Tension myositis syndrome

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Tension myositis syndrome (TMS) is a condition described by Dr. John E. Sarno in his books Healing Back Pain: The Mind-Body Connection (ISBN 0-446-39230-8), The Mindbody Prescription: Healing the Body, Healing the Pain (ISBN 0-446-67515-6), and The Divided Mind: The Epidemic of Mindbody Disorders (ISBN 0-06-085178-3). Sarno's theories and management plan for back pain and other TMS equivalents are not widely accepted by the conventional medical community, but Sarno claims to have a high rate of success at the Howard A. Rusk Institute of Rehabilitation Medicine, New York University Medical Center. [1]

Contents

[edit] Dr Sarno's Claims

According to Dr. Sarno, TMS is a condition in which emotional stress causes physical pain in the human body. Most often this pain occurs in the back, neck, shoulders, and buttocks but may appear in other parts of the body as well. The physiological reason for the pain is decreased blood flow, causing oxygen deprivation in the affected area(s) of the body, which may involve muscles, nerves, tendons or ligaments. This physical phenomenon, the decreased blood flow, is an aberration undertaken by the autonomic nervous system that causes increased pain and tension in the affected tissues. This results in muscle pain similar to what an athlete might feel after a strenuous workout. Whereas the athlete will feel relief within moments of halting the workout, the person afflicted with TMS continues to feel pain almost constantly.

[edit] Underlying Cause

Dr. Sarno claims that the underlying cause of the pain is the mind's defense mechanism against unconscious mental stress it does not want to cope with, or even directly confront, emotions such as anger, anxiety and narcissistic rage. Rather than confront the stress and its underlying causes, the unconscious mind (acting via the limbic system) causes mild oxygen deprivation in muscles, nerves or tendons, and thereby causes physical pain. The conscious mind will therefore be distracted by this physical pain, enhancing the automatic repression process to keep the anger/rage contained in the unconscious. This strategy is designed by the brain to keep such emotional stress from surfacing in the conscious mind, thus assisting in the repression of painful emotions and preventing awareness of them.[1] TMS could therefore be called a psychosomatic condition, in that it is a physical condition whose ultimate cause is psychological. However, having TMS does not make you a hypochondriac or a malingerer. TMS is real pain, with an immediate cause that is both real and physical. It is certainly not an indication of "mental illness." In fact, TMS patients are often highly responsible and successful individuals. What TMS is, is a "distraction pain syndrome" of sorts, a very painful strategy for staying sane in a crazy-making world.[2]

[edit] Treatment

Dr. Sarno claims that simply educating the mind about TMS is the most important step in the process to make it go away. However, he advises patients that they should first have a thorough physical examination by a qualified physician. This is done primarily to exclude more serious conditions, such as fractures, tumors, or infections that require conventional care, but it also can identify symptoms that are typical of TMS, such as certain tender points that become painful when pressed. The remaining steps include firstly "Repudiate the physical and acknowledge the psychological aspect" which includes moving around and resuming normal activity as much as you can bear, without worrying about "re-injury" (easier said than done). With TMS the only thing wrong with your back is that it hurts. Secondly "Drive the concept to your unconscious" by repeatedly focusing on exactly what your unconscious mind is attempting to repress - the sources of your anger. Dr. David Schechter, one of Sarno's former medical students and research assistants, has developed a 30-day, daily journal called "The MindBody Workbook"[3] to address the relative lack of treatment advice in Dr. Sarno’s book(s). In the workbook, the reader is encouraged to record emotionally significant events and make correlations between them and their physical pain. The point is to become aware of repressed emotions, which usually involves identifying their sources. The three major sources include one's childhood, personality type (self-critical, overly responsible, often perfectionist, prone to guilt) and life's challenges. The book describes personality types that are prone to TMS, and how TMS works. Once the mind understands the trick it is playing on itself, it gives up the ruse, and the symptoms will usually disappear after daily repetition.

[edit] Back Pain and Traditional Medicine

This view is a radical departure (one that could rightly be called a "paradigm shift") from conventional medical thinking about back pain, which regards it as an orthopedic problem to be treated by rest, physical therapy, exercise and/or surgery. Dr. Sarno is a vocal critic of conventional medicine with regard to back pain, which he claims often resorts to surgery. He says these methods are unnecessary and often ineffective. According to him, most back pain has its roots in emotional stress, and thus the mind, rather than the body, should be treated to address the symptoms. He and his supporters argue the following points as evidence to support his position:

  1. The most common diagnoses of back pain, degenerative discs and bulging discs, are equally prevalent in the general population as they are among those in pain. Moreover, no one knows the mechanisms by which these conditions might cause pain in the first place.[4][5][6][7]
  2. Given this information, most back pain (an estimated 85% of cases) has no known physiological cause, beyond the persistent muscle tension that is usually associated with it.[8][9]
  3. In many cases, back pain tends to move around, up and down the spine, or from side to side, which is not typical of pain caused by a physical deformity or injury.[10]
  4. Psychosocial factors, such as on-the-job stress and dysfunctional family relationships, correlate much more closely with back pain than structural abnormalities revealed in x-rays and other medical imaging scans.[11][12][13][14] This may be why back pain is more prevalent in industrialized countries, where more people have sedentary jobs, than in developing countries, where more people live by "backbreaking" hard labor.
  5. Finally, back pain peaks at midlife, during the "age of responsibility", and diminishes to the point of being relatively rare among the elderly.[15] If it were due to degenerative structural conditions in the spine, one would think that it would simply get worse with age.

Most physicians know little or nothing about Sarno's work, as it has received relatively little attention in recognized, peer-reviewed medical journals. Nevertheless, his critics in mainstream medicine argue that neither the theory of TMS nor the effectiveness of the treatment has been proven in a properly controlled clinical trial. Sarno's TMS success stories, which, along with those of his colleagues who use this approach, [2] are now estimated to number in the tens of thousands, could be due to either the placebo effect or the natural ebb and flow of back pain. Most people (estimated at 85 – 90%) recover from a back pain episode on their own in a matter of weeks without any mechanical intervention at all.[16] Also, because patients typically see their doctor when the pain is at its worst, pain chart scores will probably improve with time on account of the normal fluctuation cycle of pain. Sarno's supporters counter that his approach works almost as well with chronic patients (those who have been in pain for three to six months or more) as it does with acute patients, making it less likely that the improvement is due to the normal, cyclical nature of back pain.[17] Also, the effects seem to be permanent, reducing the likelihood of a placebo effect, which is usually more temporary,[18][19] or the normal fluctuation cycle of chronic pain. Conducting proper scientific tests of Sarno's approach presents many challenges, not the least of which is financing the study. However, late in 2003, the Seligman Medical Institute was established to do just that.[3]

[edit] Notes

  1. ^ Coen SJ, Sarno JE. Psychosomatic avoidance of conflict in back pain. Journal of the American Academy of Psychoanalysis. 1989 Fall; 17(3):359–76.
  2. ^ Schechter D, Smith AP. (2005). "Back pain as a distraction pain syndrome (DPS): A window to a whole new dynamic in integrative medicine.". Evidence Based Integrative Medicine 2 (1): 3–8.
  3. ^ Schechter D. The MindBody Workbook. Los Angeles: MindBody Medicine Publications, 1999.
  4. ^ Borenstein DG, O'Mara JW Jr, Boden SD, et al. The value of magnetic resonance imaging of the lumbar spine to predict low-back pain in asymptomatic subjects: a seven-year follow-up study. The Journal of Bone and Joint Surgery. American Volume. 2001; 83–A(9):1306–11.
  5. ^ Savage RA, Whitehouse GH, Roberts N. The relationship between the magnetic resonance imaging appearance of the lumbar spine and low back pain, age and occupation in males. European Spine Journal. 1997; 6(2):106–14.
  6. ^ Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. Magnetic resonance imaging of the lumbar spine in people without back pain. New England Journal of Medicine. 1994; 331(2):69–73.
  7. ^ 6. Kleinstuck F, Dvorak J, Mannion AF. Are "structural abnormalities" on magnetic resonance imaging a contraindication to the successful conservative treatment of chronic nonspecific low back pain? Spine. 2006 Sep 1;31(19):2250-7.
  8. ^ White AA 3rd, Gordon SL. Synopsis: workshop on idiopathic low-back pain. Spine. 1982; 7(2):141–9.
  9. ^ van den Bosch MA, Hollingworth W, Kinmonth AL, Dixon AK. Evidence against the use of lumbar spine radiography for low back pain. Clinical Radiology. 2004 Jan; 59(1):69-76.
  10. ^ Sarno JE. The Mindbody Prescription: Healing the Body, Healing the Pain. New York: Warner Books, 2000:86-89.
  11. ^ Burton AK, Tillotson KM, Main CJ, Hollis S. Psychosocial predictors of outcome in acute and subacute low back trouble. Spine. 1995; 20:722–8.
  12. ^ Carragee EJ, Alamin TF, Miller JL, Carragee JM. Discographic, MRI and psychosocial determinants of low back pain disability and remission: a prospective study in subjects with benign persistent back pain. The Spine Journal. 2005; 5:24–35.
  13. ^ Hurwitz EL, Morgenstern H, Yu F. Cross-sectional and longitudinal associations of low-back pain and related disability with psychological distress among patients enrolled in the UCLA Low-Back Pain Study. Journal of Clinical Epidemiology. 2003; 56:463–71.
  14. ^ Dionne CE. Psychological distress confirmed as predictor of long-term back-related functional limitations in primary care settings. Journal of Clinical Epidemiology. 2005 Jul; 58(7):714–8.
  15. ^ Kopec JA, Sayre EC, Esdaile JM. 2004. Predictors of back pain in a general population cohort. Spine. 2004 Jan 1; 29(1):70-7; discussion 77-8.
  16. ^ Pengel LH, Herbert RD, Maher CG, Refshauge KM. Acute low back pain: systematic review of its prognosis. British Medical Journal. 2003 Aug 9; 327(7410): 323.
  17. ^ Schechter D, Smith AP (2005). "Long-Term Outcome of Back Pain Patients Treated by a Psychologically Based Program (Abstract #1112)" (PDF). Psychosomatic Medicine 67 (1): A-101. Retrieved on 2006-09-05.
  18. ^ Hansen BJ, Meyhoff HH, Nordling J, Mensink HJ, Mogensen P, Larsen EH. Placebo effects in the pharmacological treatment of uncomplicated benign prostatic hyperplasia. The ALFECH Study Group. Scandinavian Journal of Urology and Nephrology. 1996 Oct; 30(5):373-7.
  19. ^ Montgomery SA: Efficacy in long-term treatment of depression. Journal of Clinical Psychiatry 1996; 57(suppl 2): 24–30.

[edit] External links

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