One Common But Often Overlooked Cause of Chronic Pain

© 2005 Katherine Poehlmann, Ph.D


Many chronic pain disorders in the neck, shoulder, back, and buttocks have their origin in a benign (though painful) physiologic aberration of soft tissue (not the spine). The cause is often an emotional process leading to Tension Myositis Syndrome (“myo” means muscle), or TMS.

The powerful emotions of fear, anger, anxiety, and other negative stresses, when repressed (consciously or subconsciously) can cause muscles to tense in the areas of the body near the spine. This has led to misdiagnoses of structural abnormalities of the spine, pinched nerves, disc disorders, or other physical causes without consideration of the important role that TMS can play.

Dr. John E. Sarno, M.D., coined the term “TMS” in his book Healing Back Pain: The Mind-Body Connection (Warner Books, 1991). He asserts that once the patient confronts the repressed emotions that lead to the muscle tension, the pain will lessen and eventually disappear. According to Dr. Sarno, interim treatments such as salves, heat treatments, acupuncture, acupressure, and other physical therapies provide temporary relief and address symptoms but do not get to the root cause of the problem.

Dr. Sarno says “To leave the emotional dimension out of the study of health and illness is poor medicine and poor science.”  Few medical doctors are trained to recognize a disorder whose roots are psychological. Diagnostic tests will often show the pattern of pain uncorrelated with the presumed source(s) of pain. Physicians will prescribe painkillers or recommend surgery to correct any anomaly shown on an xray, e.g., a herniated disc, slipped disc, or normal degenerative arthritic changes at the lower end of the spine, even though the patient may have pain in places that have nothing to do with the bones in that area.

The emotional aspect of illness is not new. Hippocrates advised his asthmatic patients 2,500 years ago to beware of anger. In 1946, a New England Journal of Medicine article by Major Morgan Sargent cited 96 percent of a large number Air Force personnel returning from combat with backache.

A study in 1986 looking at the previous thirty years showed steadily increasing numbers of patients reporting chronic pain, especially back pain. Chronic pain was listed as the first cause of worker absenteeism in the U.S. and second only to respiratory infections as a reason to visit the doctor. The situation is getting worse as our over-stressed society tries to cope with daily life.

An important observation Dr. Sarno made of his patients was that over 80 percent had histories of migraine headache, heartburn, stomach ulcer, colitis, irritable bowel syndrome, hay fever, asthma, eczema, and other disorders strongly suspected of being linked to repressed emotional tension. It seemed logical to him that their painful muscle condition might also be induced by tension. He put that hypothesis to the test and treated hundreds of patients with a nearly 90 percent success rate by teaching them how to deal with TMS.

The physiology of TMS begins in the brain. Repressed negative emotions cause the autonomic nervous system, which controls blood circulation, to increase or decrease the flow of blood to certain muscles, nerves, tendons and ligaments. When flow is decreased, the state is called ischemia. This also means that there is less oxygen available to those tissues than normal, with resulting symptoms of pain, numbness, tingling, and sometimes weakness. Because therapies like heat, deep massage, and active exercise increase blood flow to painful muscles and increased blood flow means more oxygen, it follows that oxygen deprivation is responsible for the pain. Ample laboratory evidence supports this theory.

Dr. Sarno has treated a large number of patients diagnosed with Fibromyalgia and determined that oxygen debt brought on by TMS was the cause of their problem. The treatment is straightforward but hinges on the patient’s taking full charge of his/her repressed emotions. To quote Dr. Sarno, “The treatment program rests on two pillars: (1) The acquisition of knowledge, of insight into the nature of the disorder; and (2) The ability to act on that knowledge and thereby change the brain’s behavior.”

When Dr. Sarno’s patients become aware of pain, they are encouraged to focus consciously and deliberately on any likely psychological cause that may have triggered the pain. This may be a family emergency, financial problem, a recurrent source of irritation, an annoying sound, a traffic incident, a memory of an affront – in short, anything that could be responsible for tension at that moment. Once the link is identified, the patient can take steps to resolve the problem and de-couple it from the manifestation of pain.

One should not expect the pain to subside immediately. The conscious mind is quick to zero in on the probable cause. The subconscious, on the other hand, is slow, deliberate, and not eager to accept new ideas and change. However, making it a habit to search for the cause of tension will pay off over time in decreased pain.

Why not try it? Results may take 2-6 weeks, but there are no pills to take, no surgery to endure, and no bills to pay. If this sounds like the familiar “Mind Over Matter” slogan, you’re right. The power of one’s mind to cure illness is illustrated in Anatomy of An Illness by Norman Cousins and in popular books by Yale surgeon Dr. Bernie Siegel such as Love, Medicine, and Miracles.




Dr. Poehlmann is the author of Rheumatoid Arthritis: The Infection Connection, available at and major bookstores, or click here to order now.


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