Chronic Pain and the Mind-Body Connection

Everyone experiences pain at some point in his or her life, and some people endure it more chronically than others. Doctors may prescribe bed rest, pain medication, MRIs, or physical therapy. Surgery or cortisone shots may also be suggested, along with the application of heat and cold, and there can be a wide range of diagnoses for why people hurt. There is a huge and profitable industry built around pain management and, while certain measures help temporarily, pain often returns in the original location or in a new one.

In the 1970s, sports medicine physician John Sarno, M.D., began to realize that the location of the pain his patients were exhibiting, such as with herniated or slipped disks, did not seem to correlate to the diagnoses they had been given. As he began talking to his patients about what was going on in their lives, he started to see a pattern emerge. It indicated that their pain might be related to the stresses of life. As Sarno shared his findings with patients, many began to recover. While he did not then fully understand the physical mechanism of how emotions create pain, he was certain there was a connection.

Sarno called the condition Tension Myositis Syndrome (TMS) because he believed the condition affected the muscles. He later came to understand that TMS could also affect tendons and nerves as well as the gastrointestinal system, skin and other parts and systems of the body. Sarno saw fibromyalgia, for example, as a very painful and common TMS condition. While the idea that the mind and brain can create pain in the body is difficult to accept, Sarno believes that nearly 80 percent of the pain we develop is emotionally based but physically felt.

The true purpose of TMS pain is to keep emotionally painful thoughts from coming to consciousness. We can be triggered in the present by an unconscious memory from the past. If this memory or emotion is distressing, our brain will distract us quickly with the best preoccupation there is—pain. As people become focused on getting relief from the physical pain, the emotional pain is pushed to the background. The usual emotional culprits are rage and fear, although low self-esteem or trauma may be involved. In addition, someone with certain personality traits, such as perfectionism and people pleasing, may be more likely to experience chronic pain. One does not have to change their personality in order to relieve their pain.

The first step in treatment is acceptance of the TMS diagnosis. This is the most difficult part of therapy as the client has likely seen many practitioners and has been given many physical explanations for the pain. There are physicians in Massachusetts and elsewhere trained by Sarno who can determine if the patient has TMS or a strictly physical situation. Another step in treatment is understanding the concept of conditioning. If we expect pain in a certain situation, it will be there. The client needs to learn skills to reverse the conditioning process. Treatment also includes helping the client be ready to allow the underlying emotional issues to come to consciousness. This part can take time and cannot be hurried.

Michele Lowenthal is a TMS practitioner and counselor who works with clients via Skype. For more information, visit or email

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