News & Perspectives

At the Root of Back Pain
Rusk Institute of Rehabilitation Medicine, New York, NY

Americans have experienced a dramatic surge in back pain in the past 50 years. Researchers estimate that up to 80% of adults will eventually suffer from the condition.

Many doctors attribute back pain to specific anatomical problems in the spine. In truth, though, most cases can't be traced to a specific structural defect. In fact spinal X rays or MRI scans of many people with disabling back pain appear perfectly normal, while the MRIs of about two thirds of those who have never had back pain reveal bulging disks and other spinal abnormalities.

What could account for these puzzling findings? Dr. John E. Sarno, a physician at the world-renowned Rusk Institute of Rehabilitation Medicine at NYU Medical Center, strongly believes that most cases of chronic back pain are caused not by a physical abnormality but rather by intense psychological stress and that the pain will persist until the person confronts the underlying emotional issues.

Beyond Conventional Therapy
While working at the Rusk Institute during the Sixties and early Seventies, Dr. Sarno saw numerous patients with debilitating back pain for whom he prescribed conventional treatments, with inconsistent and typically disappointing results. Often the pain eased temporarily, only to reappear again.

Frustrated, Dr. Sarno began to question traditional approaches to diagnosing and treating back pain. Ultimately, he became convinced that most episodes originated in the muscles rather than in a structural abnormality of the spine. Furthermore, Dr. Sarno observed that most patients tended to be hardworking, conscientious, compulsive, and perfectionistic--personality traits that might lead to unconscious anger. These observations led him to surmise that unconscious emotions might lie at the root of chronic back pain, as well as chronic neck, shoulder, and limb pain and disorders such as fibromyalgia.

Dr. Sarno has found that strong emotions generated in the unconscious mind, particularly rage, cause the mind to create a socially acceptable distraction, such as back and leg pain. The brain does this by reducing the blood flow (and thus the proper amount of oxygen) to the tissues involved. He suggests this painful change in the state of muscles, nerves, and tendons (which he dubs tension myositis syndrome) accounts for about 90% of all cases of back, neck, and limb pain. Dr. Sarno notes that therapies that enhance the flow of blood and oxygen to the affected area, such as high-frequency sound waves, massage, and active exercise, tend to relieve pain.

Belief Brings Relief
Perhaps the most convincing support for Dr. Sarno's theory comes from the tremendous success he achieved once he put his principles into practice with pain patients.

The core of Dr. Sarno's approach is helping people recognize that their mind, rather than a physical abnormality, is actually the source of the pain. Through a physical examination and personal interview, followed by lectures and group meetings, Dr. Sarno helps patients make the vital connection between their brain's response to self-imposed or external pressure and the onset of pain. He observes: "To get over this disorder, the patient has to focus exclusively on the psychological factors involved, which are very straightforward: their own personality traits, their tendencies to push themselves to be perfect, to be good." In his experience, knowledge effects the cure, once people become aware that repressed rage is the culprit, their back pain disappears.

Dr. Sarno has treated more than 11,000 patients with chronic pain--many of whom had suffered for years--and estimates he's cured more than 90% of them. Stressing that "his whole program is preventive in nature," he encourages patients to review all the things they learned in their work with him, or in his books, whenever they experience twinges of discomfort in the future.

Noting that only five or six physicians nationwide use this program to treat pain because "doctors have a very deep bias against the idea of psychologically induced physical disorders," Dr. Sarno hopes this number will grow as his ideas are more widely disseminated.

For more information:
The Rusk Institute for Rehabilitation Medicine, NYU Medical Center, 400 East 34th St., New York, NY 10016; (212) 263-7300;

Further reading:
John E. Sarno, M.D., The Mindbody Prescription: Healing the Body, Healing the Pain (Warner, 1998) and Healing Back Pain (Warner, 1991)

Date Posted: 03/14/2001

Date Published: 03/13/2001
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