FREQUENTLY ASKED QUESTIONS
What qualifies you to talk to me about my pain?
Well, I’ve got two master’s degrees (one in Human Physiology, the other in Traditional Chinese Medicine). I’ve been in private practice as a licensed acupuncturist for nearly 14 years and have helped thousands of patients find relief from a wide variety of chronic and stubborn medical problems. I’ve dedicated my entire adult life to studying health from every possible point of view — all the way from the laboratories at Monsanto headquarters to the energy vortices in Sedona, Arizona — nothing has been off-limits in my quest to understand the human body in health and disease.
But, at least in this context, my most important qualification is the fact that I’ve struggled with (and overcome) chronic pain and autoimmune disease myself, using exactly the strategies and techniques described on this site. In order for you to get better, you are going to need to be willing to believe me when I confront you with some truths that may seem pretty challenging. When you’re tempted to write me off as full of crap, please remember that I’ve walked down (and am still walking down) the road I am suggesting that you tread. I’ve wrestled with all of this myself. I know how you feel.
What the heck is TMS?
TMS stands for Tension Myositis Syndrome. This acronym was later revised to Tension Myoneural Syndrome or The Mindbody Syndrome when Dr. Sarno realized that there was no “itis” (inflammation) involved in the condition and tissues other than muscles (myo) were involved.
Pain is a hiding place for nervous tension
This phenomenon is described in great detail in Dr. Sarno’s books, but the gist of it is this: pain is a ploy on the part of the psyche to keep a person distracted from unconscious emotions that are so shameful or overwhelming or socially unacceptable that they would threaten a person’s whole sense of self and ability to function in the world if they were to bubble into consciousness. According to Dr. Sarno, when unconscious emotions threaten to emerge into consciousness, the autonomic nervous system causes blood vessels to constrict (a phenomenon that can happen as quickly as a person blushes when they are embarrassed). This constriction deprives muscles and nerves of oxygen and causes pain, pain serves as a very effective distraction, and difficult emotions remain safely locked away in the unconscious mind.
So you're saying my pain is all in my mind?!
Definitely not. Your pain is absolutely, positively real. It is caused by a lack of oxygen to muscles, nerves, and/or connective tissues. This causes very real pain, in fact it causes some of the worst pain a person can have.
But what is causing the lack of oxygen? According to Dr. Sarno, the psyche initiates a process whereby autonomic nervous system (the portion of the nervous system that is in charge of all the body functions that you cannot consciously control) restricts blood flow to specific tissues as a distraction mechanism when unconscious emotions threaten to bubble to the surface.
An alternative, but remarkably similar, explanation comes from the ancient text (written around 200 BCE) upon which Chinese medicine is based. It says “bu tong ze tong, tong ze bu tong” which translates roughly to “if there is no free [blood] flow, there is pain; if there is free [blood] flow there is no pain”. There has long been an awareness among the sages of Chinese medicine that “unresolved” emotions are a primary cause of this lack of free flow. According to Chinese medicine, chronic pain is often caused not by a physical problem but by “crystalized emotion”, which results from familial issues that have been swept under the rug, early childhood abuse forgotten by the conscious mind but remembered by the body, and/or refusal to face one’s own shadow side and trying to be “all goodness and light” while denying deeper layers of emotion. In these cases, the treatment is to “dare to shine the light of awareness into the dark death sleep of a denied truth” (Lorie Eve Dechar, in her book Five Spirits: Alchemical Acupuncture for Psychological and Spiritual Healing).
So you're saying I'm a head case?!
No, I am saying that you are human. There is a primitive, childish part of the brain (which Freud called the id) that exists in each of us, without exception. TMS is an effort on the part of the conscious mind to keep the primitive brain in check.
At one point in time, everyone suffers from TMS. It is part of being human. It is just that certain personality characteristics (more on this below) make some people more likely to suffer from TMS.
I've never heard of this before -- is this a new idea?
Although Dr. Sarno’s theory is very insightful, it is actually not new. An ancient Chinese medical text (written around 200 BCE) says “bu tong ze tong, tong ze bu tong” which translates roughly to “if there is no free [blood] flow, there is pain; if there is free [blood] flow there is no pain”. There has long been an awareness among the sages of Chinese medicine that “unresolved” emotions are a primary cause of this lack of free flow. According to Chinese medicine, chronic pain is often caused not by a physical problem but by “crystalized emotion”, which results from familial issues that have been swept under the rug, early childhood abuse forgotten by the conscious mind but remembered by the body, and/or refusal to face one’s own shadow side and trying to be “all goodness and light” while denying deeper layers of emotion. In these cases, the treatment is to “dare to shine the light of awareness into the dark death sleep of a denied truth” (Lorie Eve Dechar, in her book Five Spirits: Alchemical Acupuncture for Psychological and Spiritual Healing).
Are you saying that pain always has a psychological cause?
Please understand, I am not saying that pain should not be taken seriously and should not be thoroughly investigated when it occurs. Women in particular already have a hard time getting taken seriously when they seek medical care for pain, which can have life-altering or even life-threatening consequences.
Before proceeding with the recommendations on this site, you must get a thorough medical exam. If your neck or back pain is new; if it is getting worse, not better; and/or you have any of the red flags listed below, do not pass go, do not collect $200, go to your doctor.
- Weight loss without dieting.
- Unexplained fevers or chills.
- Light tapping on the spine is painful.
- Incontinence and/or true numbness around the groin and buttocks in a “saddle” pattern.
- Any accident with forces that may have been sufficient to fracture your spine.
- A fierce headache, and/or an inability to bend the head forward, and/or fever, and/or altered mental state.
- Severe headache that comes on suddenly and/or “the worst headache you’ve ever had”.
- Pain that grows steadily worse and is mostly unaffected by position and activity, is worse with weight bearing and at night, and comes with other signs of being unwell.
- Poor hand coordination; weakness, “heavy” feelings, and atrophy; diffuse numbness; shooting pains in the limbs (especially when bending the head forward); an awkward gait.
- Symptoms that spread equally into both legs, especially numbness and/or tingling and/or weakness, and especially if it is aggravated by lifting. The same symptoms limited to one side are also a concern, but less so.
- Difficulty urinating, incontinence, numbness around the groin, foot drop (a toe that drags), and significant weakness in the legs are all potentially serious signs of a neurological problem.
- Back pain that throbs in sync with pulse.
- Unexplained episodes of dizziness and/or nausea and vomiting may indicate a problem with stability of the upper cervical spine.
- Steroid use, other drug abuse, and HIV are all risk factors for a serious cause of neck pain.
- If you are feeling quite unwell in any other way, that could be an indication that neck pain isn’t the only thing going on.
- The main signs that neck pain might caused by autoimmune disease specifically include: a family history of autoimmune disease, gradual but progressive increase in symptoms before the age of 40, marked morning stiffness, pain in other joints as well as the low back, rashes, difficult digestion, irritated eyes, and discharge from the urethra.
It is also important to understand that acute injuries cause pain. It is when pain does not resolve within a reasonable period of time that it starts to become appropriate to seek a psychological as opposed to physical explanation. A good example is the pain that I experienced after a major car accident. There were three people in the car that day and we all had significant pain afterward. The other two people experienced resolution of their pain within a few weeks (normal). I, on the other hand, got worse in the months following the accident and went on to develop chronic pain that lasted nearly a decade (not normal).
Surely I need a MRI!
According to guidelines published in February of 2017 by American Academy of Physicians and the American Pain Society, only a small percentage of patients require MRI or CT evaluation of neck or back pain.
This excellent article explains why are you actually better off avoiding imaging procedures if you have neck or back pain.
Also see Scans for Back Pain are Ineffective.
But my doctor says that my pain is from herniated discs/degenerative changes/spinal stenosis/spondylolysis/spondylolisthesis?
A huge body of scientific research suggests that there is not a clear cause and effect relationship between degenerative spine conditions visible on MRI (such as disc degeneration, disc bulge, and disc protrusion) and pain.
For example, a recent systematic literature review of 33 scientific studies suggests that a large percentage of people have “abnormal” findings on MRI but no pain.
Degenerative Spine Image Findings in Individuals with NO PAIN
|Disc signal loss||17%||33%||54%||73%||86%||94%||97%|
|Disc height loss||24%||34%||45%||56%||67%||76%||84%|
In this study, the authors found that 87.6% of subjects WITHOUT NECK PAIN had bulging discs in their cervical spine (even subjects in their twenties were affected — approximately 75% of them had bulging discs).
What about other spinal conditions?
- 2006 study calls into question the relationship between spinal stenosis and back pain
- 2017 study calls into question the relationship between spondylolysis (with or without spondylolisthesis) and back pain.
But my doctor says that I need spinal surgery!
If you are considering spinal surgery, particularly fusion surgery, it is very important for you to be aware that the scientific evidence that surgery will fix your problem is tenuous at best. In a recent study, back pain patients were followed for 11 years after either fusion surgery, exercise therapy, or cognitive behavioral therapy. The study authors found no difference among the three groups, meaning that patients who subjected themselves to the risky surgery and lengthy recovery process were no better off than patients who exercised or underwent psychological counseling.
But I have fibromyalgia/central sensitization syndrome and my doctor says I'm incurable!
Yep, so did I.
According to Dr. Nancy Selfridge, fibromyalgia/central sensitization syndrome is the quintessential mind body disorder. Dr. Sarno says that fibromyalgia is “TMS plus”.
Each time I get over one problem, another one pops up to take its place!
But I'm not an angry person, in fact I'm really quite nice!
There is a primitive, childish part of the brain (which Freud called the id) that exists in each of us, without exception. The sole goal of this part of the psyche is immediate gratification of every impulse. The id does not take kindly loss, hardship, sacrifice, or any internal or external pressure to delay gratification, behave responsibly, take care of other people, and/or resist sexual, violent, and selfish impulses. In fact, it reacts to all of these things with seething, volcanic rage.
The conscious brain, also called the ego, makes the determination that the feelings and impulses of the unconscious mind are unacceptable and that it must to do whatever is necessary to keep these feelings from exploding into the consciousness. The threat posed by these emotions seems mortal to the psyche, which is why it stimulates the production of physical symptoms to keep the attention of the conscious mind on the body.
People who are perfectionists, do-gooders, and/or have a strong need to be liked have a particularly urgent need to confine the feelings of the id to the unconscious mind. You need to understand that the more you think of yourself as a nice person, the more internal tension is necessary to confine the workings of your id to your unconscious mind and hence the higher the risk that you will develop TMS.
How do I know if I have TMS?
After you have had a thorough medical exam to exclude the possibility of a serious condition that requires immediate treatment, the best way to evaluate the possibility that you have TMS is to read either The Mindbody Prescription or Healing Back Pain with an open mind.
The Thank You Dr. Sarno website and the TMS Wiki Success Story Forum are also an excellent resources. There you will find hundreds of stories from people who became pain-free by reading Dr. Sarno’s books. If you type the diagnosis you have been giving into the search fields on those sites, you are likely to find many stories from people with a similar situation who were able to overcome their pain.
Here is a questionnaire developed by TMS physician Dr. David Schechter, which is another good tool for evaluating the likelihood that your pain is caused by TMS.
How do I know if I have a highly sensitive personality (HSP)?
According to Dr. Sarno, perfectionism and “goodism” are the two most common personality characteristics among individuals with TMS. Dr. Sarno later acknowledged that individuals with Highly Sensitive Personalities are also apt to develop TMS and are at particularly high risk for developing fibromyalgia, a concept that was further developed by fibromyalgia expert Dr. Nancy Selfridge.
The highly sensitive temperament has four defining characteristics, according to Elaine Aron, Ph.D. Those with highly sensitive personalities are:
- Deep thinkers
- Easily overstimulated/overwhelmed
- Sensitive to subtleties
Dr. Elaine Aron developed a brief questionnaire to help people to determine whether or not they have a highly sensitive personality (HSP).
Experts believe that the HSP trait exists in over 100 species of animals and that approximately 20% of humans (regardless of culture or race) are HSP. These individuals process everything more thoroughly than others do before acting and brain research indicates that they respond more strongly to their experiences and perceive more subtleties. They have stronger emotional reactions are more sensitive to caffeine, pain, beautiful music, and others’ moods.
It is important to recognize that the HSP trait is not pathological. It is normal variation, sort of like blond hair or fair skin. If you are a HSP it does not mean that you are broken or fragile, it just means that you need to take steps that others don’t have to take in order protect yourself from becoming overwhelmed or from developing TMS, just like a blond-haired, fair-skinned person has to wear sunscreen in order to avoid getting sunburned.
I just find this really hard to believe!
Why haven't I ever heard this before?
“It is extremely difficult to alter the potentially disabling belief among the lay public that low back pain has a structural mechanical cause. An important reason for this is that this belief continues to be regularly reinforced by the conditions of care of a range of ‘hands-on’ providers, for whom idiosyncratic variations of that view are fundamental to their professional existence.” – Max Zusman
Ok, I can buy this -- what do I DO to get rid of my pain?
The information on this website is for educational purposes only. Do not delay in seeking medical care or discontinue treatment recommended by a physician or other health care provider because of what you have read on this site. Readers suffering from pain or any other symptom should undergo appropriate medical examination to exclude serious injuries or illnesses that may require immediate or aggressive treatment before initiating the self-treatment approaches described on this site.