Like many who suffer from persistent aches, whenever someone mentioned back pain, I would cautiously bring up a book that drastically changed my life. “I know it sounds a bit out there,” I’d begin, “but…”
Let’s rewind to over a decade of relentless throbbing in my left piriformis muscle, deep in the buttock. I explored various treatments: physical therapy, ultrasound, and even Botox injections. Desperate for relief, I even contemplated surgery to sever the muscle, hoping to alleviate pressure on the sciatic nerve beneath.
Then, in 2011, a library book offered an unexpected perspective: “Healing Back Pain: The Mind-Body Connection” by Dr. John Sarno. Published in 1991, this bestseller proposed that the brain, to distract from unconscious emotional turmoil like anxiety, anger, or feelings of inadequacy, creates physical pain. It does this, the book claimed, by reducing blood flow to muscles and nerves in areas like the neck, shoulders, back, and buttocks.
Dr. John Sarno, a rehabilitation physician at New York University, became a prominent figure, almost an evangelist, for this mind-body approach to pain. His methodology, primarily based on anecdotal evidence from his practice and compelling testimonials from patients such as Howard Stern and Larry David, gained considerable attention. Larry David famously described his recovery from back pain through Dr. Sarno’s methods as “the closest thing that I’ve ever had in my life to a religious experience.”
Dr. Sarno posited that repressed emotions were the root cause of most chronic pain. He suggested that by engaging in psychotherapy or journaling to uncover and process these emotions, individuals could heal themselves without relying on drugs, surgery, or specific exercises. Intrigued, I chose journaling and began documenting my anxieties, insecurities, and sources of anger in extensive lists.
I was drawn to the appealing simplicity of Dr. Sarno’s theory: emotional pain manifesting as physical pain. It was also reassuring to believe that my pain, even without a clear physical cause, was genuinely real. However, skepticism lingered. The medical community largely seemed to disregard Dr. Sarno’s ideas, and his program lacked robust scientific studies.
Despite my doubts, I couldn’t ignore my personal experience. After four months of consistently journaling and confronting a wealth of negative emotions, my pain remarkably subsided. Much to my surprise, I felt cured.
Dr. Sarno faded from my thoughts until May of this year when a new pain emerged in my inner thigh, leading me back to physical therapy. As I diligently performed the prescribed exercises, a familiar worry crept in: What if physical therapy failed again? Would I have to revisit the exhaustive emotional cataloging? And, more fundamentally, did Dr. Sarno’s theories truly hold up?
The Brain’s Role in Pain: Moving Beyond Dr. Sarno’s Initial Concepts
“The mainstream understanding is evolving to acknowledge that a significant portion of chronic pain sufferers can benefit from reconsidering the origins of their pain,” explains Tor Wager, a neuroscience professor at Dartmouth College and director of the Cognitive and Affective Neuroscience Lab. “However, this is different from definitively stating that unresolved issues with your mother directly manifest as physical pain.”
Dr. Wager clarifies that current scientific consensus views pain not merely as a bodily sensation relayed to the brain, but as a condition that can originate within the brain itself.
Remarkably, approximately 85 percent of back pain cases and 78 percent of headaches lack identifiable physical triggers. Yet, few scientists attribute all, or even most, chronic pain solely to psychological factors. “Pain is multifactorial, often arising from a combination of social, psychological, and biological influences,” notes Daniel Clauw, a professor of anesthesiology, medicine, and psychiatry at the University of Michigan and director of its Chronic Pain & Fatigue Research Center. “It’s important to recognize that Dr. Sarno’s method is not a universal solution for everyone.”
Building upon some of Dr. Sarno’s principles, a contemporary approach known as emotional awareness and expression theory (EAET) has emerged. EAET encourages patients to identify and articulate emotions they have been suppressing or avoiding. This approach has demonstrated significant pain reduction in individuals with fibromyalgia and chronic musculoskeletal pain. Notably, the Department of Health and Human Services recognizes EAET as a best practice for chronic pain management, alongside therapies like massage and cognitive behavioral therapy.
Understanding the Pain Cycle: Where Dr. Sarno’s Insights Align with Modern Science
While Dr. Sarno’s specific theory about the brain using pain to distract from emotions by reducing blood flow lacks scientific validation, modern science is uncovering intricate ways the brain contributes to chronic pain. Instead of focusing on blood flow, researchers are now investigating the nervous system’s role in chronic pain that isn’t directly linked to nerve or tissue damage. Essentially, the brain’s pain circuitry can malfunction, prolonging, amplifying, or even initiating pain sensations.
Dr. Wager explains that while the precise mechanisms are still under investigation, “stressors are known to promote inflammation in the spinal cord and brain, which is directly associated with heightened pain experiences.” Furthermore, early life adversities such as child abuse, economic hardship, violence, and neglect have been strongly linked to the development of chronic pain later in life.
Adding to the complexity, pain itself can perpetuate more pain, creating a vicious cycle. An initial injury can amplify the body’s pain response to subsequent injuries. Stress can prolong pain even after physical healing. Moreover, apprehensive thoughts about pain worsening can actually intensify the pain experience, leading to avoidance of physical activity, which, paradoxically, can further exacerbate the pain. This phenomenon is what experts term the “pain cycle.”
In this context, Dr. Sarno’s core idea of the brain triggering pain finds partial resonance with current research. Studies indicate that catastrophizing, or excessively dwelling on negative pain-related thoughts, can transform acute pain into chronic pain and heighten activity in brain regions associated with pain anticipation and attention. This understanding is prompting clinicians to approach pain disorders with strategies similar to those used for anxiety disorders. Encouraging physical activity becomes crucial, helping patients overcome their fear of movement. Just as someone with social anxiety might gradually engage in social interactions, an individual with back pain might start with gentle exercises like jogging or cycling.
Finding Your “Off Switch”: Dr. Sarno’s Legacy and the Future of Pain Management
According to Dr. Howard Schubiner, a protégé of Dr. Sarno and the director of the Mind Body Medicine Program in Southfield, Michigan, and clinical professor at Michigan State University College of Human Medicine, “all pain is real, and all pain is generated by the brain.”
He elaborates, “Whether initiated by stress or physical injury, the brain is the ultimate generator of pain sensations. And here’s the crucial, often mind-blowing concept: the brain isn’t just passively registering pain; it’s actively deciding whether to activate or deactivate the pain response.”
This perspective suggests that all pain exists in both the body and the brain. Reflecting on my own recent inner thigh pain, which resolved after eight weeks of physical therapy, I recognize the multifaceted nature of healing. Was it the exercises themselves, the encouragement from my physical therapist, the opportunity to discuss life stressors, or a combination of these factors? Likely, it was the synergy of multiple elements.
In conclusion, Dr. Sarno was prescient in highlighting the role of exercise in recovery and the undeniable connection between emotional and physical pain. However, it’s crucial to acknowledge that not all chronic pain is solely psychological. Dr. Sarno’s psychoanalytic approach is one of many effective strategies. And while his theory about the brain using pain as a distraction through reduced blood flow is not scientifically supported, his broader contribution remains significant.
I still consider Dr. Sarno a pivotal figure in my healing journey and continue to recommend his books. Some who have taken my advice have found relief, while others remain unconvinced. Despite his potential oversimplification of the psychological origins of pain and occasional overemphasis, Dr. John Sarno helped me realize the intricate interplay between mind and body in our experience of suffering. He empowered me to understand that we are not powerless in the face of chronic pain and that exploring the mind-body connection can be a crucial step towards healing.
