Tension Myoneural Syndrome (TMS)

The cornerstone of Dr. Sarno’s theoretical and clinical approach to treating psychophysiological pain disorders is that physical pain can develop as a distraction from emotional distress, even without permanent alterations in the structure or functioning of the affected part of the body. Dr. Sarno has identified Tension Myoneural Syndrome (TMS) as a psychophysiological pain disorder in which emotional experiences, which may be partially or completely out of a person’s awareness, produce ischemia or reduced blood flow to the postural muscles, resulting in mild oxygen deprivation and pain.

Dr. Sarno describes TMS, which he initially referred to as Tension Myositis Syndrome, as a physical disorder characterized by pain and/or other neural symptoms affecting a variety of musculoskeletal locations. He emphasizes that the pain is real; it is not imaginary or “in the patient’s head” as sometimes misconstrued by physicians and analytically-oriented clinicians. Because TMS is a physical disorder, the subjective experience of pain is indistinguishable from pain originating from organic conditions such as injuries, tumors, and infections, even though the physical mechanism responsible for the syndrome is psychologically induced.

TMS is a physical disorder that can only be diagnosed by a physician. Once the diagnosis of TMS has been established, Dr. Anderson and Dr. Sherman use an analytically-oriented treatment approach.

Pain Symptomatology

Dr. Sarno conceptualizes the pain symptomatology as a self-protective reaction or a psychological defense against recognizing and experiencing intolerable emotions, not the result of structural damage or disease. For example, when a herniated disc is diagnosed as the cause of the patient’s pain and disability, a psychophysiological disorder can be misdiagnosed and physical treatments not only fail but may also serve to intensify the symptomatology. Appropriate treatment is delayed or denied, and iatrogenic or medically-induced debility develops. Often the patient becomes increasingly preoccupied with the pain symptomatology. Now every bodily sensation echoes and confirms the doctor’s dire assessment, reinforcing the patient’s own sense of being permanently damaged.

Because of our work with Dr. Sarno, our treatment of patients, in contrast to mainstream thinking about the diagnosis and treatment of musculoskeletal pain and psychophysiological disorders, is guided by the idea that pain symptomatology develops in response to intolerable emotional experiences, not the other way around. Pain functions as a compelling distraction, deflecting an individual’s attention away from unbearably frightening or disruptive internal experiences.

Obviously, the profound way our thinking about pain symptomatology differs from the mainstream influences the development and application of techniques for treating patients with psychophysiological disorders, including musculoskeletal pain. Many clinicians will pay lip service to the notion that psychological factors influence an individual’s experience of pain, both favorably and unfavorably. What distinguishes Pathways to Pain Relief is that it embraces the position that musculoskeletal pain and other psychophysiological disorders can originate from psychological experiences as a means to protect an individual from unbearable emotional distress. Psychotherapeutic techniques based on the medicalization of musculoskeletal pain foreclose the possibility of approaching these conditions as a psychophysiological disorder. The medicalization paradigm prevents many clinicians from recognizing that the same emotional conflicts which lead to psychological symptoms can initiate the development of physical symptoms as well.