בית לרפואה שלמה
TMS
Tension Myoneural Syndrome
I dedicate a chapter to this method as a tribute to its groundbreaking contributions in our understanding of pain. I will elaborate on its details and explain its underlying principles.
The emotional component of surrounding chronic pain is significant. Pain is actually just one symptom to which fears, behaviors, habits, doubts and conditioning are added.
The way we perceive and respond to pain is shaped by our cultural background, as well as by biological, psychological, and social factors. By understanding these mechanisms, we can develop more effective ways to manage and ultimately eliminate it.
A little historical background:
The term TMS (Tension Myositis Syndrome or Tension Myoneural Syndrome) was coined by Dr. John Sarno, who was a Rehabilitation Medicine doctor in New York in the 1950’s and 1960’s. Early in his career, Dr. Sarno primarily treated patients with chronic back pain. However, after a decade of dedicated practice, he observed that the treatments he offered did not provide long-term relief for his patients. In his research and clinical practice with endless patients, Dr. Sarno came to understand that there are two distinct groups of people with pain. The first group experiences pain due to a clear structural problem. The second group experiences severe pain in the absence of any identifiable medical finding.
With further research he revealed that the second group of patients exhibited a significantly cultivated emotional substrate. This discovery was a critical step in understanding the mechanism of pain, as it demonstrated the link between pain production in the brain and repressed emotions.
Over the years, Dr. Sarno's studies led him to conclude that back pain is not the only physical symptom that can be caused by repressed emotions. He found that a wide range of diseases and conditions, including neurological disorders, digestive problems, skin rashes, seasonal allergies, fibromyalgia, and orthopedic problems, can also be linked to repressed emotions.
With further research, Dr. Sarno discovered a correlation between certain personality traits and individuals who are more likely to experience pain that originates from tension and repressed emotions. These would generally be:
People who suffer from high levels of anxiety
Individuals that are subjected to high levels of daily stress
People who experience recent trauma
People who experienced past trauma
Individuals with perfectionistic tendencies. These people often engage in self-criticism and have a strong need to be liked
Physiological Fact:
Approximately 85% of pain pathways traverse the emotional neural circuitry within the cerebral domain.
Pain and emotion are closely interconnected. Emotional experiences can activate pain pathways, even in the absence of physical injury. Fears and worries can also exacerbate pain, even if it is caused by a structural condition. In this type of situation, treatment may not be able to completely eliminate the discomfort, but it can significantly reduce it
A comprehensive physical examination is essential to verify the source of the pain and to determine the most appropriate treatment method. Once we have ruled out structural causes, it is possible and even desirable to explore the emotional factors, such as fear, which immensely contributes to pain
Estimated recovery periods for different conditions
Ankle sprain (without tear)
approximately 2 weeks
Nondisplaced hand fracture
4 to 6 weeks
Herniated Disc
2 to 6 weeks for full recovery, in over 90% of patients
Tendonitis
3 to 6 months, based on the location and severity of the injury
In most cases, physical healing occurs naturally and gradually over time.
However, it is not uncommon for individuals with a herniated disc to experience back pain for months to years after the injury
What is the underlying cause for this phenomenon?
Epidemiological studies have clearly demonstrated that a substantial proportion of the population has asymptomatic disc bulges, degenerative changes, knee meniscal tears, shoulder ligament tears, and hip joint abnormalities.
Why is the pain severity of a herniated disc so variable, with some people experiencing severe pain and others being asymptomatic?
Approximately 10% to 15% of individuals are believed to experience chronic pain attributable to TMS. Given the prevailing lack of awareness, a significant number of those afflicted by such pain continue to be without appropriate treatment.
From personal experience, this situation is profoundly frustrating.
How do we know if our pain is due to TMS?
As I mentioned, it is essential to undergo a thorough medical examination to rule out any underlying structural problems. This includes ruling out serious conditions such as tumors, arthritis, fractures, and cracks caused by trauma. Of course, it is important for everyone to take personal responsibility for their own health and seek the necessary imaging and blood tests if necessary.
However, once we have ruled out a structural problem, we will assess the patient's other symptoms, which can be widespread and affect multiple areas of the musculoskeletal system, including the muscles, nerves, ligaments and tendons:
Fibromyalgia
Radiating pain to hand or leg
Sleeping disorders
acute or chronic LBP
Irritable bladder
Carpal Tunnel Syndrome
Tennis elbow, Golfer's elbow, Pains in heel and knees
Tinnitus with no spot diagnosis
Migraines and recurring headaches
Seasonal allergies
Paraesthesia (burning or prickling sensations) or decreased sensation in hands or legs
Acute or chronic neck pain,acute or chronic LBP
Irritable bowel syndrome
The wide range of symptoms associated with TMS indicates that it is a highly prevalent condition that can affect anyone.
It is not uncommon to find that the symptoms and imaging findings do not perfectly align.
Additionally, there are several key parameters that can serve as directional indicators for TMS:
Discrepancy between the patient's reported symptoms and the findings of imaging studies (for example, radiating pain along the leg that does not match the finding of the bulge in the back x-ray)
Alternating pains - Symptomatic manifestations exhibit an alternating pattern, affecting various joints or disparate anatomical regions within the body
Symmetry - for example pain appearing in both wrists
Worsening of symptoms after a doctor's visit, treatments or checkups
Certain personality characteristics: Hypochondriacs, anxious people, perfectionists, and individuals with a propensity for seeking approval or validation
When contemplating the pain amplifies its intensity
Improvement in symptoms following education about the mechanism of TMS
Individuals who peruse the method and sense that it has been tailored to their specific needs
Proximity to a traumatic or dramatic event in our lives or during a period of heightened stress
Conditioning - Discomfort alleviated through positional adjustment (e.g., reclining to alleviate discomfort)
Intermittent symptoms characterized by a cyclical pattern, such as persistent pain throughout the workweek followed by remission during weekends or vacations / travel
Individuals who have endured childhood traumas or are currently facing such challenges
Individuals who consistently harbor apprehensions and fears regarding their discomfort and pain
