Treatment protocol The treatment protocol for TMS includes education, writing about emotional issues and resumption of a normal lifestyle. For patients who do not recover quickly, the protocol also includes support groups and/or psychotherapy. Sarno's protocol for treatment of TMS is used by the Harvard RSI Action Group, a student volunteer organization, as part of their preventative education and support program for people with repetitive strain injury, also referred to as "RSI". ;Education Education may take the form of office visits, lectures and written and audio materials. The content of the education includes the psychological and physiological aspects of TMS. According to Schechter, the education allows the patients to "learn that their physical condition is actually benign and that any disability they have is a function of pain-related fear and de-conditioning, not the actual risk of further 're-injury.'" ;Writing about emotional issues Sarno stated that each patient should set aside time daily to think and write about issues that could have led to the patient's repressed emotions. He recommended the following two writing tasks: * Writing a list of issues. Dr. Sarno stated that each patient should try to list out all issues that might contribute to the patient's repressed emotions. He suggested looking in the following areas: *(a) certain childhood experiences, such as abuse or lack of love, *(b) personality traits such as perfectionism, conscientiousness and a strong need to be liked, approved or validated by everyone, *(c) current life stresses and pressures, *(d) aging and mortality and *(e) situations in which the patient experiences conscious but unexpressed anger. * Writing essays. Dr. Sarno recommended that the patient write an essay for each item on the above list. He preferred longer essays because they force the patient to examine the emotional issues in depth. Schechter developed a 30-day daily journal called "The MindBody Workbook" to assist the patient in recording emotionally significant events and making correlations between those events and their physical symptoms. According to Sarno and Schechter, daily repetition of the psychological process over time defeats the repression through conscious awareness. ;Resumption of a normal lifestyle To return to a normal lifestyle, patients are told to take the following actions: * Discontinuation of physical treatments - Sarno advises patients to stop using spinal manipulation, physical therapy and other physical treatments because "they tend to reinforce erroneously a structural causation for the chronic pain." * Resumption of normal physical activity - Schechter states that patients are encouraged to "gradually be more active, and begin to resume a normal life." In addition, patients are encouraged "to discontinue the safety behaviours aimed at protecting their 'damaged' backs". ;Support meetings Sarno used support meetings for patients who do not make a prompt recovery. Sarno stated that the support meetings (a) allow the patients to explore emotional issues that may be causing their symptoms and (b) review concepts covered during the earlier education. ;Psychotherapy Sarno said that about 20% of his patients need psychotherapy. He stated that he used "short-term, dynamic, analytically oriented psychotherapy." Schechter says that he uses psychotherapy for about 30% of his patients, and that six to ten sessions are needed per patient. ;Recovery Program Alan Gordon, LCSW has created a TMS recovery program which includes various articles, exercises, and segments from sessions exemplifying therapeutic concepts. Medical evidence While psychogenic pain and pain disorder are accepted diagnoses in the medical community, the TMS modality is more controversial. A non-peer-reviewed 2005 study by Schechter at the Seligman Medical Institute (SMI), co-authored with institute director Arthur Smith, found that treatment of TMS achieved a 57% success rate among patients with chronic back pain. A peer-reviewed 2007 study with Schechter, Smith and Stanley Azen, Professor and Co-Director of Biostatistics in the Department of Preventative Medicine at the USC Keck School of Medicine, found a 54% success rate for treatment of TMS (P<.00001). The treatment consisted of office visits, at-home educational materials, writing about emotional issues and psychotherapy. The average pain duration for the study's patients was 9 years. Patients with less than 6 months of back pain were excluded to "control for the confounder that most back pain episodes typically resolve on their own in a few weeks." Schechter, Smith and Azen also compared their results to the results of three studies of other psychological treatments for chronic back pain. The three non-TMS studies were selected because of (a) their quality, as judged by the Cochrane Collaboration, and (b) the similarity of their pain measurements to those used in the TMS study. Of the three non-TMS studies, only one (the Turner study) showed a statistically significant improvement. Compared to the 2007 TMS study, the Turner study had a lower success rate (26–35%, depending on the type of psychological treatment) and a lower level of statistical significance (P<.05). Schechter, et al. state that one advantage of TMS treatment is that it avoids the risks associated with surgery and medication, but they caution that the risks of TMS treatment are somewhat unknown due to the relatively low number of patients studied so far. To see current and past research, go to https://clinicaltrials.gov/ct2/home and search for Condition or disease "Mind Body Syndrome" with status all studies. A 2021 study found that mind-body program outperforms other forms of treatment for chronic back pain.
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