tension myoneural syndrome in Manhattan

Dr. Rashbaum has carried on the work of Dr. John Sarno, a retired professor of physical medicine and rehabilitation at New York University School of Medicine and author, most recently, of The Divided Mind (Regan Books, New York, 2006), who championed the idea that real physical pain that is often severe and disabling can result from mildly decreased oxygen to muscles, nerves and/or tendons in the region of joints.  We are not talking about a significant decrease in oxygen to body regions such as in a stroke, heart attack or gangrene, but just enough to cause symptoms.  However, the process is both benign medically but often significantly painful and commonly disabling.  Dr. Sarno called this process Tension Myoneural Syndrome (TMS).

One should not presume that this process of TMS is what’s going on in you.   A physician should do a thorough evaluation to rule out other causes of pain such as tumors, cancers, fractures, inflammatory diseases (such as rheumatoid arthritis), etc. When TMS happens, the questions to be addressed here are:

How does the mildly decreased oxygen occur?
Why does the mildly decreased oxygen occur?
What can one do to make it stop?

The mildly decreased oxygen occurs through the autonomic nervous system.  The autonomic nervous system is part of the central nervous system that works automatically without our conscious will, regulating the internal organs of our body.

The mildly decreased oxygen occurs because the brain wants to create a distraction from strong and/or threatening emotions or feelings inside it.  There are neuronal connections between the emotional centers and autonomic centers in our brain so this process can occur rather easily.

More specifically, our brain consistently manufactures emotions such as rage, anger, sadness, fear, shame, guilt, etc., yet these emotions, while threatening to bubble up to consciousness, remain repressed by and large.

The sources of these emotions are external and internal.  External pressures in life can be unpleasant (such as a relationship challenge or financial setback), pleasant (such as a new baby or a job promotion), or can be a mixed bag (such as retirement that can be both anticipated eagerly and happily but also sometimes associated with a decreased sense of self-worth).  Believe it or not, personality characteristics such as perfectionism, competitiveness, conscientiousness, and people pleasing are the internal sources of pressures.  These characteristics seem to place enormous internal pressure on the part of our personality that Sigmund Freud called the id (the child-primitive, per Dr. Sarno) that does not like to be under pressure.  TMS patients cope very well, in general, with life pressures.  It appears as if this excellent ability to cope keeps a lid on these strong emotions that threaten to interfere with their daily lives.

I know it sounds confusing but in order to make the TMS process stop, one does not have to stop being perfectionistic, competitive, conscientious or a people pleaser.  In fact, I wish all of you the best of luck in the futile attempt to stop these personality characteristics!  Fortunately, this is not necessary.

By reviewing the “inconvenient truth” that radiologic “abnormalities” (that are not abnormal at all) in the joints are very common even in people without symptoms, this concept can reassure you that your body is not fragile or delicate but is strong.  If TMS is the source of pain, one must discontinue all structural-based treatments such as physical therapy or chiropractic care.  Otherwise, the brain will be given mixed messages that the pain is coming from both structural changes in the body and TMS—this strategy is doomed to failure.

One should not panic.  If the pain is severe, one can take a painkiller such as acetaminophen or ibuprofen (under the direction of one’s physician) and take it easy for a while, then try to stay as active as possible.  One can continue to think psychologically about what external and internal pressure sources are causing the brain to create TMS.

In Dr. Rashbaum’s experience, most patients are able to sort through their psychological/emotional issues on their own.  If they cannot, they should consider reaching out to a psychologist, social worker, or licensed behavioral health provider, ideally someone who embraces the ideas described by Dr. Sarno and is willing to work with patients under this matrix.


  NOTE:  This information is not intended to be a substitute for an appropriate evaluation and management by a physician.