Sarno’s groundbreaking books beginning in the early 1980’s put a ‘non-organic/non-structural’ spin on the impending epidemic of LBP in western culture. Instead of adding more ‘mistaken structural causes’ to the fields of physical medicine (trying to “explain” why back pain disables so many) he opted to consider TMS (tension myofascial syndrome). The underlying cause is assumed to be personality issues which drive physical alterations which produce pain. Such traits include:
- Having a strong inner drive to succeed
- Having a great sense of responsibility
- Being self-motivated and disciplined
- Being their own severest critics
- Being perfectionistic and compulsive
Dr. Sarno’s theory is that these personality characteristics interact with stressful life situations to cause the back pain. He points out that the source of psychological and emotional tension is not always obvious. Dr. Sarno’s theory of TMS describes a mechanism whereby emotional tension is pushed out of awareness by the mind into the unconscious. This unconscious tension causes changes in the body’s nervous system. These changes include constriction in blood vessels and reduction of blood flow to the various soft tissues, including muscles, tendons, ligaments, and nerves in the back. This causes a decrease in oxygen to the area as well as a buildup of biochemical waste products in the muscles. In turn, this results in muscle tension, spasm and back pain experienced by the patient. He contends the majority of patients will improve with ‘counseling’….a small percent require physical interventions which have no “real” impact but foster the patients placebo effect.