Example Letter to Family Doctor

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What follows is an excerpt letter that was sent to Pandamonium's family doctor so that she could inform him about TMS in the hope that he would consider it as a possibility for some of his patients with similar unexplained pain.

2009 Dear Dr,

It was nice to see you earlier this week and I am glad that you don't mind me writing to tell you about how I recovered from my awful back pain. I hope that if you have patients in similar circumstances (where severe pain exists but the physiological reason cannot be found) you could think about this letter and maybe tell them about the book I mention below? Just to remind you that I had suffered from chronic back pain for 10 years. During that time I had 2 MRIs, the first was in 2003 and found nothing of note; the second was in 2007 and found a slight annular fissure in the L5/S1 area. This made me suspect that the pain probably wasn't caused by the fissure since it post-dated the onset of my pain. I have included my personal story on a separate sheet so won't go into it here but suffice it to say that my life was bleak. I had tried chiropractic, osteopathy, physiotherapy, homeopathy, back supports, ice packs, TENS machines and Amytriptyline and was facing the Pain Clinic with not much hope that it would help (as we discussed this week).

In Feb 08 I was googling the term “annular fissure” to see if there was anything surgically that could be done for me (yes, I was that desperate) when I came across a link on “knowledge management”. This then lead on to tell me about a book called Healing Back Pain by Dr John Sarno.

Dr Sarno is professor of Clinical Rehabilitation Medicine at the New York University School of Medicine and an attending physician at the Rusk Institute of Rehabilitation Medicine in New York. When he joined the Rusk Institute in 1965 he observed large numbers of patients with neck, shoulder, back and buttock pain which were attributed to a variety of structural abnormalities of the spine and which he treated according to conventional medical treatment; injections, ultrasound deep heat, massage and exercise. He found that he could never predict the outcome of these treatments with any certainty and in addition he found that the pattern of the pain often did not correlate to the presumed reason for the pain; e.g. someone might have a lumbar disc herniated to the left but have pain in the right leg.

Dr Sarno was perplexed that people experienced so much pain for so many months and years and that the back did not heal itself. He asked himself “If the largest bone in the body, the femur, only takes 6 weeks to heal from a fracture, is it realistic to expect 10 years of pain following a minor injury such as hurting the back when playing tennis, or suffering from whiplash?” Dr Sarno soon realised that the primary tissue involved was muscle and that 88% of his patients had histories of other disorders strongly suspected of being related to tension such as IBS, eczema, migraine headache, stomach ulcer, colitis and heartburn. He therefore made an assumption that the back pain could also be induced by tension and coined the term Tension Myositis Syndrome (TMS). He treated his patients accordingly and there was a marked improvement in their symptoms. In 2 follow-up studies of 100 patients he had a 75% and an 88% success rate. Finally he was treating the cause of the symptoms and not them symptoms themselves.

In TMS terms the word tension refers to emotional factors, stress, and repressed emotions. Dr Sarno discovered that people who suffer from TMS tend to exhibit the same personality traits; they are perfectionists, very self-critical, and people pleasers. Dr Sarno's theory is that these sorts of people can easily build up resentment and anger, and when this emotional tension builds up and threatens to become conscious, their mind decides that this could become dangerous or embarrassing and so attempts to distract them. He postulates that what then follows is that the central nervous system restricts the blood flow to certain muscles, nerves, tendons and ligaments. This results in a lack of oxygen to these tissues and a build up of waste materials causing pain, altered sensations, tension and spasms. This very real and agonising pain distracts people from their emotions and keeps them out of their conscious awareness. Unfortunately this then becomes a learned response: in the same way that amputees continue to experience pain in limbs that have been amputated. The nerves that send signals to the brain become sensitized and continue to fire and those signals are interpreted as pain by the brain despite the body being healed.

The good news is that once we know what is going on we can easily start to reverse the process. Patients like me, diagnosed with TMS, are encouraged to slowly resume physical activity and remove any “props” such as back supports, special pillows and chairs which serve as re-enforcements to our mind that we have a serious structural problem with our backs. Through a process of reading and learning about TMS we effectively start the healing process but this process can be aided by journaling, meditating and occasionally psychotherapy to help process the emotional tension.

During the years Dr Sarno has also discovered that there are a number of TMS Equivalents and I know personally of people who have been cured from RSI and Fibromyalgia. He has cured thousands of patients.

This year sees the first conference to discuss TMS in the USA; health professionals from all over the country are meeting to talk about TMS and the way forward in terms of research (there are currently about 30 TMS physicians in the US) which is very exciting indeed. Dr Sarno himself is the keynote speaker.

If this letter has piqued your interest in TMS there are a number of websites that you could look at for more information. Georgina Oldfield is the TMS physiotherapist based in the UK and her website has some great information on it, the website is www.tmsrecovery.com. Another website is www.tmshelp.com, this is a forum for TMS sufferers to chat and support each other and it has helped me a lot in my recovery, just to hear other people's stories of success is so inspirational. Finally I'd like to mention www.tmswiki.org which is a Wikipedia type website dedicated to TMS. The site was developed in December of last year and is growing rapidly; its aim is to consolidate lots of information about TMS and strategies for beating it. Being a Wiki website it means that anyone can edit and add to it. We hope that it will become a great a resource for people all over the world who are recovering from TMS – and the resources will be provided by others who have recovered or are recovering.

Having been a patient of yours for many years, I have a huge amount of respect for you and the other doctors at the Medical Centre, and I would love to know your thoughts on this subject.

Yours sincerely

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