What is Tension Myositis Syndrome (TMS)?

Tension Myositis Syndrome was a term coined by the American doctor Dr John Sarno, and applies to various chronic pain conditions, from back pain to leg and shoulder pain, nerve pain as well as fibromyalgia pain, as long as the pain is not linked to an acute injury, illness or infection.

TMS is also known by the terms the MindBody Syndrome, PPD (Psychophysiologic Disorders), and Neuroplastic Pain.

Why does chronic TMS pain develop?

According to the latest research in Pain Neuroscience, the cause of persistent, chronic pain is to be found in the way that pain perception and sensitivity are heightened in the nervous system.

Factors like anxiety, stress and our tendency to react to pain with fear and trepidation may induce physiological changes in our nervous system, leading to the experience of a variety of symptoms that are not due to structural or tissue damage.

The condition may be triggered by a range of stressful situations, trauma and/or repressed emotions. However, it may also manifest after an injury due to a person’s fear of re-injury or following a significant event in a person’s life. Many people will equate TMS/PPD with Psychosomatic Pain when they first hear about it.

This is what Dr John Sarno realised when he discovered that what most of his back pain patients were suffering from was simply TMS. And when he started to educate them about the true causes of their chronic pain, a lot of them started to recover, as they shifted their perspective of pain.

The Sarno method (including Dr Sarno’s 12 daily reminders) is still popular today, and luckily it’s being improved and enhanced by the latest discoveries in neuroscience.

TMS and Conditioning

You may already be familiar with the story of Pavlov’s dogs, who salivated in anticipation of the food that was about to arrive.

In his experiment, Pavlov introduced a stimulus - the sound of a metronome - to signal to the dogs that food was coming. After a while, the dogs started to salivate following the sound of the metronome, even if no food was given. This is an example of classical conditioning, when the body behaves in a certain way following a neutral stimulus.

Conditioned TMS pain is similar in the sense that the mind and body have ‘learnt’ to overreact to certain stimuli (the stimuli could be physical activity, the weather, and even places or people).

There may be multiple factors that trigger chronic pain, and the pain cycle may become so automatic that we may lose sight of the trigger(s) altogether.

The reason why you need to help yourself is that you know yourself best - nobody else can identify the triggers for you, and nobody else can change how you react to them.

Tension Myositis Syndrome treatment addresses the cause, not the symptoms!

People who recover from chronic pain using the TMS method stop treating their symptoms as physical symptoms, and start looking at their emotional landscape instead.

The theory is that pain is there to distract you from repressed emotions and feelings. This repression occurs due to a variety of factors, but often has to do with trauma, negative situations and lack of joy and self-fulfilment.

When we don’t fully acknowledge our needs and emotions, it is easy for the brain to fire an ‘alarm signal’, as a way to distract us further from those emotions that we may be too scared to explore or admit to.

Why does TMS Pain become chronic?

Any physical pain that we feel is detected through what are called nociceptors, which are found throughout the body. These nociceptors can detect if there is the potential for damage in the body, and transmit this signal to the brain. In turn, the brain fires the pain response to alert us that something is wrong.

If we didn’t feel any pain, we may continue to cause further damage. Therefore, pain is a good thing, because it gets us to stop anything that is harmful to our bodies or seek treatment. It is a danger signal.

The problem is that under certain circumstances, the brain and body can become extra-sensitive to certain stimuli. This is called hypersensitivity or central sensitization.

For example, following an injury, the brain can remember those pain pathways even after the injury has healed. This is the reason why people may believe that an old injury is still causing pain!

When we are under significant stress or anxiety, this also increases pain perception in the body. This means we can become even more hypersensitive.

Eventually, we learn to associate specific movements and activities with pain - and for this reason, we strengthen the link between these activities and pain, and the nociceptors continue to fire. This starts a process called conditioning - where things that shouldn’t hurt start to hurt each time that we do them (because that’s how the body has learnt to respond!).

In short, chronic pain is a learnt response. Your body has learnt to keep on generating pain, for various reasons.

This is why it lasts long after any injury has healed (or even when there has never been an injury in the first place!).

You can learn more on why this happens and what you can do to reverse these processes in my Pain Free Breakthrough Program.

So how do you cure TMS?

TMS pain healing involves becoming aware of subconscious processes and bringing habitual reactions to consciousness. It involves changing the intensity of pain signals in the brain by making a distinction between real danger and ‘perceived’ danger. This is exactly what Tension Myositis Syndrome treatment is all about.

The recovery process usually starts with educating oneself on how pain is generated and why it becomes chronic. This educational process also involves learning to make sense of pain, and looking at it logically, in order to be able to distinguish between a real injury and a chronic, mindbody issue.

Usually, a person needs to have consulted a medical specialist to rule out any serious conditions, like tumours or infection.

Once a person is ready to allow that pain is not of a purely physiological origin, he or she can proceed to powerful self-exploration exercises, to determine what personality traits, behaviours and reactions are contributing to chronic pain or symptoms.

Journalling is a powerful tool that helps people get clearer on their feelings. People who are looking to cure TMS normally journal in order to explore how they feel about certain issues or experiences (both past and present), as a way of putting their focus back on their emotions and feelings.

There are other powerful tools that can help people identify their pain triggers and adopt new habits that break the pain cycle. These include learning how to react differently towards the pain itself, and also learning to move with less fear and trepidation.

Most people who heal from TMS read a TMS book or two to educate themselves on the subject, and some of them also follow a TMS pain recovery program. Here at PainOutsidetheBox, we also offer a 25-Day Ebook that combines TMS education with practical exercises and tools in an easy-to-understand manner.

How do I know if I am suffering from Tension Myositis Syndrome?

If you are suffering from Tension Myositis Syndrome, then probably your chronic symptoms do not make sense. You may have multiple symptoms that are physically unrelated, or the same kind of chronic pain on both sides of the body, which couldn’t possibly have the same physical cause. You may also experience great fluctuations in intensity, such as feeling intense pain in the morning, which gets better by evening.

If the cause of this were purely a physical degeneration or injury, how could the pain change and vary so drastically? Can you stop and think for a moment whether your chronic condition makes sense from a purely physiological perspective? My TMS Questionnaire can give you an indication that you may be suffering from this condition.

Is Tension Myositis Syndrome real?

The TMS / Neuroscience Education approach to pain go deep into the links between Chronic Pain and the brain, expanding on the traditional understanding of psychosomatic pain as merely being ‘in one’s head’.

Tension Myositis Syndrome/Neuroplastic Pain, however, is not simply in your head. It involves a real physical reaction to an emotional trigger, a reaction that has become automatic, i.e. you do not need to ‘think’ anything for the pain to manifest itself.

To give you one simple example, I’d like to to recall a time when you were particularly nervous. Perhaps you had an important interview, or a speech to make in front of hundreds of people. Do you recall your heart racing? Or perhaps your urge to go to the bathroom?

Tension Myositis Syndrome is similar. Let’s take your heart beat during that stressful situation - if someone had measured your pulse back then, he would have confirmed that your heart was really beating much faster than usual, i.e. it was not just in your head!

In the same way, when you experience chronic pain, it is really your muscles and/or ligaments or nerves that are being affected by what is believed to be mild oxygen deprivation, or temporary micro-ischemia)*. However, similar to the interview or speech situations, the trigger or root cause is on an emotional/unconscious level.

* In reality, these days we know that there are various physiological processes involved in the generation of chronic pain, beyond oxygen deprivation. These include increased muscular tension, increases in cortisol levels, and the activation of regions in the brain associated with processing pain.

TMS tender points

Although TMS encompasses quite a vast range of symptoms, there are some common tender points that may help in diagnosing tension myositis syndrome. According to Sarno, these tender points are found in 99% of TMS patients, and amount to 6 in total: 2 in the upper trapezius muscles, 2 in the lumbar paraspinal muscles and 2 in the lateral upper buttocks (TMS Wiki). He used to check these points in patients with other pain conditions, such as severe TMS back pain, to find that these areas were indeed very tender in those patients that were actually suffering from TMS.

It’s interesting to note that some specialists look for 18 tender points in order to diagnose fibromyalgia, which according to Sarno, is but an extreme manifestation of TMS. That said, TMS sufferers and fibro sufferers tend to share the same symptoms and some of the same tender points, with the only difference being that in fibro sufferers the pain has become much more conditioned and difficult to deal with, since they have been told that there is no cure for the condition.

List of TMS symptoms

There are a range of symptoms that can be diagnosed as TMS, since the condition affects people in different ways. This is because we are all individuals, and TMS pain usually manifests somewhere where it makes sense for our brain.

For example, if we firmly believe that our shoulders are incredibly strong, then it is unlikely for TMS pain to manifest in that area. On the other hand, if we’ve injured our shoulder in the past, then TMS is more likely to hit there. Essentially, TMS pain is more likely to occur in an area where we perceive there might be a potential threat - the threat of re-injury, degeneration, or damage.

Here’s a list of TMS symptoms that typically fall under the category of Mindbody Syndrome (once a person has been suffering from them for over 4 months and has ruled out the presence of tumours or infection):

• severe chronic back pain (including pain attributed to a herniated disc)

• chronic neck pain

• chronic shoulder pain

• knee pain (and joint pain in general)

• chronic foot or ankle pain

• pain blamed on arthritis (excluding rheumatoid arthritis)

• piriformis pain

• chronic sciatica pain

• nerve pain (including carpal tunnel syndrome)

• plantar fasciitis

• pelvic pain

• IBS

• chronic acid reflux with no evident cause

• chronic muscle pain (various muscles simultaneously)

• vertigo (medically unexplained)

• chronic pain syndrome (when you have both chronic pain and other symptoms like depression, anxiety and poor sleep / insomnnia)

Another strong indication of tension myositis syndrome is that a lot of people tend to suffer from more than one of the above, or the pain tends to change location, moving from the shoulders to the wrist, to the back, and so on.

It’s important to get these symptoms evaluated by a medical professional first, to exclude any serious conditions.

How to treat Tension Myositis Syndrome

Fortunately, the Sarno method incorporates various techniques to break the pain cycle. The first one is education; when Sarno first discovered this, he used to hold TMS healing seminars with patients who were willing to give his method a try. The patients had to understand why they were experiencing the pain, what triggers TMS, its various manifestations, and what they should and shouldn’t be doing to end it. A lot of his patients who thoroughly understand the concept claimed that they felt much better after attending just one of these seminars!

To start off with, you may want to have a look at Sarno’s 12 Daily Reminders for people with TMS. These reminders serve to help you uphold the belief that your pain is only TMS, and to stop you from engaging in behaviour that make your symptoms worse.

Since then, there have been several other approaches and tools to complement Sarno’s method, which I cover in my TMS Healing Program and Coaching Sessions.

So if this really works and TMS syndrome pain really exists, why doesn’t everyone know about it?

Let’s say that Sarno’s peers were not too thrilled with his ‘unscientific’ methods, especially when he stopped sending patients for physiotherapy, or when patients no longer required any medications.

Although Sarno did conduct a number of studies which showed, for example, that there are a number of people with herniated discs who have never had back pain, it was difficult to prove that his treatment worked - because the treatment involved no drugs, just a change to patients’ mindset and beliefs - something which is extremely hard to measure via a scientific process.

Sarno also used to pick out his ideal patients (those who were willing to accept his method) and refused to work with those who were not open to the mindbody connection - kind of like me and the clients I coach!

The Sarno method is now getting validated

It seems that Sarno was incredibly ahead of his time. Luckily, the latest findings in neuroscience and neuroplasticity today are now backing up Sarno’s theories.

A recent trial on Pain Reprocessing Therapy (the approach used to treat Neuroplastic TMS Pain) has had amazing results. The group educated on PRT had the best results compared to the Placebo Group and the group that underwent conventional back pain treatment."*

Research on mindfulness meditation and other forms of meditation for chronic pain has also shown that there really is a physical change in the brain when we meditate, and this in turn affects our body’s fight or flight response - the same response that is responsible for chronic pain!
It gets even more exciting - but for more info, you should consult my TMS Resources section.

* 'Yoni K. Ashar, PhD; Alan Gordon, LCSW4; Howard Schubiner, MD et al, ‘Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial’, Jama Psychiatry, September 2021.

Tension Myositis Syndrome FAQs

What is Tension Myositis Syndrome?

Tension Myoneural Syndrome, known as TMS or Mindbody Syndrome, is a term coined by Dr John Sarno to explain certain chronic pain conditions that were triggered on a subconscious and/or emotional level. The condition leads to real physical pain or other symptoms that are not being caused by pathological or structural abnormalities, but are conditioned in the body as a response to specific triggers and/or psychological processes.

Is Tension Myositis Syndrome real?

Yes, almost everyone has experienced TMS to a certain degree in his or her life. TMS pain is also very real, and is not simply in one’s head. With TMS, the brain works in tandem with the body to create real physical symptoms in response to a given situation or state of being.

What causes Tension Myositis Syndrome?

TMS is a mindbody response to a trigger, stimulus or emotion, which often have negative implications for the individual. This means that symptoms are triggered either in association with a specific event, or following a certain thought process, and then become conditioned to manifest automatically in the body. Conditioning leads to pain and other symptoms becoming programmed in the mind and body, so that we don’t need to consciously ‘think’ about them in order to experience them.

How to treat Tension Myositis Syndrome?

TMS is treated through education, self-awareness and de-conditioning. The person first needs to recognise his or her symptoms as being TMS, and identify what triggers the pain, then learn to recognise which of his/her behaviours and reactions that are contributing to the conditioning of pain in the body. The aim is to change certain automatic responses, bringing them from the subconscious to a more conscious level, thus re-programming the brain and body to stop manifesting pain.