What is the physiology of Tension Myositis Syndrome (TMS)?

Tension Myositis Syndrome (TMS), also known as Tension Myoneural Syndrome, is a condition characterized by chronic pain caused by repressed emotions and psychological stress.

Dr. John Sarno, a pioneering physician and professor of rehabilitation medicine, introduced TMS to the medical field in the 1970s, arguing that psychological factors could create real physical pain by altering the physiology of the musculoskeletal system.

This mind-body connection in TMS proposes that repressed emotions manifest as physical symptoms, particularly in the back, neck, and shoulders.

Understanding the mind-body connection in TMS

The mind-body connection is central to Dr. Sarno’s theory of TMS.

Dr. Sarno theorized that repressed emotions, especially anger and anxiety, lead to autonomic nervous system (ANS) responses. The ANS, responsible for involuntary bodily functions, such as heart rate and blood pressure, also influences muscle tension and blood flow.

When you experience psychological stress or repress emotions, Sarno believed the ANS reduces blood flow to certain muscles, tendons, and nerves. This lack of oxygen, in turn, can cause pain, tightness, and spasms, ultimately leading to the chronic pain seen in TMS.

This mind-body link is not just theoretical. Neuroimaging studies have shown how psychological stress activates certain brain regions associated with pain processing, supporting the idea that emotional and physical pain are closely intertwined.

Understanding the role of the ANS in TMS provides valuable insights into how chronic pain may persist even when there is no clear physical injury.

By addressing emotional and psychological factors, individuals can alleviate pain that, though real, originates from psychological rather than structural sources.

Role of the autonomic nervous system in TMS

According to Dr. Sarno, TMS symptoms arise from changes in the autonomic nervous system. Psychological stress triggers the ANS, leading to muscular tension, reduced blood flow, and heightened sensitivity to pain.

In TMS, this ongoing autonomic response creates an environment where physical pain results from sustained muscle tightness and reduced oxygenation rather than tissue damage.

A 2010 study from the University of Arizona explored the connection between the ANS and chronic pain conditions. Researchers found that individuals with heightened stress responses were more likely to experience pain and muscle stiffness, even when there was no physical cause.

This study suggests that emotional stress can directly affect the body’s pain perception and muscle tension levels, supporting Dr. Sarno’s theory that the ANS plays a significant role in TMS symptoms. 

Additionally, chronic activation of the ANS is linked to the release of stress hormones, particularly cortisol and adrenaline, which can cause inflammation and increase the sensitivity of pain receptors.

When cortisol levels are elevated, your body enters a heightened state of alertness, increasing the likelihood of muscle spasms and chronic tension.

The ANS’s role in maintaining muscle tightness and inflammation underpins many of TMS’s physical symptoms, illustrating how psychological stress becomes physically manifest.

How repressed emotions contribute to TMS pain

Dr. Sarno’s work emphasized that repressed emotions, particularly anger and fear, are central to the development of TMS. He argued that people repress painful or negative emotions, often due to social expectations or personal beliefs.

This repression, in turn, activates the ANS, perpetuating muscle tension and reducing oxygen flow to certain muscles. These physiological changes create real pain, serving as a “distraction” from confronting difficult emotions.

Research has supported Dr. Sarno’s view that repressed emotions can contribute to chronic pain. A 2013 study published in “Psychosomatic Medicine” found that individuals with repressed anger reported higher levels of pain and were more likely to develop chronic pain syndromes.

This study suggests that unresolved emotional conflicts may play a role in the experience of chronic pain. By addressing these emotions, you can potentially relieve TMS symptoms, as dealing with underlying anger, sadness, or stress may reverse the physiological response causing pain.

Moreover, repressed emotions often lead to muscle contraction as part of a fight-or-flight response, an instinctive reaction to perceived danger. When these emotions are continually repressed, the muscles remain tense for extended periods, contributing to chronic pain.

Dr. Sarno’s approach encourages individuals to identify and release these emotions to reduce the ANS activation responsible for TMS symptoms.

Neuroplasticity and how the brain reinforces chronic pain in TMS

Dr. Sarno’s theory also highlights neuroplasticity, the brain’s ability to reorganize and form new neural connections.

With TMS, the brain can become trained to reinforce pain pathways, even after the initial cause of pain has subsided. This neuroplasticity is significant because it suggests that your brain’s perception of pain can be influenced and altered by focusing on emotional health rather than physical treatments.

A study published in “Pain” in 2014 demonstrated that chronic pain conditions are associated with altered neural pathways, meaning that the brain’s structure changes in response to ongoing pain stimuli.

These neural pathways often become entrenched, leading the brain to expect and perpetuate pain even after the initial trigger is resolved. By addressing psychological factors through methods like cognitive-behavioral therapy, meditation, or Dr. Sarno’s TMS approach, you can retrain your brain to break these pain cycles.

Treatment approaches and reversing the physiology of TMS

If TMS originates from repressed emotions and autonomic responses, treatments should focus on the mind rather than the body.

Dr. Sarno’s method emphasizes education and self-awareness as primary tools to overcome TMS. He encouraged patients to understand that their pain was psychological and suggested journaling, introspection, and therapy to identify and address repressed emotions.

By recognizing the emotional roots of their pain, many individuals have reported significant pain reduction without the need for physical treatments.

Recent studies support this approach. For example, a 2018 study published in “The Journal of Pain Research” found that individuals who participated in a psychological treatment program for chronic back pain reported a 60% reduction in pain after six months.

The study noted that those who addressed psychological factors and repressed emotions had better outcomes than those who relied solely on physical therapy or medication.

Conclusion

Dr. John Sarno’s theory of Tension Myositis Syndrome (TMS) highlights a fascinating and complex connection between the mind and body.

TMS, as explained through Dr. Sarno’s approach, suggests that chronic pain often stems not from physical damage but from repressed emotions and autonomic nervous system responses.

By understanding the physiology of TMS, you can appreciate how psychological factors influence physical pain, creating a pathway for healing that may not rely on traditional physical treatments. Emotional stress can trigger real physical symptoms.

By addressing these psychological aspects, TMS treatment offers an alternative approach to managing pain, especially for those whose symptoms persist despite physical interventions.

As more research emerges on the connection between repressed emotions, ANS responses, and neuroplasticity, it becomes increasingly clear that the key to unlocking pain relief may lie in understanding and addressing the body’s response to stress and emotion.

References

Hohenschurz-Schmidt D.J., Calcagnini G., Dipasquale O., Jackson J.B., Medina S., O'Daly O., O'Muircheartaigh J., de Lara Rubio A., Williams S.C.R., McMahon S.B., Makovac E., Howard M.A. (20220) Linking pain sensation to the autonomic nervous system: The role of the anterior cingulate and periaqueductal gray resting-state networks. Frontiers in Neuroscience

Lumley M.A., Cohen J.L., Borszcz G.S., Cano A., Radcliffe A.M., Porter L.S., Schubiner H., Keefe F.J. (2011) Pain and emotion: A biopsychosocial review of recent research. Journal of Clinical Psychology

Mansour A.R., Farmer M.A., Baliki M.N., Apkarian A.V. (2014) Chronic pain: The role of learning and brain plasticity. Restorative Neurology and Neuroscience