Tension Myoneural Syndrome, A Theory

This is from an article in Anesthesiology News. You have to be registered to read the interview in its entirety and to register you have to be willing to have the ad replete glossy sent to your home every month, so I will assume that most will just take my word for it…
This is an interview with a physician named John Sarno, who makes a case for the underlying emotional issues, pain or rage, that can cause a patient to be under pressure to be a perfectionist, that leads to physical pain. He cites the study in the New England Journal of Medicine back in 1994 which shows that bulges and protrusions in discs in people with low back pain frequently may be coincidental. He believes that if you educate people as to the common psychogenic origins of of these pain syndromes, that he calls “tension myoneural syndrome,” or TMS, they get better. He has seen more than 10,000 such patients over 30 years and that roughly 3/4 of them have gotten better.
His basic theory goes something like this. That the physical pain serves to distract the patient’s attention from emotional pain or rage, which often derives from the pressure people put on themselves to be good or perfect. In this attempt to live up to these high standards, something in the unconscious, an inner child, becomes very, very angry. He tries to educate patients to the fact that the drive to be perfect angers the unconscious. Once the person recognizes that this is what is happening they no longer automatically react to pressure with anger and rage. They no longer need the distraction.
He says that in addition to musculoskeletal maladies, the most common illnesses are gastrointestinal. Migraines and other headaches are classic problems as well. Other conditions that can result are chronic or recurrent sinus infections, and “globus hystericus,” the feeling of a lump in the throat. Allergic problems and frequent urination are others.
He postulates that the brain reduces the amount of oxygen to a given part of the body. He uses various physical therapeutic means to increase circulation, heat, exercise and deep massage. He sees increasing circulation as key, and that “the brain was causing all this through the autonomic nervous system, which controls blood flow.”

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Migraines provide an excellent example of this process. The migraine is a condition of spasmodic narrowing of the blood vessels. The narrowing ususally takes place in one large blood vessel, such as the carotid. First you experience pain ,a nd if it persists long enough, you may have a stroke. Several studies support this oxygen-deprivation hypothesis

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He goes on to cite a 1993 paper on neuroendocrine-immune interactions in the New England Journal of Medicine (NEJM 1993, 329:1246-1253) that concluded that “the central nervous sytem influences on the immune system are well-documented and provide a mechanism by which emotional states could influence the course of diseases involving immune functions.”

I wanted to make a few points about this article since it touches on issues that are important in my practice and my view of Chinese Medicine.
1. The mind and body are not separate entities in Chinese Medicine. Indeed, each organ has its own emotional state that it is responsible for. That is one reason that I was interested in Chinese Medicine. It is a way to help heal the mind through the body without necessarily engaging the cognitive portion. This can be incredibly useful and healthy.
2. The example of migraine is classic Chinese Medicine doctrine. Migraine is often caused by a stagnation of liver qi from an underlying perfectionism and rage. We treat by dredging the liver and calming the Shen, as well as local points which increase circulation.
3. To the extent that I’ve done research it has been on the autonomic nervous system and it’s pivotal role in the effectiveness of acupuncture. Dr. Sarno’s theories do nothing to dispute that theory; though he seems to prescribe a slightly different remedy.
4. The increase in circulation has been clearly established with acupuncture treatment with infra-red documentation and the like.
5. I’d never considered that the brain would be selectively decreasing blood flow to an area of the body, but I find this hypothesis fascinating. I frequently will treat the spinal level involved in the nerves that feed an area that is in pain, and thought of the autonomic nervous system as a more general relaxation and restoration of function. More food for thought!
6. The increase in immune function with acupuncture is well documented, I’ve posted about it here, and here,and am heartened to see other practitioners accepting this link.
7. Globus Hystericus in Chinese Medicine is a common feature of the condition “running piglet” which is treated through the Chong Mai extra meridian and the liver meridian very effectively.