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Tension is the most common cause of chronic pain, Sarno surmised. It is the culprit, he says, for a host of ailments in addition to lower-back pain, including carpel tunnel syndrome, fibromyalgia, most chronic pain in the neck and shoulder areas, knee tendonitis, and tennis elbow. Tension inhibits blood circulation to the involved area, depriving oxygen to surrounding muscles and nerves and causing the sensation of pain. (Figure 1).

Sarno coined the name "Tension Myositis Syndrome," or TMS, to describe this condition involving muscles, tendons and nerves. Myositis refers to the physiological alteration of muscles, a painful but harmless state.

Since the brain controls the nervous system, the process of TMS begins in the mind. The sensation of pain is real. The mind, according to Sarno, uses the pain to divert attention from unpleasant, unconsciously repressed emotions.

"As with Freud's patients, I found my patients' physical symptoms were the direct results of strong feelings repressed in the unconscious," Sarno wrote in his book, "The Mind-Body Prescription."(4)

"Physical disorders allow sufferers to avoid frightening repressed feelings of rage," Sarno said. There are numerous triggers for rage, including childhood trauma, certain personality traits such as perfectionism, low self-esteem, and stressful life events like death and divorce.

"The brain is fearful of accumulated rage inside, fearful it will come out," Sarno said. "This creates a paradox. A person is experiencing pain, but in reality the pain exists to protect from the possibility of overt rage."

To be cured most patients need to accept that rage causes their pain but do not need a complete understanding of the rage's underlying cause. "Acknowledgement of an emotional role in the genesis of symptoms somehow banished those symptoms," Sarno wrote.(5)

Since the mid-1970s when he first developed his mind-body prescription, Dr. Sarno has treated approximately 500 new patients each year. Treatment begins with a personal phone interview. Because the belief that one's emotions are the root cause of the pain is integral to the cure, Dr. Sarno only accepts prospective patients willing to acknowledge this possibility, approximately 50% of those who call. Patients then visit the doctor for a 45-minute physical and psychological work-up. If the pain's genesis appears emotional the doctor refers patients to a two hour 10 - 12 patient group session. During the session's first hour, Dr. Sarno lectures on pain's various physical manifestations. During the second hour, he directs patients to disregard their pain, resume their normal lives, and meditate daily on the emotional connection.

"Daily morning and evening meditations should follow a specific pattern," Dr. Sarno said. Meditations are approximately 15 minutes in the morning and 30 minutes at night, and include re-reading the psychology-related treatment sections in the doctor's books. Patients are then directed to make list of possible causes of unconscious rage (Figure 2).

Patients following this regimen should find that their pain goes away, Sarno says. At the point that the patients finds that the pain is gone, patients should resume physicial activities that they used to fear would hurt. If pain returns, focus on the root causes, not the pain, Sarno tells his followers.

Several years ago, Dr. Sarno completed a follow-up study of 85 patients seen during a three month period in 1999. Eighty-five percent reported that six to seven months post-treatment they continued feeling almost or completely pain free. Fifteen percent reported no change (Figure 3).

Widespread Criticism from the Medical Community

While most professionals accept a connection between mind and body, many are put off by Sarno's specific prescription. "There is a very, very strong link between mind and body that can have a tremendous impact on the perception of pain, but that's not the whole story," said orthopedist Robert Seebacher, MD, Director at Phelps Memorial Hospital in Sleepy Hallow, NY. "It's a gross over-simplification." "Nagging back pain could signal a substantial illness, like pancreatic cancer," he added. "To give this mind-body point of view primal ascendancy over all other points of view is clearly dangerous and risky."

Sarno responds that he first examines patients for physical causes of pain before treating them for TMS. Sarno reviews their medical charts, often lengthy portfolios, compiled from the myriad of doctors who have examined and treated them yet have been unable to find a cure. "Why is it that over 29 years [as of 2002] I've never run into a malpractice problem, never been sued, and have seen thousands of patients?" Sarno asked rhetorically.

Yet the state of mind-body medicine remains at a record low level in Sarno's opinion. "Mind-body medicine is 1000% in the pits. Doctors have a romance with the lab. We have major industries, like the pharmaceutical industry, treating pain. We are in a medical crisis of the worst dimensions because of medicine's attitude, lack of knowledge and unwillingness to accept the mind can do such things."

Sarno said he can count on his two hands the medical practitioners that follow his protocol. Those followers, however, are strident in their support for Sarno's program. "I became disillusioned with conventional medicine and treatments," said Dr. James Rochelle, an orthopedist from Iowa. "When I read Sarno's book it ratified what I had been thinking, so in January, 2002, Dr. Rochelle traveled to New York City to observe Dr. Sarno. Now the Iowa physician offers Dr. Sarno's treatment program to his local patients. "In my experience, all chronic back and neck pain should be considered TMS if all other serious medical conditions have been ruled out," Dr. Rochelle said.

A Final Note

For Jeanette Barber, Rosie's former comedy producer, what matters is that her pain is gone. Two weeks after her visit and lecture with Dr. Sarno, she stepped out of her wheelchair. As of several years ago and several years after treatment, what had been labeled "incurable tendonitis" was cured - permanently. Her constant, tortuous pain is gone. "If this didn't happen to me I'd have trouble believing it because it seems so incredibly miraculous," explains Barber. "It's real and lasting. It's amazing."

After living without chronic back pain for almost ten years now, this author agrees. It is truly amazing, even if mainstream medical science can't explain how it works.

(1) Am Fam Physician. 2000 Mar 15;61(6):1779-86, 1789-90. (2) Id. (3) Jensen, Maureen, "Magnetic Resonance Imaging of the Lumbar Spine in People without Back Problems," New England Journal of Medicine, (331 (July 14, 1994), 69-73. (4) Sarno, John E., The Mindbody Prescription (New York: Warner Books, 1998), p. xiii. (5) Id. xix. Also thank you to Alice Kenny for conducting interviews and co-writing the first draft of the article.