After reading Healing Back Pain for the second time, I decided that Dr. Sarno must be right. But I needed to go and see him.
To get an appointment to see Dr. Sarno, you would have had to have read one of his books and accepted his idea that structural abnormalities do not cause back pain, but rather the pain is caused by physiological alterations in certain muscles, nerves, tendons and ligaments. There was no point in going to see him if you were not able to accept this premise.
I called his office to make an appointment. He didn’t take insurance. The cost was $1,000 in 1993! But, I felt that it had to be worth it and if it worked it was much less expensive than surgery. His receptionist prepared me for the appointment. I had to be on time. Dr. Sarno was very prompt and if I was late, he wouldn’t go over to accommodate me. I would spend 45 minutes with him. I would then be required to sit through two 2-hour lectures. He gave those lectures all in one day to accommodate his out-of-town patients.
I showed up at the appointed time and I was seen promptly. He didn’t really want to look at my x-rays and MRI’s. He asked what the diagnosis was: herniated discs at L-5 & S-1 and at L-4 & L-5, slight scoliosis, some arthritis and spinal stenosis. He asked me about my symptoms: sitting was uncomfortable and I had trouble bending over. Coughing and sneezing would bring on a stab of pain. It was bad in the morning, but got better as the day wore on. I had pain, numbness and tingling down the right side of my leg. I also had “dropfoot”. Dr. Sarno pressed on tender spots in my low back, top of my shoulders and outer aspects of my buttocks. He said that these spots were typical in people who had TMS, or Tension Myositis Syndrome, which is what he said I had.
I asked him how he knew that without even looking at my x-rays. He said that herniated discs were a finding on an x-ray and not the cause of pain. He said that they were also normal signs of aging. They were like wrinkles, gray hairs, or age spots on the inside of the body. He pointed out that the whole body ages, not just the external part. He also said that the more active we are, the more our spines take a beating. I had always been a very active person. In fact, I told him that I had recently gone on a windsurfing trip to Hawaii with my brother and his wife. I had trouble walking though the terminal and sitting on the plane. My brother had to help me with my suitcase, but once we got there, my brother helped me get into the water and I was able to go windsurfing all day. Dr. Sarno did not seem surprised at this story. He told me that if something was structurally wrong, my back would hurt all the time, not just in the mornings and that I would definitely not be able to windsurf. He said that this was proof that this was my mind causing the pain and not my body. He explained that if I broke my leg, it would hurt all of the time until it healed and then it wouldn’t hurt anymore. Inconsistent pain was a true telltale of the TMS Syndrome. He asked me if I was a worrier, or a perfectionist, if I wanted people to like me and I cared what other people thought. Yes, yes, yes and unfortunately, yes.
He told me not to worry, that there was nothing wrong with my back. I could go windsurfing or do anything else I wanted to do. He told me to throw out the back brace because it wasn’t doing anything. He also told me to stop all of the other treatments because they were just reinforcing the pain syndrome. My 45 minutes were up and he told me that he would see me at the lectures later that evening.
I attended the two lectures that evening. They took place in a university lecture hall with Dr. Sarno onstage with a slide presentation. Since it was excruciating for me to sit, I remember being uncomfortable and squirming in my seat the whole time.
The first lecture was devoted to the physiology and diagnosis of TMS and the second to the psychology of TMS and its treatment.
The physiology of TMS is that it begins with certain emotional states that set in motion activity within the central nervous system, specifically the autonomic nervous system, resulting in mild oxygen deprivation of certain muscles, nerves, tendons and ligaments. This is the cause of the pain, numbness, tingling, muscle weakness and the absence of certain reflexes. Since it is mild oxygen deprivation that is causing the pain and not a structural problem the pain can be excruciating, but it is harmless. There is no lasting damage.
The psychology of TMS is that chronic neck, shoulder, back and hip pain syndromes are not mechanical problems to be cured by mechanical means. They have to do with people’s feelings, their personalities and the vicissitudes of life. Dr. Sarno used the word tension to refer to emotions that are generated in the unconscious mind. These feelings are the result of a complicated interaction between our conscious and unconscious minds and between the mind and the outside world. It is often the repression of emotions or feelings that creates pain.
Now, this is the really interesting part, and again I’ve reached my limit for the day. I’ll talk more about this next week. Meanwhile, if you want to read more on your own, check out my resource page here.