What Is TMS? A Simple Guide for People Who Just Found Out

You searched something. Maybe “can stress cause back pain” or “why won’t my pain go away.” And somehow you ended up here, reading about something called TMS. Let’s slow down and make sense of this together.

The Short Version

The TMS acronym stands for Tension Myositis Syndrome. Dr. John Sarno, an NYU Rehabilitation Physician, developed the term and spent years helping patients who suffered from chronic pain (especially in their backs) that could not be explained structurally.

The core premise behind his work was that many individuals suffering from abnormal MRIs were pain-free and many individuals in extreme pain did not have abnormal MRIs. In other words, the structural damage identified by medical professionals was usually not the root of the patient’s pain.

So then what was?

Dr. Sarno believed that in many cases, chronic pain is produced by the nervous system due to emotional stress, suppressed feelings, and mental pressure – not by some type of damage to the body. He referred to this as TMS.

Today, the same concept is known by other names including: Mind-Body Syndrome (MBS), Psychophysiologic Disorders (PPD), or neuroplastic pain. Although the labels vary, they describe the same phenomenon – true physical pain originating from how your brain and nervous system interpret and respond to stress and emotions — and not in your tissues, discs, or joints.

“Isn’t The Pain Imaginary?”

It’s time to set the record straight regarding TMS. The pain associated with TMS is totally legitimate and absolutely real.

This is not a matter of pretending; numerous studies using various forms of brain imaging have demonstrated that those experiencing neuroplastic pain exhibit similar neural activity as individuals who have experienced tissue damage. The pain-producing pathways are active; your body truly does hurt. There’s no debate about that.

Where the pain originates is different. TMS doesn’t derive from a structural injury that must heal. Instead, the source of the pain is your nervous system — particularly the learned pathways of your nervous system that have become conditioned to produce pain without ongoing damage occurring.

Consider a car alarm sounding over and over again despite being nowhere near the vehicle. The alarm itself is legitimate; the alarm is loud and makes a lot of noise. However, the perceived threat is absent.

How Can This Occur?

Your nervous system is built to protect you. When you’re injured, it sends pain signals to alert you to cease and allow the healing process to occur. This is good; this is the way the system should function.

However, on occasion, the system fails to shut down. The injury may heal (skin within 2–4 weeks; muscle within 1–6 weeks; bone within 4–8 weeks) yet the pain persists. Why does this happen?

Pain becomes learned. Your brain develops a pattern of associating specific activities, postures, and even emotions with the possibility of damage. As such, the brain continues to send the pain signal because the neural pathway has become automatic due to repetition.

This is how the process of neuroplasticity works against you. That very same process which allows you to learn to ride a bike or to learn a new language can also allow your brain to develop chronic pain.

There is another level. Sarno noticed that many of his patients had common characteristics: they tended to be overly responsible, overly critical of themselves, and overly concerned about doing things perfectly. They were people-pleasers. People who have a tendency to push difficult emotions — such as anger, fear, or grief — into the unconscious rather than allowing themselves to feel those emotions. He theorized that the brain uses physical pain to distract itself from uncomfortable feelings and thus prevent them from entering consciousness.

Regardless of whether you agree with Sarno’s theories or not, there is substantial scientific evidence supporting a link between chronic pain and chronic stress. One study showed that individuals who experienced significant levels of stress were almost three times as likely to experience chronic low back pain compared to their non-stressed counterparts. The body keeps the score, as they say.

What Does TMS Look Like?

While TMS does not look exactly the same way for everyone, there are some identifiable patterns:

Pain that travels. You may have lower back pain for weeks, then the next thing you know, it is your neck. Then it is your hip. Then it is your wrist. Structural problems do not typically move from one area of the body to another. However, neuroplastic pain can move wherever the brain wants it to move.

Pain on both sides. You may have the exact same type of pain in your left and right shoulders. A physical injury is rarely bilateral.

Pain that does not correlate with your diagnostic findings. Your MRI indicates a herniated disc at L4-L5, but the source of your pain is in your upper back. Alternatively, your MRI reveals degenerative changes that your doctor labels as “normal” aging, yet you are being treated as though you are suffering from a legitimate health problem.

Pain that is exacerbated by stress, but not necessarily by physical activity. Your pain increases prior to an important meeting or when you are experiencing a stressful period of time, but not after a long day of hiking.

Pain that is resistant to typical recovery expectations. You injured your back approximately 8 months ago. There is nothing preventing you from recovering completely from that injury at this point. Yet, you continue to suffer.

Multiple unexplained symptoms. In addition to your current pain complaint, you have other complaints such as irritable bowel syndrome (IBS), tension headaches, temporomandibular joint (TMJ) dysfunction, chronic fatigue syndrome, and/or dizziness – none of which can be explained by anyone.

If you find yourself identifying with some or all of these patterns, it may be worthwhile to explore the possibility of TMS being a factor in your pain picture.

What TMS Is NOT

It is essential to understand what TMS is not, as the TMS community can sometimes blur the lines between what constitutes TMS and what does not.

TMS is not a diagnosis that you can give to yourself based upon reading a blog. If you are experiencing pain, the first place to begin is by consulting with a healthcare professional and having your pain evaluated to determine if there is any potential for a serious structural cause (tumors, fractures, infections, etc.) that would require medical treatment. No amount of writing or reflecting will resolve a condition that requires medical intervention.

TMS is not an excuse to disregard all medical recommendations. The purpose of learning about TMS is to broaden your understanding of the possible factors that could contribute to your ongoing pain, particularly if you have already tried various forms of treatment that have not provided relief.

TMS is not simply to tell you to “think positively and your pain will disappear.” The process of recovery from TMS requires hard work – including gaining a deeper understanding of your emotional responses to your pain, and creating a different relationship with pain – often through the assistance of a therapist or coach. This is not a weekend project.

TMS may not be for everybody; there are individuals whose chronic pain has obvious structural causes and they receive great results from physical therapy, medications, or surgery. The TMS model provides the greatest benefit to those where other explanations have failed and you have pain that does not make sense.

What Does Recovery Look Like?

Honestly, it is not linear.

There are individuals who read Dr. John Sarno’s books and experience rapid relief of their symptoms in days. While these stories are true, they are not typical. Most individuals will experience recovery of chronic pain over time by educating themselves on how their brain is working, decreasing the fear associated with the pain, and developing the ability to “feel” the pain and avoid the sensations they have been trying to ignore.

The following items tend to help people recover:

Education. Learning what is going on in your nervous system is truly therapeutic. Many individuals learn that their chronic pain is due to changes in the way the nervous system processes information and this reduces the fear associated with the pain. Fear is the energy source of neuroplastic pain.

Emotional Awareness. Emotional awareness does not require you to find a hidden childhood trauma (although this may be part of the issue). Many times emotional awareness can be as easy as becoming aware of your thoughts and feelings at any given moment. “I am feeling anxious/stressed right now.” “I am angry about this.” “I have avoided feeling sad about this.” The goal is to eliminate avoiding emotions and allow them to pass through you instead of being suppressed.

Somatic Tracking. A technique developed from Pain Reprocessing Therapy (PRT). In fact, a clinical trial conducted at the University of Colorado found that 66% of patients who received PRT were either pain-free or had minimal pain after four weeks of treatment. Only 10% of the patients who received standard care reported similar results. Somatic tracking involves observing the pain with a curious and non-fearful mindset. As you continue to observe the pain with a non-fearful mindset, you begin to teach your brain that the signal is not life threatening.

Journaling. Journaling allows you to write about your feelings – especially the ones you would normally avoid acknowledging. Once you become aware of your unconscious patterns of thought and behavior you can begin to work on changing them.

Support. Having support whether it is a therapist, TMS Coach, or community of people who are going through a similar experience can greatly assist in your journey.

Where Do I Go From Here?

If you have read the above and believe it could possibly apply to you, here are my suggestions:

Do Not Panic. TMS is not an emergency. It is simply a pattern your nervous system learned and patterns can be unlearned. There is no rush to solve all of the issues surrounding TMS today. It is a process.

Do Not Get Lost Down the Research Rabbit Hole. While it is helpful to gain knowledge about TMS, researching TMS extensively can create anxiety and potentially exacerbate the condition. Read one or two credible sources and then take a break.

Start Observing. Begin to pay attention to when your pain is better or worse. Are there any correlations to stress, conflict, large emotions? You do not need to do anything with this yet – simply observe your body.

If you would like a structured starting point, I have created a free resource titled “Your First Week with TMS.” This resource provides a step-by-step guide of what to do (and what not to do) in the days immediately after discovering TMS without overwhelming you. You can access the resource below.

Additionally, if you wish to speak with someone who understands the process of TMS and will provide you with guidance during the process, I offer 1-on-1 Coaching Sessions. These sessions will not include any programs or pressure. We can have a conversation.

This article is intended for informational purposes only and is not meant to replace the advice of a medical professional. If you are currently experiencing pain, please see a health care provider to determine if there is a serious cause for your pain before considering TMS.