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Tension Myositis Syndrome


Permission graciously given by the author to reproduce this paper.

Tension Myositis Syndrome

Cathy Tsang-Feign 
2005

Statistics show that there were almost 15 million doctor visits for low back pain in 1990, ranking this problem the fifth leading reason for all physician visits in America.  Currently two percent of the United States work force suffers from chronic back pain, costing the U.S. economy a total of $50 billion annually.  This problem disables many individuals, causing them to suffer from loss of self-esteem, depression and alienation from loved ones, friends and coworkers.  It has also become an important and lucrative business in the medical field. 

For many chronic pain patients the search for proper treatment to ease their pain and a cure for their problem can be in itself a painful and endless journey which leads from one specialist to another.  A good example is my client, John, who was a practicing physiotherapist in his early thirties.  His back pain left him disabled for six years and extremely depressed.  Like most back pain patients, he was told that there was a structural problem with his back, such as a herniated disc, an impinged nerve or degenerative arthritis condition, resulting in severe pain.  Yet regardless of various treatments, his condition persisted until very recently he was properly diagnosed as having Tension Myositis Syndrome (TMS). Only then did things begin to change.

Before we discuss Tension Myositis Syndrome it is important to understand pain associated with back pain.  Low back pain is just a symptom, and pain is a subjective experience which is difficult to define or communicate precisely.  According to Dr. John Sarno, the idea that back pain is due to structural abnormalities is highly ingrained in the medical profession.  The wear and tear and changes in the spine or discs shown in imaging studies may not substantiate the pain an individual experiences.  In fact, the correlation of pain with anatomical abnormalities is surprisingly low. Excellent point.  In other words, a person can have substantial structural abnormality in diagnostic imaging and not experience much pain. Absolutely true  Whereas another person’s diagnostic tests may be within normal limits, yet the person experiences severe pain. A recent study published in the journal Radiology (1998; 206:49 – 55) confirms that commonly diagnosed structural conditions of the spine are found in individuals without any symptoms.  MRI scans show that an asymptomatic population indicated 81% disc bulges, 55% with severe disc degeneration and 33% with disc protrusions. 

Research shows a strong link between emotional issues and back pain.  People actually experience pain in their minds. For some patients like my client John, no amount of correction in manipulative therapies, medication, exercise or re-alignment will take away the pain unless the person starts addressing the psychological elements that trigger the pain symptoms.  Some chronic back pain patients simply are caught up in the mind-body battle within themselves. This is commonly found in people who suffer from Tension Myositis Syndrome (TMS).  TMS is a term coined by John Sarno, MD.  The syndrome refers to a painful yet harmless condition in which patients unconsciously repress conflicts or emotions that they are trying to avoid.  The accumulative effect of all these emotions ultimately manifests through their body as musculoskeletal pain. 

Often individuals try to avoid unpleasant emotions such as anger and fear by pushing them out of their consciousness or distracting themselves.  However, the unresolved emotions are still lurking around in the memory and the unconscious mind, which causes changes in brain chemicals and activates the autonomic nervous system.  This mechanism automatically triggers muscle tension in the person. These physical symptoms serve a secondary psychological purpose of further distracting an individual from the repressed painful thoughts and emotions.

According to Dr. Sarno, beneath the musculoskeletal pain is tension.  Results of his studies show that 88 percent of patients with back pain had a history of various degrees of disorders related to tension, such as migraine headaches, heartburn, stomach ulcers, colitis or spastic colon.  The nervous tension causes muscles spasms which affect the blood circulation of areas involved in the above-named symptoms.  When muscles and the associated nerves are deprived of normal supply of blood it results in pain in the back and/or limbs.  At the same time the reduction in local supply causes reduction of oxygen to the muscles and nerves which directly aggravates the back pain.

The treatment modality developed by Dr. Sarno is simple yet powerful, starting with educating patients about their psychology and how it induces physical maladies.  He uses psychoneurophysiology of psychogenic processes to explain how emotions stimulate the brain to produce physical symptoms. According to Dr. Sarno, the key to recovery from TMS is understanding and accepting the diagnosis that a physical pain has its origins in the mind and in the emotions.  Connecting the mind and body is the key of TMS treatment, which allows people to release the tension and develop a new way to experience and express their previously repressed feelings and emotions.  This method is very similar to Cognitive Behavioral Therapy, which helps patients to raise their awareness and then further develops a healthier way to deal with their emotions and fears.  By gaining awareness they can help their bodies to release tension and back pain.

Dr. David Schechter, a Los Angeles based physician, also developed a mind-body approach to successfully treat Tension Myositis Syndrome patients.  He uses conjunctive therapy with a  psychologist trained in TMS treatment to work with patients.  The approach focuses on helping individuals to obtain emotional insights and awareness into the mind-body connection in back pain and other disorders such as fibromyalgia, tension headaches and irritable bowel syndrome.  His methodology also focuses on identifying types of personality traits associated with TMS.  Typically, TMS sufferers are perfectionist, self-critical, control-oriented individuals who are prone to other psychosomatic disorders.  Identifying the personality traits helps bring awareness to patients who used to pride themselves on striving for excellence in life while putting tremendous pressure on themselves without recognizing it.  This awareness forces them to take a hard look at themselves, review their way of life, and in turn make choices to alter their patterns of thinking and feeling.

My work with John helps me to appreciate the power of our mind and emotions.  We have to learn to listen to and respect our feelings and emotions instead of squashing them.  During the treatment process, John began to get in touch with his emotions, which was quite frightening for him.  There were certainly setbacks.  At times his back pain totally engulfs him and causes him to totally shut down. With a client like John, I have to work very carefully to release his pain by guiding him to address his emotions rather than shutting down.  Another major hurdle for John to overcome throughout the treatment is trusting his feelings rather than using his mind to rationalize things.  People like John usually have a very strong will and a powerful mind, yet they use it to trap themselves inside rather than freeing themselves.  It has been a crucial step to help John to connect his mind and emotions to his body so that feelings can flow naturally.  The tools I learned from TMS treatment and Cognitive Behavioral Therapy enhanced my ability to support my client to venture into the new territory that he has unconsciously avoided for a long time.  By doing so he was able to open up himself, trust his feelings and gradually experience less pain.  His back pain has not totally subsided but definitely he is on the way toward recovery.

Conjunctive Therapy and Cognitive Behavioral Therapy are both useful and effective methodologies to help individuals who get caught up in the mind-body battle.  I feel that the general public should be more educated and informed about Tension Myositis Syndrome and how our minds can contribute to or bring destruction to our overall health. 

References

Brose, W. (2004). Interdisciplinary pain rehabilitation program: the peer reviewed, 
        naturally recognized evidence: help for chronic pain suffers. 
        website: http://www.helppain.net/transcriptFL.pdf

Brose, W. (1997). Pain management – the payer’s perspective. 
         website: http://www.asahq.org/Newsletters/1997/11_97/Chronic_1197.html

Ring, A (1975).  Chronic back pain – TMS. 
         website: http://arlenring.com/chronicbackpain.php

Sarno, J. (1973). Healing back pain. 
         website: http://www.healingbackpain.com 

Schechter, D. (1970).  What is mind-body.
        website: http://www.mindbodymedicine.com/1tms.html

Reference abstracts

Brose, W. (2004). Interdisciplinary pain rehabilitation program: the peer reviewed, naturally recognized evidence: help for chronic pain suffers.

Abstract
According to Dr. Brose that treatment of chronic pain is one of the failures of the biomedical model that underpins much of the medical system. It fails to address the negative impact of chronic pain on workers over a longer term.  The cycle of failed treatment among medical professionals leaves patients with feelings of hopelessness, helplessness and other psychological barriers.  Interdisciplinary pain rehabilitation programs, working along with mental health professionals, have proven to be more effective.

Brose, W. (1997). Pain management – the payer’s perspective.

Abstract
Using the biomedical model physicians are in search of the cause of the poorly understood conditions of chronic disease and pain which lead to prolonged treatment.  The payers of health care recognize the tremendous escalation of health care costs in seeking medical cures of chronic pain.  The mounting problem in pain management has risen to a boiling point.  It is obvious to medical consumers that there is an excess of care with low return for the dollar in terms of improved health care, which can ultimately worsen the existing health system. 

Ring, A (1975).  Chronic back pain – TMS.

Abstract
According to the author, chronic pain is a subjective experience and is not well understood in the medical profession.  Patients suffering from Tension Myositis Syndrome (TMS) tend to clench their muscles unconsciously, which leads to changes in the limbic system.  There are some common physical problems masked behind TMS, such as tension headaches and irritable bowel syndrome, which at their roots are related to repressed emotions. When patients begin to address their hidden emotional issues the chronic pain can be alleviated.

Sarno, J. (1973). Healing back pain.

Abstract
The author, Dr. Sarno, discusses how he developed the mind-body model in the treatment of Tension Myositis Syndrome (TMS).  He disputes the general belief that chronic pain is caused by structural abnormalities.  His clinical data indicates that a high percentage of patients with chronic back pain have various tension-related disorders.  He suggests that helping patients to recognize their emotions is the key to releasing them from chronic back pain.

Schechter, D. (1970).  What is mind-body.

Abstract
According to Dr. Schechter, mind-body prescription is the key to healing chronic back pain.  In treating individuals with chronic back pain it is crucial to help them connect the body with their emotions rather than simply looking at the physical symptoms.  The author also developed a personality profile to identify patients suffering from Tension Myositis Syndrome.