An Introduction to Tension Myositis Syndrome (TMS)

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Have you struggled with chronic pain or another medically unexplained symptom for a long time? Have you tried everything to alleviate your pain, but nothing worked? Have you had doctors tell you they "just can’t find anything wrong?"

Then you may have Tension Myositis Syndrome (TMS). TMS is a condition that causes real physical symptoms that are not due to pathological or structural abnormalities and are not explained by diagnostic tests. In TMS, symptoms are caused by psychological stress.

You may be at your wits end. However, there is hope. We know this because the authors of this wiki struggled with chronic pain for many years, and that is exactly how we felt: hopeless. We're not doctors so, of course, we can't diagnose you, and everyone is different, but we are here to tell you what worked for us and how it did so without surgery, needles, or drugs. We found relief from pain through TMS.

What is TMS?

an image of a woman and chalkboard with question marks
Tension Myositis Syndrome (TMS), also known as Tension Myoneural Syndrome, is a condition originally described by John E. Sarno, MD, a retired professor of Clinical Rehabilitation Medicine at New York University School of Medicine, and attending physician at the Howard A. Rusk Institute of Rehabilitation Medicine at New York University Medical Center. TMS is a condition that causes real physical symptoms, such as chronic pain, gastrointenstinal issues, and fibromyalgia, that are not due to pathological or structural abnormalities and are not explained by diagnostic tests. In TMS, pain symptoms are caused by mild oxygen deprivation via the autonomic nervous system, as a result of repressed emotions and psycho-social stress.

This is not to say that the pain is “all in your head” or that it is not real. TMS symptoms are very much real, and we should know. All of the people who wrote and developed this website had debilitating chronic pain and other symptoms. We know, first hand, what it is like to have back pain, sciatica pain, RSI, fibromyalgia, chronic fatigue syndrome, migraines, irritable bowel syndrome, and a wide array of other symptoms. We visited doctors and were told the same things you probably heard: "you have a degenerative disc disease, a herniated disc, you type too much, it is due to overuse, or that you are just aging." Even though we were told this, when we applied the ideas first promoted by Dr. Sarno we became pain free and regained our lives.

For more info on TMS watch The 20/20 segment on John Sarno and TMS.

How TMS Develops

At the heart of the development of TMS is our desire to be good people, loved by those we care about. This desire leads us to strive for perfection, and to put the needs of others above our own. We will cook a three course family meal after working a 10 hour day, because that is what a good mother would do. We will be the first person to volunteer to work on the weekend, because that is what a good employee would do. We will stay up all night making sure our homework is perfect, because if we don't, we won't get a good job. Our beliefs of what a good and perfect person will do directly influence our behavior on a day-to-day basis.

But sometimes, as more and more external stress is added and our desire for perfection increases, we develop a very deep seated resentment toward these tasks. There are some nights when you come home from working a double shift and are angry that you have to cook a meal for your family, while your husband has been watching TV all night. Part of us hates telling our friends that we can't go out on Friday night, because we have to read and study for a class the next day. When our newborn baby wakes us up at 3 am for the fourth night in a row, some part of us has rage at the child, for waking us up yet again. These are all normal feelings and emotions to have. However, when a person has an emotion that goes against their belief of what a good and perfect person would do, the only option available to them is to repress that emotion. If we admit that we are angry at our family, our boss, or at doing homework, we fear that we would be considered a bad person and will be rejected by those we love or who we want to respect us. If we are not perfect, we will be unworthy of being loved. So instead of admitting that we are angry at our spouse for never cleaning up or doing the dishes, we repress it deep in our unconscious.

Another repressed emotion might be guilt. Some of us have to care for a loved one who is injured or aging. Being a caretaker is not an easy task. If we aren't able to provide the necessary care, or the care the person not only desires but may demand of us, we may feel guilt. If we repress that feeling, especially if we are the type of person who wants to please very much, it can cause us TMS pain.

As we continue to repress these emotions, we create an immense amount of emotional tension which only increases as more and more stress is added to our lives. In order to keep you from recognizing that you have these powerful emotions of anger and rage or guilt, your unconscious creates physical symptoms, such as back pain, neck pain, plantar fasciitis, acid reflux, anxiety, depression, Dizziness, and irritable bowel syndrome. These symptoms serve as a way to distract you from the unwanted emotions by having you focus on your back hurting instead of your anger, rage, or guilt. We develop TMS because we are unable to accept and/or process these emotions.


a student reading in a chair
No two people are exactly alike, and likewise, no two TMS recoveries are exactly the same. Different pain-healing techniques work for different people, and one of the keys to TMS treatment is identifying what techniques work best for you. People have reported using a variety of approaches to get better. Regardless of the specific technique, TMS treatment is based on two principles, which Dr. Sarno stated in Healing Back Pain:

1. The acquisition of knowledge, of insight into the nature of the disorder.
2. The ability to act on that knowledge and thereby change the brain's behavior.

All of the standard treatments for TMS seek to help people address one or both of these pillars. The following is a list of techniques that many people have reported being helpful in their own recovery from chronic pain. As a reminder, Sarno says, "It is important to see a medical professional before starting this treatment approach to rule out any serious medical condition."

  • Think Psychological: As previously mentioned, TMS serves as a distraction mechanism to prevent unwanted emotions to surface to our consciousness. The idea being that you will focus on your symptoms instead of your emotions. Think of how much time you spend thinking about your symptoms, worrying about when they will come next, or if they will ever go away. Thinking psychologically involves turning your focus from your symptoms to your emotions. Instead of thinking "When is my back going to stop hurting?," ask yourself "What am I stressing about now?," or "How do I feel emotionally right now?" Thinking psychologically is a process of using your symptoms as a signal to check in on your emotional state, as well as a method of changing how you view your symptoms.
  • Educate yourself: As the first pillar of TMS recovery states, learning about this condition will give you the knowledge you need to recover. Read a TMS book, forum posts, success stories, Thank You, Dr. Sarno messages, and our wiki, along with watching the 20/20 Segment, to gain a better understanding of Tension Myositis Syndrome and how to recover. We live in a society that treats chronic pain as a physical issue. In order to reverse this thinking, one must acquire an understanding of mind-body medicine and how stress can and does create physical symptoms.
  • Resume Physical Activity: In Healing Back Pain, Dr. Sarno writes: Perhaps the most important (but most difficult) thing that patients must do is to resume all physical activity, including the most vigorous. It may seem odd to become active when you are still in pain, but it can be extremely beneficial in TMS treatment. By being active you are sending messages to your unconscious that you do not have a physical problem, and will no longer think physical. The more active you are, the more confidence you will gain. People are encouraged to start slowly and build their activity level up as their recovery progresses. Resuming physical activity for some may not necessarily mean going to a gym for a work-out. It may just mean continuing to do your daily house cleaning, shopping, cooking, and walking the dog so you both get fresh air, some exercise of the legs, and hopefully sunshine. If pain is there, remind yourself it is psychologically, not physically, caused.
  • Stop all physical treatments: In order to fully accept the diagnosis it is important for people to stop using physical modalities to treat their symptoms, once a medical professional has cleared them for any serious medical conditions. There are a wide variety of physical therapies people in chronic pain use. Whether it is massage, heating pads, chiropractic manipulation, or acupuncture, all of these techniques keep people focused on their physical symptoms, instead of their emotional health. If you wear orthopedics, use ergonomic devices, or any other device to prevent or help reduce your symptoms, it is recommended to stop using them. If possible, stop taking pain-killers of any kind or strength. Full recovery can only happen when a person has full belief in the TMS process.
  • Affirmations: Many people have reported how helpful saying affirmations are in recovering. Essentially this involves talking to your brain. While it may feel slightly odd to talk to yourself, people have reported that it allows them to gain control over their thoughts and take a more active role in their recovery. Affirmations are like mantras, and examples are "I am calm," "I am at peace," "Every day I am feeling better."
  • Interact with Other TMS Peers: Hearing how other people recovered from TMS can be very helpful in your own recovery. This can be anything from posting in our forum to attending a lecture by a TMS doctor. Our organization hosts a number of events for peers including: a weekly TMS discussion group and drop-in chat, in-person support groups, and TMS webinars. Learning from people who have been there will help you gain a better understanding of this syndrome.
  • Journal/List making: Identifying and understanding what factors are fueling your symptoms is key. Many people have reported that writing about past and present events, as well as their emotions, has been particularly helpful in reducing their symptoms. Simply making a list of events and circumstances that may be creating repressed anger and rage has been enough for some people to recover. Dr. Sarno says you don't even need to solve a problem you have repressed. It is enough to identify it and tell your unconscious mind that it is what you have repressed and that is causing your pain.
  • Psychotherapy: For some people, identifying and processing their repressed emotions is challenging. This could mean that they simply have a higher level of anxiety or a more traumatic past. In these cases, a trained TMS professional can be helpful in guiding the person through their TMS treatment. Just because you need to see a therapist to get better, does not mean that you have failed this program. To find a TMS practitioner located near you, please visit Find a TMS Doctor or Therapist.

For more ideas on how to recover see: So You Think You Might Have TMS

Medical Evidence

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Research in the field of mindbody medicine is quickly developing. Up to this date, most of the research has focused on understanding the causes of chronic pain symptoms. This research has found that most chronic pain conditions lack a clear structural cause. One study by Jensen, MC in the New England Journal of Medicine found that MRI tests do not accurately depict when a person has back pain. Of the 98 symptomatic people in this study 52% had a disc bulge, 27% had a protrusion, and 1% had an extrusion. This study shows that there is no correlation between spinal abnormalities and back pain. This is one reason why Dr. Sarno called spinal abnormalities the "grey hair of the spine," referring to a harmless physical change in our body, such as having grey hair when we age.

During his time in practice, Dr. Sarno conducted two follow-up surveys of his patients to gauge the effectiveness of his treatment approach. The first, conducted in 1982, selected 177 patients at random, of which 76% reported being pain free. The second study was done in 1987 and focused on 109 patients who experienced back pain. In this survey 88% reported being pain free. Dr. David Schechter also conducted similar follow-up surveys on his patients, and reported a 57% success rate among 85 patients.

In 2010, Howard Schubiner, MD, conducted a Randomized Control Trial on the effectiveness of the Tension Myositis Syndrome (TMS) approach in treating fibromyalgia patients. This study was the first TMS-specific research study to use a RCT, the gold standard of the medical community. The study was conducted on 45 randomly chosen women who had fibromyalgia. The treatment consisted of a one-time consultation followed by 3 weekly, 2 hour group lecture sessions explaining TMS. After a 6 month follow up, 46% of the participants reported a pain reduction of at least 30%. After these promising results, Howard Schubiner received a research grant from the National Institutes of Health to further explore the effectiveness of this approach.

For further reading on the research into TMS and chronic pain visit the Medical Evidence section.

Next: So You Think You Might Have TMS

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DISCLAIMER: The TMS Wiki is for informational and support purposes only and does not provide medical advice, diagnosis, or treatment recommendations. See Full Disclaimer.