Publications

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2007: Outcomes of a Mind-Body Healing Program for Chronic Back Pain with No Distinct Structural Pathology: A Case Series of Patients Diagnosed and Treated as Tension Myositis Syndrome (TMS)

2005: Back Pain as a Distraction Pain Syndrome: A Window to a Whole New Dynamic in Integrative Medicine

2005: Long-Term Outcome of Back Pain Patients Treated by a Psychologically Based Program

2004: At Home Teaching Materials for Chronic Pain

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Outcomes of a Mind-Body Healing Program for Chronic Back Pain with No Distinct Structural Pathology: A Case Series of Patients Diagnosed and Treated as Tension Myositis Syndrome (TMS)

 

This paper was published in the Sep/Oct 2007 issue (Vol. 13 no. 5, pp. 26 – 35) of Alternative Therapies in Health and Medicine. An abstract of the article is given below. To view the full text of the article, click on the PDF above.

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    © Copyright Notice: This article is the sole copyright of  Alternative Therapies in Health and Medicine. The full text of the article has been made available here with permission from the publisher for the personal use of our Web visitors. Any other reproduction of this article by any means is subject to applicable copyright law. To visit the Alternative Therapies Web site, click on the publication title in the paragraph above, or click here.

Abstract

Context: Chronic, nonspecific back pain is a ubiquitous problem that has frustrated both physicians and patients. Some have suggested that it is time for a "paradigm shift" in treating it. One of them is John Sarno, MD, of New York University's Rusk Institute of Rehabilitation, who has argued for this in 4 books and several journal publications. We believe that a mind-body approach is more effective and involves much less risk and expense than conventional approaches in appropriately diagnosed cases.

Objective: To determine if a mind-body treatment program addressing a presumed psychological etiology of persistent back pain merits further research.

Design: Case series outcome study.

Setting: Single physician's office in metropolitan Los Angeles.

Patients: Fifty-one patients with chronic back pain, diagnosed with tension myositis syndrome, a diagnosis for "functional" back pain and treated in the principal investigator's office in 2002 and 2003.

Interventions: A program of office visits; written educational materials, a structured workbook (guided journal), educational audio CDs, and, in some cases, individual psychotherapy.

Main Outcome Measures: Pain intensity (visual analog scale scores), quality of life (RAND SF-12), medication usage, and activity level (questionnaires). Follow-up was at least 3 to 12 months after treatment.

Results: Mean VAS scores decreased 52% for "average" pain (P<.0001), 35% for "worst" pain (P<.0001), and 65% for "least" pain (P<.0001). SF-12 Physical Health scores rose >9 units (P=.005). Medication usage decreased (P=.0008). Activity levels increased (P=.03). Participants aged >47 years and in pain for >3 years benefited most. (Altern Ther Health Med. 2007;13(5):26-35.)

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Back Pain as a Distraction Pain Syndrome: A Window to a Whole New Dynamic in Integrative Medicine

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This is a paper on the theory of TMS titled "Back Pain as a Distraction Pain Syndrome: A Window to a Whole New Dynamic in Integrative Medicine" and was published in the August 2005 issue of Evidence-Based Integrative Medicine. It has been reprinted as a page on this site with permission from the publisher. The paper abstract is given below. To view the full text, see the PDF.                                                                    

 

Abstract

One of the most intractable and expensive problems facing modern medicine today is chronic, nonspecific back pain. The current approach, which attributes the pain to structural problems, is invasive, expensive and not very effective. Based on this fact, along with a growing body of clinical and circumstantial evidence, we believe that it may be time for a paradigm shift in diagnosis and treatment, in which the problem is treated in an integrative fashion as more psychosomatic than structural. Although, in our conception, the pain is both real and 'physical', in the sense that it is experienced physically and may involve functional alterations in the affected tissues, we present a rationale that melds the purely 'physical' and purely 'psychological' conceptions of pain into an integrated model that is clinically significant. We believe that the ultimate reason for the persistence of the pain is in the mind/brain or subconscious. This creates or perpetuates the pain in order to distract attention from emotions that are too threatening for the individual to address consciously, such as anger, rage, grief or anxiety, hence the term 'distraction pain syndrome'. We further suggest that a well controlled clinical trial, coupled with brain imaging studies, could corroborate or refute the promising results of the retrospective clinical studies we have conducted to date.

 

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Long-Term Outcome of Back Pain Patients Treated by a Psychologically Based Program

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Another outcome study was presented in abstract form at the March 5, 2005 meeting of the American Psychosomatic Society, in Vancouver, BC.

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ABSTRACT 1112

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LONG-TERM OUTCOME OF BACK PAIN TREATED BY A PSYCHOLOGICALLY-BASED PROGRAM David Schechter, Family Medicine, Sports Medicine, Pain Management, Seligman Medical Institute, Culver City, CA, Arthur P. Smith, Mind-Body Medicine, Seligman Medical Institute, Foundation coordinator, Culver City, CA

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The purpose of this study was to determine if there was sufficient evidence that the mind-body treatment mode called Tension Myositis Syndrome (TMS) could effectively treat persistent back pain to justify further serious study of its effectiveness.

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Methods: 85 patients treated for TMS between 1995 and 2000 in Dr. Schechter's office were interviewed on the telephone by trained medical students at least a year after treatment was initiated. It was not a randomized, placebo controlled trial.

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Results: Of those 85 patients, over 60% fell into the “A” and “B” outcome groups that showed clinically significant improvement. Eighteen percent improved some (“C”), and 21% failed to improve (“F”). Evaluation criteria included presence of pain, activity restrictions, and medication use, both before and after treatment. Nearly all the patients had tried a variety and often a combination of typical treatments including medication, physical therapy, chiropractic, acupuncture, etc. without long-term relief. Patients were also classified by pain duration before diagnosis, with those in pain over a year (72 patients or 85%) defined as “chronic,” and less than a year (13 patients or 15%), “acute.” Eleven (85%) of the “acute” patients and 41 (57%) of the “chronic” ones fell into Groups A or B.

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Conclusions: Our most significant finding is the 57% success rate among the chronic patients. Moreover, the treatment is relatively inexpensive, noninvasive, and non-pharmacological. At the very least, the effectiveness of TMS treatment for back pain merits further study as a way to address the chronic pain problem.

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This symposium will discuss the conceptual model of Tension Myositis Syndrome (TMS) and the specifics of the treatment program described above including the use of journaling, home educational program, office-based seminar, psychotherapy, etc. The results of the outcome study will be analyzed and a description of additional studies that have been done or are planned will be presented. Opportunities for input from the attendees on the neuroscientific correlations, brain imaging implications, research methodology, and clinical methods will be emphasized.

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These results are remarkable in that 85% of these patients were chronic sufferers when first diagnosed by Dr. Schechter. Also, the follow-up was truly long term (greater than one year since treatment), so this is not a random or placebo event. Outcome variables were pain level, medication use, and activity level.

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This abstract was also published in Psychosomatic Medicine, Vol. 67, Number 1, online journal, pg. A-101. (Abstract 1112, "Long-Term Outcome of Back Pain Patients Treated by a Psychologically Based Program", Schechter, Smith, et al.). To view the actual, published Abstract, click on the title heading above or click here.

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At Home Teaching Materials for Chronic Pain

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This article appeared in Practical Pain Management (May/June 2004 issue) on the use of at-home education materials to treat TMS. It was requested by the Editor of that journal after learning of our first research study (Web Survey Study below). The paper generally reviews the use of a home educational program for chronic pain and then we report our web survey data. To view an image of the article, click the title heading above. 

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The results are from a simple mail and email survey of individuals who had ordered materials on TMS from Dr. Schechter's Web site. The results show that of the 37 respondents (a relatively small percentage of total orders, however), 33 felt the materials helped them heal and 28 found them helpful (submitted for publication). Notably, these were individuals who had not even seen a TMS-oriented doctor for their pain!