Tension myositis syndrome ( TMS ), also known as tension myoneural syndrome or mindbody syndrome is the name given by John E. Sarno on the condition he describes is characterized by musculoskeletal and psychogenic nervous symptoms, especially back pain. Sarno, a Professor of Clinical Rehabilitation Medicine at New York University School of Medicine and Attending Doctor at the Rusk Institute of Medical Rehabilitation Institute at New York University Medical Center, has described TMS in four books, and has stated that this condition may be involved in pain disorders as well. Treatment protocols for TMS include education, writing on emotional issues, restarting a normal lifestyle and, for some patients, supporting meeting and/or psychotherapy. In 2007, David Schechter (a medical doctor and former student and research assistant Sarno) published a thoroughly reviewed study of TMS treatment showing a 54% success rate for chronic back pain. In terms of statistical significance and success rates, this study outperformed similar studies of other psychological interventions for chronic back pain.
TMS diagnosis and treatment protocols are not accepted by the mainstream medical community. However, TMS and Sarno's treatment methods have received national attention, including segments at ABC <2020 ; an episode of Larry King Live ; interview with Medscape ; and articles on Newsweek , The Seattle Times , and The New York Times . Leading medical doctors who support TMS treatment include Andrew Weil and Mehmet Oz. Important patients treated for myositis syndrome tension include Sen. Tom Harkin, John Stossel, Howard Stern, and Anne Bancroft.
Video Tension myositis syndrome
Symptoms
Back pain is often referred to as TMS symptoms, but Sarno defines TMS symptoms much broader than that:
- Types of symptoms: TMS symptoms include pain, stiffness, weakness, tingling, numbness, muscle contraction, cramps and other negative sensations, according to Sarno.
- Symptom location: In addition to the back, Sarno states that TMS symptoms can occur in the neck, knees, arms, wrists, and other parts of the body. Schechter states that the symptoms have a tendency to move to other parts of the body. He considers the movement of symptoms as an important indicator that the pain originates from the TMS.
Maps Tension myositis syndrome
Diagnosis
Below is a list of criteria for diagnosing TMS, according to Schechter and Sarno:
- Lack of known physical causes: Schechter and Sarno stated that physical examination, tests and imaging are needed to rule out serious conditions, such as tumors. Sarno considered herniation of the spine generally harmless, as he said the location of the symptoms was not even correlated with the location of the herniation.
- Tender points: While doctors use eleven of the eighteen tender points as diagnostic criteria for fibromyalgia, Sarno states that he uses six major tender points to diagnose TMS: two tendering points in the trapezius muscle up, two in the paraspinal lumbar muscle and two in the upper lateral butt. He stated that this was found in 99% of TMS patients.
- Other history of psychosomatic disorders: Schechter and Sarno consider another history of psychosomatic disorders which indicate that the patient may have a TMS. They noted irritable bowel syndrome and tension headache as an example of psychosomatic disorders.
Schechter and Sarno stated that if a patient can not visit a medical doctor trained in TMS, then the patient should see a traditional medical doctor to rule out serious disorders, such as fractures, tumors and infections.
Treatment
Treatment protocol
Treatment protocols for TMS include education, writing on emotional issues and restarting a normal lifestyle. For patients who do not recover quickly, the protocol also includes support groups and/or psychotherapy.
The Sarno protocol for TMS treatment is used by the Harvard RSI Action Group, student volunteer organizations, as part of their prevention education and prevention program for people with repetitive strain injuries, also referred to as "RSI".
- Education
Education can include office visits, lectures and written and audio materials. The content of education covers the psychological and physiological aspects of TMS. According to Schechter, education allows patients to "learn that their physical condition is actually benign and that any disability they have is a function of fear and pain-related deconditions, not the true risk of further 'back injury'.
- Write about emotional issues
Sarno stated that every patient should set aside time each day to think and write about issues that can cause stressful emotions of the patient. He recommends the following two writing tasks:
- Write a list of issues. Sarno states that each patient should try to list all the problems that may contribute to the patient's distressed emotions. He suggests looking in the following areas: (a) certain childhood experiences, such as harassment or lack of love, (b) personality traits such as perfectionism, thoroughness and a strong need to be liked by everyone; (c) (d) aging and death and (e) the situation in which the patient experiences conscious but not disclosed anger.
- Writing an essay. Sarno recommends that patients write an essay for each item on the list above. He prefers longer essays because they force patients to examine emotional issues in depth.
Schechter developed a 30-day daily journal called "The MindBody Workbook" to assist patients in recording emotionally significant events and making correlations between events and their physical symptoms. According to Sarno and Schechter, the daily repetition of the psychological process over time defeats repression through consciousness.
- Restart normal lifestyle
To return to a normal lifestyle, patients are required to take the following actions:
- Physical treatment terminations - Sarno recommends patients stop using spinal manipulation, physical therapy and other physical treatments because "they tend to erroneously amplify as structural causes for chronic pain."/li>
- Commencement of normal physical activity - Schechter states that patients are encouraged to "gradually become more active, and begin to resume normal life." In addition, patients are encouraged "to stop safety behaviors aimed at protecting their" broken "backs.
- Support meetings
Sarno uses a support meeting for patients who do not recover soon. Sarno states that support meetings (a) allow patients to explore emotional problems that may be causing their symptoms and (b) review the concepts discussed during previous education.
- Psychotherapy
Sarno says that about 20% of patients need psychotherapy. He stated that he uses "short-term, dynamic, and analytically-oriented psychotherapy." Schechter says that he uses psychotherapy for about 30% of his patients, and that six to ten sessions are needed per patient.
- Recovery Program
Alan Gordon, LCSW has created a TMS recovery program on the TMS Wiki, which includes articles, exercises, and segments of sessions exemplifying the therapeutic concept.
Medical evidence
While psychogenic pain and pain disorders are the accepted diagnoses in the medical community, TMS modalities are more controversial.
A 2005 non-peer-review study by Schechter at Seligman Medical Institute (SMI), co-authored with institute director Arthur Smith, found that TMS treatment achieved a 57% success rate among patients with chronic back pain.
A 2007 peer-reviewed study with Schechter, Smith and Stanley Azen, Professor and Co-Director of Biostatistics at the Department of Preventive Medicine at USC Keck School of Medicine, found a 54% success rate for TMS ( P & lt ;.00001). Treatment consists of office visits, home education materials, writing about emotional issues and psychotherapy. The mean duration of pain for the study patients was 9 years. Patients with less than 6 months of back pain are excluded to "control the confounders that most episodes of back pain usually go away by itself in a few weeks."
Schechter, Smith and Azen also compared their results with the results of three other psychological treatment studies for chronic back pain. Three non-TMS studies were selected because of (a) their quality, as assessed by Cochrane Collaboration, and (b) the similarity of their pain measurements to those used in the TMS study. Of the three non-TMS studies, only one (Turner study) showed a statistically significant increase. Compared with the 2007 TMS study, the Turner study had a lower success rate (26% -35%, depending on the type of psychological treatment) and a lower level of statistical significance ( P & lt;.05).
Schechter, et al. states that one benefit of TMS treatment is to avoid the risks associated with surgery and treatment, but they warn that the risk of TMS treatment is somewhat unknown because of the relatively low amount. patients studied so far.
Theory
According to Sarno, TMS is a condition in which unconscious emotional problems (especially anger) begin a process that causes physical pain and other symptoms. His theory shows that the unconscious mind uses an autonomic nervous system to reduce blood flow to muscles, nerves or tendons, resulting in oxygen deprivation (while micro-ischemia) and metabolite accumulation, experiencing pain in affected tissues. Sora theorizes that because patients often report that back pain seems to be moving around, up and down the spine, or from side to side, that this implies pain may not be caused by a physical deformity or injury.
Sarno states that the underlying cause of pain is the mind-defense mechanism of unknowable mental and emotional stress such as anger, anxiety and narcissistic anger. The conscious mind is disturbed by physical pain, because the process of psychological repression keeps the anger/anger contained in the unconscious and thus prevents entering conscious consciousness. Sarno believes that when patients recognize that the symptoms are only a disorder, the symptoms are useless, and they leave. TMS can be regarded as a psychosomatic condition and has been referred to as "disorder disorder syndrome".
Sarno is a vocal critic of conventional medicine related to the diagnosis and treatment of back pain, often treated with rest, physical therapy, exercise and/or surgery.
Famous patient
Notable patients who have been treated for TMS include the following:
- Howard Stern's radio personality praised TMS's treatment by removing the torturous "shoulders and shoulders" and obsessive-compulsive disorder.
- 20/20 John Stossel's deputy was treated by Sarno for his chronic and debilitating back pain. In the 20/20 segment of his former doctor, Stossel expressed his opinion that TMS treatment "cures" his back pain, though he admits that he continues to experience relapsing pain.
- Television writer and producer Janette Barber says that for three years, she is getting less able to walk, and finally starts using a wheelchair, due to severe ankle pain that was initially diagnosed as tendinitis. He was later diagnosed and treated for TMS. According to Barber, he was "pain-free one week after college [Sarno]" and was able to walk and run in a few months, despite the "occasional" relapse of pain.
- The late actress Anne Bancroft says that she saw some doctors for back pain, but only Sarno's TMS treatment helped her.
- Famous filmmaker Terry Zwigoff says he is on the brink of suicide due to his debilitating back pain, until he turns to the Sarno method and "saves [his] life", as well as the life of a woman he was told about it recently.
Controversy
TMS diagnosis and treatment protocols are not accepted by the mainstream medical community. Sarno himself stated in a 2004 interview with Medscape Orthopedics & amp; Sports Medicine that "99.999% of the medical profession does not accept this diagnosis." Although most physicians do not accept TMS, there are reputable doctors who do so. Andrew Weil, a prominent medical doctor and advocate of alternative medicine, supports TMS treatment for back pain. Mehmet Oz, a television personality and Professor of Surgery at Columbia University, included TMS treatment in four recommendations to treat back pain. Richard E. Sall, a medical doctor who wrote a book on workers compensation, included TMS on the list of conditions he deemed to be the cause of back pain that resulted in missed working days that increased the cost of workers' compensation programs.
Critics in mainstream medicine suggest that both the TMS theory and the effectiveness of treatment have been proven in well-controlled clinical trials, citing placebo and regression effects to the mean as possible explanations for its success. Patients usually see their doctor when the pain is at the worst score and the pain score statistically increases over time even if left untreated; most people recover from episodes of back pain in a few weeks without any medical intervention at all. The TMS theory has also been criticized for being too simple to explain the complexity of the pain syndrome. James Rainville, a medical doctor at the New England Baptist Hospital, said that while TMS treatment works for some patients, Sarno mistakenly uses TMS diagnosis for other patients with real physical problems.
Sarno's response was that he was successful with many patients who had run out of other ways of treatment, which he said was proof that setbacks on purpose were not the cause.
Notes and references
Source of the article : Wikipedia
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