Every time someone tells me they have a backache, I lower my voice before starting my story, “I swear I’m not woo-woo, but…”
Let me rewind for a moment. For over a decade I had an almost constant throbbing sensation in my left piriformis, a small muscle deep in the butt. I tried to treat it with physical therapy, ultrasound and Botox injections. At one point, I even considered surgery to cut the muscle in half to decompress the sciatic nerve that runs underneath.
Then, in 2011, I picked up a library copy of the 1991 bestselling book “Healing Back Pain: The Mind-Body Connection.” It claimed that, in order to distract the patient from suppressed fear, anger or feelings of inferiority, the brain causes pain in the neck, shoulders, back and buttocks by reducing blood flow to the muscles and nerves.
The author of the book, Dr. John Sarno, was a New York University rehabilitation physician and sort of evangelist, praising a methodology supported by anecdotes from his practice and passionate testimonials from patients such as Howard Stern or Larry David, who described his recovery from back pain as “the closest I’ve ever had in my life to a religious experience.”
According to Dr. Sarno, almost all chronic pain is caused by repressed emotions. By undergoing psychotherapy or journaling about them, he said, you could get them out of your subconscious — and heal yourself without drugs, surgery or special exercises. I chose a journal and started writing page-long lists of everything I was angry, insecure, or worried about.
I appreciated the clear logic of Dr. Sarno’s theory: Emotional pain causes physical pain. And I loved the reassurance it gave me that although my pain wasn’t from a shaky gait or my sleeping position, it was real. l not done as if no one in the medical community sided with Dr. Sarno seemed to choose whether he had no studies to support his program.
But I couldn’t deny that it worked for me. After banishing the negative feelings of a journal for four months, I was healed, despite my disbelief.
After that I didn’t think much about Dr. Sarno, until May of this year, when I had to go back to physical therapy for pain in my inner thigh. My physical therapist assigned me a handful of exercises, and I did them every day. The whole time I worried: If physical therapy failed again, would I have to go back to exhaustively cataloging my misery? Were the claims of Dr. Sarno even?
Pain often starts in the brain.
“The idea is now mainstream that a significant portion of people can be helped by rethinking the causes of their pain,” said Tor Wager, a professor of neuroscience at Dartmouth College and director of the Cognitive and Affective Neuroscience Lab. “But that’s different from the idea that your unresolved relationship with your mother is manifesting as pain.”
dr. Wager said most scientists now believe that pain isn’t always something that starts in the body and is perceived by the brain; it can be a disease in itself.
About 85 percent of back pain and 78 percent of headaches have no identifiable trigger, yet few scientists would say that all or even most chronic pain is purely psychological. “There are also social and biological reasons for pain. In most people, it’s a confluence of the three,” said Daniel Clauw, a professor of anesthesiology, medicine, and psychiatry at the University of Michigan and director of the Chronic Pain and Fatigue Research Center. “I’m sorry, there are a lot of people for whom Sarno’s method is not going to work.”
Today, a similar approach to Dr. Sarno’s theory of emotional awareness and expression, in which patients identify and express emotions they have avoided. Not only has it been shown to significantly reduce pain in people with fibromyalgia and chronic musculoskeletal pain, it is also considered a best practice for treating chronic pain (along with massage and cognitive behavioral therapy) by the Department of Health and Human Services. .
Pain can take on a life of its own.
But how does the brain cause chronic pain in the first place? dr. Sarno’s theory that our brains use pain to distract us from negative emotions by cutting off blood flow to the muscles, according to Dr. Wager not backed by science.
Instead of blood flow, scientists are now looking to the nervous system to understand chronic pain not caused by nerve or tissue damage. Basically, your brain circuitry isn’t working properly, prolonging, amplifying, and possibly even causing pain.
dr. Wager said we don’t fully understand the mechanisms of this, but “we do know that stressors can promote inflammation in the spinal cord and brain, which is linked to greater pain sensations.” Early adversity, such as child abuse, economic hardship, violence and neglect, has also been linked to chronic pain.
Complicating things further: Pain can cause more pain. For example, an injury can increase the volume of your pain response to future injuries. Stress can cause pain to persist long after an injury has healed. And if your back hurts and you start imagining how it could get worse, that fear can increase your pain, which can lead you to avoid physical activity, making the pain worse. Experts call this the pain cycle.
Here was Dr. Sarno’s idea of the brain causing pain is partially correct. Research shows that catastrophizing can turn acute pain into chronic pain and increase activity in areas of the brain associated with anticipation and attention to pain. This is one of the reasons why clinicians are beginning to treat pain disorders in the same way as anxiety disorders, for example, and encourage patients to exercise so that they can overcome their fear of movement. While a socially anxious patient may take small steps to talk to strangers, a patient with back pain may, for example, go jogging or cycling.
You will find the power switch.
The bottom line, according to Dr. Howard Schubiner, a protege of Dr. Sarno, that “all pain is real and all pain is generated by the brain.” Today Dr. Schubiner is the director of the Mind Body Medicine Program in Southfield, Michigan, and a clinical professor at the Michigan State University College of Human Medicine.
“Whether pain is caused by stress or physical injury, the brain generates the sensations,” he said. “And — this is a stunning concept — it doesn’t just reflect what it feels like, it’s the decision to turn pain on or off.”
So according to this line of reasoning, all pain is in both the body and the brain. That’s why, in July, when my adductor stopped hurting after eight weeks of physical therapy, I didn’t expend too much mental energy trying to figure out what had worked: the exercises themselves, my physical therapist gave me the green light to continue. exercising, the opportunity to talk to her once a week about my recent move and the other stressors that may be contributing to my pain or (most likely) all of the above.
In the end, Dr. Sarno is right about helping exercise, not hindering recovery, and about the link between emotional and physical pain. But not all chronic pain is psychological. dr. Sarno’s Freudian treatment is far from the only one that works. And few scientists would say that our brains use pain to distract us from negative emotions (and certainly not by cutting off blood flow to the muscles).
I consider Dr. Sarno still as a savior and I continue to recommend his books to friends and family; some have read them – and have had success – while others have declined politely. yes, dr. Sarno has almost certainly overemphasized the psychological origin of pain. But he also helped me see that both the mind and the body are responsible for our physical suffering. And that we are not powerless to change it.