Tension Myositis Syndrome SARNO 2009

The Divided Mind JE Sarno 2006

Do you suffer from one or more of the following problems and are they now becoming a chronic problem where it seems the pain is constantly present? Neck, back and trunk pain, stiffness in the neck and or back, headaches, pains in the joints or muscles or even in the hands or feet.

You may have a condition called TENSION MYOSITIS SYNDROME (TMS). This condition was discovered by Dr John Sarno (1970s), Professor of Clinical Rehabilitation Medicine, New York School of Medicine, and attending physician at the Howard A Rusk Institute of Rehabilitation Medicine, New York University Medical Centre.

This disorder refers to physical disorders of the mindbody, disorders that may appear to be purely physical but which have their origin in unconscious emotions. This is not a condition brought about by the daily stresses of life. When physicians are confronted with these disorders and there are many different configurations of TMS, they do not recognise it for what it is and only treat the symptoms.

It is important to understand that this is a physical condition with physical symptoms and it is not ‘in your head!’ If the suffering patient understands and accepts the condition, he or she is able to banish the condition, it cannot be ‘cured’ by the doctor!

How often is a patient that is suffering with severe pain, sent for an MRI X ray examination only to be told that there is nil to be seen and that all the tissues are normal, yet they are in extreme and constant pain?

How often is a patient told that they have a disc lesion or degenerative changes in their spine at a specific level and yet the pain is not found in the exact area of the so-called lesion?

How often is a patient sent for an X-ray and they are diagnosed with a disc lesion, degenerative changes in the spine, knee or shoulder and yet they have no pain?

How can a condition continue for years and yet the patient remains relatively healthy?

Yet pain itself often debilitates the person preventing them from enjoying all the normal activities of daily life including sport, entertainment and even possibly sex. Chronic pain may depress a patient and may make them fearful of moving and cause limitations in both their work and their lifestyle.

The concept of this type of medicine is to understand and internalize the knowledge on a deeply personal level that the mind has great power over the body. The mind contains the root cause of the physical distress and emotions and feelings have an awesome power that is totally unconscious which is capable of producing this physical effect on the body. This is not the same as a condition worsening because the patient is anxious!

The brain is actually able to induce physical symptoms as it orders a reduction of blood flow to a specific part of the body, resulting in mild oxygen deprivation, which causes pain and other symptoms depending on what tissues have been oxygen deprived. Imagine a tourniquet on your arm for even ten minutes – excruciating pain would develop because oxygen deprivation would occur in all the tissues of the arm and it can only be relieved by the tourniquet being released as the blood flows back into the arm – this is similar to what the brain is able to do in any area of the body – but the good thing about it is that this mild ‘tourniquet situation’ is totally harmless!

How does the brain achieve this control of our body? One of the pathways of control is through the autonomic-peptide system. This is a branch of the central nervous system which controls the involuntary systems of the body such as the circulatory, gastrointestinal and genitourinary systems. It is active 24 hours a day and functions outside our awareness. The word peptide has been added because these molecules participate in a system of intercommunication between the brain and the body and play an important role in this process. The most common disorders produced through this system are those of TMS and besides pain in the neuro/muscular/skeletal system also includes: gastroesophageal reflux, peptic ulcer, oesophageal spasm, hiatus hernia, irritable bowel syndrome, spastic colitis, tension headache, migraine headache, frequent urination (unrelated to diabetes), most cases of prostatitis and sexual dysfunction, tinnitus or dizziness unrelated to neurological disease.

If there is a localised reduction in blood flow to a specific region or structure such as a spinal nerve, the result is pain which is the primary symptom of TMS. The tissues that may be targeted by the brain include the muscles of the neck, shoulders, back or buttocks, any spinal or peripheral nerve and any tendon. Any nerve involvement may also create pins and needles and or numbness.

Other ailments that can be initiated by the brain are those associated with the immune system and it is not yet known which system or symptom the brain chooses to employ. The result is either an under or over active immune activity. Over activity leads to allergic phenomena (rhinitis, conjunctivitis, sinusitis, asthma) and a large number of skin problems (eczema, hives, angioedema, acne, psoriasis). If the immune system is underactive it renders the person susceptible to infection.

Another pathway that is susceptible to the brain’s influence is the neuroendocrine-peptide system which controls the body’s hormonal distribution.

Why does the brain do this to our bodies? It seems the purpose is to deliberately distract the conscious mind – it is less ‘painful’ and more acceptable to have a physical pain than to feel the emotional pain of sadness, loss, embarrassment, anger and rage, and many others. The type of symptom and location in the body is not important as long as it fulfils the purpose of diverting attention from what is transpiring in the subconscious. Often the choice of symptom may contribute to the diversion process by creating a pain after an activity or even infection which is then assumed by the patient to have been caused by the ‘injury’ and provides a valid reason for the pain. The brain has decided that the time is right for a physical diversion and renders an area slightly oxygen deprived and hence the pain! If the symptom loses its power to distract, then another symptom will occur (the brain will simply find another target) and due to its physical nature it will be assumed that it will require physical treatment. The altered physiology that causes the pain therefore occurs due to mild localised reduction of blood flow to a small region or specific body structure such as a spinal nerve resulting in a mild state of oxygen deprivation.

Many people find it very difficult to accept that emotions and feelings could be responsible for their physical condition and find it insulting, implying that there is something strange or weak about the individual. This is unfortunate because the symptoms are very real, the result of a very physical process. Many people find stress easier to accept as a causative factor for physical symptoms because it seems that it is something ‘out there’ that does not have anything to do with the individual. Mindbody reactions and the emotions that cause them are universal. They are not illnesses, in fact they are a part of life, part of the human condition.

It has been discovered that buried rage (totally unconscious) is most often the cause of the physical process and by uncovering the source and understanding this information by the patient will ‘cure’ the pain. The patient has to go back to childhood and recall all the situations that may have caused anger, irritation, distress, sadness, in fact emotional pain of any description. It is only in the recall and acknowledgement of the situation that the subconscious emotion/s rise to the surface of consciousness. Once the event is recalled, acknowledged and understood then the emotion is no longer subconscious and the physical symptoms will recede. It can be immediate or take up to 3 months depending on the acceptance by the patient. There is no need to dwell on the remembered situation and the only treatment that is recommended is that the patient should allocate 15 minutes twice a day to writing in a notebook the events that may have caused any distress from earliest memory. Ask yourself: what made me angry, sad, gave emotional pain or caused unhappiness? As you continue to do this exercise, you may find your pain disappearing and you will be able to resume all your normal activities and movements. If some pain resurfaces or symptoms that you attribute to TMS occur, ask yourself what emotion is buried that you are unaware of that relates to this pain? Once you know the emotion, the pain (if TMS) will disappear before it becomes entrenched and you become fearful of moving.

What must you do when you feel pain? Learn to become unconcerned, even ignore the pain as you work on your inner feelings. If the pain is too difficult to ignore then treat your pain with mild medication or use a procedure that normally assists the pain such as applying heat, electrical devices, creams or gels. If necessary provide a short period for rest and in some situations even exercise may prove beneficial. Concern breeds anxiety and fear and these thoughts and feelings produce substances that aggravate pain.

Why does the brain need to produce pain to protect us from our emotions? Our natural instincts are more about self-preservation and activities that serve the self rather than others. In order to exist in a civilised socialised society we constantly need to repress feelings that we have and alter our behaviour to please others. We have to teach children how to behave properly otherwise their behaviour would be unacceptable in our normal society. This repression becomes totally unconscious but may eventually manifest in a condition which causes pain and discomfort.

Is there a specific personality that develops TMS? It is noted that persons most commonly affected by this disorder are the do-gooders, those people that always put others needs before themselves. This may stem from feelings of lack of self-esteem and wishing to be a good person and please others. If this is our common behaviour then our subconscious mind may become angry because our own needs are most often not met leading to internal rage and anger and these are the emotions that we are totally unaware of.

Back pain associated by the patient as occurring after a long car journey may be considered as an example of TMS. We should ask this patient: what were the circumstances around this trip, the purpose of the trip as well as the emotional outcome of the trip? Awareness and understanding of the emotional underpinnings of defensive behaviour (pain in the structure) must occur during your treatment analysis of the situation and physical (back pain) and repressive measures (lack of movement) must be recognised as counterproductive.

Always consult your doctor before you embark on this programme to insure that you have not overlooked other serious conditions.

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