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TMS-Description

Dr. Sopher (l) with Dr. Sarno (r) (17600 bytes)Much of the chronic and recurrent pain and discomfort we all experience is psychologically induced. This is the premise of Dr. John Sarno (see image on right, Dr. Sopher-left, Dr. Sarno-right), who has helped thousands of people in his own practice and reached thousands more with his books. TMS, or tension myositis syndrome, is the term he has coined to describe this pain that often appears in the back, neck or legs but can affect any part of the body or organ system. Having realized in recent years that nerves, tendons and other body systems could be targeted by the brain in the disorder that he has described, Dr. Sarno and I have decided that another term would be a more accurate designation for the entire process.� After much thought and discussion, he and I have agreed that the term, The Mindbody Syndrome, would be a better choice and would be used henceforth in place of tension myositis syndrome.� This has the virtue of retaining the acronym, TMS, which has become familiar to many that have read Dr. Sarno's work.� Some common TMS disorders include headaches, irritable bowel syndrome, dyspepsia, gastroesophageal reflux disorder (GERD), carpal tunnel syndrome (CTS), plantar fasciitis, temporomandibular joint syndrome (TMJ), and fibromyalgia. Using today's popular lingo, TMS is a mindbody disorder - the symptoms arise from the mind and are experienced by the body.� Thus, The Mindbody Syndrome is an appropriate title.

TMS is a strategy of the brain’s to keep unpleasant thoughts and emotions from rising from the unconscious into the conscious mind. The brain, through established physiologic pathways, creates pain as a distraction. By focusing our attention on physical symptoms, we keep these painful thoughts and emotions repressed. This is a very effective strategy as there is an absolute epidemic of mindbody disorders in our society.

Eliminating the pain is startlingly simple. We can banish the pain and thwart the brain’s strategy by simply understanding and accepting that the pain has a psychological causation, that it is not physically based.

While much of the pain we experience has a psychological basis, it is essential to first be evaluated by your physician to determine that there is not a significant disease process. Unfortunately, if your physician does not consider TMS in the process of generating a differential diagnosis of your symptoms, it is possible that he or she will give an incorrect diagnosis. This occurs all too frequently as a physical cause is mistakenly offered. This results in a treatment plan that is often unsuccessful. As an example, many people with back pain are told that their symptoms are due to a herniated disc or disc degeneration, when in fact these findings are often incidental and normal. This helps to explain why physical therapy, medications and surgery are often unsuccessful.

I have been treating patients from all over the US and Canada using Dr. Sarno's approach since early in 1999. A patient of mine asked me to read Healing Back Pain and offer my opinion on its value. Unbeknownst to my patient, I had low back pain for nearly two years and intermittent sciatica for more than fifteen years. This all vanished after reading the book. Intrigued, I contacted Dr. Sarno who graciously invited me to The Rusk Institute of Rehabilitation Medicine at New York University to train with him. After seeing patients with him and attending his lectures, I decided to offer TMS treatment. With his support and encouragement, I have attempted to follow his approach faithfully. Unfortunately, because of health problems (sadly, not TMS), I recently closed my practice and stopped seeing patients. However, I am happy to offer phone consultations. As before, I screen all potential patients by phone or email. If their symptoms appear consistent with TMS and their mind is open to this way of viewing their health, an appointment for a thirty minute consultation is offered. Results have been excellent. Dr. Sarno and I have remained in regular contact, reviewing cases and theory

Life is Stressful

Life is stressful. Even if we are happy and feel good about our families, jobs and finances, we all experience stress. Stress, anger, conflict arise from three main sources. There are everyday issues such as: our home and work responsibilities, worrying about our children, worrying about our parents, the inconsiderate drivers, the long line at the market, etc. Some of us have experienced much emotional distress in childhood. Even if we have made peace with it, it is still there, a potential source of unpleasant feelings. Our personalities also predispose us to these emotions. If we have high expectations for ourselves, if we are ambitious and place great demands on ourselves, if we are very conscientious about our performance, then these perfectionist traits are causes of stress. If we go out of our way to help and care for others, even to the point of self-sacrifice, then these "goodist" traits also create stress as we make our needs subordinate to those around us.

These personality traits are not undesirable—they make us successful, kind and considerate. But it is essential to understand how these very qualities can contribute to the accumulation of stress, anger and conflict. The way our brains work, we repress unpleasant thoughts and emotions. They find a home in the unconscious. This is a very good defense mechanism—it allows us to move on and take care of our responsibilities and be nice people that others like and respect. Unfortunately, we can only hold so much of these unpleasant thoughts and emotions in the unconscious. Accumulated anger, stress and conflict become RAGE. This RAGE wants to rise to consciousness, but we usually do not let this happen. If it were to happen, we might rant and rave and do things which would not be acceptable--things that would make others not think well of us. To distract us from these unpleasant thoughts and emotions, our brain creates pain, real physical pain. In our society it is acceptable, even "in vogue", to have certain symptoms, like back pain, headaches and reflux. When we focus on our pain, we are distracted from these causes of RAGE. A brilliant strategy on the part of the brain. Why does this occur? No one can know for sure, but we know this happens because by learning about it, we can stop it. We can stop it and thereby eliminate the pain.

Dr. Sarno has pioneered this approach to the evaluation and treatment of a variety of pain syndromes. His treatment program involves education only--no medications, no special exercises, no injections, no surgery and no manipulation or massage. His results and those of the physicians, like myself, who embrace his theories, are outstanding, far exceeding any other modality.

TMS is the name Dr. Sarno has given to describe the chronic and recurrent syndromes of pain and discomfort. The pain, wherever it occurs, is very real. However, it does not have a physical cause, but a psychological cause. Getting better involves acceptance of this. It is not necessary to change our personalities to get better and we could not, anyway.

Unfortunately, most physicians are not familiar with Dr. Sarno’s work or do not accept his theories. The traditional medical training seeks to explain most symptoms as having a physical cause. While this may be true in some cases, it does not explain much of the pain and discomfort that we all experience. Most physicians do not consider the possibility of a psychological cause for the pain. As a result, they will prescribe medication, special exercises, physical therapy, injections or even surgery to address what they believe is a physical problem. When this is not successful, people seek alternative remedies, such as chiropractic, craniosacral therapy, prolotherapy, etc. in an effort to relieve their discomfort. Unfortunately, these modalities are even less successful than the traditional therapies.

What does work is Dr. Sarno’s approach--the acquisition of knowledge. Put aside the notion that there is a physical problem, accept that there is a psychological cause and understand how and why the brain does this. I recommend that all people read and re-read my book and/or Dr. Sarno’s books to fully integrate this information. Some will benefit from seeing Dr. Sarno or myself for a consultation. You can thwart the brain’s strategy and get rid of your pain. When you do, you will truly feel empowered.


Dr. Marc Sopher nears the summit during
the Mt. Washington Road Race, June 1999.

 Foot Pain, the Newest Epidemic

There is a veritable epidemic of foot pain in our society. All of a sudden, everyone has foot problems, from pro athletes to the couch potato next door. This has not always been the case. Think hard, back 15-20 years ago. Do you remember hearing so much about plantar fasciitis, heel spurs and other foot disroder? Of course you don't, because foot pain was relatively uncommon then. Now it is in vogue and everywhere you turn. It is yet another manifestation of TMS.

Below are a few letters that will support this.

Dear Dr. Sopher,

Two years ago, I successfully overcame neck, shoulder, and buttock pain using the mind-body approach. Your book was invaluable to me -- thank you so much for writing it. Utimately the approach that worked for me was pretty simple: I just started doing things again, regardless of how much it hurt. This meant sitting, running, typing, and just bearing the pain. When I stopped letting the pain dictate what I could do, it rapidly diminished, and I got my life back.

I am sure you get plenty of email inquiries, and I will understand if you can't reply to this one. But if you have a couple of spare moments, I am hoping you can answer a question for me. The pain I dealt with back then was chronic. I'd had it for 6 months, and it was pretty obvious there was no real injury. But once you get active again, how do you tell if an "injury" is really an injury or TMS?

This is relevant to me because I am registered for a marathon on Oct. 28. Last weekend, I started having severe foot/ankle pain -- it's painful to walk on (much less run) and tender to touch. My doctor says that I've injured a ligament and tendon below my ankle, probably by turning my ankle. He says to forget about the marathon. On the other hand, I do not remember turning my ankle. There's no obvious swelling. This injury also occurred after the first week of my taper, when I'd significantly reduced my mileage. After hearing that it wasn't a stress fracture or anything like that, I tried to treat it as TMS and run through it. This is what I usually do when I experience pain when running -- and it's always gone away. But after a grand total of 12 excruciatingly painful miles this week, it is only getting worse, and I am starting to think the doctor may have been right. I don't think I will run the marathon.

I know you can't diagnose me via email. But as a runner yourself, I know you've faced similar situations (in fact, I read about one in your book). If you do have time to respond to this, I would appreciate your thoughts on how to distinguish TMS from a real injury, particularly when one doesn't have access to a TMS doctor.

Thank you -- and best wishes,
S.

S.,

Your story is classic--it is one of that I have heard many times and also experienced. I have absolutely no doubt that your foot pain is a TMS manifestation and an example of what Dr. Sarno refers to as the symptom imperative. That means that the brain never gives up its strategy and will find new places to put pain. Foot pain has become epidemic in our society, a fact that I discuss in my book. Preparing for a marathon is very stressful; there is a tremendous amount of self-imposed pressure. There has to be--training requires an enormormous time commitment and meticulous attention to detail about nutrition and fluid intake, not to mention a lot of long runs. What your doctor has told you is what I refer to as "myth." The more you train, the more fit you become; that means you become stronger, more able and less prone to injury. If you do not recall a particular traumatic event, then there was none and you cannot be injured. I hear from so many distance runners about pain that begins when they taper, when they are doing less! How does that make sense?!?! The reality is that the marathon is getting closer and with it comes the inevitable anxiety about performance. Did I train enough? Will I hit my goal for time? What if the weather does not cooperate? Bad weather on race day is beyond disappointing--it can make the weeks of preparation seem almost a waste, right? Acknowledge these sources of stress.

If you can apply the TMS concepts as you did before with your other symptoms, you will triumph again. The key to getting better is eliminating the doubt you have that there could be some physical, rather than psychological cause.

Please keep me posted with your progress.

Marc Sopher, M.D.

Dr. Sopher,

Thanks for your reply. You told me exactly what I needed to hear. I did my best to think of my ankle pain as TMS and convince myself I couldn't have a physical injury. On Monday of last week, my ankle suddenly felt much better -- I doubt a real physical injury would have healed overnight like that. I ran my marathon on Sunday and qualified for Boston, as I'd hoped. My ankle feels just fine (though everything else is pretty sore!).
Thanks again for your help,

S.

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J. is a 41 year old woman who had experienced bilateral foot pain for two years. She had seen an orthopedist, podiatrist and other practitioners and been given the diagnosis of plantar fasciitis. One physician told her that her pain was due to Raynaud's! Despite the use of splints and orthotics, cortisone injections and other remedies, her pain persisted, even with simple activities like walking. She reported that, "Pain was dominating my life."

Hello,

I hope all is well with you. I just wanted to update you on the progress of my foot pain since I visited with you at your office early this past Spring. You may recall that I had been diagnosed with plantar fasciitis and had had severe pain for almost 2 years when I met with you after reading about Dr. Sarno's and your work. By the end of May, I was no longer experiencing constant pain and was able to go to Disneyland with my husband and children! I walked all around the parks for 3 days and only had moderate to light intermittent pain. By early June I was pain free and have been since. I now walk as much as I want, jump rope for conditioning, do Pilates, yoga. . .anything I want! I don't wear orthotics for any of this. This is not a shock to you I'm sure but I thought you'd want to know nevertheless.

Thanks again for previous help this Spring!

Best,
J.

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Dear Dr. Sopher,

My wife and I are self-employed podiatrists and we are firm believers in TMS theory. Dr. Sarno's concepts on the mindbody paradigm present an utterly fascinating revelation into the human conditionwith regards to health and well-being.

We have witnessed and upsurge in the incidence of plantar fasciitis, beginning in the early 1990s (recognizing it to be a form of TMS tendonalgia, we have emplyed the term "plantar fasciitis" merely to designate a particular clinical presentation of foot pain).

In addition to our clinical experiential evidence, we also have anecdotal substantiation of a virtual epdiemic of plantar fasciitis and foot pain in general. Every patient that we have seen with this condition has denied any prior traumatic incident and most relate a history of having first experienced the pain upon arising from bed one morning.

Even before learning about TMS, my wife and I had never felt truly comfortable with the practice of prescribing orthotics for the treatment of non-traumatic foot pain or discomfort. Our human ancestors first walked upright about 5.6 million years ago; it strikes us as absolutely absurd to believe that human beings have evolved to the point in the last two or three decades where we now require "arch support" to prevent our feet from hurting us as we go about our daily activities.

The following is a quote from noted shoe expert and podoanthropologist William A. Rossi, DPM:

A modern example of the required ruggedness of the foot is the rickshaw men of 19th century China. A century ago China had over 10,000 rickshaw men at work. Each averaged over 25 miles of trotting each day, seven days a week, running barefoot over cobblestone streets and gravel roads. Even a slight injury could threaten their livelihood. Despite the rugged terrain, the feet remained strong and mostly trouble-free. The feet of the early hominids had the same rugged nature.

Knowing the true, psychological etiology of plantar fasciitis (versus the pathomechanical gibberish we were taught in school), we now have justification for our anti-orthotic position. There is no doubt that such a stance would have us branded as heretics by othe rmembers of our profession. In addition to not addressing the actual source of the problem, one is doing a disservice to the patient by providing another external support besides the shoe. One must also consider the risk of eliciting the infamous symptom imperative if a placebo "cure" should be achieved.

We could never understand the rationale behind the surgical treatment of plantar fasciitis. To add fuel to the fire of the plantar fasciitis epidemic, a high-tech gimmick called ESWT (extracorporeal shock wave therapy) has been touted as an alternative to surgery after the failure of traditional conservative measures. The case of plantar fasciitis certainly exemplifies this witty observation from Dr. Sarno: "Therapeutic eclecticism is a sign of diagnostic incompetence."

Here is an amusing story:

A woman had returned to the clinic one day for re-evaluation of bilateral plantar fasciitis (a pair of custom-made orthotics had been made for her). She stated she was now pain-free. Inspection of her shoes revealed that she had been wearing her "precision" orthotics upside-down!

And another:

In a letter to a podiatry journal, a podiatrist cited the case of a man who presented to the office with a complaint of heel pain. He was given a diagnosis of plantar fasciitis and was scheduled to return in one week for a steroid injection. During his follow-up visit he reported that his pain had completely disappeared after using the device dispensed to him. The podiatrist was puzzled until the patient pulled out a foot-shaped refrigerator magnet from inside his shoe. The magnet had been given to him by the receptionist the week before.

In our practice we have been introducing TMS to certain select, open-minded individuals. Embracing TMS as a cause of foot pain requires a major restructuring of a deeply entrenched belief system...

In closing, we salute you for becoming a TMS standard-bearer in Dr. Sarno's noble crusade to bring enlightenment to the modern medical establishment and healing to the multitudes of sufferers of mindbody disorders.

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 Shoulder Pain, Another Epidemic


Shoulder Pain, Another Epidemic


I would be remiss if I did not mention that shoulder pain is currently in vogue. While standbys like back pain, sciatica and knee pain continue to appear with regular frequency, more and more people are now complaining of persistent shoulder pain. This is all the more remarkable since almost every one of these individuals cannot recall a traumatic event or provide a good history that would explain the sudden appearance of this discomfort.

Naturally, their physicians are obtaining x-rays and MRIs and then diagnosing them with rotator cuff tears, rotator cuff tendonitis, bursitis, arthritis, etc. This is despite the fact that the incidence of "abnormal findings" on x-rays and MRIs is the same for those with pain as those without! Not too surprisingly, their shoulder pain is failing to respond to medication, physical therapy, cortisone injections, etc. and prompting orthopedists to recommend and perform shoulder surgery. Unfortunately, most continue to have discomfort following surgery. Some do have temporary relief, but find that symptoms return, evidence of a placebo effect. This experience confirms that this latest epidemic is yet another TMS manifestation.


 More Letters and Case Reports

A few letters and case reports may help you to decide whether this approach may be beneficial for you.


More Letters and Case Reports


Dear Dr. Sopher,

First of all, I'd like to thank you for the time spent with me discussing my shoulder and arm pain(s). Your insights and "diagnosis" (gained from both my visit with you and subsequent reading of your book) resulted in what was a fairly stunning and immediate occurrence for me that, after a period of lengthy reflection, I'd like to now share with you. During the evening hours after my visit, I began reading your book and finished approximately 3/4's of it before falling asleep. As had been the case for the past several months, the pain (present in both arms/sides of my body-which is important to understand because, being a competitive, right-handed tennis and squash player for several years I've had several playing-related ailments that have been specific to my right arm) was quite noticeable that evening. During the evening, I had an extremely vivid dream after which (or perhaps during which-I know very little about dreams, dream-states or any other sleep-related states of mind) I awoke to realize that the pain was gone. Through what I can only suppose was the result of a combination of several of the anecdotes (both those depicted in the numerous drawings, analogies and text of the book) and subconscious recollections of your spoken words and insights shared in person earlier in the day, the pain (and I can clearly remember the point in the dream when this happened because the sensation was unusually physical in manifestation) felt as if it had been flushed from my body. I felt like a "healing" had occurred; a sort of (metaphorical) exorcism in which my body, and/or perhaps my mind (which if I understand you correctly is at the core of both your studies and your book) had been cleansed of whatever contributory elements had resulted in the pain. While this dream was certainly a bit stunning (for me anyway), what was equally unusual was the fact that, upon awakening, I knew immediately that I was better and that the pain was gone. Certainly, I "pinched myself" to be sure I was conscious and even walked around the room rotating my arms to confirm that what I felt in the dream had actually happened. ..the pain was really gone. I then went back to bed as it was sometime in the middle of the night (or at least still dark out anyway) that this all happened. When I awoke again with the daylight, the pain was still gone. Later that morning, after I felt like I had accurately recalled and assembled the aforementioned events in my mind, I shared them with my wife. She's more of an open-minded person than me who has been somewhat critical of my characteristic skepticism toward alternative or nontraditional ways of thinking; ibuprofen and other types of anti-inflammatorys coupled with a reasonably strong and enduring threshold for these types of pain had been my usual remedy. She too, has now read your book and is similarly intrigued and appreciative of your research, study and all the other efforts that went into it, as am I.

Sincerely, DC

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Hi Dr. Sopher,

I live in Brazil these days (past 6 years), am a former TMS success story (hooray), and have now been diagnosed with tenosinovite de quervain OR, worse yet, with CRPS II, perhaps even second stage of this latter. This all started with an injury to the wrist (car accident while driving). When the Dr. was describing CRPS, and mentioned the autonomic nervous system, that bell of "I've seen this movie" went off in my brain. So my question is: can either/both of these diagnoses be TMS? If so, I know what to do. If not, I need to do some serious treatment, as per instructions here in Brazil. I can go into more detail (I have a current MRI), history, etc, should that be helpful.
Thanks!

C

C,
While I cannot diagnose you via email, I think it is very likely that your symptoms are due to TMS. In my book I write about my experience helping those with wrist pain. Given your previous success, I have no doubt you'll succeed again.

Good luck,
Marc Sopher, MD

Dr Sopher,

Thanks so much for your quick response, it made my day, or month, maybe year for that matter. You'd have quite a market down here. Carpal tunnel is a major problem, they call it LER.

My MRI shows partial rupture of the interosseo intrinseco escafosemilunar ligament in its central and flying (? maybe upper?) part, with a certain degree of increase in the corresponding articular space (excuse my tranlation weaknesses). My physical therapist says she still thinks I have some CRPS II, (which doesn't concern me - I'm clear that I can make that disappear) and that I need to continue to treat the area until the ligament heals and we can strengthen the thumb (I've lost some movement).

I know you can't diagnose via e-mail. My question is about the partial tear in the ligament, and if I can forget it, and tell my brain all is well, and proceed to deal with the emotional aches I need to deal with, or if, in fact, I need to pay attention to this ligament. That's a today question, for which I'd rather not wait weeks.

Thanks again, and glad to meet you.

Regards, C

C,

Time and time again I find that MRI findings are incidental and not the cause for symptoms. Because physicians are inclined to seek a physical explanation for physical symptoms, they "over read" studies to come up with an abnormality. "Partial tear" is a common diagnosis on MRIs of virtually every body part (in my opinion) and can usually be ignored--I'd ignore it. Remember, if there really was an injury, it would heal! So, a "chronic partial tear" should either not really exist or not cause symptoms. Healed areas of injury can appear "abnormal", too. I hope this helps.

Marc Sopher, MD

Dr M,

this helps a lot, and I thank you from the bottom of my heart. In these last few days, my hand/wrist have improved 1000 percent. If you need my story for any reason, I'd be pleased to oblige.

best, C

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Sent: February 25, 2000 8:51 AM
To: Dr. Sopher
Subject: Phone consultations(?)

Dr. Sopher,

My husband is in the midst of a severe "episode" of sciatica pain, involving his left hip, knee, and ankle. He has had a C.T. scan and x-rays which show a broken bone in his back, but a neurosurgeon suggested he delay an inevitable surgery as long as possible. (He was originally treating my husband for neck and arm pain and he didn't think it was related to this break, and he believed that it was possible that the break was congenital.) He has reluctantly been taking a myriad of painkillers and valium, with only some relief. He is scheduled to have an MRI next week if he can manage the ride to town, and his general practitioner is urging him to get an epidural injection of cortisone and painkillers.

Meanwhile, we've both read Dr. John E. Sarno's book, "Healing Back Pain," and it seems as if the book was written for him. Unfortunately, even though he intellectually bought into the idea, his pain didn't just go away after reading the book, as it has for some. I've purchased Dr. David Schechter's "The MindBody Workbook," but I think a diagnosis from a doctor and some personal guidance may be what he needs at this point.

So far I've been unable to find anyone in our area who knows enough about TMS to make a diagnosis. We are planning a move to the East coast this summer, so I thought it might be a good idea to see if there was anything you could do for him "long-distance" in the meantime.

Thanks in advance for any help you can give on this.
L

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February 25, 2000

Dear L,

Some people will indeed benefit from seeing a physician who can diagnose and treat TMS. Unfortunately, only a small minority are able to eliminate their pain quickly after reading the book. Working on the therapeutic program that Dr. Sarno discusses is often hard work and can take weeks and even months-even for those who see me, Dr. Schechter or Dr. Sarno. So, I would advise your husband not to get too discouraged, but to keep working-re-programming the brain may take time. You don't mention the type of vertebral abnormality that he has, but I've often found that these findings are incidental and not the cause of the pain. Epidural steroid injections and "painkillers" are frequently ineffective as a result. Not only that, medications like valium and "painkillers" are often addictive-both physically and psychologically and can worsen the problem. I hope this advice is helpful. If you decide that a consultation with me would be of benefit when you are in the region, feel free to contact me.

Good luck,
Marc Sopher, MD
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January 09, 2001

Dr. Sopher,

I emailed you out of desperation one morning last year. My husband had been in extreme back pain brought on by driving to work and I was frightened by the severity of pain that he was feeling and by the "official" diagnosis that this was caused by a spine abnormality that needed to be surgically corrected.

Your advice was a great comfort to me, as it was impossible to find a physician where we live who would entertain the notion that the cause of the pain could be "all in his head." As crazy as this sounds, I read him two of Dr. Sarno's books while he was pretty doped-up, and when he was able to, he started reading them himself. After he finished the second reading of one of the books, his pain pretty much went away. (This was after 6 1/2 weeks of intense pain.) It is still gone.

I want to thank you for the email that helped me believe that this was a possibility, and not some flaky idea.

Sincerely, L


Dr. Sopher:

I emailed you and spoke to you by phone around the end of July this year. I had read Dr. Sarno's Healing Back Pain book and you suggested that I read the Mindbody Prescription to help me get over the last 20% of the back pain that I had been suffering from for a year. You affirmed for me that I needed to stop taking Celebrex, using a heel lift, doing back exercises and seeing the doctors in order to rid myself entirely of the TMS induced pain. We talked about whether I needed to attend one of your sessions and I decided to try it on my own first with the knowledge that I could seek the "jump start" from you if necessary. The night of our phone conversation I ceased any physical treatment of my L3 L4 arthritis and compressed disk. I had started to golf again but still had fear. As I read the Mindbody Prescription I worked very hard at total acceptance of the TMS theory and started to play 27 holes of golf, as I used to daily on the weekend, carrying my bag. I immediately rid myself of pain, as you knew I would. I have had to hone my skills to get back on track now and then as this TMS thing is quite insidious. If you don't stay on top of the mental awareness it tries to creep back in. But it can be easily controlled if you keep working at it.

I have waited to write and thank you until I saw my family practice doctor yesterday for a check up on my back. I knew you would be amused by the fact that I tried to cancel the appointment but was met with extremely strong resistance by her nurse when I told her that I didn't need to see the doctor because there is nothing wrong with me. So I decided to take more of your advice and keep the appointment for the sole purpose of telling my doctor why I am better and to educate her about TMS. I did that yesterday. I started the appointment by telling her that I am 100% better and I am here to tell you why. She was very receptive and I gave her a copy of pages down loaded from your web site and from Amazon pertaining to Dr. Sarno's two books. I suggested that she get in touch with you because she has a professional interest in this topic. She was very open and said that she was pleased and wanted to learn about it because it could help with her other patients. That is why I suggested that she contact you. She is very open minded and had originally talked to me about stress just before the TMS happened. I told her that I was impressed with her observation about stress as I look back on it but that I didn't know what to do or how to deal with it at the time. I told her that Dr. Sarno's theories and books would give her a tool to use when she observes this in other patients. She agreed with me that I should cancel the follow up appointment with the rheumatologist, which I have done this morning.

I want to thank you for your commitment to this very worthy endeavor. I have taken your advice to heart about spreading the word, consequently, I have told a lot of people why I am better instead of just saying it was stress. I have referred half a dozen people to your web site. I hope they seek your assistance if they are unable to do this on their own. I am a person that feels my health is my responsibility, not that of the medical community, and I am now confident that I have found probably the most valuable tool that a person could have for long term optimal health. I am disheartened by the numbers of people I meet that appear to have TMS so I, like you, hope that the word really gets out. Thanks again for taking the time with me that helped me over the final hurdle. Best of health and happiness to you. Roxane


Dear Dr. Sopher,

I wrote a letter to you last November, after my visit in October, to let you know how well the program was working for me. I also sent a picture along of the two of us. I was fearful of Springtime. It was what I called the "acid test". If I could get through Spring without an incident , I was pretty confident the rest of the Summer would be fine. Well, I did it!!!! I'm so proud of myself. Without your support and knowledge of the underlying problem I know my life would have continued on in fear and pain. It's almost scary to feel this good. I have to admit I still find myself waiting for the other shoe to drop.

When I pick up my sweet grandson, (6 mo & 22 lb. & always wriggling in my arms) I find that I don't even think about my back. I actually pick up anything all of the time and don't think about my back. If I do have an occasional day or two of stiffness and low pain (2), I play the tape of the meeting, and hearing your voice, and listening over and over again to your words of wisdom, will usually relieve any discomfort I'm experiencing at the time. Applying all the messages which you recommended about the ID and the oxygen deprivation helps tremendously. Also, my doctor is applying the same technique when his back starts bothering him, and he is also sharing the book Mindbody Prescription with his patients.

Thank you again Dr. Sopher. My life has done a l80 thanks to you. If you ever need a testimony from a 58 year old woman with a history of 30 years of suffering, feel free to call. I'd make a trip up there anytime.

Sincerely,

Charlene Penz


Paul Teta is a 52 year old gentleman who had experienced low back pain for more than 20 years. Often the discomfort would radiate to the right leg. Approximately 15 years ago he underwent surgery to repair a herniated disc. His symptoms did improve but returned, sometimes severe enough to make it impossible to work or do the athletic activities that he enjoyed.

During his consultation he acknowledged various sources of stress and was able to recognize that he often placed significant pressure on himself. Within several weeks of his appointment with me and attendance at the evening lecture, his pain vanished. He sent the following email to me, which he wished to share.

Dr. Sopher- My name is Paul Teta. I recently(two weeks ago) had an appointment with you. I came with my brother,who you were nice enough to invite to the seminar. I just wanted to give you a quick update on my progress. The day I arrived for my initial exam I was in pain & also on a strong pain killer, & had been for weeks.

I had read Dr.Sarno's book twice. After you confirmed that I had tms, you said to me, do not fear the pain for it was harmless & my back was normal. I think that statement saved me weeks of time. That evening we went to the seminar, which gave me even more confidence. I have not taken any medicine of any kind for back pain. Several days after I put on my roller blades & bladed about 10 miles. At that point my leg was killing me. I continued to blade for another 8 miles and my back started to twist & I was losing the lumbar curve. I kept repeating to myself, "the pain is harmless & my back is normal." At about 19 miles the pain stopped and my leg turned warm. Afterwards I had a twenty mile drive home. I had no pain sitting for the first time. While driving home I started to scream out loud, "I'm sick of this pain dictating my life." I began to cry & did so for about 30 minutes (possibly childhood rage?).

After that I have taken out my running shoes (after 15 yrs) & resumed running. "NO PAIN". I feel 18 again. I also can bend over & can for the first time put on my socks without lying down. In my wildest dreams, I never expected to do this well. Twenty years of fear & pain erased so quickly. I have since purchased about 10 books & have given them to friends & customers of mine. THANK YOU DR.SOPHER & DR.SARNO. I will send you a future letter of more details as soon as time permits.

Paul Teta 1-5-2000.


Case Reports


  • K.N.* is a 48 year old gentleman with a history of low back pain of more than 25 years duration. His pain can radiate down his leg and can be worsened by sitting or virtually any physical activity. Two back surgeries and every conceivable other modality have failed to relieve his pain. A serious athlete, he has had to significantly curtail activities that gave him great pleasure, like bicycling, hiking and inline skating.

    K.N. was quick to recognize his personality traits that made him a set-up for TMS and was also able to identify significant stressors in his life. He experienced gradual reduction of his symptoms following his visit with me and by 3 months was virtually pain-free as he enjoyed all of the athletics that he formerly pursued.

  • S.C.* is an interesting case because of his age. It has been Dr. Sarno’s and my experience that older individuals with TMS have a more difficult time overcoming it, perhaps due to too many years of conditioning. S.C. is a 66 year old fellow with lifelong back pain, worse over the previous 6-7 years. Hi s pain persisted despite physical therapy, chiropractic, myotherapy, acupuncture, yoga, medication, 2 surgeries, facet blocks and radiofrequency ablative treatment. Always athletic, he, too, had to curtail his passions, tennis and skiing. A perfectionist, he was able to understand why his physical symptoms did not abate with various physical treatments-that there was a psychological basis for his pain. Within 6 weeks he acknowledged being 80% better, but was continuing to focus on this information as he wished to be 100% (his perfectionist nature shining through!).
  • B.Q.* is a 33 year old woman with severe low back pain that developed after a complicated pregnancy. This pain could travel into either leg; soon after she experienced pain in various other parts of her body. Her failure to improve with traditional therapies and medication increased her fear that she would not be able to care for her child, nor return to work (as she desired). In retrospect, she identified her history of panic attacks, irritable bowel syndrome and previous episodes of back pain and paresthesias more than 10 years prior as earlier manifestations of TMS. Within 4 months of her consult (and with the help of a good psychotherapist), she had experienced a dramatic reduction of her pain and was able to exercise regularly and resume a normal life, without restriction.
  • S.C.* is a 45 year old woman with low back and buttock pain for more than five years. Her discomfort could radiate to her left leg, and at times she also experienced pain in both hips, feet, shoulder and neck. Chiropractic treatment, acupuncture, and medication all failed to relieve her symptoms.

    She admitted to having perfectionist traits and being "a worrier." Within 2 months of her consultation she was able to eliminate her pain and told me that "(her) back is terrific" and she was back to enjoying activities that she had given up due to pain.

This next person’s case is particularly fascinating.

  • N.A.* is a 62 year old man who had undergone surgery and radiation therapy for aggressive prostate cancer. Unfortunately, in the course of routine follow-up it was discovered that his PSA (prostate specific antigen-a blood test that is used to screen for and monitor status of prostate cancer) was rising and his cancer had spread. After reviewing treatment options, he opted to hold off on chemotherapy and read The Mindbody Prescription and books by Dr. Bernie Siegel. He then spent time each day talking to his brain and body, utilizing Dr. Sarno’s theories. His most recent studies indicate that his cancer is in remission, with no evidence of it on blood tests or on CAT scan.
  • K.V.* is a 55 year old man with a long history of various joint and muscle aches. He developed right-sided sciatica symptoms several months prior to his visit with me. He began to "think psychological" and was able to eliminate all of his symptoms in 6-8 weeks, after years of enduring them.
  • K.O.*, a 44 year old woman, who had experienced hip pain "for years", finally gave up running due to an increase in discomfort. Told she had arthritis, she believed this as both of her parents had been diagnosed with arthritis. She was advised to not run and went through years of chiropractic and osteopathic manipulation without relief. Aware of having many perfectionist and "goodist" traits, she has been able to eliminate her pain and resume running since her appointment with me.
  • J.M.* is a 44 year old gentleman with a long history of low back and hip pain. Told by orthopedists that he had degenerative disease in these areas, he was advised to limit athletics, his passion, and consider hip replacement surgery. He, too, recognized sources of rage and identified strong perfectionist and "goodist" qualities. Within a few weeks of his consultation with me, his discomfort had decreased considerably and he has been able to resume exercising. He sees continued improvement at the time of this writing.
  • O.C.*, a 52 year old man, came to see me with low back pain for many years. Massage, special exercises and medication failed to resolve his pain. After reading Dr. Sarno’s books, he realized that this "fit him to a ‘T’." Within a short time of his appointment with me, he was able to get rid of years of back pain and resume running and more active exercise.
  • P.B.* is a 57 year old woman who had experienced right sided low back and buttock pain that often radiated down her right leg. These symptoms persisted for years despite traditional treatment. She had been told that the physical demands of her work were to blame for her symptoms and had been diagnosed with arthritis. In speaking with me, she came to understand the likelihood that her pain had a psychological basis. Years of pain vanished soon after.
  • H.T.* is a 62 year old gentleman with a history of low back pain with intermittent sciatica for approximately 30 years. Initially the pain was episodic, but over the years became more prevalent. X-rays, CAT scans, CT myelograms and MRIs were performed and at various times the following diagnoses were given: herniated disc, degenerative disc disease, osteoarthritis and spinal stenosis. Treatment strategies included: limitation of activities, special back exercises, physical therapy, anti-inflammatory medications, chiropractic manipulation, massage therapy, acupuncture and epidural steroid injections. Five years ago back surgery was performed for treatment of herniated disc without improvement of symptoms. The most recent recommendation was for a multilevel spinal fusion procedure.

During my evaluation, H.T. revealed that his back symptoms began during a difficult time in his first marriage. Exacerbations often occurred with times of increased stress in that marriage and in his second. Additionally, he has devoted extraordinary resources to his second wife in her lengthy battle with cancer. His personality is clearly that of the "goodist"--one who does for others, often to the point of self-sacrifice.

He was able to "think psychological" and accept that his pain had a psychological cause. H.T. repudiated the physical—though his pain was real, it was not due to a physical problem, despite the findings of his diagnostic studies. He understood that the pain was created by the brain to distract him from unpleasant thoughts and emotions stored in the unconscious, the unconscious "rage" described by Dr. Sarno. He was able to eliminate his pain and resume activities that he had given up.

  • D.G.* is a 47 year old gentleman with severe low back pain of 2 years duration. His pain was significant enough to cause him to limit his ability to work, as well as curtail athletic activities that had been the source of much pleasure. Hospitalization was even required to treat the pain. Physical therapy, anti-inflammatory drugs, muscle relaxants, osteopathic manipulation, massage therapy, prolotherapy and epidural steroid injections were all tried without relief.

He is self-employed and described his work as being very stressful. He worried about his aging parents, both in their 80’s. A self-described "perfectionist", he understood that he put a tremendous amount of pressure on himself to be successful.

D.G. was able to eliminate his pain within several weeks of his consultation with me.

  • D.Q.* is a 56 year old woman with low back pain of greater than 20 years duration. She had the full range of diagnostic studies and was told that she had 3 degenerated discs and extensive osteoarthritis. Special exercises, physical therapy, anti-inflammatory medications, oral steroids, muscle relaxants, anti-depressants, chiropractic manipulation, epidural steroid injections and counseling had been unsuccessful at eliminating her pain.

A classic "goodist", she recently has helped her daughter battle cancer. Her own father abandoned the family when she was young.  She happily reported a dramatic reduction in her pain soon after her visit with me and sees continued improvement.

  • L.L.* is a 31 year old gentleman with a 2 year history of bilateral elbow and wrist pain. Told he had epicondylitis and carpal tunnel syndrome, he was managed conservatively with anti-inflammatory drugs, limitation of activities and use of wrist splints and forearm bands.

In consultation, he revealed that his symptom onset coincided with increasing marital stress with his second wife. With children from both marriages, he acknowledges significant financial pressures as well as a desire to be a good father to all of his children.

Following his consultation, L.L. successfully eliminated his elbow and wrist pain.

*Some names have been changed to protect patient privacy.

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