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Mind body Syndrome

The Mind Body Syndrome (also labelled TMS) is a phrase created by Dr Howard Schubiner to explain the growing medical evidence that many chronic pain conditions like RSI, fibromyalgia and lower back pain are mind-related rather than structurally physical conditions.

Chronic pain has become one of the most serious illnesses in the Western world today. Science has increased the ability of the medical community to treat major illnesses, however these advances have not seen an increase in healing chronic pain. It is estimated that around 8 million people suffer from chronic pain in the UK – prescriptions for painkillers alone reach £1/2 billion every year. Chronic pain is the second most common reason for claiming incapacity benefit. (BBC)

All of this points to a failure in the medical community to accurately and effectively diagnose and treat chronic pain. Patients suffering from chronic illnesses have not received satisfactory results from the medical community, despite the advances in modern medicine.

While there has been a failure to treat chronic pain with standardized medical procedures, there is one area of medicine that has seen tremendous success at curing chronic pain at a low-cost. Many health care practitioners have found success using a mind body approach to treat chronic pain. These practitioners diagnosis patients with TMS (Tension Myoneural Syndrome), also known as MBS (Mind Body Syndrome).

The concept of TMS was first used by Dr. John Sarno, Professor of Clinical Rehabilitation Medicine at New York University School of Medicine. More recently Dr Howard Schubiner Professor of Medicine at Wayne State University Medical School Detroit has relabelled the condition MBS. There is now a network of dozens of doctors who have adopted this approach (listed here)

Many patients suffering from chronic illnesses have significant amounts of stress and anxiety in their lives triggered both by immediate events and past history. Therefore, a successful treatment of chronic pain involves a patient addressing what aspects of their past and current life trigger stress and anxiety. This treatment involves a mixture of meditation, information, journaling and talking therapies.

A 2007 peer reviewed study (1) by researchers at the Seligman Medical Institute reported that they were able to reduce the pain levels of 51 chronic back pain patients (average pain duration 9 years) by over 50%. The methods used were journaling, informational reading, meditation and in some cases psychotherapy. Arthur Smith, PhD, said “We do think we have enough anecdotal evidence here to justify more serious research on this approach. Most had already tried multiple conventional and alternative treatments to no avail. With this program, most of them got well or at least significantly improved.”

A number of studies have already underlined the fundamental psychological role in chronic pain. Robert Kerns, professor of psychiatry at Yale University, published a 2007 meta-analysis of 22 trials of psychological treatment for patients with chronic lower back pain. The results were that patients who learnt different methods of thinking about their pain (such as cognitive behavioural therapy or forms of meditation) could make that pain go away. Co-author of the report Benson Hoffman summed up the remarkable findings “These psychological treatments reduced the pain more than anything else.” (2)

In studies of 3000 Boeing workers in the 1980s, and also in a study published by Stanford Professor of orthopaedic surgery Dr Eugene Carragee, the best predictor of chronic pain has been found to be emotional distress, stress or depression. As Dr Carragee noted “The structural problems were really overwhelmed by the psychosocial factors. People without mental risk factors were able to deal with their back pain. But for people with a psychological problem the pain was often crippling and catastrophic.” (3)

There is published evidence which speaks to the medical benefit gained by expressing emotions through journaling. Joshua Smyth et al.(4) conducted a study on rheumatoid arthritis and asthma sufferers. They found significant clinical improvements for both asthma and rheumatoid arthritis sufferers against the control group in objective measures. A separate study by Diane Berry et al.(5) reviewed studies into the expression of verbal and non verbal emotion, and concluded that such activities led to immediate reductions in autonomic nervous system activity, and led to improved physical health, an enhanced immune function and were associated with fewer medical visits.

A study by Fadel Zeidan et al into the effectiveness of mindful meditation found that even a brief 3 day meditation program was successful in reducing pain ratings and anxiety scores compared to baseline measurements. He says, "We knew already that meditation has significant effects on pain perception in long-term practitioners whose brains seem to have been completely changed -- we didn't know that you could do this in just three days, with just 20 minutes a day. All you have to do is use your mind, change the way you look at the perception of pain and that, ultimately, might help alleviate the feeling of that pain." (6)

There is already a flourishing internet community of hundreds of former chronic pain sufferers who all credit TMS techniques as the key to becoming pain free. The TMShelp Forum has over 2000 members and the [../ TMS wiki] has upwards of 200 pages of information on the theory. Some of the stories truly are remarkable. Hilary, a founding member of the TMS wiki, suffered from RSI for 13 years. She says of her recovery: “After having been completely dependent on voice recognition software for many years to do my IT job I am now completely cured and have no problems using the keyboard and mouse for as long as I like.”

And her story is just one amongst scores. Chronic back pain, RSI, neck pain and migraines. Seriously debilitating conditions which former long term sufferers give testimony to overcoming within weeks, and sometimes within hours or days of reading about TMS. This is more powerful than any concept of placebo – which cannot in any case cure what are, according to conventional medical thinking, supposedly structural deficits.

Despite the mounting scientific evidence of the benefits of employing TMS techniques to alleviate chronic pain, for now the concept of TMS remains outside the mainstream. But the compelling nature of the numerous success stories online, the impressive success reported in small scale studies and the growing body of medical evidence attesting to the fundamental role of the psyche in chronic pain, all suggest something far more substantial than either statistical fluke or placebo. Perhaps there are psychosomatic roots to a range of chronic pain conditions and in neglecting this concept in favour of structural diagnosis we are consigning large number of people unnecessarily to years of pain. At the very least further research is desperately needed, and for chronic pain there needs to be a much greater emphasis on treating the mind as well as the body.

Mindbody syndrome in the media:

Healthcare Counselling and Psychotherapy Journal 01/2010 In early 2010 Alan Gordon, a psychotherapist in California, wrote an article for HCPJ entitled Miracles of Mindbody Medicine.

The Huffington Post 08/27/2009 Colleen Perry is a psychotherapist from Santa Monica and also a blogger at The Huffington Post. She published an article on the Huffington Post about TMS entitled "Treating Chronic Pain - There is a Better Way!"

Best Life Magazine November 2007Jonah Lehrer is a contributing editor at Wired. He wrote an article for Best Life Magazine in November 2007 on the psychology of chronic back pain. Here he reprints the entire 5000 word article on his blog. It's a brilliant account of some of the science behind the theory, and includes an interview with Dr Marc Sopher on TMS.Where the Client Is 2010 In early February 2010 Will Baum interviewed psychoanalyst and chronic pain expert Frances Sommer Anderson in the article “Treating Chronic Pain – An Interview with Frances Sommer Anderson, PhD.” In the interview Anderson describes how she became involved with TMS and what is was like working alongside Dr. John Sarno.

Newsweek 04/26/2004 Claudia Kalb is a General editor of Newsweek and focuses on health and medical issues. In 2004 she wrote an article entitled [[1]], in which she investigates the causes and treatments of back pain.

Runner's World 08/2004 In 2004, Marc Bloom, a runner, coach, author and senior writer for Runner's World magazine, wrote an article entitled "Mind Over Matter". MedScape Today 06/07/2004 In June of 2004, freelance journalist Pippa Wysong, interviewed Dr. John Sarno for a story for MedScape Today. The interview is entitled, An Expert Interview With Dr. John Sarno, Part 1: Back Pain is a State of Mind. In the piece, Wysong investigated what interested Dr. Sarno in chronic pain treatment and what he initially found wrong with standard medical treatment. (original Medscape article behind a login – here it is reprinted online)

The Seattle Times 07/23/2000 Molly Martin is the Assistant Editor of the Pacific Northwest Magazine. In July of 2000, she wrote an article for the Seattle Times entitled, Minding the Back. The article begins with Martin's own account of how stressful situations sometimes lead to her having back pain. John Stossel in a 20/20 ABC show 07/25/1999 John Stossel, former co-anchor of the ABC news show 20/20, was a patient of Dr. John Sarno's and claims that his fifteen years of back pain were overcome through using Dr. Sarno's TMS approach. He presented a piece on the 20/20 programme about this. New York Magazine 03/10/1986 In March 1987 Schwartz wrote an article for New York Magazine entitled, Ah, My Non-Aching Back. Other resources:Success Stories online:Backpain success storiesRSI success storiesFibromyalgia success storiesCitations:(1i) “Outcomes of a Mind-Body Treatment Program for Chronic Back Pain With No Distinct Structural Pathology.” David Schechter et al. In Alternative Therapies, September, 2007 - VOL. 13, NO. 5.Journal abstract: Study press release: Meta-analysis of psychological interventions for chronic low back pain. Journal of Health psychology. 2007,vol.26,no1,pp.1-9 HOFFMANet al.

(3) Carragee EJ et al.Prospective controlled study of the development of lower back pain in previously asymptomatic subjects undergoing experimental discography. Spine2004 May 15;29(10):1112-7Quote from in Joshua M. Smyth et al. Effects of Writing About Stressful Experiences on Symptom Reduction in Patients With Asthma or Rheumatoid Arthritis: A Randomized Trial. JAMA, Apr 1999; 281: 1304 - 1309.

(5) Berry D et al. Nonverbal and verbal emotional expression and health. Psychotherapy and Psychosomatics. Vol 59(1), 1993, 11-19. Zeidan F et al. The Effects of Brief Mindfulness Meditation Training on Experimentally Induced Pain. The Journal of Pain (published online 23 October 2009). Quotes from University of North Carolina at Charlotte press release, printed at