Tension Myositis Syndrome (TMS) is a diagnosis for back pain given by Dr. John Sarno.

According to Sarno, TMS is a condition in which unconscious emotional issues (primarily rage) initiate a process that causes physical pain and other symptoms. His theory suggests that the unconscious mind uses the autonomic nervous system to decrease blood flow to muscles, nerves or tendons, resulting in oxygen deprivation (temporary micro-ischemia) and metabolite accumulation, experienced as pain in the affected tissues

This theory is popular but not widely accepted by the scientific community.

Is there evidence that this diagnosis (and related treatment) works?


2 Answers 2


There is an article (not peer-reviewed though) that I personally like that goes into science behind our current understanding of biopsychosocial model and cites a lot of primary literature (peer-reviewed).

Answering your question will require citing this article or similar work, but to assist in understanding this problem, consider that currently we don't have good double-blind studies. Ideally you want an experiment, where one group has been made angry, and another control group that has been left at peace. Then we compare rate of back pain.

We don't have that experiment, but we know that people with depression will show greater probability of developing chronic pain or just be more sensitive to pain. Generally speaking, emotional state and pain are linked. However, I can't find studies that connect specifically rage and development of pain. It has been discussed that rage and depression can correlate (more recent paper).

  • Your ideal experiment is unlikely to pass an Ethics Review Board. It would probably sufficient to show that treating rage reduces back pain in people diagnosed with TMS (assuming treating rage isn't done through rest, exercise, massage and/or surgery!)
    – Oddthinking
    Aug 31, 2019 at 6:41
  • 3
    Consider that chronic pain causes depression. This has been fairly well established. Aug 31, 2019 at 11:53

Yes, back pain is often caused by unconscious emotional issues. Such pain is called psychosomatic or psychogenic pain; common associated terms include myofascial pain, tension myositis, fibromyalgia and central sensitization.

1) Sarno JE, Psychosomatic backache (The Journal of Family Practice, 1977):

It is contended in this report that the majority of pain syndromes involving the neck, shoulders, and low back are the result of a benign, reversible process in the musculature which is psychosomatic in nature and which has been called tension myositis.

2) Work strain and symptoms of musculoskeletal disorders (The National Institute for Occupational Safety and Health, 1999):

Elevated state anxiety was directly related to symptoms, while depression and psychosomatic symptoms acted as mediators between job and home demands and MSD symptoms, especially symptoms in the lower back.

3) Central sensitization in chronic low back pain: A narrative review (Journal of Back and Musculoskeletal Rehabilitation, 2016):

The etiology of chronic low back pain is, in most of the cases (up to 85%), unknown or nonspecific, while the specific causes (specific spinal pathology and neuropathic/radicular disorders) are uncommon. Central sensitization has been recently recognized as a potential pathophysiological mechanism underlying a group of chronic pain conditions, and may be a contributory factor for a sub-group of patients with chronic low back pain.

4) The Psychology of Pain (Emergency Medical Clinics of North America, 2005):

The National Institutes of Health Technology Assessment Conference Statement... identified six factors that correlated with treatment failures of low back pain—all were psychosocial. Even chronic, episodic, low back pain may have a vital component of socioeconomic and psychological influences.

Regarding treatment: Psychosomatic pain arises from personal issues and resolving them can resolve the pain. It's a person with pain who needs to solve personal problems, which can include false believes, wrong attitudes, bad relationships, inappropriate job, etc. Regular discussion with an emphatic and experienced person can help but relying on various therapeutic "techniques" can be disappointing.

  • "it is contended" does not mean proven, it just means "we postulate".
    – jwenting
    Dec 19, 2019 at 6:04
  • @jwenting, neither the author (in the quote) nor I explained "contended" as "proven."
    – Jan
    Dec 19, 2019 at 10:05

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