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What is Tension Myositis syndrome?

Tension myositis syndrome abbreviated as TMS [1], also known as tension myoneural syndrome is a concept developed by Dr. John E. Sarno. It is a psychosomatic pain [2] syndrome that is characterized by pain symptoms in muscles, nerves, tendons, and ligaments of mostly the neck and the back [3][4][5]. This pain develops because of stored stress that can be repressed rage and tension.

Dr. John Sarno was America’s most famous back pain doctor and is the author of 4 best-selling books [6][7][8][9], including Healing Back Pain and The Divided Mind. He developed this theory after his keen observation and study of symptoms in his patients and relating them to their psychological health. 

Introduction:

The central idea of TMS – tension myositis syndrome is that the physical pain symptoms are generally psychogenic. Sarno believed that our brain used pain symptoms to distract us from experiencing unwanted negative emotions by psychological defense mechanisms such as denial or repression. This psychological illness manifests physical symptoms in the skeletal muscles and related connective tissue. 

What causes Tension Myositis Syndrome?

Although the exact mechanism of the cause of the syndrome is not completely understood, it is believed that the underlying cause of TMS is built-up stress. There are different kinds of stress. Eustress, positive stress, and other beings negative ones. A major negative life event, childhood trauma, feelings of inadequacy, resentment, and anger when not dealt with healthily and have been suppressed by distraction techniques, will end up in chronic conditions [10]

The psychological stress caused by an emotional event will trigger the ANS – Autonomous Nervous System. ANS is the part of our nervous system that regulates the pulmonary, digestive, and circulatory systems of our body. So once triggered, the ANS will bring about changes in the blood flow and thus the levels of oxygen reaching the site of need. Thus oxygen disturbance and deprivation on the site affect the local tissues, nerves, and muscles. [3][10]

Symptoms of Tension Myositis Syndrome:

The symptoms of TMS are numerous and varied and may be confused with another disease. As mentioned, the most affected part of the body is the muscles and surrounding structures, ligaments, and tendons of the neck and the back. Some of the most common manifestations are:

• Chronic neck pain 

• Chronic and recurrent back pain 

• Pain that may radiate from the back to the legs or arms

• Tendonitis of elbow

• Carpet tunnel syndrome

• Knee pain 

• Numbness, weakness, and loss of sensation, diminished reflexes of arms and/or legs

• Back pain may have a close resemblance to inflammatory conditions like a herniated disc.

The symptoms of TMS are closely related to many other diseases as well, the most common being confused with TMS are:

• Irritable Bowel Syndrome (IBS)

• Back Pain

• Fibromyalgia

• Migraine

• Tinnitus – ringing in the ears

• Sleep cycle disturbance

• Anxiety and more

When the symptoms and conditions mentioned above, are present, but none of the tests confirm the conditions then it is most likely that the cause of the pain symptoms is psychological.

How is it diagnosed?

Diagnosis of a disease is an essential step toward management. But the diagnosis of Tension myositis syndrome can be challenging because there is no definitive diagnostic test that confirms the illness. Moreover, many physicians may not be well aware of the illness.

Sarno and Schechter worked on creating a list of criteria for the diagnosis of the syndrome that is as follows:

• No definite physical cause is found on examination and tests.

• Six Tender Points [2]; two in the Trapezius muscle, two on the sides of the lumbar region, and two in the lateral upper buttocks.  He states that these are found in 99% of TMS patients. [9]

• The patient has been diagnosed or has a history of other psychosomatic illnesses such as IBS and tension headaches. [2][9]

Tensions Myositis Syndrome Vs Fibromyalgia:

Tension myositis syndrome and fibromyalgia are similar in how they are diagnosed and treated. They are often misdiagnosed as each other, which can lead to a delay in treatment.

Tension myositis syndrome is a neuro-musculoskeletal condition that’s characterized by muscle tightening and pain related to chronic stress. Yet, it does not exhibit the clinical characteristics of fibromyalgia such as muscle tenderness and fatigue.

Fibromyalgia [16] is a neuro-musculoskeletal disorder characterized by chronic widespread pain. It has no known cause and is associated with widespread symptoms of fatigue and depression. However, it does not exhibit the neuro-musculoskeletal characteristics of TMS such as muscle tension or pain.

The tender points of both conditions vary. TMS has 6 tender points [2], while fibromyalgia has 12.

Symptom Resolution:

As the roots of the illness are psychogenic, the mind needs to accept that it is capable of handling what it has been avoiding for a long time. TMS treatment is not physically invasive. The treatment is meant to be non-invasive, that is any surgical procedure will be unnecessary, and so is the use of toxic drugs. The key to managing and treating the symptoms is divide and rule. TMS therapy involves subjective treatment of each symptom.

Patient Education; in the form of written material or lectures. According to Schechter, the education allows the patients to “learn that their physical condition is benign and that any disability they have is a function of pain-related fear and deconditioning, not the actual risk of further re-injury” [14]

Through psychotherapy [2] [10] for unresolved trauma. Once the mind accepts that it can handle what it had been desperately trying to avoid, it no longer needs to use pain as a form of distraction. It is at this point that the TMS pain should resolve. 

Journaling; According to psychologists, journaling your thoughts and issues helps with repressed emotions. Sarno suggested that a person should look in the following areas: 

• Childhood experience, lack of love or abuse

• Personality trails like OCD [13] and perfectionism

• Current life stressors

• Aging and mortality

• Events of unexpressed anger.

Sarno suggested that setting aside time every day, possibly 15 minutes in the morning and 30 minutes to review and write about these thoughts will over-time defeat the repressed emotions through conscious awareness [15] within 30 days [12]. He suggested that the patient may first list up the symptoms and then recommended writing a longer in-depth essay on it.

Support meetings; allow the patient to explore their emotional issues that also find the cause of the issues.

References:

1. (2001) Abbreviations Dictionary. CRC Press. ISBN 0849390036. 

2. Schechter D, Smith AP, Beck J, Roach J, Karim R, Azen S (2007). “Outcomes of a Mind-Body Treatment Program for Chronic Back Pain with No Distinct Structural Pathology-A Case Series of Patients Diagnosed and Treated as Tension Myositis Syndrome.” Alternative Therapies in Health and Medicine 13 (5): 26-35. PMID 17900039.

3. Wysong, Pippa (2004-07-06). An Expert Interview With Dr. John Sarno, Part I: Back Pain Is a State of Mind. Medscape Orthopedics & Sports Medicine. Retrieved on 2007-09-14.

4. Greenberg, Jerome (2000-02-01). Back Pain: An Unconventional Approach. Proceedings of UCLA Healthcare. UCLA Department of Medicine. Retrieved on 2007-09-12.

5. McGrath, Mike (2004-11-03). When Back Pain Starts in Your Head: Is repressed anger is causing your back pain? Prevention.com. Rodale Inc… Retrieved on 2007-09-12.

6. Sarno, John E. (1982). Mind over Back Pain. Berkley Books. ISBN 0-425-08741-7. 

7. Sarno, John E. (1991). Healing Back Pain: The Mind-Body Connection. Warner Books. ISBN 0-446-39320-8. 

8. Sarno, John E. (2006). The Divided Mind: The Epidemic of Mind-body Disorders. HarperCollins. ISBN 0-06-085178-3. 

9. Sarno, John E. (1998). The Mind-body Prescription: Healing the Body, Healing the Pain. Warner Books. ISBN 0-446-52076-4. 

10. Rashbaum IG, Sarno JE (2003). “Psychosomatic concepts in chronic pain”. Archives of physical medicine and rehabilitation 84 (3 Suppl 1): S76-80; quiz S81-2. PMID 12708562.

11. Waxenbaum JA, Reddy V, Varacallo M. Anatomy, Autonomic Nervous System. [Updated 2021 Jul 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539845/

12. Schechter D, Smith AP (2005). “Long-Term Outcome of Back Pain Patients Treated by a Psychologically Based Program (Abstract #1112)” (PDF). Psychosomatic Medicine 67 (1): A-101. Retrieved on 2006-09-05.

13. Pengel LH, Herbert RD, Maher CG, Refshauge KM (2003). “Acute low back pain: a systematic review of its prognosis”. BMJ 327 (7410): 323. doi:10.1136/bmj.327.7410.323. PMID 12907487.

14. Schechter D, Smith AP, Beck J, Roach J, Karim R, Azen S. Outcomes of a mind-body treatment program for chronic back pain with no distinct structural pathology–a case series of patients diagnosed and treated as tension myositis syndrome. Altern TherHealth Med. 2007; 13(5):26–35.

15. Schechter D. The Mind-Body Workbook. Los Angeles: Mind-Body Medicine Publications, 1999, ISBN 1-929997-05-1.

16. Fibromyalgia Research Unit, Oregon Health & Science University, 3455 SW Veterans Road, Portland, OR 97239, USA?

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