A summary of what I found in the book "Healing Back Pain: The Mind Body Connection" by John E. Sarno M.D.
OXYGEN DEPRIVATION; THE PATHOPHYSIOLOGY OF TMS
We have postulated that in TMS the autonomic system selectively decreases blood flow in certain muscles, nerves, tendons and ligaments in response to the presence of repressed emotions like anxiety and anger. This state is known as ischemia, that is, the tissue involved is getting less than its normal complement of blood. This means that there will be less oxygen available to those tissues than they are accustomed to and the result will be symptoms-pain, numbness, tingling and sometimes weakness. These things happen because of the critical importance of oxygen in all physiologic processes. When it is reduced below its normal levels one can expect a reaction that will signal that fact.
What is difficult to understand is why the autonomic system should react so as to cause pain and other unpleasant symptoms when its normal function is to keep the body operating at an optimal level regardless of what's going on around it. This is clearly highly unusual but suggests that there must be some pressing need for the reaction. As we have suggested earlier, that need is to deflect the person's attention away from those very unpleasant, often painful emotions that the mind is trying to keep repressed. It is as though the mind had decided that a physical pain is preferable to an emotional one. When viewed in this light the process is not so illogical. .. One body of evidence that the physiologic alteration in TMS is oxygen deprivation is clinical. It has long been recognized that heat, introduced into muscle by diathermy or ultrasound machines, will relieve back pain temporarily. So will deep massage and active exercise of the muscles involved. All three of these physical measures are known to increase blood flow through muscle. Increased blood flow means more oxygen, and if that relieves pain it is logical to assume that oxygen deprivation was responsible for the pain. There is also laboratory evidence for this concept. In 1973 two German research workers, H. G. Fassbender and K. Wegner, reported finding microscopic changes in the nuclei of biopsied muscles from back pain patients suggesting oxygen deprivation in "Morphologic and Pathogeneses des Weichteilrheumatismus," Z. Rheumaforsch (Vol. 32, p. 355).
For additional evidence on the critical role of oxygen in TMS we are indebted to a group of research workers who have demonstrated in their laboratories in recent years that muscle oxygenation is low in patients suffering from a disorder known as primary fibromyalgia.
The Physiology of TMS 65
The term trigger points, which has been around for many years, refers to the pain elicited when pressure is applied over various muscles in the neck, shoulders, back and buttocks. There is some controversy over what precisely is painful, but most would agree that it is something in the muscle. Rheumatologists, who have taken the lead in studying fibromyalgia (TMS), appear to avoid using the term, probably because of its association with other diagnoses through the years. I neither use it nor avoid it, for I have concluded that these points of tenderness are merely the central zones of oxygen deprivation. Further, there is evidence that some of these points of tenderness may persist for life in TMS-susceptible people, like me, though there may be no pain. In the first chapter the point was made that most patients with TMS will have tenderness at six key points: the outer aspect of both buttocks, both sides of the small of the back (lumbar area) and the top of both shoulders. These tender points, trigger points, call them what you will, are the hallmark findings in TMS and they are the ones that tend to persist after the pain is gone. It is an important part of the physiology of TMS to know that the brain has chosen to implicate these muscles in creating the syndrome we know as TMS. Patients sometimes ask if breathing pure oxygen will relieve the pain. This has been tried and, unfortunately, does not help. If the brain intends to create a state of oxygen deprivation it will do so regardless of how oxygen-rich the blood is. ..
P79 Theres nothing like a little physical pain to keep your mind off your emotional problems.
P82 Review the Daily Reminders
This is an important strategy but one must be careful that it does not become a ritual. Patients are given a list of twelve key thoughts, and it is suggested that at least once a day they set aside fifteen minutes or so when they can relax and quietly review them. They are called daily reminders.
ท The pain is due to TMS, not to a structural abnormality. ท The direct reason for the pain is mild oxygen deprivation. ท TMS is a harmless condition, caused by my repressed emotions. ท The principal emotion is my repressed anger. ท TMS exists only to distract my attention from the emotions. ท Since my back is basically normal there is nothing to fear. ท Therefore, physical activity is not dangerous. ท And I must resume all normal physical activity. ท I will not be concerned or intimidated by the pain. ท I will shift my attention from the pain to emotional issues. ท I intend to be in control-not my subconscious mind. I must think psychological at all times, not physical.
P141 It is possible that the anxiety that is a part of everyone's life stems from the response of this part of our emotional systems to the stresses and strains of daily existence. The greater the stress, the more anxiety is generated. And, as stated in the psychology chapter, the same goes for anger. Anger may be one of the most important and least appreciated of the emotions we generate. The celebrated psychoanalyst and ethicist Willard Gaylin published a book in 1984 titled The Rage Within, which explored the subject of anger in modern man. Because anger is so antithetical to our idea of appropriate behavior in a civilized society we tend to repress it at the very moment it is generated in the unconscious and so remain unaware of its existence. There are many reasons, most of them unconscious, why we repress anger. They were enumerated in the psychology chapter (see page 38). The tendency to repress undesirable emotions is a supremely important element of one's emotional life.
P144 Experience with TMS and these related conditions suggests that there may be a common denominator, anxiety perhaps, that can bring on any one of these disorders. In that case, some other emotion, anger for example, may be the primary one that may in turn induce anxiety, which then brings on the symptom. Personally, I have experienced gastric hyperacidity, colitis, migraine headache, palpitations and a variety of musculoskeletal symptoms typical of TMS and know that they were all the result of repressed anger. Once having learned the trick, I could usually identify the reason for the anger-and often turns off the symptom. It is interesting to note that most of the disorders listed above are mediated through the autonomic nervous system.
The Physical Disorder as a Defense Against Repressed Emotions
This has been discussed in chapter 2 on psychology, and it will be only briefly reiterated here that the purpose of the physical symptomatology, whether it is musculoskeletal, gastrointestinal or genitourinary, is to distract attention, which is a mechanism for allowing the individual to avoid feeling or dealing with the undesirable emotions, whatever they may be. It is, in essence, a lack of desire of the mind to cope with these feelings. One must make a sharp distinction, however, between a decision made in the subconscious and one which the person would consciously make. . Mind and Body 147 The Emotions and More Serious Disorders
There are those in medicine who believe that emotions play a role in all aspects of health and illness. I am one of them. Alexander suggested doing away with the term psychosomatic medicine since it was redundant-everything medical is influenced in some way by the emotions. I believe that all medical studies are flawed if they do not consider the emotional factor. .
Before discussing other kinds of medical problems in which emotions may play a prominent role, it is important to make it clear that people do not do these things to themselves. It is not uncommon for patients to say to me after the diagnosis of TMS has been made, "I feel terrible; I did it to myself." Upon which I tell them that their emotional patterns were well established long before they reached the age of responsibility and that what they are now is a result of a combination of genetic and developmental-environmental factors over which they had no control. Might as well take responsibility for how tall you are or the color of your eyes. Therefore, they are reacting to life in the only way they know how. Further, if one begins to understand why one reacts the way one does and wants to change, some degree of progress is possible. . P151 Because of their tendency to be compulsive, perfectionistic, and very responsible and conscientious, people with TMS often describe themselves as Type A. They are, in fact, different in some important respects. Many TMS patients are the antithesis of hostile; they often have a strong need to be good, nice, pleasant, accommodating and helpful. Though they may be ambitious and often very accomplished, they do not necessarily pursue their goals with the intensity that
End of the book quotes
Thanks for the book recommendation Lil and others.
What did I think of the book? Get your mind off the pains, keep moving, try not to stuff your feelings, find something interesting to do, take a few pain pills as needed but not too many.
My daughter works for a pain management specialist (2 or 3 docs in the office) and said pain patients spend too much time on pain symptoms. She said they "fixate" on the symptoms, some become drug addicted, and forget about other things in life.
Cobra asked, BTW, what happened to this board? Its like it is dying a slow death .
Cobra, in my case, I don't think I can go on like I used to post. I don't see making many improvements in my R and maybe I just better take care of Lou more and let what ever happens happen. Like I said before, it's coasting time for me.
I still read other people's threads so it's not like I don't care anymore. I do but haven't come up with much that might be helpful to other posters.
that pretty well sums it up. Yes, I did read it, too! LOL! and Lil thought my mind was "snapped shut".
Its intriguing...but I'm still not completely convinced. Some of his arguments are weak. OTOH...one of his descriptions of "the young man bedridden for 3 days" is exactly what happened to me. and my back problems are rather random and unpredictable. That personality description pretty much is me, too. hmmm...maybe...
But he goes on to apply the same theory to tendonitis, which I've also had severe bouts with, and known people in my professional life who have had it worse. He says there's no evidence that its from over-use of the tendons in question; My experience is the exact opposite. As a music performance major in college, I spent hours and hours and hours every day playing an instrument. Stepping up to that level is when the problem started. had terrible problems in my wrist. I had to go away to army basic traing one summer (joint the national guard to pay for school), and I was afraid I'd have trouble, as basic training soldiers spend a great deal of time supporting their body weight on their wrists. (push-ups). Well, basic started a week after school got out, and I never had a single problem. When I got back to school, the problem started up again. hasn't bothered me in years, now...since I don't play anymore. This is a very common problem with musicians. I can name a few people who went through the same thing. I've also had trouble in one of my ankles since I got my first real job as a teenager. the problem persists to this day, but is extremely predictable. If I stand for too long, its trouble. Interestingly, I can walk for miles, with no problem. But standing for long periods of time, and I'll get a flare up.
I don't know how many times he referenced the concept of mind/body in relation to the classic ulcer. "everyone knows ulcers are caused by anxiety, and accepts that concept". (paraphrasing). well, actually, now we know that the vast majority of ulcers are caused by the h-pylori virus. And sure, the guy that first postulated that was nearly run out of the medical community for proposing something so "rediculous", but *eventually*, it was proven, and he got the Nobel prize. *eventually* hasn't happened for Sarno, yet.
I won't say that Sarno Is completely right. I know the strees I cause myself contributes to any back attacks/pains I have.
I know some of the symptoms are physical but I wonder sometimes about how mental stress, wishing things were different, feeling like I have limited options adds to the underlying mechanical problems.
My life changes in 1981, I did OK till 1986 and since have been mostly up and down at times. Let me tell you this back thing sucks.
Part of the book talked about "secondary gains" or what might be called, sympathy shown to the back pain suffer. Well, I don't like the idea of having someone doing what I think I should be doing in the first place.
It might apply to some people but I would rather work than have some of the limitations I have now. That is one reason I just tell myself, screw the pain, take a 15 second break and go on, even if things hurt some or a lot.
I see this as the best option. Other choices don't toughen me up.
If I stand for too long, its trouble. Interestingly, I can walk for miles, with no problem. But standing for long periods of time, and I'll get a flare up. Yea, standing is something I don't do for long. Bending over to wash dishes, change spark plugs is also on my avoid list. Life is a lot easier walking than standing.
The book hinted at it and my physical therapist also said more oxygenated blood goes to the affected area when you walk. My physical therapist has a doctorate degree (7 yrs) and seems to be a straight shooter. I know she doesn't baby some patients and tells them to keep moving.
Sarno's book seems like a long winded speech about how people's pain is all in their heads. Just because the medical community can't come up with a medical reason for pain, repressed emotions are causing it? Coupling positive techniques for having the best outlook on pain with effective medical treatment seems like the most logical path to take.
I don't mind the sun sometime
The images it shows
I can taste you on my lips
And smell you in my clothes
Cinnamon and Sugar
And softly spoken lies
You never know just how you look
Through someone elses eyes
BHS-"Pepper"
Re cinemanymph Coupling positive techniques for having the best outlook on pain with effective medical treatment seems like the most logical path to take. I agree with that Cn.
I need PMA right now. When I have setbacks, my PMA goes out the door. Something that seemed simple/easy gets put on a decision tread-mill that takes way too long to decide what to do, too much time doing it, too much mental effort wondering if I screwed up or could I have done it a better way. Some 2 hr jobs take 8 hours to finish. I am still a nice guy, still have self-esteem, just don't like some of my circumstances. Really bad about that.
So the book helps get me back to having a better frame of control. How much back (back really doesn't hurt but the pains shoot down my legs) pain is stress, how much is mechanical. Lower the mental results in a lowering of the physical sort of thing.
Just because the medical community can't come up with a medical reason for pain, repressed emotions are causing it? I hear you. Some things are not easy to correlate, like event "A" causes "B" to happen and the person experiences pain/feeling/symptoms "C".
I know I am willing to accept a multiple choice answer with percentages of why things are the way they are. I used to buy what some people with degrees said, and loked for concrete answers, but now it's OK for people to not know.
cinemanymph, if some people believe in prayer causing a person to get better, I suppose bad feelings can make some things worse. When someone feels worse, I think it is human nature to want to place the blame, at least that seems less stressful than having things up in the air.
I guess it's like the saying, "It's more comfortable to stick with the devil we know, no matter how bad, than to fear the devil we don't know.
Gee, there are lots of people that wonder why they are here on the earth at least at some point in their life. I think having answers like being connected to other people solves most of that question. We need to see a big picture, need to see and understand the map before we take a trip. It makes the traveling through our daily living or through medical/relationship problems and phases, feel more secure.
Quote: Sarno's book seems like a long winded speech about how people's pain is all in their heads. Just because the medical community can't come up with a medical reason for pain, repressed emotions are causing it?
Hmmm... it's hard to believe a 4 wrote this...
Emotions cause blood pressure to go up. Emotions can cause blood sugar to go up. Emotions can cause headaches. Emotions can trigger heart attacks and strokes.
IMHO since we are Mind/Body organisms, there is no such thing as something being ALL in your head, or for that matter, ALL in your body. We are made up of both and each affects the other.
Re Lil IMHO since we are Mind/Body organisms, there is no such thing as something being ALL in your head, or for that matter, ALL in your body. We are made up of both and each affects the other. I agree, people are both.
From what i read in the book Sarno's opinion is most back pain is not associated with anything physical or mechanically out of place. He said bulging disks don't cause pain, lack of oxygen causes the pain. Sarno, thought physical therapy helped relieve pain but later in the book he states physical therapy is not necessary to make a person more pain free.
He places physical therapy in a class as being good for the body but not part of fixing something.
Lil, I can see how many times stress, anxiety made my back pains worse or to occur more frequently. I see exercises and physical therapy as treatments to relieve some of my back problems. I don't think Sarno sees any good being done by physical therapy or surgery in 90% (just picking a number) of the cases.
From what I got out of the book, get rid of the notion that some mechanical malady causes the problem and think more that stress, anger/anxiety are at the root of the back pain. That the herniated disc isn't the cause of the pain but something causes less oxygenated blood to go to the pain area and the muscle then spasms and pain results.
No matter what different groups think, I see the connection between stress and back problems. Unlike Sarno, I see the benefits from physical therapy, braces, and surgery if things go on for a long time and there is muscle weakness. Why not use both camps to work on a problem.
BTW, everything I posted from Sarno's book was done on my scanner and run through an OCR program. I tried to present points that were repeated several times in the book. If I posted it, he said it. Lil, do you dis agree with anything I posted?
Emotions cause blood pressure to go up So can no sex. And after sex my BP drops 5 to 10 points. Just thought I would throw in some personal observations.
Now, lets see, sex daily or a pill to drop BP 5 points. Gee, that is a hard choice? not! But what do i know?
Re Lil It certainly makes more sense to me to start with investigating possible non-surgical remedies before one goes under the knife. It Absolutely does Lil. BTW, I am mot even thinking about or needing surgery.
I have one of these things every couple of years. It mostly gets old real fast and my PMA goes out the window. I got over the feelings I "Have to work" and cant take a week off. I discovered I am more than what I do, worth more than what I earn.
It's sort of like when the barn burnt, now I can see the moon coming up.
I'm a 4? On a system that doesn't even have the creativity to come up with worded lables for it's categories? I can only imagine the personality traits attributed to a 4.
I don't mind the sun sometime
The images it shows
I can taste you on my lips
And smell you in my clothes
Cinnamon and Sugar
And softly spoken lies
You never know just how you look
Through someone elses eyes
BHS-"Pepper"
And after sex my BP drops 5 to 10 points. Just thought I would throw in some personal observations. 
