Dr. John Sarno was a pioneer in the field of psychophysiologic medicine, successfully using psychological techniques to cure thousands of patients suffering from low back pain and other disorders. However, his theories have fallen under scrutiny in light of advances in research and clinical techniques.
This is unfortunate because much can be learned from his wealth of empirical observations. Through my own personal experience and extensive study, I can adamantly state that TMS is real. In this piece, I’ll attempt to explain the pathophysiology and treatment of it through a modern framework.
First off, what is TMS? It is a chronic pain state in which pain, tingling, numbness, burning and other symptoms can be experienced in virtually any part of the body. Back and neck pain are the most common, but this can also affect the extremities. This condition is associated with abnormal muscle knots also known as “trigger points.” This type of pain can mimic almost anything, from tendonitis, to arthritis, to “pinched nerve” syndromes.
Many people with chronic pain (fibromyalgia being the most striking example) experience muscle knots, or “trigger points.” These can be extremely painful, and can even cause pain which radiates to other locations in the body. Dr. Sarno believed these were caused by alterations in blood flow, causing oxygen deprivation to the muscle tissue.
I believe this not to be the case; but rather, I would assert they are caused by chronically increased muscle tension resulting from the underlying state of the mind and body. Neuroscience research indicates that abnormal functioning of the primary motor cortex is a common finding among patients with chronic pain (see citations below). The brain controls the muscle and induces an abnormal functional state, which fortunately doesn’t typically cause any permanent tissue damage.
It makes sense to me that a feedback loop between the mind and body is involved in the causation of TMS:
-Pain can start from an injury, or simply due to muscle cramping from excessive mental stress which led to tightness.
-Unconscious parts of the brain perceive this pain as tissue damage, even if this is not the case in reality.
-In a reflexive response, muscles around the painful area further tense up to guard the “injury.”
-Since the brain and nervous system are already in a state of excessive threat, the increased muscle tightness is perceived as neuroplastic pain. If the muscle tension within the knot is significant enough, there can also be a component of nociceptive pain (due to activation of pain receptors in the tissue).
-The pain can amplify and spread due to the pain/fear cycle, which has been well described by other authors.
-The trigger points can cause referred pain because stimulation of these points can activate adjacent brain regions (motor/sensory homunculus). Massage therapists have literally mapped out the common referral patterns of trigger points. These do not fit cleanly within spinal nerve root or peripheral nerve distributions, and therefore I conclude that the over-reactive state of the brain must be involved.
Fortunately, the above cycle can be broken using a variety of mental and physical techniques. One has to address the pain/fear and pain/stress cycles. Of equal importance, one has to get moving again, to neurologically retrain movement patterns. Sarno intuitively realized and used some version of these concepts, but didn’t have access to the neuroscience studies to make proper sense of it all!
Please contact me if you’d like further assistance regarding the diagnosis and/or treatment of TMS.
Illustration: example of “trigger point” referral patterns. The scalene neck muscles are a great example because they are one of the primary muscle groups to tighten up under stress. I’ve also had this exact symptom pattern which I cured using mind/body techniques. This will all be the topic of a future blog post. For now, this is just to illustrate the concept:
Citations:
Gentile, E., Brunetti, A., Ricci, K. et al. Movement observation activates motor cortex in fibromyalgia patients: a fNIRS study. Sci Rep 12, 4707 (2022). https://doi.org/10.1038/s41598-022-08578-2
Gentile E, Ricci K, Delussi M, Brighina F, de Tommaso M. Motor Cortex Function in Fibromyalgia: A Study by Functional Near-Infrared Spectroscopy. Pain Res Treat. 2019 Jan 16;2019:2623161. doi: 10.1155/2019/2623161. PMID: 30792923; PMCID: PMC6354141.
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