The diagnosis of stress-related back pain The diagnosis of stress-related back pain is often made by a thorough medical history and physical exam. Patients must be cautious in trying to self-diagnose stress related back pain, as there may be a serious medical condition (such as a tumor or infection) causing the pain. A good medical examination can usually rule out the more serious structural causes of back pain in a great majority of patients. For cases of stress-related back pain, the history of onset of back pain is often quite variable. The pain may start with an identifiable incident, or it may start insidiously. For instance, it is not uncommon for the pain to start with an incident such as a lower back sprain or strain, only to have it continue as the result of emotional factors long after the injury has healed. In many cases there may be MRI findings such as a “disc bulge” or “degenerative disc disease” when stress-related back pain is the actual culprit. In these instances, the MRI findings are not clinically significant and ultimately determined not to be the cause of the pain. The overall characteristics of stress-related back pain include symptoms such as: Back pain and/or neck pain Diffuse muscle aches Muscle tender points Sleep disturbance and fatigue In many stress-related back pain cases, patients complain of the pain “moving around” In general, symptoms of stress related back pain are similar to those of fibromyalgia. According to Dr. Sarno, the diagnosis of TMS is made not only by ruling out other organic causes for the pain but also by positively identifying the features of TMS.