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Of all musculoskeletal problems, chronic back pain is the one that is seen most frequently by healthcare professionals. Not surprisingly, chronic back pain is typically treated as a purely physical problem by the many medical doctors, chiropractors and physical therapists who encounter it every day. However, in the 1970s, Dr. John Sarno proposed a psychological basis for this chronic pain, calling it tension myositis syndrome (TMS), also sometimes referred to as tension myoneural syndrome.

Sarno is Professor of Clinical Rehabilitation Medicine at the New York University School of Medicine and Attending Physician at The Rusk Institute of Rehabilitation Medicine at New York University Medical Center. He wrote four books about TMS, which he describes as chronic pain produced by a combined psychosomatic musculoskeletal neurological disorder due to muscle tension that is created by repressed psychological or emotional stress.

The mechanism by which TMS is brought about, according to Sarno, begins with an emotional trigger. The trigger causes the autonomic nervous system to reduce blood flow to the muscles, connective tissue and nerves, resulting in insufficient oxygen being delivered to the tissues. This in turn causes pain. He believes that in repressing feelings of anger or anxiety, the body responds by creating physical pain as a distraction from the emotional pain. The theory is that, if the patient recognizes the repressed feelings and learns how to resolve them, the pain will disappear.

Most of the mainstream medical community does not recognize TMS as a valid diagnosis and has not endorsed related treatments for back pain. Nevertheless, TMS has received a lot of media attention and has been embraced by Dr. Mehmet Oz, Andrew Weil and other alternative health professionals. Dr. Sarno claims that he has a cure rate of 85% for those who follow his protocol.

Symptoms of TMS include recurring, intermittent back pain, stiffness, tingling, numbness and weakness in the affected area, as well as discomfort in other parts of the body, such as the neck, knee, arms and wrists. Symptoms can come and go. Some with TMS also report suffering from tension headaches, chronic arm pain, fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome and TMJ. Symptoms are often relieved temporarily after a vacation, and flare-ups are often unrelated to physical activity.

Educating patients about the syndrome itself is a core part of the treatment, and patients are encouraged to keep a daily journal in which they write about any potential sources of repressed emotional stress, such as trauma from childhood, the need for perfectionism, fear of aging, and so on. In time, patients learn how to express their emotions rather than repressing them. In addition, patients are instructed to resume as many of their normal daily activities as possible, and to stop doing anything special to protect their back. In some cases (about 20% of the time), short-term psychotherapy is also recommended.

Whether you’re experiencing acute back pain from some sort injury (auto-, work- and sports-related ones are very common) or have chronic back pain related to another health condition, your chiropractor can help. In the vast majority of cases, there is an underlying structural cause for pain and restricted mobility. As experts in treating disorders of the musculoskeletal system, DCs understand the deep connections between lifestyle (including aspects such as nutrition, exercise and stress management) and your overall health and well-being. If you or someone you care about is looking for relief from back pain, call or visit our office today.


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