On page 61 of Healing Back Pain, Dr Sarno makes clear that he believes the underlying pathophysiology of TMS is the result of oxygen deprivation in the patient's nerves, tendons and muscles. "This state is known as ischemia, that is, the tissue involved is getting less than its normal complement of blood. This means that there will be less oxygen available for those tissues than they are accustomed to and the result will be symptoms - pain, numbness, tingling and sometimes weakness". I was wondering if my experience of sleeping at higher altitudes this summer confirms this process of oxygen deprivation causing TMS symptoms or no? Well, each time I've driven up to Tioga Pass and slept at nearly 10,000 ft msl, I've noticed on the first night that my sciatica and lower back pain have increased then gone down as I've acclimatized over the next three nights or so. This occurs when I've been having little or no TMS symptoms down in the SF Bay area at sea level and was feeling fine on the drive up to altitude - no tingling feet, no sciatica in the left leg, no lower lumbar pain or stiffness. Some of my symptoms undoubtedly have to do with the high altitude period, like waking up often during the first night. Feeling restless etc. etc. But I also begin to feel TMS pain in my leg on the left side when I'm sleeping on a foam pad that presses on the IT band. Also, if I exercise vigorously on my first day at altitude, I'll get pain in my leg, knee and back. However, if I do the same exercise after three days of sleeping and living at high altitude, there is no pain. Same goes for walking and hiking. If I start hiking uphill on a steep trail the first day at altitude, my sciatica and lower back pain flare up. Three days later I stride right up the hill without any pain whatsoever. Each of my five trips to altitude this summer have also coincided with an ongoing reduction in my TMS symptoms, so it seems to me that the acclimatization process (and just getting into better shape perhaps?) has played a part in expanding my range of pain-free motion. Of course, some of my symptoms no doubt have to do with the process of acclimatization to high altitude, but they do seem to confirm Dr Sarno's ischemia hypothesis. There is also a psychological component to this: Just being outdoors in the High Sierra brings you into a relationship with a beautiful aesthetic experience that overwhelms any tendency a TMSer might have to engage in an obsessive neurotic inner dialog between the inner child and the inner parent. This makes sense too: If you're overwhelmed by the task at hand of climbing a trail up to 12000 ft and looking at huge vistas that sweep away for miles and miles, it's very hard to focus on keeping your repressive emotional dialog intact. Swept away? Blown away? Overwhelmed by the experience of nature? You can certainly see how British Romantic poets, like Wordsworth and Shelley, felt attracted to the Lake Country and the Swiss Alps as places where they could go to escape England's grimy industrial cities and dream big dreams about reconciling inner and outer states of consciousness. See Marjorie Hope Nicholson, Mountain Gloom and Mountain Glory, for all the scholarly particulars about how in the late 18th century people began to regard nature in a new light.