The average citizen in this country believes that the low back is a vulnerable, fragile structure, easily injured and constantly prone to reinjury. As that perception widens, the occurrence of back pain in the population increases so that now one repeatedly hears the astonishing figure that 80 percent to 85 percent of adults have a history of one of these pain syndromes. Ideas about the vulnerability of the back are, to a large extent, based on the diagnoses practitioners make. Such words as herniation, degeneration,

The Traditional

(Conventional) DiagnosesHealing Back Pain deterioration and disintegration, constantly used to describe the lower end of the spine, provoke fear and provide a ready explanation for the ?injury? and the attack of excruciating pain. Further, there are dozens of prohibitions and admonitions people learn in their interaction with physicians and other practitioners, and sometimes from family and friends, like these: Don?t bend.

Don?t slouch.

Don?t sit on soft chairs or couches.

Don?t arch your back.

Don?t swim the crawl or breast stroke.

Don?t wear high heels.

Always lift with a straight back.

Running is bad for your spine.

Some critics have said that I get such good results because I only accept patients who believe in my concepts. But I can only work with patients who are reasonably receptive to the idea that their emotions are responsible for their pain. Even so, most of my patients are still skeptical when I first see them. It is my job to convince them of the logic of the diagnosis, because only by acknowledging the role of emotions can we get the brain to stop doing what it is doing. That is not believing?it is learning.

Would a surgeon operate on a patient who was not a good surgical risk? Should I be less selective than a surgeon? Another common criticism by my peers, since we are talking about critics, is that I go too far in claiming that the majority of pain syndromes of the neck, shoulders and back are due to TMS. ?He may be right in 30 percent to 40 percent of the cases,? they say.

If 30 percent to 40 percent of back pain patients have TMS, why then do these critics never make the diagnosis themselves? The sad fact is that they cannot because it means repudiating long held diagnostic biases and acknowledging the role of the emotions in these pain syndromes?something for which they have a ?visceral incapacity,? to borrow a phrase from Senator Byrd of West Virginia.

One of the biggest problems for patients is developing confidence that they can banish this physical disorder with a learning program. That kind of thing is completely outside of people?s medical experience. It is my job to convince them that it can be done.The Treatment of TMS FOLLOW UP SURVEYS An important confidence builder is the fact that most people who have gone through the program have been successful. In 1982 we did a follow up survey on 177 patients who had been treated between 1978 and 1981. Seventy six percent were leading normal lives with little or no pain, 8 percent were improved and 16 percent were unchanged. Some of those patients had not had the benefit of lectures and in many other ways the program was not as sophisticated as it is now.

In 1987 a similar follow up study was done, this time on a group of patients who all had CT scan?documented herniated discs and had the TMS program between 1983 and 1986. This time percent (ninety six people) were successful, 10 percent were improved and only 2 percent were unchanged.

Still more recently the well known journalist writer Tony Schwartz, who was successfully treated in 1986, mentioned in an article he wrote for New York magazine on Dr. Bernie Siegel that he had referred the program to forty patients for treatment and thirty nine of them were free of pain. I call this Tony Schwartz?s miniseries.

The cause of ?growing pains? has never been identified but physicians have always been comfortable in reassuring mothers that the condition is harmless. It occurred to me one day while listening to a young mother describe her daughter?s severe leg pain in the middle of the night that what the child had experienced was very much like an adult attack of sciatica, and since this was clearly one of the most common manifestations of TMS, ?growing pains? might very well represent TMS in children.

Little wonder that no one has been able to explain the nature of ?growing pains? since TMS is a condition that usually leaves no physical evidence of its presence. There is a temporary constriction of blood vessels, bringing on the symptoms, and then all returns to normal.

The emotional stimulus for the attack in children is no different from that in adults?anxiety. One might say that the attack in a child is a paranightmare. It is a substitute for a nightmare, a command decision by the mind to produce a physical reaction rather than have the individual experience a painful emotion, which is what happens in adults as well.

At the other end of the spectrum, I have seen the syndrome in men and women in their eighties. There appears to be no age limit, and why would there be? As long as one can generate emotions one is susceptible to the disorder.The Manifestations of TMS What are the ages when it is most common, and can we learn anything from those statistics? In a follow up survey carried out in 1982, 177 patients were interviewed as to their then current status following treatment for TMS. (See ?Follow Up Surveys? for results of the survey.) We learned that 77 percent of the patients fell between the ages of thirty and sixty, 9 percent were in their twenties, and there were only four teenagers (2 percent). At the other end of the spectrum, only 7 percent were in their sixties and 4 percent in their seventies.