What is sometimes wrong with the traditional concept of pain syndrome?
Some patients in whom pain is attributed to a structural abnormality actually have a different disorder. It is a syndrome in which the pain is real, but it is initiated by emotional factors.

What are these emotional factors?
These factors are a person’s emotional constitution, their childhood experiences and the stressors of everyday life. The most common emotion is rage. When any or all of these factors become overwhelming patients develop pain in an effort to mask these threatening emotions.

Patients with this syndrome tend to be perfectionists. They are hard-working, conscientious, ambitious, success oriented and driven. In addition, these patients need to please other people, and want to be liked.

How common is this type of pain syndrome?
These mind/body disorders are spreading in epidemic fashion in the United states. They are often incorrectly diagnosed as structural abnormalities and therefore inadequately treated.

What are the actual causes of this syndrome?
The cause of pain in these syndromes is not a structural abnormality, but mild oxygen deprivation, which is a result of the brain altering blood flow to the involved area. Pain is produced when there is a reduction of oxygen supply to a muscle, nerve or tendon.

How are patients with this pain syndrome evaluated and treated?
Initially, a history, physical examination and review of previous medical records is completed. This is followed by a lecture explaining the condition, and then a series of individual meetings designed to create insight into the emotional dynamics of the process.

What are the results of this treatment protocol?
Most of these patients have had progressive deterioration in their ability to be functional and active. They may be limiting their recreational pursuits and modifying their work and family life. Some patients have constant discomfort. Almost everyone has seen multiple practitioners and tried a variety of treatments. With proper patient selection, most patients learn to understand the dynamics of their pain and regain a normal lifestyle.

May I do the exercises and stretches that I’ve been doing to prevent a new attack?
Although physical therapists are wonderful about emphasizing the psychological basis for pain, each treatment session focuses the patient’s attention on his body, which is incompatible with the primary therapeutic goal of ignoring the physical and concentrating on the psychological. The same idea applies to any exercise routine, whether it is in the form of stretching, strengthening or mobilizing.

Therefore, patients should discontinue exercises designed to protect or otherwise help the back. Warm-up exercises prior to athletic activity are appropriate for better performance but specific exercises are otherwise unnecessary.

Physical activity of all kinds is highly recommended for its psychological and general health value.

I was in psychotherapy for over a year. Why was I still having pain if it was psychologically induced? In fact, my therapist thinks the pain is somehow psychological but he has never heard of TMS.
You were still having pain because the brain would not give up its strategy. The pain will continue if you have not established the connection between the physical and psychological events.

I know I am angry, I can feel it and often show it. Why do I still have pain?
The anger you know and express is not the anger causing your pain. TMS is a response to anger-rage generated in the unconscious (you are not aware of it), or conscious anger suppressed. TMS is not a response to conscious anger felt or expressed.

This is a subtle but important distinction. In fact, it is at the heart of the divergent approaches to mindbody research. Psychologists interested in conditions such as chronic pain focus on perceived emotions like anxiety, depression and hostility. TMS theory considers these and other physical disorders to be the outward manifestations of a more fundamental process that takes place in the unconscious.

We repress anger that violates our image of ourselves. For example, if you have a strong need to seek approval and someone does something that angers you, you will automatically repress that anger because it destroys your image of yourself as a “goodest” or “nice guy”. Repression is a consistent unconscious reaction. We become angry inside but do not express the emotion.

Everybody knows that I’m a calm, controlled person; that I handle everything very well and am never anxious. Why in the world should I have back pain?
All of the personality traits that keep you calm are stirring a great deal of rage internally.

I am the world’s best coper. Why should I have back pain?
Copers put great pressure on themselves, and that activity generates anger.

I think I know what I’m angry about inside; in fact, I’m sure it has to do with the fact that my parents criticized me as I was growing up. Why doesn’t the pain go away?
Questions like this are common. There are three possible reasons for the persistence of symptoms:

1. Patients don’t realize how angry they are inside. People often find this insight very helpful and will see a reduction in pain when they realize that they are in a blind rage internally.
2. In addition to acknowledging the anger, some patients attempt to feel it directly. Then, if their symptoms do not improve, they may want to consider psychotherapy.
3. For some patients, something other than what they think is stimulating the rage may be the culprit. They, too, will probably need to work with a psychotherapist.