Last weekend I attended the annual SIRPA conference – “The role of emotions in chronic pain”. I’ve blogged about the work of SIRPA before and you can find that information in a previous blog (

Chronic pain is a massive problem globally and we are seeing huge increases in the level of disability and opiate drug use. As a GP, I see many patients with medically unexplained* chronic pain and in many our current paradigm of medication / physiotherapy and multidisciplinary pain clinics doesn’t appear to be particularly successful. Many come back, sadly, still experiencing pain.

Dr Sarno (1923-2017) was Professor of Rehabilitation Medicine at the New York University School of Medicine. Back in the 1970s, he noticed that many patients with medically unexplained pain often had powerful repressed emotions – particularly rage. These often dated back to childhood and many had been under significant stress as children.

These patients also appeared to have higher rates of other conditions thought to have a high emotional component such as migraine and irritable bowel. He hypothesised that the pain was a distraction from these emotions. This was a unconscious strategy, used by the body-mind to keep these difficult emotions buried and prevent them exploding into consciousness. He named this process TMS (Tension Myoneural Syndrome).

Once the patient became aware of the strategy that the body-mind was using and took conscious action to address the unconscious emotions, the pain would no longer be needed and would be turned off. Sarno treated thousands of patients using this method. Some people recovered simply from reading his books. Others needed more intensive treatment and psychotherapy to identify and feel these buried emotions.

I should add at this stage that these emotions are not consciously felt. They are often buried deep in the psyche at a time when the patient was younger and had no other strategy at their disposal to process them. When they come into conscious awareness, they can feel incredibly intense and the patient may fear that they will lose control or go insane. One of the US physicians I was talking to over the weekend likens it to “swallowing a grenade”. This explains why pain or physical symptoms can seem to the unconscious mind a preferable strategy.

Dr Sarno’s work continues to develop both in the US and the UK. The original term that Sarno used to describe conditions driven by unconscious emotions – Tension Myoneural Syndrome, has been replaced by the term Psychophysiologic Disorder or PPD which is thought to be a more accurate descriptor of the processes involved. For patients, the term Mind-Body Syndrome is often used to recognise the involvement of the whole body/mind in creating these symptoms.  It’s also important to be aware that PPD doesn’t just involve painful conditions but can be mapped over to a whole spectrum of patient experiences. These can include medically unexplained gastrointestinal conditions or neurological symptoms.

Generally it’s thought that the more medically unexplained symptoms the patient has, the more likely a PPD process exists at the root.

Dr Howard Schubiner is the director of the Mind-Body Medicine Center at the Providence Hospital in Southfield, Michigan. He has developed Dr Sarno’s work further and describes the process of pain as a “neural pathway”. There is a helpful video on YouTube where he explains this in more detail ( He is also actively involved with research into Mind Body Syndrome and you can find his website here (

I’d encourage anyone who is experiencing chronic pain to research this field of PPD/Mind-Body Syndrome. I’ve included some helpful links below to clinicians who are working in this field as as well as links to Dr Sarno’s published books.

In the next blog I will be talking about adverse childhood experiences and how these are thought to be linked with PPD.

Further links 

The UK arm of this work founded by Physiotherapist Georgie Oldfield 

The PPD Association (US) 

Collection of research articles, forums and a self-help program for patients experiencing TMS/PPD symptoms

Link to Dr Sarno’s book – The Mind Body Prescription

*That is pain that has not been shown to be due to a ongoing disease process such as cancer or a physical issue such as a fracture. Many of the tests are normal or in the case of lower back pain, the scans suggest normal wear and tear processes that do not correlate closely with the patient’s symptoms.