Dr. John Sarno and TMS: Similarities and Differences with Our Work

by Jessica Shahinian, PPDA Executive Director and creator of GotPainCure

Many people who have heard about the mind-body connection are familiar with Dr. John Sarno and his work with Tension Myoneural Syndrome (TMS) and might be wondering why we prefer the term Psychophysiologic Disorder (PPD). You might also be wondering about our opinion of Dr. Sarno, whether our approach to treating mind-body symptoms differs, and generally why there have been so many terms to refer to the mind-body connection over the years.

As Executive Director for the PPDA, and a recovered PPD patient myself, I wanted to set the record straight.

Why does the PPDA use the term PPD instead of TMS?

Tension Myositis Syndrome (TMS) was the first term that Dr. John E Sarno used in his 1986 book “Mind Over Back Pain.” TMS later became Tension Myoneural Syndrome, and then The Mindbody Syndrome in his later work. Dr. Sarno hypothesized that mild oxygen deprivation caused pain and other TMS symptoms, and that this was likely a distraction from unpleasant emotions that our mind would rather repress than express, but he never supported these concepts with scientifically valid evidence.

During the 20th Century, it was very challenging to study the mind-body connection or the neuroscience of pain in general before the development of functional magnetic resonance imaging tests (fMRI). As fMRI became available for randomized controlled trials (the gold standard of scientific evidence) it was discovered that learned neural pathways, NOT mild oxygen deprivation, were the cause of these symptoms. This also advanced our understanding about how Dr. Sarno’s techniques for educating patients was so useful because learned neural pathways can become “unlearned” - a concept called neural plasticity.

Dr. Sarno faced a lot of skepticism from physicians because of the limited amount of scientific evidence during the early years of his practice. Even though thousands of his patients achieved remarkable outcomes when he clarified the mind-body connection for them, the TMS approach struggled for acceptance in the broader medical community.

To gain greater recognition for scientifically valid diagnostic and treatment techniques, the health care practitioners at the PPDA, including several who studied directly with Dr. Sarno, adopted the term Psychophysiologic Disorder (PPD). PPD captures the fundamental idea that the mind (psyche) can affect the body's physiology. It has been used in published clinical research and has become the preferred term among clinicians with experience in this field.

Have any health care professionals discovered an effective treatment for PPD independent of Dr. Sarno?

Yes! While many mind-body health care practitioners were inspired by or studied directly with Dr. John Sarno (including PPDA Board members Dr. Howard Schubiner and Dr. David Schechter, as well as PPDA Co-Founders Dr. Frances Sommer Anderson and Dr. Eric Sherman) other health practitioners developed their understanding of the mind-body connection by keenly observing and interviewing hundreds or thousands of PPD patients.

PPDA President & Co-Founder, Dr. David Clarke, is a perfect example. Early in his Gastroenterology/Internal Medicine career, Dr. Clarke discovered that stress, trauma and repressed emotions could cause real physical symptoms that could be treated without surgery or medication. After treating over 7000 patients with this approach he wrote “They Can’t Find Anything Wrong!” and continues to educate health professionals around the world on how to better diagnose and treat medically unexplained symptoms and chronic functional syndromes.

Dr. Sarno was definitely a trailblazer in the mind-body medicine field, and one of the most famous doctors in the field of chronic pain. The PPDA is supporting and extending his work by advancing the scientific study of the diagnosis and treatment of stress-induced medical conditions in order to one day end the chronic pain epidemic and opioid crisis.

Why all the skepticism in the past?

Science is skeptical by design, always testing theories through peer review to remove any bias and potential flaws. It’s very important not to conflate correlation with causation, for example. If you removed the skepticism from science, what you’d have left would be the opposite of science - faith, which is belief in something without any need for demonstrable evidence.

The PPDA’s approach is evidence-based, and this means that our terms and treatments may change as our tools for observing the complexity of pain and neuroscience become better. This is the main reason why there have been some differences between Dr. Sarno’s initial TMS hypotheses and what we now refer to as PPD.

That being said, much of what Dr. Sarno claimed in the 1970s and 1980s still holds true today:

  • The mind and body are intimately connected.

  • Stress, trauma, and repressed emotions can cause real physical symptoms.

  • Education is a key component in relieving symptoms of PPD.

For more info, watch my animated explainer video Dr Sarno’s TMS Research: Addressing the Skepticism and explore the rest of our website for information about the symptoms, diagnosis and treatment for TMS/PPD.