by John E. Sarno

Chapter 1

I have never seen a patient with pain in the neck, shoulders, back or buttocks who didn't believe that the pain was due to an injury, a "hurt" brought on by some physical activity. "I hurt myself while running (playing basketball, tennis, bowling)." "The pain started after I lifted my little girl" or "when I tried to open a stuck window." "Ten years ago I was involved in a hit-from-behind auto accident and I have had recurrent back pain ever since."

The idea that pain means injury or damage is deeply ingrained in the American consciousness. Of course, if the pain starts while one is engaged in a physical activity it's difficult not to attribute the pain to the activity. (As we shall see later, that is often deceiving.) But this pervasive concept of the vulnerability of the back, of ease of injury, is nothing less than a medical catastrophe for the American public, which now has an army of semidisabled men and women whose lives are significantly restricted by the fear of doing further damage or bringing on the dreaded pain again. One often hears, "I'm afraid of hurting myself again so I'm going to be very careful of what I do."

In good faith, this idea has been fostered by the medical profession and other healers for years. It has been assumed that neck, shoulder, back and buttock pain is due to injury or disease of the spine and associated structures or incompetence of muscles and ligaments surrounding these structures — without scientific validation of these diagnostic concepts.

On the one hand, I have had gratifying success in the treatment of these disorders for seventeen years based on a very different diagnosis. It has been my observation that the majority of these pain syndromes are the result of a condition in the muscles, nerves, tendons and ligaments brought on by tension. And the point has been proven by the very high rate of success achieved with a treatment program that is simple,rapid, and thorough.

Medicine's preoccupation with the spine draws on fundamental medical philosophy and training. Modern medicine has been primarily mechanical and structural in orientation. The body is viewed as an exceedingly complex machine and illness as a malfunction in the machine brought about by infection, trauma, inherited defects, degeneration and, of course, cancer. At the same time medical science has had a love affair with the laboratory, believing that nothing is valid unless it can be demonstrated in that arena. No one would dispute the essential role the laboratory has played in medical progress (witness penicillin and insulin for example).

Unfortunately, some things are difficult to study in the laboratory. One of these is the mind and its organ, the brain.

The emotions do not lend themselves to test tube experiments and measurement and so modern medical science has chosen to ignore them, buttressed by the conviction that emotions have little to do with health and illness anyway. Hence, the majority of practicing physicians do not consider that emotions play a significant role in causing physical disorders, though many would acknowledge that they might aggravate a "physically" caused illness. In general, physicians feel uncomfortable in dealing with a problem that is related to the emotions. They tend to make a sharp distinction between "the things of the mind" and "the things of the body," and only feel comfortable with latter.

Peptic ulcer of the duodenum is a good example. Although some physicians would dispute the idea, there is a fairly wide acceptance among practicing doctors that ulcers are caused primarily by "tension." Contrary to logic, however, the major focus in treatment is "medical," not "psychological," and drugs are prescribed to neutralize or prevent the secretion of acid.

But failure to treat the primary cause of the disorder is poor medicine; it is symptomatic treatment, something we were warned about in medical school. But since most physicians see their role only as treating the body, the psychological part of the problem is neglected, even though it's the basic cause.

In fairness, some physicians make an attempt to say something about tension, but it's often of a superficial nature like, "You ought to take it easy; you're working too hard."

Pain syndromes look so "physical" it is particularly difficult for doctors to consider the possibility that they might be caused by psychological factors, and so they cling to the structural explanation. In doing so, however, they are chiefly responsible for the pain epidemic that now exists in this country.

If structural abnormalities don't cause pain in the shoulder, back and buttocks, what does? Studies and clinical experience of many years suggest that these common pain syndromes are the result of a physiologic alteration in certain muscles, nerves, tendons and ligaments which is called the Tension Myositis Syndrome (TMS). It is a harmless but potentially very painful disorder that is the result of specific, common emotional situations. It is the purpose of this book to describe TMS in detail.

The ensuing sections of this chapter will discuss who gets it, in what parts of the body it occurs, the various patterns of pain and the overall impact of TMS on people's health and daily lives. Following chapters will talk about the psychology of TMS (which is where it all begins), its physiology and how it is treated. Conventional diagnosis and treatment will be reviewed and I will conclude with a chapter on the important interaction between mind and body in matters of health and illness.

Who Gets TMS?

One might almost say that TMS is a cradle-to-grave disorder since it does occur in children, though probably not until the age of five or six. Its manifestation in children is, of course, different from what occurs in adults. I am convinced that what are referred to as "growing pains" in children are manifestations of TMS.

The cause of "growing pains" has never been identified but physicians have always been comfortable in reassuring mothers that the condition is harmless. It occurred to me one day while listening to a young mother describe her daughter's severe leg pain in the middle of the night that what the child had experienced was very much like an adult attack of sciatica, and since this was clearly one of the most common manifestations of TMS, "growing pains" might very well represent TMS in children.

Little wonder that no one has been able to explain the nature of "growing pains" since TMS is a condition that usually leaves no physical evidence of its presence. There is a temporary constriction of blood vessels, bringing on the symptoms, and then all returns to normal.

The emotional stimulus for the attack in children is no different from that in adults — anxiety. One might say that the attack in a child is a paranightmare. It is a substitute for a nightmare, a command decisions by the mind to produce a painful reaction rather than have the individual experience a painful emotion, which is what happens in adults as well.

At the other end of this spectrum, I have seen the syndrome in men and women in their eighties. There appears to be no age limit, and why would there be? As long as one can generate emotions one is susceptible to the disorder.

What are the ages when it is most common, and can we learn anything from those statistics? In a follow-up survey carried out in 1982, 177 patients were interviewed as to their then current status following treatment for TMS. (See page 87 for results of the survey.) We learned that 77 percent of the patients fell between the ages of thirty and sixty, 9 percent were in their twenties, and there were only four teenagers (2 percent). At the other end of the spectrum, only 7 percent were in their sixties and 4 percent in their seventies.

These statistics suggest very strongly that the cause of most back pain is emotional, for the years between thirty and sixty are the ages that fall into what I would call the years of responsibility. This is the period in one's life when one is under the most strain to succeed, to provide and excel, and it is logical that this is when one would experience the highest incidence of TMS. Further, if degenerative changes in the spine (osteoarthritis, disc degeneration and herniation, facet arthrosis and spinal stenosis, for instance) were a primary cause of back pain, these statistics wouldn't fit at all. In that case, a gradual increase in incidence from the twenties on would occur, with the highest incidence in the oldest people.

To be sure, this is only circumstantial evidence, but it is highly suggestive.

So the answer to the question "Who gets TMS?" is "Anybody." But it is certainly most common in the middle years of life, the years of responsibility. Let's now take a look at how TMS manifests itself.

Copyright © 1998 by John E. Sarno, M.D.
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