TMS, or Tension Myoneural Syndrome, is a theory that explains the kind of pain that persists for long periods despite the absence of clear physical damage or injury. It is most often associated with back, neck, and intestinal pain, but has been applied to a wide variety of conditions including itching, tinnitus, and fibromyalgia. Even when physical abnormalities such as a bulging disk seems to present a likely cause, the strategies taught by Dr. John Sarno and others are effective at reducing and often eliminating the pain. One of the best explanations of TMS is in this video by Dr. Howard Schubiner:
Dr. Schubiner and Dr. Sarno focus on education as a means to help people see the “true” cause of their pain, and then take steps to eliminate it.
After first reading Crooked and Everyone has Back Pain, I read Dr. Sarno’s book, The Mindbody Prescription: Healing the Body, Healing the Pain. Towards the end of the book Dr. Sarno lays out the formula for exposing and confounding the brain’s covert plan of distraction-by-pain, by exploring the emotional issues underlying the brain’s motivation.
Dr. Sarno is unequivocal in his assertion that relief will not last unless each possible source of emotional issues has been unpacked and dissected through essay writing. This process must be combined with conscious effort to retrain mental reactions to perceived pain. The Mindbody Syndrome (TMS) Discussion Forum has posted a helpful list of reminders to accompany the essay writing:
- The pain is due to TMS, not to structural abnormalities
- The direct reason for the pain is mild oxygen deprivation
- TMS is a harmless condition, caused by my repressed emotions
- The principle emotion is my repressed anger
- TMS exists only to distract my attention from the emotions
- Since my back is basically normal there is nothing to fear
- Therefore physical activity is not dangerous
- And I must resume all physical activity
- I will not be concerned or intimidated by the pain
- I will shift my attention from the pain to emotional issues
- I intend to be in control – not my subconscious mind
- I must think psychological at all times, not physical
My story of back pain is pretty common. One “bad episode” every few years starting in my late 20s and increasing in frequency to one or more a year in my 40s.
In preparation for my 100 lakes project in early 2007 (age 46) I spent a lot of money to purchase a super ultralight canoe in order to prevent further injury to my back. In some ways this worked. I paddled weekly for 2 years with little or no back issues.
At age 49 my marriage of 29 years came to an end. In the months leading up to moving out of the house, I experienced growing back pain and one night I collapsed at 3:00 am in the morning after being awakened by the pain. I was taken to hospital by ambulance, and after no damage to my spine was found on medical scans, I was sent home. It turns out it had only been a case of Vasovagal syncope (fainting) brought on by the pain. In the year following my separation (age 50) I experienced one episode of severe neck pain and one of severe back pain.
These two episodes were notable for their intensity, and I missed work. I again sought out medical help, trying a variety of pain killers, Novocain injections, and physiotherapy treatments. I spoke with friends and relatives who experienced back pain and attended a Tia Chi class for about a year. In 2014 (age 53) my new girlfriend (later to become my wife) recommended magnesium and this supplement eliminated all the concurrent muscle spasms I had been having and I did not experience a bad episode of back pain until the following year. I seemed to be doing well as long as I didn’t lift anything heavy or “turn the wrong way.”
In December of 2016 I began to have trouble again and by mid January I was almost incapacitated, struggling to climb stairs and taking time off work. After a successful treatment regime with a new physiotherapist (inter muscular stimulation seemed quite effective) I felt a reduction in pain and was back to gingerly doing my normal activities, walks and gentle hikes, careful not to trigger an episode.
Then in September the pain returned, lasting into November. I was now anxious and depressed about a condition that seemed to be taking up more and more of my mental energy. I was anxious that the pain would not go away and depressed as I began to really beleive that I would become more and more disabled over the coming years. I finally decided to hit the problems with a deep research dive.
I currently believe that 80% or more of my pain is caused by my brain as a function of Tension Myoneural Syndrome (TMS). Certain emotions, especially anger and rage, are repressed in my unconscious mind which fears their release. To prevent the conscious mind from becoming aware of these bottled-up feelings, my unconscious mind capitalizes on minor injuries to create pain as a distraction. Three things in particular have been helpful.
Research By reading the books mentioned above, and watching a number of videos, I was able to assemble a “likely” explanation for my pain that includes some gaps I am still filling as I collect and interpret data and ideas. The research was proactive and gave me a sense of empowerment. I was doing something about my pain.
Physiotherapy I was honest and straight-forward with my physiotherapist, Anika, and she surprised me by being open to the idea of TMS and offering her own perspective. She agreed that emotions and stress play a big part in the pain, and patiently answered my questions about what exactly is going on with the muscles and nerves, and why IMS works. She articulated what I believe to be the “current” medical understanding in Canada, that “in some people, the nerves that ‘wake up’ to alert you to the danger in your tissues calm down very slowly.” 1 The focus in this model is to develop strategies to deal with the negative emotions and stress that keep the neural system”dry” or in a “flight or fight” state of readiness. The strategies are designed to produce a “wet” brain that trickles down parasympathetic chemicals to calm the nervous system, muscles, etc. Much emphasis is places on staying active. “Motion is Lotion” has become my new mantra.
Self Talk After reading the books and becoming convinced that Dr. Sarno was really on to something, I began to challenge my thoughts about the pain and to tell myself repeatedly that I would not cause harm by walking, bending, etc. and that the pain was being caused by my brain. I now routinely notice the pain, notice my temptation to freak out about it, and mentally or verbally tell myself that the problem is the worrying, not the moving. It really is all about the brain, my beliefs, and my emotions.
Here it is, 13 November. I still have difficulty tying my shoes, standing at the kitchen counter, and walking at more than a leisurely pace, but my attitude is good. I continue to work on my essays. I have a lot to write about. My goal is to integrate this into my weekly routine.
How does this relate to Sabi? My journey these last 10 years, since my parents died and my marriage died, has been one revelation after another. I journeyed into the wilderness, experienced sabi many times, grieved, cried, connected with friends, and finally found a new love, many powerful insights, and a keen appreciation for the discovery and acceptance of what is – for suchness. I’m still struggling to accept certain things about myself. My high level of sensitivity, my excellent ability to assess possible threats, and my high agreeableness and openness are all hard to fully embrace. Equally hard to love are my low levels of assertiveness and industriousness. Sabi really helps with this. It is fundamentally a mood of receptiveness, a quality of acceptance that provides a toe hold in these difficult realities about myself. Practices to find, savour, and fully experience sabi help dampen the brain, help shift perspective, and generally increase the salience of life.
I have a fear that Sabi really hasn’t produced enlightenment in me. This is typical of me. It is the constant call of my defectiveness schema, my deepest wound. I am beginning to understand that my path goes this way. Seeing the suchness of things is not an escape into bliss, it is an emergence into pain. Like Neo waking up from the matrix. Sabi has giving me the ability to turn and contemplate my inner world of emotions, perceptions, beliefs, and thoughts. For some people it is a different kind of ‘wake-up’ call, but for me, it started in beauty. I will continue to seek the healing there.
For Further Investigation
- For the past 2 years I have been practicing the Welcoming Prayer as part of a conviction that the spiritual life, for me, has much to do with “letting go.” It relates to my exploration of Thomas Merton’s idea of the “true self” and the relationship of the true self to the large self talked about in writings on the “hero’s journey,” — a journey that we are all supposed to take. Could this practice be causing or exacerbating the problem?
- What is with this sensitive brain? Is avoidance of stress a legitimate strategy for people like me? I feel I must listen again to wu wei, and surrender have many challenges for me.
- Micheal Singer’s Surrender Experiment continues to intrigue me. Are surrender and other “virtues” that I find attractive simply more in alignment with my desires, and so potential pitfalls for me?
- What about attachment? I have a suspicion that much of my wounding and pain are related to feelings of being on my own, isolated, and abandoned. Are these wounds causing my affinity with sabi?
I hope to explore these subjects in detail in further posts.
1 – page 53 of Everyone Has Back Pain by Adrian Louw, TM Flynn, and EMilio Puentedura