Can You Heal Most Back Pain with Your Mind? The Case of Dr. John Sarno.

Introduction

In this article, I discuss the theory and practice of legendary - and controversial - mind-body doctor, John Sarno, MD. He's helped thousands of followers permanently rid themselves of chronic pain, all without drugs, surgery or exercise. Dr. Sarno's book about his treatment plan, Healing Back Pain: The Mind-Body Connection, has become one of the all-time most popular books on mind-body health since its publication in 1991 and remains as one of the best sellers in the category. If one takes a look at the customer book reviews on Amazon, and they number in the hundreds, the vast majority of them demonstrate a cult-like devotion to him. The extremely small number of negative reviews express an equally strong, though highly negative, opinion of his approach, calling it “dangerous" and “unscientific". He is openly mocked by doctors who have posted comments on various websites.

I am not an unbiased author of this article. In 1999, after about 15 years of excruciating lower back pain, I saw Dr. Sarno on “Larry King Live" and called to make an appointment the next day, though it ended up being scheduled for several months later because he was so booked. I spent those 15 years seeing several orthopedists, chiropractors, massage therapists, physical therapists and others and I probably received five different diagnoses. After I read Dr. Sarno's books and went to my appointment with him, my back pain disappeared after practicing his program for one month.

It was amazing, even convincing me that I should pursue a career in mind-body health and wellness, which I have done to an extent. For a decade, I told everyone who would listen that they should not get surgery for their back pain until they read Dr. Sarno's books (and because of the published studies that questioned whether disc fusion surgery is effective or not). Then last year I practically shattered a disc in my neck and all of Sarno's lessons combined couldn't take away the unbearable pain or prevent the nerve damage that was occurring in my right arm. I had disc fusion surgery and that treatment also felt like a miracle. I haven't had pain since then either. So I'm no longer so anti-back surgery, but I'm still a strong believer that Sarno's program works for many people. It is also generally known that stress, on which Sarno does not focus, can create tense muscles and pain.

So is Dr. Sarno's pain treatment program a miracle cure or simply “all in one's head"? You decide.

John Sarno's Mind-Body Prescription

She endured, fought and ultimately capitulated to the searing pain. What began as an ankle injury from a simple fall while jogging ultimately landed Jeanette Barber, comedy producer for the former “Rosie O'Donnell Show" in a wheelchair. The agony led her on a three year odyssey, visiting every specialist she could think of, from orthopedists to faith healers. She was told she had incurable tendonitis. “Get used to the pain," doctors advised, “It will only get worse."

Unable to accept this dire diagnosis, Rosie placed her producer on the air, asking viewers to call in names of doctors who might help. Thousands of calls came in, some crazy, some credible. One doctor was named most often, a physician with a long list of credentials and cured patients: Dr. John Sarno.

As professor of clinical rehabilitation medicine at New York University School of Medicine and an attending physician at NYU Medical Center in New York City, Sarno has devoted over 35 years to curing patients with persistent, stubborn pain. Frustrated by the growing epidemic of Americans suffering from pain in the back, muscles and tendons and traditional medicine's inability to provide long-term cures, Dr. Sarno developed his own diagnosis and treatment plan. While orthopedists generally blamed disc abnormalities for back pain, Sarno noticed a growing body if authoritative stories indicating there may be no such link.

Cause of Pain

The brain, not injuries and abnormalities, is the primary source of persistent pain, Dr. Sarno claims. It is a “mind-body" or psychosomatic physical reaction tricking people into focusing on pain rather than understanding their hidden rage and emotional issues. Accepting this diagnosis, even without completely understanding the rage's cause, cures patients, the physician states.

Talk-show host Howard Stern, actress Anne Bancroft, “20/20" co-anchor John Stossel (whose journalistic focus has been on sniffing out frauds and gimmicks for years) - add them to the list of patients, now numbering in the thousands, whose long-time pain ended when they visited Dr. Sarno or read one of his books. As for professional followers, however, Dr. Sarno has attracted few. Most disregard his work. Others say his counsel could be dangerous. But supports and detractors agree that incidence of back pain has escalated to epidemic proportions during the past several decades, yielding a number of diagnoses but few long-time solutions.

The Epidemic Problem of Persistent Pain

About nine out of ten adults experience back pain at some point in their life. Almost half of working adults experience back pain every year. (1) This condition is responsible for health care expenditures of more than $20 billion annually and as much as $50 billion per year when indirect costs are included. (2) Professionals have come up with a plethora of possible solutions: surgery, physical therapy, massage, and pain killers. Yet people's pain persists.

“The brain will not be defeated," Dr. Sarno says in his office at the Rusk Institute of Rehabilitative Medicine at New York University Medical Center. If you take a patient away from one outlet [for the pain], the brain will just find something else."

Since 1965 when he began as the Institute's director of outpatient services, Sarno has seen a rapid increase in the number of patients with persistent pain in the neck, shoulders, back or buttocks, and the inability of traditional medical models to cure them. He ran CAT scans looking for spinal abnormalities, arthritis and disc disorders and, like fellow doctors, injected a local anesthetic into the painful area and prescribed physical therapy. The treatment often provided only short-term relief or, perhaps worse, stopped the pain in one place only to migrate to another. Eighty-eight percent of these patients had a history of tension or migraine headaches, heartburn or stomach ulcers, colon disorders, allergies and other tension-related conditions, Sarno determined from a survey of his patients he completed in 1975.

While physicians blamed disc deterioration and abnormalities for back pain, statistical studies did not support this conclusion. Aging is the primary cause of deterioration, yet people in the 25-50 year age bracket, not the elderly, comprise the greatest percentage of back pain patients. Such abnormalities may have little to do with back pain, studies indicate. For example, in 1994 researchers used magnetic resonance imaging tests (MRIs) to example the lumbar spines of 98 volunteers. Although they were asymptomatic, or without back pain, almost two thirds of the MRIs revealed disc abnormalities, including disc herniations and degenerative disease, according to the study, published in the New England Journal of Medicine. So while orthopedists use MRIs to document disc problems and justify surgery, disc abnormalities, according to the researchers, may not be causing the pain.(3)

TMS - An Overview

Tension is the most common cause of chronic pain, Sarno surmised. It is the culprit, he says, for a host of ailments in addition to lower-back pain, including carpel tunnel syndrome, fibromyalgia, most chronic pain in the neck and shoulder areas, knee tendonitis, and tennis elbow. Tension inhibits blood circulation to the involved area, depriving oxygen to surrounding muscles and nerves and causing the sensation of pain. (Figure 1, available on our website).

Sarno coined the name “Tension Myositis Syndrome," or TMS, to describe this condition involving muscles, tendons and nerves. Myositis refers to the physiological alteration of muscles, a painful but harmless state.

Since the brain controls the nervous system, the process of TMS begins in the mind. The sensation of pain is real. The mind, according to Sarno, uses the pain to divert attention from unpleasant, unconsciously repressed emotions.

“As with Freud's patients, I found my patients' physical symptoms were the direct results of strong feelings repressed in the unconscious," Sarno wrote in his book, “The Mind-Body Prescription."(4)

“Physical disorders allow sufferers to avoid frightening repressed feelings of rage," Sarno said. There are numerous triggers for rage, including childhood trauma, certain personality traits such as perfectionism, low self-esteem, and stressful life events like death and divorce.

“The brain is fearful of accumulated rage inside, fearful it will come out," Sarno said. “This creates a paradox. A person is experiencing pain, but in reality the pain exists to protect from the possibility of overt rage."

To be cured most patients need to accept that rage causes their pain but do not need a complete understanding of the rage's underlying cause. “Acknowledgement of an emotional role in the genesis of symptoms somehow banished those symptoms," Sarno wrote.(5)

Sarno's Treatment

Since the mid-1970s when he first developed his mind-body prescription, Dr. Sarno has treated approximately 500 new patients each year. Treatment begins with a personal phone interview. Because the belief that one's emotions are the root cause of the pain is integral to the cure, Dr. Sarno only accepts prospective patients willing to acknowledge this possibility, approximately 50% of those who call. Patients then visit the doctor for a 45-minute physical and psychological work-up. If the pain's genesis appears emotional the doctor refers patients to a two hour 10 - 12 patient group session. During the session's first hour, Dr. Sarno lectures on pain's various physical manifestations. During the second hour, he directs patients to disregard their pain, resume their normal lives, and meditate daily on the emotional connection.

“Daily morning and evening meditations should follow a specific pattern," Dr. Sarno said. Meditations are approximately 15 minutes in the morning and 30 minutes at night, and include re-reading the psychology-related treatment sections in the doctor's books. Patients are then directed to make list of possible causes of unconscious rage (Figure 2, available on our website).

Patients following this regimen should find that their pain goes away, Sarno says. At the point that the patients finds that the pain is gone, patients should..........NOTE: readers please go to our website to read the remainder of this article due to length and content restrictions (lots of free resources there). mblwellness.com in the Community section.