Healing Back Pain

1. TMS: A Mind-Body Connection Causing Physical Pain

TMS is characterized by physical pain, but that acute discomfort is induced by psychological phenomena rather than structural abnormalities or muscle deficiency.

Mind-body connection. Tension Myositis Syndrome (TMS) is a condition where physical pain, typically in the back, neck, or shoulders, is caused by psychological factors rather than structural issues. This challenges the conventional medical view that pain must have a physical cause.

Common misconceptions. Many patients attribute their pain to injuries, degenerative processes, or congenital abnormalities. However, TMS is a benign condition caused by mild oxygen deprivation in muscles and nerves, triggered by repressed emotions. Understanding this connection is crucial for proper diagnosis and treatment.

Widespread impact. TMS affects a significant portion of the population, with over 80% of people experiencing back pain at some point in their lives. This "epidemic" of pain has risen dramatically in the past 30 years, costing billions in healthcare and lost productivity.

2. The Psychology Behind TMS: Repressed Emotions

To sum up, the word tension will be used here to refer to repressed, unacceptable emotions.

Emotional roots. TMS is primarily caused by repressed emotions, particularly anxiety and anger. These feelings are often unconscious, stemming from personality traits such as perfectionism, conscientiousness, and a strong need to please others.

Unconscious defense. The pain serves as a distraction from these uncomfortable emotions, effectively keeping them repressed. This process is entirely unconscious and not a deliberate choice by the patient.

Common personality traits:

• Hardworking and responsible
• Perfectionistic and self-critical
• People-pleasing tendencies
• Difficulty expressing anger
• High achievers with a strong sense of obligation

3. Physiology of TMS: Oxygen Deprivation in Muscles

We have postulated that in TMS the autonomic system selectively decreases blood flow in certain muscles, nerves, tendons, and ligaments in response to the presence of repressed emotions like anxiety and anger.

Autonomic nervous system. TMS is triggered by the brain's autonomic nervous system, which controls involuntary bodily functions. In response to repressed emotions, it reduces blood flow to specific areas, causing mild oxygen deprivation.

Symptoms of oxygen deprivation:

• Muscle pain and spasms
• Nerve pain, numbness, and tingling
• Tendon and ligament pain

No structural damage. Unlike many traditional diagnoses, TMS does not involve actual damage to muscles, nerves, or other structures. The pain is real, but it's caused by temporary changes in blood flow rather than injury or degeneration.

4. Challenging Traditional Diagnoses of Back Pain

In my experience, structural abnormalities of the spine rarely cause back pain.

Overdiagnosis of structural issues. Many common diagnoses for back pain, such as herniated discs, spinal stenosis, or degenerative disc disease, are often incidental findings rather than the true cause of pain. These structural abnormalities are frequently present in people without pain.

Misattribution of symptoms. Doctors often attribute pain to visible abnormalities on imaging studies, leading to unnecessary treatments and surgeries. This focus on structural issues can reinforce patients' fears and lead to chronic pain.

Examples of overdiagnosed conditions:

• Herniated discs
• Spinal stenosis
• Facet syndrome
• Arthritis of the spine
• Spondylolisthesis

5. The Treatment of TMS: Knowledge as Medicine

Information is the penicillin that cures this disorder.

Education as treatment. The primary treatment for TMS is education about the condition. Understanding the true cause of the pain allows patients to break the cycle of fear and avoidance that often perpetuates the condition.

Key components of TMS treatment:

1. Learning about the mind-body connection
2. Recognizing the role of repressed emotions
3. Understanding that the pain is not caused by physical damage
4. Accepting that it's safe to resume normal activities

Breaking the pain cycle. By recognizing the pain as a distraction from emotional issues, patients can begin to focus on addressing these underlying concerns rather than fixating on physical symptoms.

6. Overcoming Fear and Resuming Physical Activity

Perhaps the most important (but most difficult) thing that patients must do is to resume all physical activity, including the most vigorous.

Fear as a perpetuator. Many patients with chronic pain develop fear of movement, believing that physical activity will cause further damage. This fear often leads to deconditioning and increased pain sensitivity.

Gradual return to activity. A crucial part of TMS treatment is overcoming this fear and resuming normal physical activities. This process helps break the pain cycle and reinforces the understanding that the pain is not caused by physical damage.

Steps to resuming activity:

1. Start with gentle movements and gradually increase intensity
2. Challenge fearful thoughts about movement
3. Focus on functional goals rather than pain reduction
4. Engage in previously enjoyed activities and hobbies

7. The Broader Implications of Mind-Body Medicine

Experience with TMS contradicts both biases. The disorder is a benign (though painful) physiologic aberration of soft tissue (not the spine), and it is caused by an emotional process.

Paradigm shift. The understanding of TMS challenges the traditional medical view that separates mind and body. It demonstrates that emotions can have profound effects on physical health.

Implications for other conditions. The mind-body connection observed in TMS may have implications for understanding and treating other conditions, such as:

• Gastrointestinal disorders (e.g., irritable bowel syndrome)
• Allergies and asthma
• Some cardiovascular conditions
• Certain immune system disorders

Future of medicine. Recognizing the role of emotions in physical health could lead to more holistic and effective treatments for a wide range of conditions. This approach encourages addressing both the physical and emotional aspects of health for optimal well-being.

Last updated: July 31, 2024