Body and Mind Medicine in Chronic Pain

TMS (Tension myoneural syndrome)

Everyone has experienced physical pain at one point in their lives, but for some, pain can be severe and persistent and turn into chronic pain.

Dr. John Sarno who was the director of the Rusk Institute of Rehabilitation Medicine in New York, discovered that the bulk of musculoskeletal pain was not the result of a structural damage, but in fact a tension-related pain. This condition was referred to as TMS (tension myoneural syndrome) [Sarno J. Healing back pain, New York: Warner Books, 1991]

John Sarno’s theory states that the autonomic nervous system is responsible for the great majority of chronic pain conditions, and that the underlying cause of that pain is the minds defence mechanism against unconscious mental stress which is distracted by  physical pain and therefore conscious awareness is prevented. In other words the physical pain becomes obvious to the patient and emotional pain becomes invisible.
TMS pain
The autonomic nervous system controls the circulation of the blood flow in the body. When there is not enough blood flow to a particular tissue, oxygen is reduced and the result will be symptoms, such as pain, numbness, tingling weakness etc. These symptoms can occur in the neck, knee and other parts of the body.

Schlechter states that the symptoms have a tendency to move to other parts of the body and considers symptom movement to be an important indicator that the pain is from TMS.

Schlechter and Sarno consider a prior history of other psychosomatic disorders such as irritable bowel syndrome and tension headache as examples of TMS pain. However a physical examination tests and imaging studies may be needed to rule out serious conditions, such as tumours.

Psychological Therapy for TMS patient

The Psychiatrist Henry Maudsley [1918] wrote:  ‘The sorrow which has no vent in tears may make other organs weep’.

He states: When our habitual ways of coping psychologically are overwhelmed, we are capable of somatising psychological pain. In such cases, the mind senses that the emotions are too painful to experience, so it attempts to protect the psyche. That is to say that experiencing the pain physically, as, terrible as it may feel, is more tolerable than feeling the depth of the psychological pain.

Studies have revealed that TMS clients avoid a variety of feeling, such as anger, sadness, helplessness, dependency, envy, guilt, even happiness. Sarno and the psychologists he worked with found that when TMS clients were focused on their physical pain, they were less apt to focus on deeper psychological pain.

Most people have experienced a way of distracting themselves from difficult emotions.
To relieve anxiety or depression, people overeat, smoke, drink alcohol, use drugs etc.  All these activities serve to shift a person’s focus from their emotional pain to a different sensation. Physical pain is simply the minds way of shifting the focus for us.

Examples of repressed emotions could be:

•  certain childhood experiences, such as abuse or lack of love,
• personality traits such as perfectionism conscientiousness and a strong need to be liked by everyone,
• current life pressures
• aging and mortality and
•  situations in which the patient experiences conscious but unexpressed anger

TMS treatment is gaining momentum, and author and physician, Dr. Marc Sopher, speaks for many when he writes: ‘Ultimately, I am confident that TMS theory will become part of mainstream medicine for the simple reason that it is correct, and more successful at alleviating pain than any other modality.
Once TMS has been clinically diagnosed, the client’s acceptance of the diagnosis is an integral part of recovery.

One of the primary goals of TMS treatment is to help clients reframe the meaning of their pain. Instead of focusing on it with frustration, fear and powerlessness, the client learns to use the pain as a guide to become aware of his emotions.

An essential part of counselling is to help the clients to identify these emotions, and eventually accept and express these painful parts of themselves [E Sherman, personal communication, 09/05/09].
If you feel that you have exhausted every other means of treatment perhaps psychological counselling is your answer?

(Parts taken from a BACP article [Therapy Today] published in April 2010, p16 to 21)
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References:   

*National Institute of Health NIH guide:new directions in pain research I. September 1998, available via: http//grants.nih.gov/grants/guide/pa-files/PA-98-102.htmls
*Sarno J. Healing back pain.New York, Warner Books,1991
*Sarno J. The mindbody prescription: healing the body, healing the pain New York, Warner books, 1998
*Sarno J. The divided mind: the epidemic of mindbody disorders , New York, Harper Collins, 2006

Article by:
Christine Shah (MBACP)
Contact number: 0774 808 0774