Excerpted from The MindBody Prescription: Healing the Body, Healing the Pain

By John E. Sarno, M.D.

Pain, disability, misinformation, fear –  that quartet has plagued the Western world for decades and the plague shows no sign of abating. Back, neck and limb pain are rampant, and statistics indicate that the epidemic is spreading. Disability in American industry from low back pain continues to increase year by year.

Industries that employ large numbers of people working at computers are experiencing great disability and health insurance problems because of a new pain disorder known as repetitive stress injury (RSI). Millions of Americans, mostly women, suffer from a painful malady of unknown cause called fibromyalgia. While gigantic medical industries have arisen to diagnose and treat these conditions, the plague continues.

This book is about that epidemic. It describes both a clinical experience that has identified the cause of the pain disorders and a method of treating them. Sadly, mainstream medicine rejects the diagnosis because it is based on the theory that the physical symptoms are initiated by emotional phenomena. Intelligent laymen in large numbers have embraced the concept, however, no doubt because they are not burdened by the bias imposed by a traditional medical education.

As if the pain epidemic were not of sufficient magnitude, a large group of physical disorders have been identified as equivalents of the pain syndrome, since they appear to stem from the same psychological process. These maladies have occurred commonly for years and, taken together with the widespread pain maladies, are universal in Western society. I refer to many of the headaches, gastrointestinal symptoms and allergies, as well as respiratory, dermatologic, genitourinary and gynecologic conditions that are the stuff of everyday life.

If most of these are psychogenic-that is, they originate in the mind (and it is my goal to demonstrate that they are)-we have a public health problem of staggering proportions. The medical, humanitarian and economic implications are obvious and will be enumerated.

This book is about emotions, illness and wellness, how they are related and what one can do to enhance good health and combat certain physical conditions. The ideas are based on twenty-four years of successfully treating an emotionally induced physical disorder known as the Tension Myositis Syndrome (TMS). Although I will provide an up-to-date description of that condition, my major focus is the impact of the emotions on bodily function.

That connection came close to being accepted by Western medicine in the first half of the twentieth century and then fell into almost total disrepute. Repudiation of psychoanalytic theory, increased interest in laboratory research and the tendency of doctors to shy away from psychological matters (they see themselves as engineers to the human body) are the likely reasons for this historical trend. As the century draws to a close, few practitioners, either in physical or psychological medicine, believe that unconscious, repressed emotions initiate physical illness. Psychoanalysts are the only clinicians who have held to that concept, but their influence in the larger fields of psychiatry and general medicine is limited. In the physical medicine specialties virtually no one adheres to the idea.

Despite the lack of interest of mainstream medicine, much has been written on the “mind-body connection.” Careful studies have been conducted that relate psychological factors to pathological conditions such as coronary artery diseases and hypertension. I know of only one investigator outside the field of psychoanalysis who has identified unconscious emotions as the cause of a physical illness. One reads of stress, anger, anxiety, loneliness, depression, but they are discussed as conscious, perceived emotions. In many instances these feelings are thought to aggravate underlying structural pathological processes, such as herniated discs, fibromyalgia or repetitive stress injury.

In view of the widespread Freud bashing of recent years I may be courting disapproval to state that my concepts descend from Freud’s clinical observations and theories. But I know this only in retrospect, for I did not set out to prove Freud right. My developing ideas were the consequence of clinical observations; they were not based on preconceived notions about the mindbody connection. As with Freud’s patients, I found that my patients’ physical symptoms were the direct result of strong feelings repressed in the unconscious. In addition, I have drawn on the concepts of three other psychoanalysts: Franz Alexander, founder of the Chicago Institute for Psychoanalysis, did pioneer work in mindbody medicine in this century; Heinz Kohut conceptualized what is known as Self Psychology and pointed out the importance of narcissistic rage; Stanley Coen suggested the crucial idea that the mindbody disorder I was studying (TMS) was a defense, an avoidance strategy designed to turn attention away from frightening repressed feelings.

This book addresses physical disorders that are caused by repressed, unconscious feelings. Because these disorders are very specific, they can be accurately diagnosed and successfully treated.

The Tension Myositis Syndrome is currently the most common emotionally induced disorder in the United States, and probably in the Western world. Since the publication of Healing Back Pain, other painful conditions of significant public health importance have emerged. They, too, are manifestations of TMS.

The book is laid out in three parts. Part I is a discussion of the psychology that induces these physical maladies, and it includes a chapter that might be called a bridge, for it describes the psychoneurophysiology of psychogenic processes: in other words, how emotions stimulate the brain to produce physical symptoms. After traversing this bridge (which sounds more formidable than it is), Part II takes up the various emotionally induced physical maladies, beginning with TMS, the disorder that introduced me to the world of mindbody medicine, and including such ailments as the common disturbances of the gastrointestinal tract, headaches, allergies and skin disorders.

Part III discusses treatment for these disorders.

For those who are interested, an appendix covers the more academic aspects of the mindbody (psychosomatic) process.

A word of caution to the reader: What follows is a description of my clinical experience and the theories derived from my work. No one should assume that his or her symptoms are psychologically caused until a physician has ruled out the possibility of serious disease.

About the Author

John E. Sarno, M.D., is Professor of Clinical Rehabilitation Medicine, New York University School of Medicine, and attending physician at the Howard A. Rusk Institute of Rehabilitation Medicine, New York University Medical Center.

Read more………………… interviews John E. Sarno MD

From Medscape Orthopaedics & Sports Medicine > Expert Interview

Editor’s Note:
John E. Sarno, MD, is a pivotal figure in the arena of pain management because of his hotly debated approach to the diagnosis and management of back pain.

Dr. Sarno, Professor of Clinical Rehabilitation Medicine at New York University School of Medicine, and Attending Physician at The Rusk Institute of Rehabilitation Medicine at New York University Medical Center, is the author of 3 books that postulate the theory that most back pain is triggered by psychological origins instead of by a physiological defect.

This phenomenon, which is known as tension myositis syndrome, may also be the culprit in other pain disorders.

Dr. Sarno sat down with Medscape’s Pippa Wysong to spotlight how he became interested in pain management and outline how he came to structure his precepts for freeing his patients from back pain.

This is the first of a 2-part interview.

Medscape: I think our readers would be interested in starting off with how you first became interested in back pain. What triggered your interest?

Dr. Sarno: I became interested in back pain when I came to the Rusk Institute here at the New York University Medical Center as head of the outpatient department. I was exposed for the first time in my medical career to large numbers of people with back pain. To make a long story short, after a few years of making the conventional diagnosis and administering the conventional treatments, I came to the conclusion that there was something terribly wrong, because my results were as poor as everybody else’s. I found this frustrating and decided I’d better take a closer look at this and really question the diagnosis.

Medscape: In your opinion, what was wrong with the diagnoses of back pain? What did you find?

Dr. Sarno: When I started to look into it, I found that large numbers of people in whom the pain was being attributed to some structural abnormality actually had a totally different disorder. It was a disorder in which the pain was very real, but it was initiated by emotional factors.

Medscape: Emotional factors such as…?

Dr. Sarno: It primarily had to do with the stresses in patients’ lives and, interestingly enough, the stresses that they put on themselves. Once I began to make this diagnosis and to deal with it accordingly, for the first time I began to have success. And of course that’s why I started to write books about this. But here in the United States virtually no one in the medical profession is willing to consider this diagnosis. That’s, incidentally, very, very important. I do not have an approach to dealing with pain but rather the stresses that cause it.

Medscape: Are the stresses that lead to back pain, as you say, very common?

Dr. Sarno: It is more than back pain. What we can refer to as stress-related disorders have turned out to be more widespread: It’s low back, upper back and neck; it’s pain involving the knees, pain involving the feet. From what I understand from an article in the New York Times, there were 10 million people in the United States with foot pain, which is an epidemic. And all of these pain syndromes have spread in epidemic fashion in the United States over the last 30 years — precisely because they are mind/body disorders that have been incorrectly diagnosed, and therefore, as far as I’m concerned, incorrectly treated. I want to make that clear: The major factor is not what treatment one employs but what diagnosis one makes.

Medscape: Can you describe some of the diagnostic features you use? What about the physiology?

Dr. Sarno: Let me tell you very briefly about the physiology. I’ve based my findings on clinical experience and the way patients reacted to conventional treatments, as well as through material from the clinical literature. What is actually causing the pain in these people is not the herniated disc, or some of those other structural things, but a condition of mild oxygen deprivation, which is brought about by the brain simply altering the blood flow to a particular area. This mild oxygen deprivation is what causes pain in muscle.

Take sciatica as an example. There are a number of spinal nerves going into the leg via the sciatic nerve and the brain would mildly oxygen-deprive them. That would then, of course, give you pain in the leg, and give patients feelings of numbness and tingling. It would also produce actual weakness. But doctors have assumed that these changes and symptoms in the leg were the result of some damage to nerves in the low back — as a result of herniated discs and things of that sort.

Medscape: What exactly does the oxygen deprivation do?

Dr. Sarno: It produces symptoms. Oxygen is a crucial substance for normal function. You can’t do without it for more than a few minutes or cells begin to die. When there is even a minimal reduction in the oxygen supply to a tissue, say a muscle, a nerve, or a tendon — those are the 3 tissues that we realized the brain might target in order to produce this disorder.

Medscape: Are you saying that this oxygen deprivation is the underlying cause for all back pain?

Dr. Sarno: The underlying thing in this diagnosis, yes. If it involves a tendon around the knee, for example, the patient will have a painful tendon there. Invariably a magnetic resonance imaging (MRI) study will be done and doctors may find a minor tear of the meniscus, the cartilage, in the knee and say, “That’s where the pain is coming from.”

Invariably there are alternative explanations. For example, shoulder pain is very common now. With MRI studies demonstrating abnormalities of the rotator cuff, immediately doctors and radiologists will say, “That’s causing the pain.” So, for every area in which people have pain, one can find structural abnormalities of one kind or another.

Medscape: According to your theory, structural abnormalities don’t even contribute to the condition.

Dr. Sarno: In my experience they have nothing to do with the problem in many cases. I can’t say in 100% of instances, but in many, many cases I’ve concluded that they have nothing to do with the problem. Of course, my proof is that my patients get better. They couldn’t possibly have gotten better if the pain were due to the structural abnormality.

Medscape: If there is a structural abnormality, doesn’t it need attention?

Dr. Sarno: No, no, no, no, no, that’s the whole point. From what I’ve been able to gather, you see there’s so much material in my books and really we’re trying to capsulize this now.

Here’s an example: There was a paper published in 1994 by a doctor and her colleagues in the New England Journal of Medicine. They performed MRIs on about 98 people who had no history of back pain. The researchers found normal discs in only 36% of the people. Everyone else had bulges, herniations of various kinds, and so on, and yet no pain. That’s the kind of information that doctors in this country totally ignore.

Medscape: Who was the lead author of that study?

Dr. Sarno: Maureen Jensen. This and other studies are referenced in my books.

Medscape: Do you have a name for this oxygen-deprivation disorder?

Dr. Sarno: Yes. Incidentally, it’s a name that’s become somewhat obsolete, but, since I’ve used it in 3 books I continue to use it — tension myositis syndrome (TMS). It’s called a syndrome because it has so many different manifestations. In the late 1980s, I realized that nerve involvement was also part of the syndrome and then later, tendons, too. In fact, I now believe that nerve involvement is much more important in the syndrome than muscle involvement.

Medscape: Can we back up and see how you came to the idea that oxygen deprivation was behind all of this?

Dr. Sarno: First of all, there are some papers that suggest that. Clinically it was because I had observed, when I was doing conventional treatment in prescribing physical therapy, that the things that seemed to relieve the pain temporarily, but pretty definitely, included deep heat in the form of ultrasound, deep massage, and active exercise. All 3 of these increase the local circulation. I said to myself, “That probably is what the brain is doing to produce the pain; it is reducing the blood flow.”

Medscape: Do you have physiological studies or cellular samples to show what’s going on, as proof?

Dr. Sarno: The studies that were done to demonstrate this were done by a rheumatologist on fibromyalgia. In my experience, fibromyalgia is nothing more than a severe form of TMS. Rheumatologists got interested in fibromyalgia in the 1980s and did studies. One group in Sweden did 2 studies that made it very clear that mild oxygen deprivation was the reason for the pain in the muscles in people with fibromyalgia. This supported what I had concluded on clinical grounds.

Medscape: Can you elaborate?

Dr. Sarno : Now let me tell you something interesting. Having said this, it wouldn’t make any difference if there were a half a dozen other explanations for the pain, as long as it was clear in one’s mind that the brain was doing this. That the brain was producing symptoms — and this is the heart of the matter and this is what’s extremely important — we haven’t gotten into the psychology yet. But the brain was producing symptoms in order to protect the patient from psychological trauma, turmoil, something of that sort. And I came to that conclusion only after many, many years. I wasn’t ready to say that until I published my book, The Mindbody Prescription, in 1998.

Medscape: So we’re shifting from a physical cause to a psychological cause?

Dr. Sarno: What has been clear right from the beginning is that people were responding to stressful situations in their lives. Even more interesting, people were responding to the pressures and the stresses that they put on themselves. I came to realize that people who tend to be perfectionists — that is, hard-working, conscientious, ambitious, success-oriented, driven, and so on — that this type of personality was highly susceptible to TMS.

Later, I realized that there is another kind of self-induced pressure, and that is the need to be a good person. This is the need to please people, to want to be liked, to want to be approved of. This, too, like the pressure to excel or to be a perfectionist, is a pressure and seemed to play a big role in bringing on this disorder.

Medscape: How would you say this all plays a role?

Dr. Sarno: You might say, “What is wrong with trying to be perfect and trying to be nice and good?” Nothing is wrong in terms of our conscious lives. However, in doing this work I had to become very knowledgeable about the unconscious mind. Sigmund Freud’s work is critical in this regard because he introduced us to the idea of the unconscious. I realized that these self-imposed pressures were causing some difficulty inside our minds. There’s a leftover child in all of us that doesn’t want to be put under pressure, and indeed it can get very, very angry. It began to look as though the primary factor psychologically here was a great deal of internal anger to the point of rage.

Medscape: So this is the crux of your theory, that it has to do with internalized pressure and rage?

Dr. Sarno: Self-imposed pressure is one of the sources. It’s difficult to understand because one has to think in terms of what’s going on in the unconscious mind. There are other kinds of pressures that are equally important, the ones that life puts upon us. Pressures from our jobs, our personal lives, our marriages, our children, and so on. It turns out that these pressures were equally disturbing to this leftover child inside of us.

Then a third category, which is also extremely important, are the angers that might be left over from childhood. These can extend all the way from outright abuse to what I call subtle abuse. Say, parents that expected too much of a child, or parents who didn’t provide enough emotional support.

Medscape: These all contribute to pain?

Dr. Sarno: Things of this sort could contribute to a reservoir of rage that I believe we all carry around inside of us. This is part of the human condition in Western society. It’s because we’re all under such pressure, and so many of us are conscientious and hardworking.

Medscape: So you’re saying it’s a psychological problem?

Dr. Sarno: It turns out that the rage is the primary difficulty.

Medscape: This is a very different approach from other back-pain professionals.

Dr. Sarno: Yes, it is.


Read more…………… Part 2…………..Interview with John Sarno MD

Editor’s Note:
John E. Sarno, MD, is a pivotal figure in the arena of pain management because of his hotly debated approach to the diagnosis and management of back pain.

Dr. Sarno, Professor of Clinical Rehabilitation Medicine at New York University School of Medicine, and Attending Physician at The Rusk Institute of Rehabilitation Medicine at New York University Medical Center, is the author of 3 books that postulate the theory that most back pain is triggered by psychological origins instead of by a physiological defect.

This phenomenon, which is known as tension myositis syndrome (TMS), may also be the culprit in other pain disorders.

In Part II of his interview with Medscape, Dr. Sarno expands on the mind-body pain connection and highlights in further detail his concepts of back pain diagnosis, the role of emotion in triggering symptoms of pain, and the controversy his pain management concept has fostered in the medical community.

Medscape: You said that there is internal rage and anger in the brain, and that these are responsible for symptoms of back pain, not structural defects.

Dr. Sarno: It becomes clear why the brain produces these symptoms: They are intended to be a distraction to make sure your internal rage does not come out. The unconscious has been described by some writers as a kind of “maximum-security prison” where the brain keeps undesirable feelings or dangerous feelings repressed.

One reason why I’ve concluded that we all have rage inside of us is because there are other “equivalent” physical states that seem to be serving the same psychological purpose — conditions that are analogous to back pain. I’m referring to [gastroesophageal] reflux, which is very common; irritable bowel syndrome; headaches; common allergies; hayfever; and asthma. I’m referring to common skin disorders like eczema and others. The skin is a great area that the brain uses to create symptoms. These conditions all serve the same purpose: to keep one’s attention focused on one’s body.

This is important in medicine. It’s all so universal, and it’s important to make the right diagnosis. If you make the wrong diagnosis, if you attribute the pain to something structural, or if you say, “The reflux is due to your stomach acting up and you have to take this drug or that drug,” then people will continue to have symptoms. This is why the back pain problem is of epidemic proportions in the United States.

Medscape: Just to clarify: You’re saying that a lot of these conditions are due to a translation of stresses, anger, rage in the brain to physical symptoms?

Dr. Sarno: No. It’s not a translation, the brain is doing this as a protection. Protecting you from the unconscious rage and other bad feelings you might have. The reason childhood things are a factor is because — and we’ve known this for over 100 years — the unconscious has no sense of time. In other words, things that happened to us when we were 8 or 10 years old, if they’re emotionally powerful, are still there at the age of 40, 50, 70, or 90.

Medscape: Perhaps we can move on to treatment?

Dr. Sarno: Of course. Now remember, it’s not an approach, it’s a diagnosis. If you want to know what I do about it therapeutically, and this is very interesting, I teach people what’s going on. Believe it or not, doing that will stop the pain in many cases. There is a small army of people out there who have gotten totally better just by reading one of my books. I mean totally better. I get letters all the time from people around the United States telling me how this happened and they can’t believe it; they’ve had the problem for years and read the book. The reason that they get better is because they accept the idea that what is causing their pain is that disorder. That’s crucial. That’s the point of my teaching my patients. Obviously my patients are those who have not gotten better just from reading one of the books, because virtually all have done that before they come to see me. It’s clear that they need something more.

But those who stay with the program will get better. I think most people recover simply by learning in greater detail what’s going on, by going into the specifics of the pressures in their lives that are most important and so on.

About 20% of the people who come to see me, who come into my program, cannot apparently get better until they’ve spent some time working with one of my psychologists. Psychotherapy is needed for about 20% of the patients.

Most patients in the United States cannot accept this diagnosis. So I calculate that I’m working with representatives of perhaps 10% or 15% of the population. Secondly, 99.999% of the medical profession does not accept this diagnosis.

Medscape: Do you get much flak from the medical community?

Dr. Sarno: No, I don’t get any flak because there’s no occasion for it. Although I do expect to get some flak soon. I’ve been invited to give a lecture at the 2004 North American Spine Society meeting in October, and that’s going to be fun. I’ve never addressed such a group. I’m going to be telling them about my experience with this disorder. At any rate, I don’t get flak; I just get ignored.

Medscape: I guess getting ignored is easier than getting flak?

Dr. Sarno: Easier in one sense, harder in another, because I’ve always wanted the approval of my peers and I haven’t gotten it. Except I’ve heard from 1 or 2 people in the United States who are very well known in their work in trying to bring objective standards to this whole pain problem, and I have had some approval from them. So that’s been very helpful.

Even the majority of psychiatrists don’t accept this diagnosis either. Many of the so-called biological psychiatrists believe that these psychological things are the result of chemical changes and they’re in the business of treating the chemistry. A lot of people in psychiatry have repudiated Freud and repudiated the idea of unconscious phenomena.

Medscape: Isn’t it possible that physical stresses or nerve or tendon damage play a role? Say you sleep in the “wrong” position and your neck is sore the next morning.

Dr. Sarno: No. I’ll tell you how that works. The brain will often use some physical incident as a good excuse, a good opportunity, to introduce or start the TMS. But I’ve had no evidence whatsoever over the years that there are truly physical things that are going on here that the brain is using. It’s just that it will introduce the symptoms and, of course, the brain is very tricky that way. The brain is very concerned about these repressed emotions, and very concerned that they not come out. It will act in a very slippery way and introduce symptoms. One of the examples is whiplash.

Medscape: That’s a common problem.

Dr. Sarno: Whiplash is usually the result of you being hit from behind in an automobile accident. One of the papers from the medical literature that I reproduced in my latest book was absolutely fascinating in this regard. It was published in the New York Times, where they reported on findings from Norway.

This was a good many years ago now, but Norway at that time was having an epidemic of whiplash. Now, Norway has probably one of the most generous insurance programs in the world. But doctors in Norway were dumbfounded. They couldn’t understand why they had so many people in Norway on disability because of whiplash. They wondered if perhaps a generous medical system might have something to do with it. So, they went to Lithuania and did a controlled study there. They got the names of 212 patients in Lithuania who were involved in rear-end collisions and they went out and found 212 controls, and they found that whiplash did not exist in Lithuania. In Norway — epidemic; in Lithuania — zero.

They said, “Wow. This is incredible, it must have something to do with social things.” Well, of course, it doesn’t. Clearly the patients with whiplash were having TMS. And mind/body disorders like TMS will spread in epidemic fashion if they are not correctly diagnosed.

Medscape: But what if imaging, say from a magnetic resonance imaging (MRI) study, depicts a damaged tendon or muscle?

Dr. Sarno: This is my experience — what the MRI studies show in these people has nothing to do with the symptoms. And I have proven this concept.

Medscape: By “symptoms,” you mean pain?

Dr. Sarno: Yes. The pain and the stiffness, there are dozens and dozens of [symptoms]. The ones that are the most frightening are the nerve symptoms — pain, numbness, tingling, weakness. All of those things are scary. If a patient has them and a doctor finds a structural abnormality, he says he needs surgery. Very simple.

In my experience, and we’ve demonstrated this by getting these people better, they wouldn’t get better if the structural abnormality were responsible for their symptoms. They would get better by being educated, which is what I do.

If you ask, “Why do I think the education makes people better?”, I’ve given an enormous amount of thought to this. There was a contemporary of Freud, Alfred Adler, who observed some of the same things that I’ve observed, but over 100 years ago. Adler said to teach people. I think we’re reorganizing what’s going on in the brain and the brain is no longer as afraid of the rage as it was before. Adler used the same term — rage. I think that’s what happens. When I teach people what this is all about, what’s going on physically, and what’s going on psychologically, I think the rage is no longer as threatening as it was before, and so they don’t need to have symptoms.

Medscape: Let’s move on to treatment. What should patients with back pain do? What should their doctors do?

Dr. Sarno: The only thing you can say to people in general, if they’re interested, is to read the books. The 2 that I recommend are Healing Back Pain and The Mindbody Prescription. There is another book that has a corny title by one of my young colleagues from Vermont: To Be Or Not To Be…Pain-Free: The Mindbody Syndrome, by Marc Sopher, MD. If people read the book and they have the same experience that some people in the United States have had, pain will go away spontaneously.

Medscape: So, what do you recommend? Look at sources of stress, potential emotional upsets?

Dr. Sarno: First of all, personality is number one; remember that. Self-imposed pressure. Be aware of that — being “perfect,” being “good.” Secondly, think about all of the regular pressures in your life. And if you are aware that your childhood was not the greatest, that probably is a contributing factor, too. If people look at these things and if they’re open to the idea, they may do better.

Medscape: Do you recommend relaxation exercises?

Dr. Sarno: No, no, I do not. This is not a physical disorder and I recommend nothing physical.

Medscape: How should patients deal with the stresses?

Dr. Sarno: The only thing I can recommend, and I hate to do it because it sounds self-serving, is to read the books. That’s the only thing out there for them. The last one has the most information about the psychology — that’s The Mindbody Prescription. It tells you what we do and what we try to bring about.

Medscape: Does it walk people through different things they look at? Does it have step-by-step mental exercises?

Dr. Sarno: Exactly. In the last book there’s even an outline by a patient from upstate New York. This is one of the patients I never saw but who got better by reading one of the books. He sent me this little program that he designed for himself and I put it in the last book. Actually, I have improved on that and made my own program, but I have to admit that he gave me the stimulus to do it. At any rate, it’s there and it’s something that people can follow.

Medscape: Have you ever had back pain?

Dr. Sarno: Of course. Not only that, but I’ve had a half dozen of the equivalents as well. I think it was one of the reasons why it was so obvious to me once I allowed myself to think about this. But because I know what it is, it has never disabled me. And that’s the secret — knowledge, knowledge, knowledge. That’s the cure here. Knowledge is the penicillin.

Medscape: And the brain is a powerful thing?

Dr. Sarno: You bet! One should never, never forget that fact.

Read more about MindBody Issues from Howard Schubiner MD……………

Dr. Howard Schubiner, MD
Providence Hospital
Department of Internal Medicine
16001 W. Nine Mile Rd.
Southfield, MI 48075
Office Phone:  (248) 849-4728  (248) 849-4728

Welcome to the Mind-Body Center of Providence!
Dr. Howard Schubiner is a compassionate, caring physician.  He has successfully treated patients who felt there was no hope of being their normal, healthy self again.

Specializing in the treatment of disorders with significant psychological components


TMS/MBS Lecture Series Intro – by Howard Schubiner MD

Part 1

Dr Howard Schubiner MD talks about the Mind-Body work developed by Dr John E. Sarno
TMS/MBS Lecture Series – Part 1

Part 2

TMS/MBS Lecture Series Part 2 – Howard Schubiner MD

Part 3

TMS/MBS Lecture Series Part 3 – Howard Schubiner MD

Part 4

TMS / MBS Lecture Series Part 4 – by Howard Schubiner MD

Part 5

TMS/MBS Lecture Series Part 5 – by Howard Schubiner MD

Mind-Body Center of Providence
22255 Greenfield Rd., Suite 410
Southfield, MI 48075
Phone: 248-849-4728
Director: Howard Schubiner, MD

What are “chronic symptom complexes?”

Chronic symptom complexes that are likely to have a significant psychological component include:
Low Back Pain, Sciatica, Neck pain, Whiplash, Fibromyalgia, Tendonitis, Tension headache, Migraine headache, Insomnia, Non-ulcer dyspepsia, Irritable Bowel Syndrome, and others.

Studies show that 70 – 80% of people with these symptoms improve significantly with this type of treatment.

Who is likely to benefit?

Patients who are likely to benefit from this service include:

  • Those whose symptoms wax and wane over time, particularly in relation to stressors, weekends, and/or vacations.
  • Those whose symptoms tend to “alternate,” i.e. back pain recedes when insomnia or headaches worsen and vice versa.
  • Those whose symptoms began during stressful periods, even if the person did not feel particularly stressed at the time.
  • Those who do not recognize any relation between stress and symptoms may still benefit because the stress causing the symptoms is often unconscious and therefore not recognized.

Program elements

The program consists of an individual assessment followed by group workshops. Approximately half of the costs are billed to third party payers.

Contact Dr. Schubiner at 248-849-4728 for questions or appointments. He is willing to discuss this program to help determine if this treatment might make sense for a particular individual prior to making an appointment.

Tension Myositis Syndrome (TMS)

Specializing in the treatment of Tension Myositis Syndrome (TMS)

What is TMS?
TMS is the actual cause of pain and disability in many cases of chronic pain.  Many people with chronic back pain, neck pain, fibromyalgia, headaches, repetitive stress injury and other pain syndromes actually have TMS.  TMS is a condition in which the brain causes a lack of blood supply to certain muscles, tendons or nerves leading to pain.  However, this condition can be reversed through changing the underlying conditions in the brain that cause the changes in the blood supply.  We now know that pain can be “learned” over time by a subtle conditioning process between the brain and the body.  Sometimes this conditioning is fueled by stress and psychological distress, while other times it is mainly due to a misunderstanding of the actual cause of the pain.  Once people understand that their pain can be cured, they are on the road to recovery.

How do we diagnose TMS?
TMS can be diagnosed by ruling out conditions that will cause pain in everyone, such as fractures, infections and cancer.  Research has shown that minor changes seen on X-rays or CT or MRI scans can occur in people who have NO pain.  Therefore, if bulging discs, arthritic changes or other minor “abnormalities” are present, it is often wrong to assume that this is the cause of pain.  In order to exclude conditions that are not TMS, everyone in this program will have an individual consultation with Dr. Schubiner to make sure that the diagnosis is correct before proceeding to treatment.

How do we treat TMS?
  TMS is treated by a six-step program developed by Dr. Schubiner. 

The steps are:

  1. Recognizing the true disorder through thorough review of the medical history, examination and test results.  Making sure that the correct diagnosis is clear before proceeding to treatment. 
  2. Reading books and articles about TMS to educate the patient about TMS to begin to alter the way in which one thinks about the disorder and/or the pain.
  3. Writing exercises are prescribed to help change the underlying brain chemistry and alleviate psychological distress.
  4. Reflections are used (via a CD developed for this program) to alter the signals sent by the brain to the body and to alter the signals received by the brain from the body.
  5. Reprogramming the brain to change the neurologic pathways that keep the pain or other symptoms present.
  6. Rebuilding the lives of patients by gradually increasing activities and decreasing fears of recurrences.

The program consists of an individual consultation with Dr. Schubiner followed by a 3-week course in a small group format.  The consultation is billed to medical insurance carriers, however the 3-week course is not covered by insurance.

Please contact Dr. Schubiner directly at               248-849-4728         248-849-4728 if you would like more information or you would like to discuss your situation to see if you might benefit from this program.  Studies have shown that approximately 70% of people with TMS benefit greatly from this type of treatment program.

Real-world stories

1. The immediate cure: A 48-year-old woman developed pain the left gluteal area with some radiation down into the leg. There was no significant precipitating event. She works as the CEO of a software company, is married without children. There were no significant stressors identifi ed initially. She saw an orthopedic surgeon who diagnosed her as having pyriformis syndrome and referred her to a physiatrist. She had physical therapy, trigger point injections, massage therapy, and manipulative medical therapy to no avail. Despite excellent compliance to recommended therapies, the pain persisted and progressed to the point where she had to step down from her job. She could not sit down for any length of time and therefore could not ride in cars or airplanes. Approximately, 18 months after the pain began, she read one of Dr. Sarno’s books,The Mind-Body Prescription. The book explains that chronic pain syndromes in many people are actually caused by unrecognized stress and emotions. She recognized that she was angry at her husband for retiring and moving to Florida, leaving her to run her company by herself in a cold climate. The evening after reading this book, she went to a concert and was able to sit without pain through the whole concert. Within a few days, she was pain free.

2. Cure requiring a few weeks:A 35-year-old man was involved in a “roll-over” motor vehicle accident. Doctors in the emergency room found no fractures, but he had many bumps and bruises. He began to recover from the assorted aches and pains, but about a week later began to have neck pain. His physician diagnosed whiplash syndrome and prescribed physical therapy and a cervical collar, but the symptoms did not improve. The pain gradually worsened to the point that he was unable to perform his usual activities and was frequently disabled due to pain. He was referred to a mind-body medicine program and began to learn techniques to deal with underlying emotions and triggers to pain. Within 3 weeks, the pain had subsided and has not recurred for several years.

3. Cure requiring months:A 38-year-old woman with the diagnosis of fibromyalgia and insomnia was referred to a mind-body center. She had been treated with pain medications, sleeping pills, vitamins supplements, and herbal remedies. The program set up for her included reading to understand the relationship between emotional stress and physical symptoms, refl ecting on the issues causing stress in her life, writing exercises to express long-held emotions, and gradual increase in physical activity. Over the first month, her symptoms persisted but she had occasional episodes of mild relief. Following the initial series of workshops, she started psychological counseling with an emphasis on identification of stressors and the relationship between those stressors and her physical symptoms. After approximately 10 months, her symptoms began to subside and although she continues to have some pain, it is manageable without pain medications and she is able to sleep and perform daily activities.

Other patients would like to share their experiences…FINALLY, relief with the assistance of Dr. Howard Schubiner…

1. Sue from Novi, age 46, recalls:   Three years ago I changed to a more physical job and immediately began to have hip pain.  Physical therapy did not help and the pain continued to worsen. Within six months my back and joints ached everyday, I could barely walk a flight of stairs, and I was exhausted by midday. Four specialists and three courses of physical therapy later, I was diagnosed with fibromyalgia.  I began to understand the emotional stresses that contributed to the hip problem.  I had been in a difficult marriage for years, moved out of state, lost my mother suddenly, and then experienced a divorce. That led to parenting two boys on my own, financial concerns, moving two more times, and resuming a full-time professional career.  I continued to search for recovery.  The medical management of the symptoms helped, but did not alleviate the persistent pain and exhaustion.
   Dr. Schubiner’s one night informative session on chronic pain caught my eye.  At this session, he had some very convincing statistics about Tension Myositis Syndrome and theories about why pain may be so persistent. I signed up for his Mind Body Medicine program and at the initial individual consultative session, we investigated the widespread pattern of pain. He helped me understand how my thought patterns were helping to keep a chemical cycle of pain going. I began to experience a lessening of headaches and joint pain immediately. Following two more sessions focusing on meditative practices and journaling to express anger, I was feeling ‘lighter’ and less tired. I understand now how much I was contributing to the ongoing symptoms and what I can continue to do to feel physically ‘normal’ again.  Dr. Schubiner’s workshop was probably one of most important pieces of work that I did to regain my health and energy. Thank you Dr. Schubiner!!

2.  From Oak Park, MI, age 58, NL’s experience:   Before I was referred to Dr. Schubiner by my regular doctor, I was nearly incapacitated.  I was “diagnosed” with interstitial cystitis, fibromyalgia, vulvar vestibulitis, irritable bowel syndrome, trochanteric bursitis, back problems, all of which caused PAIN—PAIN—PAIN.  I was feeling that my life as an active, productive human being was over.  The PAIN as well as the medications (Darvocet, Vicoden, etc.) made me so tired, I could hardly function.  Truly I had “chronic fatigue” and I was somewhat depressed and homebound.  I was afraid to go off the interstitial cystitis diet, afraid of re-injuring my back, afraid to be “too active,” afraid! I even had to have care from my long term home health care insurance for over two months.
   After I met Dr. Schubiner and read Dr. Sarno’s book (The Mind Body Prescription), I began to have hope.  After the physical exam when the diagnosis of Tension Myositis Syndrome was confirmed, I was determined to help myself through the class. The seminars were very informative and interesting. I worked hard at doing the homework (the reading, the writing exercises and listening to the meditation CD). After the second week, I began to see improvement. I learned that there was no danger in trying new food, walking, shopping by myself, etc. I continued to attend my Recovery, Inc. weekly meetings and they also teach that there is no danger. Slowly, slowly, I began to regain mobility and “joi de vivre.” After a while, I even danced at a wedding, and have done so twice more.  Hoorray!!  Appreciating every improvement is part of the cure.  I thank you for giving me a good part of my life back.

3.  JD, age 59, Commerce Township, MI shares her story:   I am a 59 year old woman who is generally in very good health. However about 2 years ago, I developed pain in my left upper hip that continually woke me up from sleep during the night.  The pain was excruciating and scared me a great deal. I saw my regular internist who took several X-rays and did not find the source of the problem. Then I took Dr. Schubiner’s Mind Body Medicine class and after starting the meditation and writing techniques, the pain disappeared and has not recurred. I highly recommend taking this class for people who suffer from painful conditions for which no medical therapy has been found.

4.  MC, age 68, of Northville tells:   In the spring of 2005, I came to a point where I knew I could no longer sit and wait for a “cure.” I needed to take action! Coincidentally, I had just received a brochure from Providence Hospital that gave a brief description of the TMS program: the Mind Body Medicine clinic.  After I attended an introductory lecture and an interview, I knew you were offering me a solution to the chronic pain I had experienced for the past 32 years. 
   After a serious fall in 1983, I had three painful back surgeries. During the course of the last 32 years, I have tried massage therapy, physical therapy, myofascial release, shots, medications, etc., etc., etc. However, after the first two classes in the Mind Body Medicine program, I began to feel 100% better.  By using the breathing exercises, medication, and learning to refuse to accept pain in my busy life, I started to heal.  Also, recognizing the hurts and fears of my childhood have contributed to my feelings of well-being. Thank you so very much!!

All ages can benefit from this workshop and program, teens and adults alike. For more feedback on Dr. Schubiner’s program and results, Mind-Body Center Program Testimonials.

Read more about Fibromyalgia Pain……………………………..

February 1, 2010, by Gabe Mirkin MD  —   Fibromyalgia means that a previously healthy person develops unexplained exhaustion, fatigue and muscle aches and pains that last for more than six months, all blood tests are normal and doctors can’t find a cause. One report showed that a large number of people who were diagnosed as having fibromyalgia really had polymyalgia rheumatica that does have an abnormal blood test.

Another study showed that many sufferers have low spinal fluid levels of vitamin B12 and can be treated with 1000 mcg oils of B12 each day. The diagnosis of fibromyalgia should be made only after all other causes have been ruled out. Many infections can cause fatigue and muscle pain, such as parvovirus B19, which was reported to be cured with intravenous injections of immunoglobulin. The evaluation should include tests for infectious diseases; such as Lyme disease and hepatitis B or C, cytomegalovirus, toxoplasmosis or the helicobacter that causes stomach ulcers;/ autoimmune diseases, such as rheumatoid arthritis, lupus, Crohn’s disease or ulcerative colitis;/ hidden cancers such as those of the breast or prostate; hormonal diseases such as low thyroid/ or side effects from a medication or illicit drug. Around 20 percent will be depressed, and most people miss work and complain of illness long before their diagnosis, but the majority will not have a known cause and doctors often diagnose fibromyalgia or chronic fatigue syndrome.

Chronic fatigue means that they are tired, but most also have constipation and diarrhea. Fibromyalgia usually means that muscle and joint pains are major symptoms, but muscle biopsies are normal, pressure points are not reproducible and ultrasound is normal. These diagnoses mean that untreated, these symptoms will usually continue in adults for the rest of their lives.

A study in the New England Journal of Medicine said that three months of antibiotics are not effective in curing people who have had Lyme disease and still suffer from muscle and joint pain, chronic fatigue, difficulty concentrating and many other signs and symptoms.

These studies show that there is no dependable way to define chronic fatigue syndrome or fibromyalgia. The authors did not treat Lyme disease, they treated a large group of people who suffered from what doctors call fibromyalgia or chronic fatigue syndrome. They treated 79 people with positive blood tests for Lyme disease and 51 who did not have positive blood test for Lyme disease. They showed that treating people with chronic fatigue syndrome or fibromyalgia for three months with antibiotics will not cure them.

Three months is not long enough to treat a person with reactive arthritis from any source. However, before a doctor is allowed to diagnose chronic fatigue syndrome or fibromyalgia or Lyme disease, he must rule out other diseases that can cause the same symptoms. There is little question that patients with hepatitis C can be treated successfully with interferon injections and that people with reactive arthritis can be treated successfully with antibiotics. However, people who have terrible fatigue and muscle and joint pain often cannot be cured by antibiotics.

Reactive arthritis patients who may be be cured by antibiotics are:

* Those who have positive blood tests for arthritis which are really measures of an overactive immunity that is trying to kill a germ,

* those who suffer from a chronic infection characterized by burning on urination, urgency or having to get up many times during the night

* those who have chronic diarrhea,

* those who have belching and burning in the stomach,

* those who have a chronic cough or sinus infections,

* those who have swelling in the middle of the hand which is characteristic of Rheumatoid arthritis.

The authors showed that three months of antibiotics does not cure fibromyalgia, chronic fatigue syndrome or presumed Lyme disease. However, people who have reactive arthritis must be treated for longer than three months, often for more than a year. We still do not know what chronic fatigue syndrome or fibromyalgia really are.

An article from the University of Washington, Seattle demonstrates that fibromyalgia, chronic fatigue syndrome, temporomandibular joint syndrome, irritable bowel syndrome, interstitial cystitis and chronic headaches share the same symptoms, occur in the same people and doctors can’t find a cause or treatment. I have prescribed doxycycline 100 mg twice a day for several months, and sometimes azithromycin 500 mg twice a week, and some get better. However, this treatment is controversial and is not accepted by most doctors. Please check with your doctor.