-compulsive disorder]].<ref name="mindbody-back-cover"/><ref>{{Cite book |last=Stern |first=Howard |author-link=Howard Stern |editor=Judith Regan |editor-link=Judith Regan |title=Miss America |edition=Mass Market Paperback |publisher=[[HarperCollins]] |isbn=0-06-109550-8 |pages=[https://archive.org/details/missamerica00ster/page/ Chapter 3] |no-pp=true |year=1995 |orig-year=1995-11 |title-link=Miss America (book) }}</ref>
* ''[[20/20 (US television series)|20/20]]'' co-anchor [[John Stossel]] was treated by Sarno for his chronic debilitating back pain.<ref name="prevention"/> In a ''20/20'' segment on his former doctor, Stossel stated his opinion that the TMS treatment "cured" his back pain, although he admitted that he continues to have relapses of pain.<ref name="20-20"/>
* Television writer and producer [[Janette Barber]] said that for three years, she had been increasingly unable to walk, and eventually began to use a wheelchair, due to severe ankle pain originally diagnosed as [[tendinitis]].<ref name="larryking">{{cite episode |title=How Can Chronic Back Pain Be Cured? |series=Larry King Live |series-link=Larry King Live |network=[[CNN]] |airdate=1999-08-12 |transcript-url=https://web.archive.org/web/20031106133652/http://www.tarpityoga.com/larryking.html |transcript=Transcript}}</ref> She was later diagnosed and treated for TMS.  According to Barber, she was "pain-free one week after [Sarno's] lecture" and able to walk and run within a few months,<ref name="20-20"/><ref name="larryking"/><ref name=foodnetwork>{{cite web  |url=http://www.foodnetwork.com/food/hosts_celebrity_chefs/article/0,1974,FOOD_9889_1842044,00.html  |archive-url=https://web.archive.org/web/20050308142934/http://www.foodnetwork.com/food/hosts_celebrity_chefs/article/0,1974,FOOD_9889_1842044,00.html  |url-status=dead  |archive-date=8 March 2005  |title=Janette Barber (Food Network host biography)  |access-date=25 January 2008    }}</ref> notwithstanding her "occasional" relapses of pain.<ref name="larryking"/>
* The late actress [[Anne Bancroft]] said that she saw several doctors for back pain, but only Sarno's TMS treatment helped her.<ref name="NYTimes-A"/><ref name="20-20"/>
* The acclaimed filmmaker [[Terry Zwigoff]] said he was on the verge of suicide due to his debilitating back pain, until he turned in desperation to Sarno's method and it "saved [his] life", as well as the life of a woman he told about it more recently.<ref>{{Cite web|url=https://www.vice.com/en_us/article/terry-zwigoff|title=TERRY ZWIGOFF|website=Vice|date=27 August 2010 |language=en-us|access-date=2017-04-30}}</ref>

==Reception==
The TMS diagnosis and treatment protocol are not accepted by the mainstream medical community.<ref name=vox>{{cite web | last=Belluz | first=Julia | title=America's most famous back pain doctor said pain is in your head. Thousands think he's right. | website=Vox | date=2017-10-02 | url=https://www.vox.com/science-and-health/2017/10/2/16338094/dr-john-sarno-healing-back-pain | access-date=2024-03-12}}</ref><ref name="NYTimes-A"/><ref name="20-20"/> Sarno himself stated in a 2004 interview with ''[[Medscape]] Orthopaedics & Sports Medicine'' that "99.999% of the medical profession does not accept this diagnosis."<ref name="medscape1"/> 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.<ref name=weilsite>{{cite web|url=http://www.drweil.com/drw/u/id/QAA400205 | first = Andrew | last = Weil |title=Help for an Aching Back? |access-date=2 March 2010}}</ref><ref name="weilbook">{{Cite book | last = Weil | first = Andrew | title = Spontaneous Healing: How to Discover and Enhance Your Body's Natural Ability to Maintain and Heal Itself | url = http://tmswiki.wetpaint.com/page/TMS+In+The+Media/revision/8 | archive-url = https://archive.today/20130111122055/http://tmswiki.wetpaint.com/page/TMS+In+The+Media/revision/8 | url-status = dead | archive-date = 2013-01-11 | publisher = Ballantine Books | year = 1996 | isbn = 0-449-91064-4 }}</ref> [[Mehmet Oz]], a television personality and Professor of Surgery at [[Columbia University]], includes TMS treatment in his four recommendations for treating back pain.<ref name=oz>{{cite web|url=http://www.oprah.com/health/Dr-Oz-Treatments-for-Low-Back-Pain| first = Mehmet| last = Oz |title=4 Treatments for Low Back Pain |date=15 September 2009 |work=Oprah.com |access-date=16 March 2010}}</ref> 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.<ref name="hall">{{Cite book| last = Sall, MD  | first = Richard E.  | title = Strategies in Workers' Compensation | publisher = Hamilton Books | year = 2004  | isbn = 0-7618-2771-4   | page = 91 }}</ref>

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.<ref>{{Cite journal|vauthors=Pengel LH, Herbert RD, Maher CG, Refshauge KM |title=Acute low back pain: systematic review of its prognosis |journal=BMJ |volume=327 |issue=7410 |page=323 |year=2003 |pmid=12907487 |doi=10.1136/bmj.327.7410.323 |pmc=169642}}</ref> The TMS theory has also been criticized as too simplistic to account for the complexity of pain syndromes.<ref name="20-20"/> 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.<ref>{{cite news |url=http://www.highbeam.com/doc/1G1-57116120.html |archive-url=https://web.archive.org/web/20131031162356/http://www.highbeam.com/doc/1G1-57116120.html |url-status=dead |archive-date=31 October 2013 |author=Lasalandra, Michael |title=Gettin back to basics; Doctor believes tension, trauma to blame for pain. |work=The Boston Herald |date=11 May 1999 |access-date=28 August 2013}}</ref>

==Notes and references==
{{Reflist|colwidth=30em}}

==External links==
* [https://www.takingcharge.csh.umn.edu/what-is-the-mind-body-connection What Is the Mind-Body Connection?]

{{Use dmy dates|date=September 2019}}

{{DEFAULTSORT:Tension Myositis Syndrome}}
[[Category:Musculoskeletal disorders]]
[[Category:Syndromes]]
[[Category:Alternative diagnoses]]
[[Category:Mind–body interventions]]