# Tension myositis syndrome

Tension myositis syndrome (TMS), also known as tension myoneural syndrome or mindbody syndrome, is a name given by John E. Sarno to what he claimed was a condition of psychogenic musculoskeletal and nerve symptoms, most notably back pain. Sarno described TMS in four books, and stated that the condition may be involved in other pain disorders as well. The treatment protocol for TMS includes education, writing about emotional issues, resumption of a normal lifestyle and, for some patients, support meetings and/or psychotherapy.
The TMS diagnosis and treatment protocol are not accepted by the mainstream medical community.

## Conceptual basis

According to Sarno, TMS is a condition in which unconscious emotional issues (primarily rage, though other practitioners include other subconscious emotional issues such as anxiety, past trauma, and fear) initiate a process that causes physical pain and other symptoms. His theory suggests that the unconscious mind uses the autonomic nervous system to decrease blood flow to muscles, nerves or tendons, resulting in oxygen deprivation (temporary micro-ischemia) and metabolite accumulation, experienced as pain in the affected tissues. Sarno theorized that because patients often report that back pain seems to move around, up and down the spine, or from side to side, that this implies the pain may not be caused by a physical deformity or injury.
Sarno stated that the underlying cause of the pain is the mind's defense mechanism against unconscious mental stress and emotions such as anger, anxiety and narcissistic rage. The conscious mind is distracted by the physical pain, as the psychological repression process keeps the anger and rage contained in the unconscious and thereby prevented from entering conscious awareness. Sarno believed that when patients recognize that the symptoms are only a distraction, the symptoms then serve no purpose and subsequently go away. TMS can be considered a psychosomatic condition and has been referred to as a "distraction pain syndrome."
Sarno was a vocal critic of conventional medicine with regard to diagnosis and treatment of back pain, which is often treated by rest, physical therapy, exercise and/or surgery.

## Symptoms

Back pain is frequently mentioned as a TMS symptom, but Sarno defined TMS symptoms much more broadly:
* Symptom type: TMS symptoms include pain, stiffness, weakness, tingling, numbness, muscle contractures, cramps and other negative sensations, according to Sarno.
* Symptom location: In addition to the back, Sarno stated that TMS symptoms can occur in the neck, knee, arms, wrists, and other parts of the body. Schechter states that the symptoms have a tendency to move to other parts of the body. He considers symptom movement an important indicator that the pain is from TMS.

## Diagnosis

Below is a list of criteria for diagnosing TMS, according to Schechter and Sarno:
* Lack of known physical cause: Schechter and Sarno state that a physical examination, tests and imaging studies is needed to rule out serious conditions, such as tumors. Sarno considers spinal disc herniations to generally be harmless, because he says the symptom location does not even correlate to the herniation location.
* Tender points: While medical doctors use eleven of eighteen tender points as a diagnostic criteria for fibromyalgia, Sarno states that he uses six main tender points to diagnose TMS: two tender points in the upper trapezius muscles, two in the lumbar paraspinal muscles and two in the lateral upper buttocks. He states that these are found in 99% of TMS patients.
* History of other psychosomatic disorders: Schechter and Sarno consider a prior history of other psychosomatic disorders an indication that the patient may have TMS. They list irritable bowel syndrome and tension headache as examples of psychosomatic disorders.
Schechter and Sarno state that if a patient is unable to visit a medical doctor who is trained in TMS, then the patient should see a traditional medical doctor to rule out serious disorders, such as fractures, tumors and infections.

## Treatment

Sarno recommended ignoring chronic muscular-skeletal pain, and living everyday life as if there was none.

## Notable patients

Notable people who have been treated for TMS include the following:
* Radio personality Howard Stern credited TMS treatment with the relief of his "excruciating back and shoulder pain", as well as his obsessive-compulsive disorder.
* 20/20 co-anchor John Stossel was treated by Sarno for his chronic debilitating back pain. In a 20/20 segment on his former doctor, Stossel stated his opinion that the TMS treatment "cured" his back pain, although he admitted that he continues to have relapses of pain.
* Television writer and producer Janette Barber said that for three years, she had been increasingly unable to walk, and eventually began to use a wheelchair, due to severe ankle pain originally diagnosed as tendinitis. She was later diagnosed and treated for TMS. According to Barber, she was "pain-free one week after [Sarno's] lecture" and able to walk and run within a few months, notwithstanding her "occasional" relapses of pain.
* The late actress Anne Bancroft said that she saw several doctors for back pain, but only Sarno's TMS treatment helped her.
* The acclaimed filmmaker Terry Zwigoff said he was on the verge of suicide due to his debilitating back pain, until he turned in desperation to Sarno's method and it "saved [his] life", as well as the life of a woman he told about it more recently.

## Reception

The TMS diagnosis and treatment protocol are not accepted by the mainstream medical community. Sarno himself stated in a 2004 interview with Medscape Orthopaedics & Sports Medicine that "99.999% of the medical profession does not accept this diagnosis." Although the vast majority of medical doctors do not accept TMS, there are doctors who do. Andrew Weil, an alternative medicine proponent, endorses TMS treatment for back pain. Mehmet Oz, a television personality and Professor of Surgery at Columbia University, includes TMS treatment in his four recommendations for treating back pain. Richard E. Sall, a medical doctor who authored a book on worker's compensation, includes TMS in a list of conditions he considers possible causes of back pain resulting in missed work days that increase the costs of worker's compensation programs.
Patients typically see their doctor when the pain is at its worst and pain chart scores statistically improve over time even if left untreated; most people recover from an episode of back pain within weeks without any medical intervention at all. The TMS theory has also been criticized as too simplistic to account for the complexity of pain syndromes. James Rainville, a medical doctor at New England Baptist Hospital, said that while TMS treatment works for some patients, Sarno mistakenly uses the TMS diagnosis for other patients who have real physical problems.