Monday, August 3, 2009

Book Review-Shreyasi Majumdar

Pain in the Neck? Could be TMS

Book Review: Healing Back Pain-The Mind-Body Connection
Author: Dr John E Sarno, MD
Publisher: Warner Books
First Edition: February 1991
Price: USD 13.99 (INR 674)
Number of Pages: 193

In this detailed sequel to his first book Mind Over Back Pain first published in 1984, Dr J Sarno explains the concept of Tension Myositis Syndrome (TMS) as the major cause of back and neck pain. He demonstrates how patients with common back ailments can identify the emotional roots of the pain and heal themselves permanently without exercise, surgery or drugs.

Although contemporary medical science would fiercely oppose any theory that has to do with a psychological relation to bodily anomalies, “Healing Back Pain” might make the rigid medical community think twice about the conventional causes and cures of back ailments.


TMS has to do with the manifestation of emotional and psychological conditions in the soft tissue surrounding the spine and consequently emerging as the major cause for pain in the neck, shoulder, back, buttocks and limbs. Although the painful yet benign syndrome is brought on mainly by stress, the cause can be a wide range of latent emotional issues.

Dr Sarno suggests that the acceptance and treatment of TMS as a legitimate syndrome TMS may be deemed a “holistic” approach because unlike conventional medicine, TMS is treated not by addressing the symptoms, but by identifying them and then treating the underlying cause rooted in emotional and psychological factors. Having faced negative attention from his contemporaries himself, he backs up his claim with many testimonials at the end of the book, from TMS affected patients that he successfully cured.

The Four W’s:

Who -TMS is a cradle-to-grave disorder affecting people of all ages. However on a general note, people between 30-60 years of age have been found to be the most affected. Since this age group is also the “maximum stress” group with most responsibility, stress is accepted as the most common cause of TMS.

Where - As the name suggests, the most affected soft tissue in TMS are muscle (myo) and also peripheral nerves. In some cases, there can be accompanying pain in tendons or ligaments, which tends to disappear once the back pain is treated.

- TMS usually occurs as a sudden acute attack with an excruciating pain most commonly affecting the lower back and buttocks. However many people also report a gradual beginning to the pain, which is usually localized in the neck and shoulders to later move further down the back.

When - Acute or slow, the timing of the pain can only be determined by the patients’ psychological state at the time, with a physical incident acting merely as a trigger. He explains a delayed onset reaction wherein a person sails through tough stressful times without a hiccup, but develops TMS later due to the accumulated anxiety.

Psychology and Physiology

In an attempt to stress his point about TMS being a psychological phenomenon rather than a structural aberration in the spine or muscle deficiency, Sarno does tend to get rather repetitive. But he gets the point across.

Repressed unacceptable emotions which give rise to tension and physical or emotional stress are two of the major causes of TMS. Differentiating between the conscious and unconscious mind and keeping a safe distance from psychiatric jargon, Sarno reflects on how various psychological factors such as low self-esteem, narcissism, fear, anxiety, anger and unnatural repression of natural traits will at some point or the other cause the body to retaliate and defend itself-consequently manifesting as back pain.

As for the physiology of TMS, the basics are already pointed out in the first chapter. Although the explanation is a bit heavy with a lot of medical terms, in a nutshell, the physiology of TMS can be said to be represented by certain emotional states that cause mild oxygen deprivation of the abovementioned soft tissues. This dearth of oxygen is the primary cause for the pain, sensory abnormalities and muscle control deficits.

Talk to your brain

The treatment of TMS is as non-linear as the concept itself with the focus being on understanding the nature of the disorder and training oneself to act on it and change the brain’s behavior. Simply being aware of the potential psychological causes of the pain and telling one’s brain that one is not helpless and intimidated can actually cause the pain to go away. Such is the power of volition.

Sarno also urges patients to get over fears of the pain relapses, to resume all kinds of normal physical activity including the more rigorous ones as well as discontinue all physical treatment or therapy. However he is very careful to mention in various instances throughout, that the book is not meant for self diagnosis but is merely an introduction to a newly discovered syndrome. He clearly states that TMS should be diagnosed and treated only after a thorough medical exam of the back has been conducted yielding no conclusive evidence of spinal aberrations.
As an important part of the treatment, Sarno asks patients to review daily reminders of what TMS actually is and list out possible causes for the syndrome.

Overall, I would say the book is a bold venture into a realm which is still not considered “solid” medicine owing to its subtle nature. However Dr Sarno’s reputation as a professor of Clinical Rehabilitation Medicine at the NYU School of Medicine, and attending physician at the Howard A Rusk Institute of Rehabilitation Medicine at NYU Medical Centre, his many years of research into the syndrome and the large number of patients who have benefited from his work, certainly adds credibility to the book.

If you are suffering from any of the symptoms mentioned, if you are brave enough to try something out-of-the-box, if you have an open mind and if you wish to heal yourself naturally, this book may serve as a potentially explorable avenue for a safe alternative remedy to back pain.

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