What Is Tension Myositis Syndrome (TMS)
By Stacey Townsend, PRT-trained pain recovery coach
When I was deep in chronic pain and fatigue, I felt like I was standing at the bottom of a hole so deep there was no way out. I'd seen the doctors. I'd had the tests. I kept waiting for someone to find something wrong.
Looking back, my life was running on fear. As a retail manager, I pushed myself constantly, trying for perfection because I was more afraid of getting fired than anything else. I lived in near-constant anxiety with an all-or-nothing mindset. I didn't connect any of that to my body. Pain was physical, so I assumed the cause had to be physical too.
What I didn't know then, and what I want you to know now, is that a lot of chronic pain is neuroplastic. It's created by the brain, not by damage in the body. Learning that was the moment I knew I could finally recover. The name for it, at least the name I found first, was Tension Myositis Syndrome.
Understanding what's really happening in your body is the first step toward feeling this at ease.
What is Tension Myositis Syndrome?
Tension Myositis Syndrome (TMS) is real, physical pain that the brain and nervous system create in response to emotional stress, not structural damage. Dr. John Sarno, a physician at NYU's Rusk Institute of Rehabilitation Medicine, coined the term after noticing that many of his back pain patients didn't get better with standard treatment. Their scans often didn't match their pain, and the patients who did recover seemed to share something else: a lot of pressure, perfectionism, and unexpressed emotion.
How your brain creates real pain
TMS is a false alarm. Think of a smoke detector that goes off every time you make toast. There's no fire, but the alarm is loud, and it's real.
Pain is one of your brain's alarm signals. Its job is to protect you. When your brain senses danger, it can turn up pain to get your attention. Most of the time that's helpful: you pull your hand off a hot stove.
But your brain doesn't only watch for physical danger. Stress, anger, guilt, shame, anxiety, and grief can register as danger too. When those build up, especially when we push them down or push through them, the survival brain shifts into an overprotective mode. It starts sending danger signals the body doesn't need.
Then the fear-pain cycle takes over:
Pain shows up.
You feel afraid of it. What's wrong with me? Is this getting worse?
Your brain reads that fear as more danger.
It turns the pain up.
The severer the pain, the more fear it creates, and the loop keeps going.
Over time, the brain gets very good at producing pain, the same way we get good at anything we practice. That's what makes it neuroplastic. And it's also the good news: what the brain learned, it can unlearn.
Signs your pain might be TMS
First things first: always see a doctor to rule out structural or medical causes. TMS is something we consider after that, not instead of it.
Once you've been checked, these are some common clues that pain may be neuroplastic:
It started during a stressful time, or without a clear injury.
Tests and scans don't explain how much it hurts.
It moves around the body or shows up as new symptoms.
It changes with stress, emotions, time of day, or certain situations.
It eases when you're distracted, relaxed, or on vacation.
It has lasted long after a normal injury would have healed.
You tend toward perfectionism, people-pleasing, or putting everyone else first.
TMS can show up as back, neck, and jaw pain, but also as fibromyalgia, headaches, pelvic pain, digestive issues, fatigue, and more. Even now, the one symptom I still sometimes get is my jaw tightening up. It feels like I'm clenching, but I'm not. For a fuller list, read What Are the Symptoms of Tension Myositis Syndrome?
From TMS to neuroplastic pain
Sarno's work opened the door, and the science has come a long way since. Today you'll hear several names for the same basic idea: TMS, mind-body syndrome, mind-body pain, and neuroplastic pain.
Dr. Howard Schubiner expanded Sarno's ideas into what he calls mind-body syndrome. Brain imaging research has shown how the nervous system can learn and maintain pain. Alan Gordon developed Pain Reprocessing Therapy (PRT), which teaches the brain to reinterpret pain signals as safe.
In 2021, a randomized clinical trial published in JAMA Psychiatry tested PRT with 151 adults who had chronic back pain. After treatment, 66% of the PRT group were pain-free or nearly pain-free, compared with 20% of the placebo group and 10% of the usual care group. Most of those gains held up a year later. (NIH summary)
That study is important because it confirms what so many of us lived: when you change how the brain understands pain, the pain can change too.
What recovery looks like
Recovery starts with knowledge. When I understood that my pain was a signaling problem in my brain and not damage in my body, that single shift became one of the keys to getting better. Knowing alone isn't the whole picture, though. The brain also needs new experiences of safety, practiced again and again.
That practice usually includes:
Gathering evidence. Noticing the clues that your pain is neuroplastic, so your brain can start to believe it's safe.
Somatic tracking. Paying attention to sensations with curiosity and calm instead of fear.
Feeling your emotions. Making room for the anger, grief, guilt, and fear the brain has been protecting you from.
Easing the pressure. Softening perfectionism, people-pleasing, and the all-or-nothing thinking that keeps the nervous system on alert.
Self-compassion. Treating yourself with the same kindness you'd offer someone you love.
For me, writing and journaling were a big part of healing. I still use them. When my jaw tightened up recently, I sat down and started writing about what was going on underneath. The pain eased, and that writing became this post.
Recovery isn't always a straight line. Symptoms can flare when life gets stressful, and that doesn't mean you're back at square one. It means your nervous system is still learning that it's safe, and you can teach it again.
There is a way out
If you're standing at the bottom of that hole right now, I want you to know there's a way out. It worked for me, and I've watched it work for my clients. Your pain is real, your body isn’t damaged, and your brain can learn to feel safe again.
Here are a few places to start:
Take the Neuroplastic Pain Quiz to see whether your symptoms fit a neuroplastic pattern.
Read 10 Steps to Retraining Your Brain Out of Pain for a step-by-step path.
Book a coaching session if you'd like support. You don't have to do this alone.
Sources
Ashar YK, Gordon A, Schubiner H, et al. Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain. JAMA Psychiatry, 2021. NIH summary
This post is for education and isn't medical advice. Always see a doctor to rule out medical causes of pain.