Part 1

Healing Back Pain : The Mind-Body Connection
by John E. Sarno, M.D.

I have never seen a patient with pain in the neck, shoulders, back or buttocks who didn't believe that the pain was due to an injury, a “hurt” brought on by some physical activity. “I hurt myself while running (playing basketball, tennis, bowling).” “The pain started after I lifted my little girl” or “when I tried to open a stuck window.” “Ten years ago I was involved in a hit-from-behind auto accident and I have had recurrent back pain ever since.”

The idea that pain means injury or damage is deeply ingrained in the American consciousness. Of course, if the pain starts while one is engaged in a physical activity it's difficult not to attribute the pain to the activity. (As we shall see later, that is often deceiving.) But this pervasive concept of the vulnerability of the back, of ease of injury, is nothing less than a medical catastrophe for the American public, which now has an army of semidisabled men and women whose lives are significantly restricted by the fear of doing further damage or bringing on the dreaded pain again. One often hears, “I'm afraid of hurting myself again so I'm going to be very careful of what I do.”

In good faith, this idea has been fostered by the medical profession and other healers for years. It has been assumed that neck, shoulder, back and buttock pain is due to injury or disease of the spine and associated structures or incompetence of muscles and ligaments surrounding these structures - without scientific validation of these diagnostic concepts.

On the one hand, I have had gratifying success in the treatment of these disorders for seventeen years based on a very different diagnosis. It has been my observation that the majority of these pain syndromes are the result of a condition in the muscles, nerves, tendons and ligaments brought on by tension. And the point has been proven by the very high rate of success achieved with a treatment program that is simple,rapid, and thorough.

Medicine's preoccupation with the spine draws on fundamental medical philosophy and training. Modern medicine has been primarily mechanical and structural in orientation. The body is viewed as an exceedingly complex machine and illness as a malfunction in the machine brought about by infection, trauma, inherited defects, degeneration and, of course, cancer. At the same time medical science has had a love affair with the laboratory, believing that nothing is valid unless it can be demonstrated in that arena. No one would dispute the essential role the laboratory has played in medical progress (witness penicillin and insulin for example).

Unfortunately, some things are difficult to study in the laboratory. One of these is the mind and its organ, the brain.

The emotions do not lend themselves to test tube experiments and measurement and so modern medical science has chosen to ignore them, buttressed by the conviction that emotions have little to do with health and illness anyway. Hence, the majority of practicing physicians do not consider that emotions play a significant role in causing physical disorders, though many would acknowledge that they might aggravate a “physically” caused illness. In general, physicians feel uncomfortable in dealing with a problem that is related to the emotions. They tend to make a sharp distinction between “the things of the mind” and “the things of the body,” and only feel comfortable with latter.

Peptic ulcer of the duodenum is a good example. Although some physicians would dispute the idea, there is a fairly wide acceptance among practicing doctors that ulcers are caused primarily by “tension.” Contrary to logic, however, the major focus in treatment is “medical,” not “psychological,” and drugs are prescribed to neutralize or prevent the secretion of acid.

But failure to treat the primary cause of the disorder is poor medicine; it is symptomatic treatment, something we were warned about in medical school. But since most physicians see their role only as treating the body, the psychological part of the problem is neglected, even though it's the basic cause.

In fairness, some physicians make an attempt to say something about tension, but it's often of a superficial nature like, “You ought to take it easy; you're working too hard.”

Pain syndromes look so “physical” it is particularly difficult for doctors to consider the possibility that they might be caused by psychological factors, and so they cling to the structural explanation. In doing so, however, they are chiefly responsible for the pain epidemic that now exists in this country.

About the Author

John E. Sarno, M.D., is Professor of Clinical Rehabilitation Medicine, New York University School of Medicine, and attending physician at the Howard A. Rusk Institute of Rehabilitation Medicine, New York University Medical Center.