Minding the Back

TWO OF THE PAST three times my lower back has seized up, my husband Torben has been out of town. The third time we were about to leave town. So I don't need much convincing to consider there might be a relationship between the state of my mind and the state of my back.

John Sarno takes this theory a bit further.

In a trio of books, starting with "Mind Over Back Pain" in 1984, then "Healing Back Pain" in 1991 and "The Mindbody Prescription" in 1998, the New York M.D. argues that for most back problems, stress and emotions are not a cause but the cause.

A professor of clinical rehabilitation medicine at New York University and an attending physician at NYU Medical Center, Sarno introduced what he says is not a new approach to back pain, but a new diagnosis: Tension Myositis Syndrome. In brief, he says TMS is a painful but harmless change in muscles, nerves and tendons. Pain is triggered when we generate anger - consciously or unconsciously - from trauma in childhood, from internal conflict, or from the stresses and strains of daily life. The pain is a defense mechanism to divert attention to the body in order to avoid becoming aware of repressed feelings.

Sarno's books are filled with examples of common back ailments from arthritis to sciatica and why he believes most of the time they are examples of TMS. Structural abnormalities may exist, he says, but they are not necessarily the cause of pain.

Furthermore, Sarno contends, TMS can be found in people with fibromyalgia, post-polio syndrome, whiplash, repetitive stress injury, shin splints and several forms of tendinitis. Many other physical conditions, he says, are similarly distractions from unconscious rage: headaches, allergies and skin conditions, to name a few.

From a physical exam and patient history, Sarno diagnoses TMS, which he then treats simply with a consultation and two lectures. Patients must accept that although their pain is physical, its cause is psychological.

"The consultation and lectures bring about disappearance of symptoms in 80 to 85 percent of patients, usually within a matter of weeks," Sarno writes.

Though few medical practitioners seem to have jumped on board the TMS train - I found a list of only 15 nationwide who treat the condition - a study in last December's journal Spine may have offered some credence. Researchers at Stanford University found that subjects with a torn vertebral disc were only slightly more likely to have back pain than those without any disc degeneration. And 25 percent of those with disc problems had no lower back pain at all. The scientists concluded torn discs are not always painful, and not all lower back pain is a result of a torn disc. The researchers found that better predictors of pain were a subject's psychological and social state of mind.

Some back specialists might take issue with aspects of Sarno's approach - for example, his suggestion to stop all structure-oriented treatment (back stretches and exercises). He does encourage physical activity for general physical and mental health, and emphasizes that anyone considering a TMS treatment first be examined and tested by a physician to rule out serious disease.

Probably the biggest obstacle among potential patients is getting past the stigma of pain being "all in the mind." (I'm torn about even suggesting this book to friends with chronic problems.) Sarno assures that pain can be both psychological and real.

I don't necessarily buy Sarno's assertion that, for example, all shin splints are a form of TMS tendinitis. It seems clear the shin splints I often get from running too much, too soon, are caused by the physical stress of pounding on pavement; when I progress slowly they aren't a problem.

At the same time, I once suffered several years from what I thought was a chronic groin pull. I saw a sports-medicine specialist, an acupuncturist, was fitted for orthotics, even had a custom mouthpiece made to better align my wacky left side. But the pain persisted. Finally I saw an orthopedic surgeon who said it wasn't a groin pull at all, but a problem related to a childhood hip disease, and it wasn't going to get any better. So I stopped worrying about it.

And the pain went away.

Molly Martin is assistant editor of Pacific Northwest magazine.



TMS resources, feedback

-- David Schechter, M.D., a family and sports-medicine physician who has trained under John Sarno, has written "The MindBody Workbook" ($18), a 30-day Tension Myositis Syndrome structured journal "to identify and heal from psychological issues that may be causing back pain, neck pain, fibromyalgia, irritable bowel syndrome, tension headaches and other disorders." It's available via www.amazon.com and also Schechter's Web site, www.mindbodymedicine.com, which also offers videotapes and presents other information on Tension Myositis Syndrome.

-- Other TMS Web sites include www.tms-mindbodymedicine.com/ and www.kimakoi.com/tmsdocs.htm, which includes that list of 15 doctors nationally who diagnose and treat the syndrome, including a couple who do phone consultations.

-- If you've tried Sarno's program, please let me know whether it helped. Write me at one of the addresses below.

How do they do it?

Is there someone - family, friend, co-worker, celebrity - whose exercise or nutrition plan you'd like to know more about? Drop me a note (with leads on how to contact them, if possible) and I'll try to find out, and feature them here. E-mail mmartin@seattletimes.com or write "On Fitness," Pacific Northwest magazine, The Seattle Times, P.O. Box 70, Seattle, WA 98111.