Practical Science on Movement and Pain

A Skeptical Look at the Theories of Dr. John Sarno

Illustration of the pain pathway in René Desca...

Did your repressed rage light this fire?

I have recently noticed several comments on the blogosphere which compare the ideas of Dr. John Sarno to the findings of modern pain science. While there may be some superficial similarities, there are some very important differences that I would like to clarify in this post.

Mainstream Acceptance

First, Sarno’s theories are generally considered to be untested and speculative, and are looked upon with significant skepticism by mainstream science. Sarno himself admitted that his theory is not accepted by 99.99% of the medical community. (But Andrew Weil, Mehmet Oz and Howard Stern are fans!) By contrast, the basics of pain science that I discussed in previous posts are very well accepted (despite being generally ignored), and are supported by a great amount of research and solid theory by many leading neuroscientists.

While this does not prove that Sarno is wrong about anything, it at least demonstrates that his theories are quite different from the pain science principles I have outlined in various posts on this blog. So let’s review his major claims and compare them to some of the basics of modern theories on pain.

Sarno’s controversial theory – tension myositis syndrome

Sarno’s theory is that a great deal of chronic pain, including most back pain, is caused by a condition he calls Tension Myositis Syndrome or TMS. The basic idea is that TMS is initiated in the brain, not the body, as a result of the brain’s psychological need to repress deep emotional issues such as anger. According to Sarno, the brain creates pain as a “distraction” to avoid dealing with troubling emotions. The brain does this by using the autonomic nervous system to restrict blood flow to certain tissues of the body, resulting in hypoxia and then pain.

Sarno treats patients by convincing them that their anger or rage or whatever emotion being repressed is the true cause of their pain and that there is no actual damage to the body parts that hurt. Patients are encouraged to return to normal activity, cease physical therapy and possibly undergo psychological therapy. According to Sarno, once the client recognizes the symptoms for what they really are, they go away.

Modern pain science – the neuromatrix theory of pain

Now let’s compare Sarno’s theory to the core claims of pain science. Modern theories of pain are well exemplified by what is now called the neuromatrix theory of pain, based on the work of Ronald Melzack and Patrick Wall, and more recently articulated in some excellent research, articles, and books by Lorimer Moseley.

The neuromatrix theory embodies a fundamental paradigm shift from the way scientists viewed pain for hundreds of years. Beginning with René Descartes, pain was considered to be the simple consequence of the brain reading pain signals (called nociception) from the body. Under the Cartesian view, pain is an input from the body which the brain perceives passively like a paper receiving ink. Based on this idea, we would expect to see a simple one to one relationship between tissue damage and pain.

But that is not what we see. Scientists have extensively documented a huge variety of circumstances under which there is little or no correlation between tissue damage, nociceptive signaling, and pain. For example, some people suffer extreme pain with no tissue damage at all, as in the case of phantom limb pain. Some people are temporarily pain free after suffering very severe injuries in an emergency situation. Many people without back pain show herniated discs or other spinal abnormalities on MRIs. These results help prove that physical harm is neither necessary nor sufficient to cause pain.

The neuromatrix theory explains the disconnect between physical harm and pain by viewing pain as an output of the brain, not a preformed input from the body. When a body part is damaged, nerve endings send a nociceptive signal to the brain containing information about the nature of the damage. But no pain is felt until the brain interprets this information and decides that pain would be a good way to encourage action that will help protect and heal the damage. The brain considers a huge amount of factors aside from just the damage signals in making this decision, and no two brains will decide the same thing. Many different parts of the brain help process the pain response, including areas that govern emotions and past memories. The “neuromatrix” is simply the combination of brain areas that produce pain when activated. Given the complexity of the matrix and the many parts of the nervous system forming it, the processing of harm signals from the body can be upregulated, inhibited, interpreted, and misinterpreted in a stunningly wide variety of complex and interactive ways.

The neuromatrix theory explains a great deal of previously unexplainable evidence related to pain, such as why placebos work, why someone can experience pain with no tissue damage, why someone can have significant tissue damage without pain, and why pain can be significantly affected by non-nociceptive sensory information, thoughts, memories, emotions, and social interactions.

TMS vs. the Neuromatrix

Now let’s compare the neuromatrix theory to Sarno’s theory to compare similarities and differences.

First, Sarno is correct that chronic pain often results more from processes in the brain than from any significant tissue damage in the body. He is also correct that emotions such as anger or stress can be major contributors to pain. In fact, studies have shown that job satisfaction is an excellent predictor of back pain, and that MRI results showing herniated discs or torn rotator cuffs are nowhere near as predictive of pain as you might imagine.

Despite the support that the neuromatrix theory gives to some aspects of Sarno’s claims, he does not cite to it in his writing. This should raise concern because he has written three books on pain without citing to current pain science! (I will admit that I only read the most recent book and just browsed the others.) Sarno instead spends a great deal of time discussing Freud, the ego, the superego, and other archaic metaphorical concepts. Bad sign.

I would guess that the reason Sarno ignored the science relevant to his theories is that it directly contradicts them in a fundamental way, which is this. The neuromatrix theory proposes that the purpose of pain is to encourage you to take action to prevent or heal harm to the body. TMS proposes that the purpose of chronic pain is not to protect the body, but to repress emotion. To accomplish this goal, the brain harms the body by inducing hypoxia – on purpose! Here we have two polar opposite explanations of the brain’s intentions in relation to chronic pain – one is that pain is intended to protect the body, the other that pain is the result of the brain’s attempt to harm the body. Sarno’s view seems completely counterintuitive and raises several questions from an evolutionary perspective.

The Evolutionary Perspective

Why would natural selection create people who feel back pain when they have repressed rage? One might imagine that the ability to repress anger would be useful to get along harmoniously with other tribe members. But why would back pain be the best way to go about repressing the anger? Back pain makes you irritable, disagreeable and unable to perform useful work – these are hardly qualities that will assist you in getting along with others. (But to get empathy and avoid work? Maybe.) Surely there are more effective ways to distract us from uncomfortable emotions than pain, such as compartmentalization, denial, projection, obsession, neuroses, work, etc. Why does pain help repress emotion better than these mechanisms?

And even if pain is a good way to repress emotion, is it really worth the price? Why is repressing emotion so important that we need to create disabling pain to do it? It is hard to imagine how such a function could have evolved.

Further, even assuming the brain would have some good reason to create pain in order to repress an emotion, why would damaging the body through hypoxia be the chosen mechanism? Pain science tell us that the brain is perfectly capable of creating pain without any nociceptive signaling from the body. Accordingly, it would be theoretically unnecessary for the brain to damage the body in order to cause pain. Damaging the body to cause pain is a circuitous, inefficient and costly path to accomplish a goal that seems pointless and counterproductive.

Conclusion

In sum, Sarno is correct that the brain and emotional stress play a big role in chronic pain, but his proposed mechanism for how this relationship works appears implausible and inconsistent with what we know about pain science and evolution.

Of course, none of this means that his treatments do not work. That is a separate question! So if Sarno’s methods work for you, that is great, congrats on your progress and keep at it. But don’t think that proves that TMS is a real disease, or that Sarno’s methods work by curing it.

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116 Responses to A Skeptical Look at the Theories of Dr. John Sarno

  1. […] This post was mentioned on Twitter by painphysioscan and Diane Jacobs, Todd Hargrove. Todd Hargrove said: New blog post: A Skeptical Look at the Theories of Dr. John Sarno: http://t.co/hp2OFEQ […]

  2. Amy says:

    Great post. I have read all of Sarno’s books many times, and while I don’t agree with all of his Freud-based beliefs, I do agree with some of his theory. One of his weaknesses is, he goes to great lengths of the how and why, but very little “treatment” other than his “knowledge cure.” He refers resistant cases to psychotherapy. In regards to the evolution aspect, the person that repressed their rage would probably be more “evolved” i.e the person with a highly developed cortex that acts considerate, and socially correct in the modern world, and doesn’t go around expressing their anger and “socially uncacceptable emotions” verbally and physically would have to according to Sarno repress the anger. In fact it is because we have evolved to inhibit/override our baser primitive instincts the repressed urges get “stuck” in the nervous system. And it more socially acceptable to have the disease of the day (back pain currently, ulcers in the 50’s, depression in the 90’s, etc) than to say “I’m mad at my boss.” Two of Sarno’s key ideas are the “symptom imperative” in which the repressed emotions will inevitably come out physically somehow, “if it’s not one thing, its another,” and “equivalency” in which the ANS will “choose” pain vs. OCD, vs. other mind body ailments such as high blood pressure. I.e. the chronic pain IS OCD. The pain is the “drug of choice.” The mind will supposedly choose something that has been “learned”, i.e CNS pathways that have been sensitized, weather that is to the GI system, certain regions of the body (Peter Levine refers to a painful body part as one that has been dissociated, ie. the brain has remapped to dissociate the region-dissocation being physcially local ischemia or mild hypoxia-same thing). And the hypoxia is thought to be mild and temporary, not permanent or destructive. Also when faced between yelling at the boss and getting fired and having a ruined career (unevolved person), the lesser of two evils may be to “choose” subconciously the back pain, or the headache or the OCD or the vocal dystonia or whatever the reflexive “go-to” mind body syndrome is stored in the circuitry of the individual’s insular cortex. A better “treatment” book that takes the “best” of Sarno’s hypotheses and uses evidence based ideas is “Unlearn Your Pain” by Dr. Howard Schubiner, MD. He focuses on “learned (sensitized)” neural pathways-the amygdyla, ANS, etc, and the importance of activating the DLPFC.

    • Thanks for the comments Amy, very interesting. I definitely believe that there is significant adaptive value in repressing anger but don’t think that pain is a good way to get that done. I also believe that stress can cause pain, but not that it causes you to choose it. I could imagine that the brain would choose pain to get attention or sympathy, but not as way to repress emotion.

      • MarieL says:

        The pain isn’t a way of repressing anger. It’s a consequence.

      • Christos says:

        Of course pain isn’t a good way to get that done! That’s the whole point. All ‘defence mechanisms’ for want of a better expression are not a good way to get things done.
        That is why they end up being more problematic than the original issue when they become overused.

    • rob wylie says:

      were is the “science” in neuromatrix pain theory??? (except in the cool name) you have got to be kidding. “the brain decides….” you have got to be kidding, what an unexplained filler, what a gap, what a friggin’ leap… my friend you don’t even hear yourself.

      • Todd Hargrove says:

        Hi Rob,

        I don’t think it’s a huge leap to say that the brain is capable of deciding things. Where is the science? Follow the link cited in the article and you will find an article with a decent summary.

    • Andrew says:

      Great comments Amy, another contemporary resource that seeks to synthesis evidence based approaches together with phenomenology gleaned from a lifetime of supporting individuals via body orientated psychotherapy, is The Psychophysiology of Self-awareness (Rediscovering the Lost Art of Body Sense)
      by Alan Fogel.

  3. adiemusfree says:

    Excellent rebuttal of some of the more problematic aspects of Sarno’s work. There are other reasons for avoiding the treatment that Sarno deduces should be carried out and that is the lack of evidence to support catharsis as a treatment for so-called ‘repressed’ emotions. In fact, there is good evidence to suggest that expressing emotions such as anger, particularly through cathartic means, serves only to exacerbate the experience of distress.
    What seems to be a more helpful approach to both emotion regulation and pain is to recognise the thoughts that occur, test their validity and helpfulness, and manage behaviour in such a way as to honour what is important. This is at the heart of the CBT approach to pain management, and the newer wave of therapies such as Acceptance and Commitment Therapy.

    • Thanks Adiemusfree,

      Interesting ideas about catharsis, I think I have heard similar things from my wife – she is a psychotherapist. Since Freud, people tend to think of repressed emotions as like a pressure cooker – some day it will burst if you don’t blow off steam. But it ain’t a pressure cooker. What’s a better analogy? Maybe a bad habit?

    • MarieL says:

      …but Sarno specifically doesn’t suggest catharsis. His approach recommends just what you suggest; “to recognise the thoughts that occur, test their validity and helpfulness, and manage behaviour in such a way as to honour what is important.” – mainly just the recognising this ourselves.

  4. I spent six weeks working in Sarno’s department in New York in ’73, right out of school. I remember being totally unimpressed, and I knew absolutely nothing. His theory leaves a great deal to be desired, as you have wonderfully pointed out – but his publicist is a genius.

    Don’t forget that Regis Philbin is also a big fan.

    • Thanks Barrett,

      That’s right you are the Forrest Gump of PT. John Stosell is also a fan.

      • brandon says:

        There are a lot of people with chronic pain who aren’t fans of Sarno, that’s typically why they have chronic pain. You have got to be an absolute fool to try and discredit a physician who has literally dedicated his entire career to chronic pain research and has achieved the results he has. But hey, what do I know Todd? I’ve only got a PhD in Exercise Physiology, suffered through debilitating back pain for years right up until I read a book by Sarno. Probably should have just done some “core exercises,” would have fixed me right up!

        • Todd Hargrove says:

          Hi Brandon,

          You seem to be suggesting that I am claiming that Sarno’s methods do not work. However, as I made clear in the post, this post is not about whether Sarno’s methods work, but whether his explanations make any sense.

          If indeed Sarno has spent his career in pain research as you claim, he should to cite to some actual pain science in his books, because it would explain why his approach works far better than his own outdated theories about TMS and Freudian psychology.

          I’m glad you were able to cure your back pain through Sarno’s methods, but as you know as a PHD, the efficacy of a therapeutic technique is proved by RCTs, not personal anecdotes.

          • Christos says:

            Well both really. RCTs can give us one type of information. Rich qualitative research or anecdotes as you refer to them give another type of information. Both are needed to capture the complexity of human experience. Also not everything is amenable to RCT.

        • AMY N PAINE says:

          I agree!! That’s so funny!!! Core exercises!! I have been to SEVERAL different PTs and none ever got me pain free as I am now after only two weeks with Sarno’s method. I don’t have a PhD in Psychology but I will someday. I hope to be treating pt’s just like myself too. The brain is largely unknown and we are only BEGINNING to understand brain mapping and all that it is capable of. We don’t give our brains enough credit. The scientist who said the world was round and not flat was laughed at and discredited at first as was the scientist who said the earth rotated around the sun not the sun around the earth.

          • Ed Labossiere says:

            Hi,
            What about the Hungarian doctor who suggested doctors and nurses wash their hands to help stop the spread of disease and infection? He was disgraced and ruined!

    • Joan says:

      I was A Sarno Patient..I guess until you have chronic pain you may be not able to understand how people heal I Did with the help of Sarno with crippling back pain

      • Ed Labossiere says:

        Dr. Sarno’s theory makes sense and his treatment strategies work. The key is that one has to have an open mind to take a good look inward. It is amazing.

  5. Dale Favier says:

    Great article! (Though I’d dispute your social-means-late assumption about evolution. Mammals have been highly social since before they were mammals.)

  6. Rod says:

    The reality of all this is that Sarno was on to something that was important clinically and was completely different than the clinical models he was supposed to work with. .Imagine being an atheist in the vatican!It is obvious that like many Dr’s he was not a scientist. In my experience the hurdle is to convince yourself/others that the model of pain/damage is not the way it works, nor is our concept of how we work as an ego or personality intuitive to us. Despite all the great scientific “break throughs” we havent really improved on the bhuddas “aggregate” approach to creation of the self and suffering.The problems presented here are, if we throw Sarno under the bus we run the risk reinforcing the damage/pain model to many people,and if we push Sarno’s model on people, we run the risk of well read and thought out people with some current science in them ,to ignore a very valid approach to many current muscoleskeletal problems that individuals and society are dealing with.I would very much like to see more discussion of current treatment techniques that are standing on Sarno’s shoulder.
    Rod
    ps-I really enjoy your posts and approach to things.You aren’t shying away from trying to grab smoke!

    • Rod,

      Thanks for the comments. Yes Sarno is in some ways a step in the right direction and I don’t want to throw him under the bus. Interesting you should mention atheists in the vatican because I am just finishing up a post inspired by this one which will apply Dan Dennett’s ideas about “deepities” to the phrase “mind/body connection.”

  7. Seth says:

    This is a great post Todd. You have done a good job of both describing the neuromatrix model and the shortcomings of Sarno’s. I am only somewhat familiar with Sarno having not been able to get through any one of his books cover to cover. There is something really annoying about his theory and the broad generalizations he makes about people with back pain, actually I find it rather insulting. Not to mention he seems to find no reason for any kind of physical therapy, or any other approach like Feldenkrais. By the way, if you read or re-read the Potent Self by Feldenkrais, there is a good deal of writing about what he sees as the short comings of the Freudian/Reichian model of catharsis and this idea of having to express anger as if it were steam built up in the pressure cooker. Thanks for all the great posts!

  8. Todd,

    Tomorrow’s blog post in Range of Motion at SomaSomple.com is about this thread.

  9. Jim says:

    Todd,
    Another great post. Thanks.
    I know several people who suffered with long term back pain, who were in the “pain results from tissue damage” school, whose pain subsided after reading Sarno. They were all *extremely* skeptical before reading the book, and only did so to placate friends. Also, they all dismissed the Freud stuff. Maybe, for them, Sarno was right for the wrong reasons.
    –Jim

  10. hello Todd,
    thank you for your very interesting post. Every post makes me think. I know that negative emotions can afflict pain and anger especially. Anger activates some regions of the brain like anterior cingulate cortex, amygdale and brainstem involved in Neuromatrix(Damasio et al.2000)and also reduces endogenous opiod activity (Bruhel et al. 2002,2003).
    I don’t know if repressed anger is more important than showed anger but I think that Dr Sarno has broken tradinonal approach to many body disorders. I don’t agree with Dr Sarno on some aspects, I don’t think that no treatment is necessary, I think that an integrated work on learning about pain processes and a refine of the body maps with a CBT approach is the best. We have to understand more and more about brain networks.
    Have everyone a nice sunday

    antonello

  11. I advise to read this book:

    Fabrizio Benedetti, The patient’s brain, the neuroscience behind the doctor-patient relationship, Oxford Univerity press, 2011

    kind regards
    Antonello

  12. In this book there is much food for thought. Please let me know what you think after you read it, I’m really interested in your and others opinion.

    Thank you

    Antonello

  13. Great post!
    working as an manuell therapist for 20 years,mainy chronic pain patients Sarno opened my eyes for the “body-mind” conection 15 years ago.
    Negative emotions(anger,fear,anxiety etc) can be felt as bodily pain ,no dought about that,in my point of view.
    If you dont consider your inner negative thoughts/thinking as potentional rat poison you will not be able to heal your body.
    Your thoughts are connected to your cells in your brain,muscles,skinn etc.
    In my clinical practise i use alot of cognitiv therapy,pain education(Butler,Moseley) ,feldenkrais etc.as an active mental and physical approach ,selfeducation, in order to maintain in balance.

    BUT we have to be awer of that even though the paitent may have lot of “cognitiv fuzz” the patients painproblem might be a mechanical dysfunction.(yes i know that the pain is an output from the brain)

    Sorry about my badly written english

    RIN

  14. robert says:

    I WOULD JUST LIKE TO LET YOU ALL KNOW THAT DR. JOHN SARNO HAS DISCOVERED THE MAGIC BULLET FOR MOST OF TODAYS ILLNESSES, SYMPTOMS, AND SYNDROMES.HOW CAN I BE ABLE TO MAKE SUCH A BOLD STATEMENT? BECAUSE I HAVE HAD MORE OF THESE ILNESSES, SYMPTOMS AND SYNDROMES THAN ANYONE COULD POSSIBLY HAVE HAD. HORRIBLE BACK PAIN, FIBRIMYALGIA, CHRONIC FATIGUE SYNDROME, EPSTEIN BAR SYNDROME,CHRONIC CANDIDIASIS, TMJ, SWOLLEN JOINTS, SWOLLEN LYMPH NOTES, CHRONIC SORE THROAT, MIGAINE HEADACHE, SCIATICA AND THE LIST GOES ON AND ON.I AM CURED OF ALL THESE PROBLEMS AND HAVE BEEN FOR OVER 11 YEARS AFTER APPLYING DR. SARNO’S THEORY. ALL OF THESE CONDITIONS HAVE THE SAME CAUSE AND THE SAME CURE. THIS MAN IS THE GENIUS OF OUR LIFETIMES AND IS THE PIONEER AND FOUNDER OF TMS AND ONE DAY WILL BE RECOGNIZED AS ONE OF THE GREAT DISCOVERERS IN AMERICAN HISTORY. NO I HAVEN’T LOST MY MIND, I’M JUST ESTATIC THAT I WAS LUCKY ENOUGH TO FIND SOMEONE THAT HAS DISCOVERED THE CURE TO MOST OF TODAYS ILLNESSES. AND I’M ONE OF THE BEST EXAMPLES YOU COULD GET WITH OVER 100 SYMPTOMS AND SYNDROMES.I WAS MISERABLE UP TO 11 YEARS AGO. EVERYONE WITH ANY OF THE PROBLEMS I’VE HAD OR ANY KIND OF PROBLEM WHATSOEVER SHOULD NOT ONLY READ HIS BOOKS BUT STUDY THEM AND PRACTICE THE KNOWLEDGE IN THEM. THE PROBLEM IS THAT THE SCIENTIFIC TYPES OUT THERE THAT TRY TO DISPEL HIS THEORY DO NOT HAVE FIRST HAND EXPERIENCE LIKE I DO. ITS EASY TO JUDGE A BOOK BY ITS COVER. ONLY WHEN YOU ARE DESPARATE AND HAVE NO WHERE TO TURN WILL YOU SOMETIMES FIND THE ANSWER. THANK GOD I DID, THE CURE IS OUT THERE JUST WAITING FOR YOU ALL. BACK TO SCIENTIFICALLY SPEAKING IT’S A KNOWN FACT THAT THE SUBCONCIOUS MIND CONTROLS EVERYTHING IN THE BODY, NOT THE CONSCIOUS MIND, RIGHT. AND SINCE THE SUBCONCIOUS MIND CONTROLS EVERYTHING IN THE BODY WE MUST ALL AGREE THAT IT CONTROLS ALL PAIN AND FEELINGS THAT WE HAVE RIGHT. SO IF WE CAN CONTROL AND MAKE THE SUBCONSCIOUS DO WHAT WE TELL IT TO DO LIKE CUT OUT ALL PAIN, SYMPTOMS, SYNDROMES ETC. AND MAKE US HAPPY AGAIN THAN ALL OF THAT WILL GO AWAY-ABSOLUTELY AND POSITIVELY RIGHT!! DR. SARNO’S ONLY FLAW MIGHT BE THAT HE DOES NOT ELABORATE ENOUGH ON HOW TO DEAL WITH AND CONTROL OUR SUBCONSCIOUS MINDS. IT’S REALLY QUITE SIMPLE, JUST PRACTICE 5-10 MINUTES A DAY AND YOU’LL BE CURED OF ALMOST ANY AILMENT! THERE ARE MANY BOOKS ON THE SUBCONSCIOUS MIND, AND I SUGGEST YOU ALL READ AS MUCH AS YOU CAN ON THE SUBJECT AND MOST OF ALL YOU MUST BELIEVE IN THIS WHOLEHEARTEDLY. FINALLY, I KNOW THIS WAS EXTREMELY LONG BUT I’D LIKE TO SAY I OWE MY LIFE TO DR. SARNO. DON’T TAKE MY WORD THAT HE’S THE REAL THING, TRY TO MAKE AN APPOINTMENT TO SEE HIM IN OFFICE IN NEW YORK. BE EXPECTED TO WAIT 3-6 MONTHS FOR YOUR FIRST APPOINTMENT. OH, AND BY THE WAY HE ONLY SEES NEW YORK RESIDENTS. SORRY FOR BEING SO LONG WINDED. THANK YOU.

    • rachel says:

      Well said robert,
      DR SARNO IS THE BEST AND ONE OF THE MOST HONEST AND INFORMATIVE DOCTOR ALIVE TODAY.
      AS FOR THE ABOVE COMMENTS ON THIS SITE, I THINK IT IS BLOODY NONSENSE! THE PERSON WHO WROTE THIS CLEARLY DOESN’T UNDERSTnd whatsoever. FIRSTLY THE PAIN IS HARMLESS, NO DAMAGE OCCURS, AND SECONDLY PAIN CAN BE SEEN AS A SIGNAL RATHER THAN AS MERELY A DEFENCE. YES IT DOES MOVE AROUND TO GET ONE’S ATTENTION (ONCE YOU TOTALLY IGNORE IT’S EXISTENCE OR FOCUS ON HOW YOU ARE FEELING AND REPRESSING YOUR EMOTIONAL ENERGY), BUT IT IS BEST TO BE GRATEFUL FOR IT AND TAKE IT AS A SIGNAL OR WARNING SIGN THAT SOMETHING NEEDS TO BE EXPRESSED OR DEALT WITH WITHIN HOW YOU ARE BEING. NOT WHAT YOU ARE DOING. ALSO YOU WILL NEVER DAMAGE YOURSELF WITH TMS, I RUN 85 MILES EACH WEEK NOW. I AM WINNING THE FIGHT WITH TMS. FEAR IS THE STRONGEST EMOTION WHICH CARRIES IT ON AS WELL AS CONDITIONING. YOU MUST BE BRAVE AND SEEK OUT THE TRUTH FOR YOURSELF, YOU DESERVE TO. LOVE AND GOD BLESS TO YOU ALL.

      • Danielle says:

        What? What are you people talking about; “the pain is harmless”? How can you possibly speak for every person who has ever suffered chronic pain? How can Sarno?

        I’ve had back pain/sciatica/piriformis syndrome for years. It’s chronic pain. And after years of testing and injections, I finally got the right test, a neurogram, which showed that my sciatic nerve is split inside the muscle instead of lying on top (10% of the population have this). So when the piriformis muscle contracts it pinches the nerve and causes pain that also irritates my SI joints, facet joints, and L5-L3. My piriformis and external hip rotator muscles are prone to dysfunction because I have fallen arches and knee pronation, as well as extremely loose ligaments, hyper mobility, and my pelvis rotates forward on one side because one leg is slightly shorter. I have fallen arches partly because I have a little extra bone in each of my feet (according to podiatrists X-rays). Piriformis syndrome is also more common in athletes with “forward motion” activities like running and biking. I was a competitive distance runner. I also was a ballet dancer, where extreme external hip rotation is desired. So my “chronic pain” that so many doctors initially told me had no cause, and so many alternative holistic doctors told me was caused by my emotional repression etc. is actually a complicated puzzle but ALL TOTALLY LOGICAL. Its taken years to put it all together but there IS a physiological explanation for my back pain and dysfunction.

        I suffer from other chronic pain conditions and while I understand stress and negative emotional holding patterns contribute to pain and illness, in almost every aspect, tireless research in medical science has yielded physiological, structural, and genetic reasons for my problems that have nothing to do with repressing emotions.

  15. Andrew says:

    Hiya

    Interesting post – I think the key thing is

    “In sum, Sarno is correct that the brain and emotional stress play a big role in chronic pain,”

    I have used Sarno’s TMS techniques to cure my RSI – and have met with (and spoken online with) a large number of people who have also had great success using this approach. Now, it is perfectly possible that the mechanism that Sarno proposes is incorrect – certainly things have moved on medically in the 25 years or so since he first wrote The Mindbody Prescription. Nevertheless there is significant evidence that the methods he proposes (mediation, journaling, GET, talking therapies) do have a big impact on chronic pain conditions….

    There is a pretty comprehensive list of abstracts on the subject here (http://tmswiki.wetpaint.com/page/Annotated+Bibliography) which may be of use if you want to look at the medical evidence for the efficacy of the TMS techniques….

  16. Dear Todd,
    thanks very much for this blog. I am a rheumatologist who moved to New Zealand and I am doing a mindbody healthcare integrated paper at AUT. I have started to see these types of symptoms which are very meaningful in my rheumatology practise. I think that some of the problem is that as biomedical physicians we are illiterate in up to date psychological and psychotherapeutic interventions when we do see ‘stories’ behind disease. There are huge problems developing an evidence base – aside from the pain models- when often n=1, no one person has had a life experince like any other. Dr Sarno like all of us thinks his experience of a group of patients ay in American rehab centres tells us about all patients with back pain when it doesnt. This is reductionist thinking. As you have quite rightly pointed out Dr Sarno is often right for the wrong reasons. As I am currently reading around alsorts of new disciplines including neuroscience, phenomenological philosophy, psychotherapy, and dipping into both academic and ‘popular’ self help books about chronic pain I can see that we have all become too specialised to communicate with our patients as whole persons. As if you didnt have enough to read I am recommending another book- Meaningful disease by Dr Brian Broom which attempt to combine these disciplines in a useful way, and is readable. We have started a mindbody trust to help integrate the mind and the body in healthcare in ways other than in chronic pain. We are also doing mixed methods qualitaive research to try and overcome the loss of data when individuals are excluded from research in preference to ‘cohorts’. I also wonder if you would mind writing an article for the Postgraduate Medical Journal (BMJ group) on chronic pain. I am commissioning editor.

    Best wishes
    Dr Karen Lindsay

    • Karen,

      Thanks for the information. Glad you like the blog.

      And thank you for the offer to write an article. I am flattered but can’t imagine what subjects I could discuss with sufficient expertise to merit inclusion in a professional journal. What did you have in mind? My only post graduate degree is legal. Perhaps I could write something on legal liabilities stemming from giving unqualified medical advice?
      If you want a discussion of pain science and the role of emotions and thoughts in regard to pain and the immune system, I would recommend talking to a recognized expert in the field such as Lorimer Moseley. How do Broom’s theories square with what Moseley has to say? At first glance, he seems to fall into some of the same trap as Sarno.

      That being said, I would love to help if I can. Let me know what you have in mind.

  17. Stephanie says:

    I am at my wits end with this sciatica and foot pain my bet is on Dr Sarno and I am trying it now.
    Stephanie

  18. Simon says:

    Hi Todd

    As somebody who has been healed from fibromyalgia and numerous other maladies by Sarno’s work, I am incredibly grateful to him, and have become quite knowledgeable in TMS. I have managed to heal myself, where over years and years, our modern medical system could do nothing for me, except disappoint me time and again and make me poor.

    So let me address the three good and valid issues you have with his theory:

    First you find it hard to believe that pain is necessary to suppress emotion. In response, I have to say that it is not the only defense, and the other defenses that you mention are also used as well as many others. But as a defense it is an extremely powerful one, and often a last ditch effort where other defenses have failed. Sometimes it is needed, but sometimes it is chosen because in this modern world we don’t believe that such things are caused by emotions. Our unconscious knows us best, and doesn’t want us to look inside. At the moment body pains are in vogue and socially acceptable.

    Second you question if the pain is needed – that it has trade offs in making people irritable and unable to work. It does have this effect, that is true. But having these emotions burst out is a bigger threat to survival. It is often an absolute last ditch effort of the brain. It is also worth remembering that humans didn’t live as long as they do today, and they passed on their DNA sooner. In understanding why humans do this it is also useful to look at the structure of the brain – it is at its core an emotional brain, then evolution added the human part on top. These two parts are fighting for control.

    Third, you question why does the brain damage us. That pain science shows that the brain can create pain without affecting the body. The problem is that if the brain did that, we would quickly come to disbelieve it.

    Do not underestimate how important it is to keep these emotions in check.

    I totally commend your commitment to seriously look at TMS. If I had never experienced it I probably wouldn’t believe it either. Even though it is now apparent to me that humans are suppressing socially unacceptable emotions all the time. Even if it is simply a shaky leg or an itchy nose. There is a scale of things the brain does to keep threatening emotions out of our awareness, and things like fibromyalgia are at the extreme end of it.

    • Simon says:

      I also want to mention that TMS doesn’t actually damage us, although it feels like it does. I once ran down a mountain with incredibly painful knees. It felt like I had torn things. Convention would say that I should be an invalid now, but I’m not – I treated it as TMS, and one of the knees had stopped being painful by the time I reached the bottom. The other knee was not as bad as it had been but took a few more days to completely resolve. An incredibly strange event.

  19. Michael Tankovich says:

    Todd,

    This was a great post. It’s interesting how many “experts” love to talk/write about pain, yet are completely in the dark about the neuromatrix and all that we have learned about pain the last few decades.

    As David Butler has been quoted “We’ve learned more about the brain’s functioning in the past seven years than we had in the previous thousand. Because of this, there are now “knowledge gaps” between what we know and clinical practice.”

    Dr. Sarno seems to be stuck in this “gap”.

    Thanks

  20. rachel crowe says:

    Hi everyone,

    Just wanted to say that TMS/STRESS ILLNESS, call it what you like, does exist. It is how we are all made and therefore is fact, whether you understand it or not. I have had various pains all over my body for 5 years now. Since learning about TMS and after all other treatments failed to help me whatsoever, I resumed my running. I have now been running 85 miles a week for the past 2 years or so. I run even if i have pain, as i get pain at rest anyway and i know it is just me bringing it on 100%. If there was an actual injury redness/swelling and inflammation would be present ALWAYS, and one would make the problem worse by exercising. I have never had any such symptoms. Actually when i have been to my doctor or to a physio etc, in the past , my pain would disappear whilst talking to them, even though i could be limping down the road the next minute. Conditioning plays a huge role in pain. If you suffer chronic pain, very quickly you expect it to be there, so why would it ever go? You have to make it go and get your complete 100% attention of the physical sensation. People are prone to pain in this modern age, because most of us do not live very mindfully in our daily lives. Stress, worry etc, are all to common. Doctor Sarno’s books are great, but don’t go into enough detail of how to alter your thinking to remove the pain. A great website is runningpain.com, which provides more in depth detail of how to remove your pain for good. It works, end of! If you don’t believe the mind can do such a thing then sadly you will never end your symptoms, unless you have a placebo resonse to treatment or naturally feel happier or decide not to dwell on your body any more.
    I still get pain now, but i know no one physically can help me. To me it is obvious that i am bringing it on. I only have to think of certain body parts and i get pain. The problem is i worry to much and feel angry living with my mum, but i always know i am holding onto some negative emotion when i feel the pain. It’s obvious if you allow yourself to observe without question your feelings and were your focus is going. I can only hope there will be a shift one day, as there will have to be for people to be helped. Thanks,
    my email is rlcrowe22@aol.com if anyone wishes to discuss TMS further or has overcome their symptoms. Bye.

  21. Mogwai says:

    I basically agree with both sides of thi discussion. Yes, Sarno gets results in appropriate cases because subjectively, pain feels overwhelmingly physical. If it really isn’t, then the reason by which the patient arrives at this conclusion is largely irrelevant.

    I would like to say that there is very likely a neurotype more likely to have chronic pain than others. I think Sarno is on to one of the vulnerable personality types (pleasing to others, perhaps wounded early, etc.) and studies have shown that sexual abuse is predictive of CP. So we are now left with trying to understand pain as part of the “story” or narrative of a person’s life as they understand it. This is why Freud (or Jung) becomes useful.

    It is probably hard for people to think of themselves as a neuromatrix floating in spacetime. It is much easier to conceptualize the Freudian model because it is a very story-like theory. One can identify with the universal experience of child, adult, and parent (Id, Ego, Super Ego.) Do these things really exist? Wrong question I think. Is it useful to imagine they exist? Perhaps.

    It would be odd, I think, for creatures as complex and socially dependent as humans to not have a basic set of signaling tools around unmet needs. Developing chronic pain may at some level have an advantage if the person works through it without total debilitation. It may be an adaptation that made sense 10,000 years ago but has gone haywire in our stress filled world. It’s hard to say what the utility was actually… But I certainly would not dismiss the emotional origin and role of personality in it. I would like to see more work in this area and both drug and psychotherapeutic treatments that start with the brain rather than the body…

    • Todd Hargrove says:

      Mogwai,

      You make some excellent points about pain as a social signaling tool. I have been thinking about this recently and believe you are a correct. Perhaps I will write a post about this soon. Thanks for the insightful comments.

      • maya says:

        Todd – did you write that article about pain as a social signal? I’m doing phd research and finding this discussion very helpful – thanks very much

  22. Gary Mcdavitt says:

    Hi I suffered chronic back neck and face pain/strain and a severe non stop headache for 11 years, i did everything possible to repair it from running/fitness/yoga/CBT/pschologists/pills you name it, i found Sarnos work and book ‘the divided mind’ and was skeptical to the point of being really offended that it could be ‘all in my mind’ but after consideration, and reading it, i believe he is right, and it has fixed most of my illness im still recovering and getting better, and it seems i get better in increments, strangely after inexplicable bouts of intense crying that are occuring which i dont understand and out of character for me as ive always tried to be tough emotionally, maybe thats whats wrong with me. Just thought id add my opinion.

    • Todd Hargrove says:

      Hi Gary,

      Thanks for sharing your experience. I’m glad Sarno helped and best of luck on a full recovery.

  23. Peter Roundy says:

    I am a 68 year old neophyte in the world of clinical psychological studies. I was, however, a professor of English for 35 years and have spent a career “analyzing” novels, plays, and poems that portray the range of human experience. I know that for years I have had an ambivalent attitude towards psychology– often referring to it as an “art form” rather than as a science. It has only been in the last few years or so, with the prevalence of new drugs and public discussions of our nation’s chemical dependency, that I have begun reading about (and taking seriously) new therapies and approaches to human problems……that and my PERSONAL problems dealing with chronic back pain.
    Although I have suffered intermittent lower back pain for 25-30 years, Sarno’s first book, “Mind Over Back Pain,” read 2 weeks ago, was my introduction to the serious study of pain management. The book arrived in the mail courtesy of a friend who was getting tired of me complaining about my back problems.
    I am now halfway through his latest “The Divided Mind,” and I must say his ideas seem completely logical. Over the years, the one truth I have known about my own pain is that it has always been worse when I have been stressed out and caught up in difficult life issues…..a pretty simple truth.
    As stated, I am by nature a skeptic, which brought me to your blog today. I was looking for disputation. You and others on your blog have a vocabulary and wealth of citations to support differing points of view. But what strikes me after reading all is that underneath there seems to be common agreement that Sarno “is on to something.” And, after two weeks of reading about TMS…… “I think I know I feel better.”
    I would like to add one more point: For the last several years I have been practicing (lower case) buddhism through reading and meditation. I think there are some potentially important comparisons to be made between the power of samsara, the suffering that results from attachment, and the psychology of our “grasping and clinging” to various aches and pains. Can you recommend reading that looks into this topic?
    So, I’m going to finish “The Divided Mind,” and then dig into the Neuromatrix theory.
    P.S.: wish I had discovered this stuff years ago. Special thanks to you and your bloggers, and, of course, to Dr. Sarno (and my friend who sent me his book).

    • Todd Hargrove says:

      Hi Peter,

      Thanks for taking the time to comment. I’m glad you are feeling better, that’s the important thing. If it feels good do it, and whatever works. But the reason why it works is a different matter.

      I’m also interested in small B buddhism and have been trying to find some books that try to look at buddhism from a scientific perspective. There’s a lot out there and I am not sure what to recommend. Here are some potential sources. Sam Harris is a buddhist and neuroscientist, so he may have some good recommendations. Jon Kabat Zinn studies mindfulness. Jon Haidt wrote a book called the happiness hypothesis that I liked. The other positive psychology authors also may have good stuff – Martin Selgman, Kahneman. Best of luck.

    • maya says:

      Hi Peter
      Thanks for your post – I don’t know if you will receive this but I’d love to make contact with you – I’m doing an English PhD looking at pain and trauma among other things. If it’s of interest to you, of course.
      you can contact me at mayaward@yahoo.com.au
      Thanks Todd for your facilitation of powerful knowledge
      Cheers
      Maya

  24. SB says:

    It has been a while since I read one of Sarno’s book but as one doctor used to say, “You can’t treat all of the people all of the time with the things that work for some of the people some of the time”. I believe Sarno’s theories have merit for some case but the inherit fault is his ability to assess what is true injury. He assessed people based on the assessment of others to determine that there is no physical cause of the injury so it must be emot/psych.

    Many years ago, I injured my left knee. Had pain for over a year. Had 2 MRIs that were negative. An x-ray that was negative. Saw various doctors and was given diagnosis’s ranging from patella femoral syndrome to RSD. Finally, dr. #7 did an arthroscopy and found a loose piece of cartilage broken off from the medial condyle which he removed.

    My knee issues didn’t stop there but had I gone to Sarno before the arthroscopy, he would have diagnosed TMS since all the other doctor confirmed no “physical” cause. But clearly, there was one but only Dr. #7 found it.

    I have been perusing your blog and I am much more a proponent of the idea that chronic pain results from the constant messaging the nerves in the injured area that are firing. The remodeling or remapping the brain is the path to get this to stop. Not just trying to find the emotional cause of your pain.

    • Lara says:

      I am sorry to hear about your knee injury. I too had two knee reconstructions by the age of 21, although it was a little more obvious as to what was wrong with mine!

      I understand your position in thinking that chronic pain results from constant input, and in some cases you are completely right. If there is damage in the tissues, this will contribute to the brain’s decision to let the body-self experience pain and hopefully make the individual discontinue the movement or action that is causing pain. Why keep turning your head to the left if it causes you pain, right? But in some cases, this can be debilitating for a person…expecially if the tissues have healed but the person still continues to experience pain from this lateral rotation of the neck to the left. Not only does this contribute to an escalating cascade of movement-avoidance (in addition to other components from fear-avoidance models), but also leads to changes in the brain…

      According to clinical scientist Professor Lorimer Moseley, pain is a process of the brain, and depends on a patients perceived stimulation level. Any credible evidence of danger to the body modulates pain. Pain is therefore a conscious experience. Unlike nociception (pain caused due to stimulation of nociceptors) which can occur in the absence of brain activity and consciousness, pain and its physical responses can manifest according to how an individual interprets danger opposed to the physical state of tissues and nociceptive fibre activity. As pain continues, neuroplastic changes weaken the connection between tissue damage and pain. Alterations in the brain not only deliver an explanation for this, but provide a focus for treatment and rehabilitation beyond physical tissue damage.

      In chronic or persistent pain, two predominant changes occur; increased neuron sensitivity (central sensitization), and disinhibition of neural networks. Central sensitization (CS) is a form of biological adaptation manifesting as allodynia and hyperalgesia due to a repetitive stimulation of spinal nerves, but may become maladaptive in cases of chronic pain. Cortical disinhibition (CD) occurs in chronic neuropathic pain and describes a decrease in or loss of intracortical inhibition, being important for accurate neural activations. Together, CD and CS initiate a systematic change termed cortical reorganization. The association between pain and primary sensory cortex reorganization (and therefore altered motor control) is recognized in numerous chronic pain conditions including phantom limb pain, chronic back pain, and complex regional pain syndrome.

      So in summary, pain is an OUTPUT of the brain, not an INPUT. the pain ‘neurosignature’ is part of the neuromatrix in the brain, and although based on genetics, can be modified by sensory input. Therefore, pain can occur due to any number of reasons (visual, auditory, tactile, olfactory stimuli plus emotions, past experiences etc.) and noxious stimuli/nociception is neither sufficient nor required to cause pain in some circumstances.

      Have you ever heard of someone being in an accident, them healing and being fine, but then returning to the place and getting “phantom accident pain”? That’s what happens in this case due to the mere memory of the damage they encountered. It doesn’t make their pain any less severe with someone than actual tissue damage (although maybe less life threatening), and their pain certainly is ‘real’.

      Cheers!

      Lara, 23 yo, physiotherapy student

  25. Tommy says:

    I think Sarnos theory makes more sense when you think of pain is what happens (via TMS) when you repress emotion or not deal directly with something that is bothering you. You don’t deal with it because it is painful and may require action that may be very stressful and life changing. If you think the wife is cheating, confronting her about it could mean a divorce and lots of upheavel and dealing with trust and ego issues. Perhaps you feel unappreciated or unhappy about something but can’t express it for what ever reason. This sets the body up for pain. And what is the effect of the pain? It brings focus to it. It’s a physical problem that needs some ineffective physical therapist or needs imaging done and then treatment for whatever normal defect is found. So it actually does have the effect of taking the focus even more away from the real issue.. which is usually unexpressed anger. It helps to repress it more because you are even further away from wanting to deal with it when you think you need a spinal fusion or chiropractor or dazzling book on pain science.

    I personally think he is mostly right. Being not true to ones emotional experience and expressing oneself or even being aware of how one feels I bet causes a lot of pain. That, and caffeine addiction.

  26. Renee says:

    Thanks for a great post. I would like to share my experiences and observations, having suffered from chronic pain syndrome for several years, and having seen Dr. Sarno. It’s complicated!
    Chronic pain hit me out of the blue after nearly a year of extreme dental (and emotional) pain, brought on by incompetent work – 21 crowns, several root canals – that had to be totally redone. It was the worst pain of my life, even worse than the chronic pain which followed. Prior to that, I had had bouts of localized pain, probably brought on by stress and bad body use. Several years earlier, I went through Alexander Technique work, which brought about subtle but huge body changes, at least as long as I was able to study and remain aware of how much tension I was holding in.
    I became aware through AT work just how much the body pulls itself in when in a state of fear and anxiety. It is usually beneath our general level of awareness; we have become used to it and deem it normal. But you’re in a state of “fight or flight,” and you can do neither, so you are stuck holding it in. So it was no surprise that there was a reaction to what I had been through. The level of fear and heplessness during the dental fiasco was also high.
    After epidurals and a host of other treatments for diagnosed herniated discs, I went to see Dr. Sarno. I fit his profile in many ways, though during one of his group therapy sessions, I realized I was the only one who was outright angry, and expressing it. The rest of the people were timid and whining (with good reason, they were in pain) rather than expressing their rage. Also, the “testimonials” reeked of religious revival meetings, with the “you can be cured, but you MUST BELIEVE!” Lastly, he told me I needed to see a new therapist, trained in his method, twice a week for 6 months. At $200 a visit, this was not an option. So, I was supposed to sit through endless testimonials and group “therapy.” Not an option!
    My therapist, who had done a lot of pioneering work with biofeedback, explained that chronic pain was probably caused by a heightened reaction to pain (I paraphrase loosely), and that the best thing I could do was everything that could “calm down my system.” It took a year and a half, but I am finally free of chronic pain. I still have intermittent localized pain, probably from bad body use, but the overall constant pain is gone.
    I believe that Dr. Sarno is on to something, but his model is flawed. There may indeed be ischemia, but it’s not brought on by repressed rage in the manner in which he describes it. I think it’s brought on by the constant fight/flight response in the body, where one pulls oneself in and remains in a state of constant high muscle tension. I recall vividly my AT teacher talking about the tight knots in my back – he said, “imagine clenching your fist tightly, then imagine clenching it for years!”
    So yes, the emotional state does come into play, as emotions do manifest themselves physically and may affect the body’s pain threshold. And yes, there is no doubt a great deal of ischemia. But repressed rage and the brain telling the body to use pain as a distraction? It doesn’t add up. One must also discern chronic overall pain from localized (though sometimes chronic) pain. They are not the same thing.
    I would be very interested to hear what others have to say about these ideas. I can thank Dr. Sarno for delving into ideas that are outside the mainstream of medicine, but he has turned his theories into the gospel truth, and there is much he has left unexplored. I find this as dangerous as the medical model. Lastly, my apologies for such a lengthy post!

    • Gina Baverstock says:

      Hi Renee – my thoughts exactly! BUT what did you do to calm your system down? I would be extremely grateful if you can help me!

  27. Matt says:

    You might benefit from reviewing the work of Dr. Howard Schubiner, professor of medicine at Wayne State Medical College in Detroit. He has developed a model of chronic pain treatment that was originally inspired by Dr. Sarno, but which is a vast improvement and is more grounded in current brain and CNS/ANS research. I have seen the program completely resolve chronic pain in very short periods of time. The program is called Unlearn Your Pain and openly is a psychophysiologic approach that emphasizes regional CNS activation patterns to promote top-down suppression of pain modulation in limbic and autonomic pathways, for example increased activation of the (left) dorsal-lateral pre-frontal cortex) through belief based and intentional, strong/willful self-talk, meditation, and therapeutic writing, as well as intensive short-term dynamic emotional release/awareness therapy. I have found the work far more useful and effective than Moseley’s (and colleagues) “Explain Pain” model. So many people are afraid to truly go down the psychophysiologic path for pain treatment… for good reason, resistance is high and you have to be deeply versed in it personally to help others work with it successfully, without triggering “it’s all in your head” blame, fears and misunderstandings (VERY important to emphatically convey that all pain is real and pscyhophsyiologic origins to non-pathological and chronic pain is NORMAL).
    BTW, I do appreciate your review of Moseley’s presentation which I just discovered on a LinkedIn update. Finally, not sure if it is because I’m on a Mac, but I can’t seem to see any of the replies to this post – they are all blank except for showing dates and an occasional picture. Any suggestions, let me know at my email address, I’d like to read what others said about your post.

    • Todd Hargrove says:

      Thanks for the reference to Schubiner Matt, sounds interesting. There are many replies to this post, not sure why you can’t see them.

  28. Matt says:

    Looks like you need to update your web page software??? None of the comments show and I did a test on Adobe comparer and the only version of a web browser that shows the posts is IE7… can’t get it on IE9, Google Chrome or Safari. I would like to read some of these older blogs if possible, let me know if there is something I am missing here or if you update your site compatibility.

  29. Nancy Allen says:

    I have also been struggling with the Sarno approach- trying to sort out what, if any, symptoms are due to actual physical problems versus mind- body -emotional issues. Like many diagnosed with FM, my symptoms began with a neck trauma. Of interest, my body temperature dropped from normal of 98.6 to 97.5. The low body temp is common in the FM group. I asked Dr. Schubiner if this could be a TMS-related issue. He kindly answered – No. Any comments on this?
    Are we headed in the direction of appreciating that all body health issues can be healed by the mind ? If so, where does that leave the people who are known to have spinal cord injury? Unfortunately, not all spinal cord trauma is obvious. There are about 50 myelopathies ( normal MRI) listed in this article: Wong SH et al. Myelopathy But Normal MRI. Practical Neurology 2008; 8: 90-102. In 2009 neurosurgeon Robert Bray described a new disorder – thoracic epidural arteriovenous malformation. Dx requires special MRI procedure. Surgery has been very successful in alleviating symptoms. This is much more common in women, and Dr. Bray comments on his site that it may not be rare.
    Before the mycobacterium that causes T.B. was discovered this disease was thought to be due to hysteria or poor mental stamina. Wasn’t malaria ascribed to. ‘bad air?’ Do other mammals become ill ( distemper, feline leukemia, etc.)
    because of emotional issues ? Where the $&!?&@ are we on this ??

  30. I, for one, suffered for years with back pain. I was told I had degenerated discs and needed surgery. Then I read Dr. Sarno’s book. It changed my life and now my mission is to publicize this approach.

    Why not try a non-invasive mental approach to resolving your pain before going under the knife.

    It changed my life and I would encourage you to do the same.

  31. Stan says:

    Fascinating subject. I was cured of sciatica by Sarno about 20 yrs ago and i’ve followed the mind-body subject ever since. I have serious problems with distraction theory and Sarno does not provide all the answers. It is clear to me, however, that the mind plays a major role. For example, inthe case of the herniated disc, either it is the cause of pain (indirectly if you believe the neuromatrix idea) or it isn’t. If the ‘injury’ must be protected, than I doubt ‘straining’ the back would help reduce rather than exacerbate pain–as it does with Sarno’s approach. Hopefully those who have taken on the challenge Sarno presented will begin unravelling all the mystery.

  32. If i had time, i would go through a point by point rebuttal of many of the issues you have raised- alas, i dont. In short, i will say that what you call Sarno’s approach predates both him and the neuromatrix theory of pain by many decades. You might want to dismiss anything Fruedian, however if you were as familiar with neuroscience as your article suggests, you would also be aware that there are many aspects to Freud’s model of the psyche and general psychological functioning which are reciving a great deal of support from modern research in this field- modern neursoscience finds it much harder to dismiss than do most of Freud’s critics. When ‘Sarno’s’ approach was being developed (the precursers even predate Freud, but you also have to look at Franz Alexander), there was no neurmatrix model. Neurological knowledge was extremely primitive, and there was not a lot of point trying to make sense of complex experiences like chronic pain via neurology. Sarno began developing his own variation of these ideas in the 1970’s- again, neurology did not offer a lot at the time. As such, like Freud, he didnt bother attempting to explain his approach with neuroscience language- instead, he used the psychological language that was available at the time. If he was beginging his career now, my guess is that he would be utilising the neuromatrix model, primarily as there is no inherent contradiction. You might like see how these two approaches can be quite easily blended in my book, ‘The Hidden Psychology of Pain: the use of understanding to heal chronic pain’ (2012).
    Sarno is now in his 90’s, and is obviously beyond such a project. I, however, am not. Critics of Sarno have to contend with a few basic facts. There is abundent evidence (from both his own clinical outcome research, as well as that of others who use similar approaches) that these notions work- ie. a great many people get better (ie. become pain free) as a result. The piece of science which his critics need to address (usually people who make money from physical approaches to working with chronic pain) is that there is not one physical therapy for chronic pain which has been demonstrated to work beyond mere placebo rates. Sure, some people will get better- but some people will get better from rubbing ‘special’ butter all over themselves as well. When physical therapies are compared against placebo treatments, none of them (including those who purport to be mind/body therapies, but which tend to revert to a focus on the body as their default position) show better rates of improvement beyond chance in their treatment of chronic pain. Physical therapist would be much better advised to stick to what the evidence shows about their efficacy, ie. with acute pain.
    Creating ‘straw-man’ arguments, just for the pleasure of knocking them down, and advancing your own pet theory/therapy, hardly advances the state of knowledge. As neuroscience has advanced in recent years, so has the next generation of theorists/therapists who are further advancing Freud’s, Franz Alexander’s, and Sarno’s approach. You, and your readers, would do well to familiarise yourself with this next generation of TMS/neuromatrix theorists/therapists. There is a convergence happening, and attempts to poo-hoo what clearly works for many people sounds more like professional territorialism than science. PS- there is plenty in Sarno’s approach which is supported by contemporary science. Read my book and see.

    • Todd Hargrove says:

      Hi James,

      I will try to address your points in turn.

      Regarding your accusation that I “dismiss all things Freudian”, I never suggested that everything Freud said can be dismissed or that neuroscience does not confirm some of his ideas. My point is that modern pain science provides a far better framework than Freud to understand why Sarno’s therapeutic approach might be effective.

      You suggest that Sarno should be forgiven for ignoring pain science because of his advancing age and the date when he formed his theories. That’s not the issue (although I do note that his books appear to written well after pain science emerged.) The issue is whether his explanations for the success of his therapy should be dismissed in favor of those suggested by modern pain science. On this point, we seem to agree.

      You also point out that there is evidence that Sarno’s approach is effective. Again, that may be true but it is not the issue discussed in this post. The issue is whether his explanation for the claimed success of his therapy makes sense. Therapists get results from all sorts of things – cranial sacral, reiki, reflexology, and other methods, and their explanations for the results make no sense at all. Sarno’s explanation is less ridiculous but still very questionable particularly given what we know about pain science.

      As to your claim that physical therapy has a very poor record for reducing chronic pain any better than placebo or general exercise, I am well aware of that, and nothing in my post suggests otherwise.

      In regard to your suggestion that me and my readers should get better acquainted with neuromatrix theories of pain, I would ask you to look at the pain section of my blog, which has more than ten posts on this issue, including a four part series summarizing Lorimer’s Moseley’s talk at a recent conference I attended.

      As to your claim that I set up several straw men just for the fun of knocking them down and advancing my own per theories, you don’t cite any evidence at all to support that claim. In fact, this seems to be exactly what you did with your comment, arguing against several points I did not make, and in the process trying to sell your book. Sounds like projection. See, I don’t dismiss everything Freud said.:)

      • Jesse says:

        haha, the good Dr. got owned.

        • Teacher says:

          If that is what you want to believe, junior, than great. If your mind is too small to understand complex concepts then coming back with comments like “owned” makes sense. Please study and hard and grow as a person. The mind is a powerful thing…for most people.

          P.S. I had read Dr. Sarno’s books over the last 6-7 years and they have helped me conquer 25 years of pain (lower back, rib, shoulder, neck). That was after 35 years of going to various doctors and having verious tests and medications and physical therapy that did nothing but lighten my wallet. Most doctors stick to what they were told in medical school and prescribe the same “cures”. Most of the time they are guessing or are stumped. You believe what you want to believe, but I know what worked for me.

  33. Ian says:

    Sarno is AMAZING!

    And if you doubt his abilities “go knife”. Seriously, think about it! Surgery or a few weeks with the Guru.

    On top of this look into EFT (Emotional Freedom Technique) and what has been achieved with US Vets. Pure destripping of conventional “cut, burn poison”.

  34. Antonio Signore says:

    Interesting reading….I guess I’ll let you know about the method. I’ve got a bad MRI with the classic protrusion L5-S1, and I’m a martial artist. Excruciating pain but no intention to quit. The ortopedist suggested me to turn to golfing. I asked him if it was legal in golfing beat up other competitor with club. He smiled no…so I guess I’ll stay with my Jiu Jitsu and Capoeira fighting.

    I know that physical therapy, chiro, osteo do not work. I know by personal experience. I know that I have had very hard to deal episodes in my life (could it be frustrating to not being able to kill the rapist of your wife ?) so I’ve scheduled a talk to my wife psico-therapist.

    I’m by no means an expert of pain theories, psichology and such but instinctively what Sarno says makes sense. The point that it would be not evolutionary beneficial to cause self-pain and that the brain may have other forms to distract you rather then torture you could be opinated: what if the pain is so bad that those forms would not suffice to provide distraction ? And what if the pain is extruciating exactly because it is so bad that the pain of dealing with it would be even worst ?

    Will keep you updated how it goes…

  35. Evan Mahoney says:

    I am fascinated by Sarno’s theory. Having two episodes of back pain corresponding with life changing events and new responsibilities, I can empathize with Sarno’s explanation of how we get into pain.
    Getting out of pain is still a difficult challenge, even knowing Sarno’s explanation. Quite often the counseling recommended coincides with the natural length of time it would take for one to come out of pain.
    As an Acupuncturist I have found a strong correlation between Sarno’s theory and the Korean 4 needle technique known as “Saam Acupuncture”, and the Gall Bladder Channel technique. The Gall bladder channel in Saam Acupuncture has an emotional component called “revolutionary rage” directly correspondent to Sarno’s “Unconcious Rage”.
    http://www.transcendentalacupuncturist.blogspot.com has written alot about Sarno and has passages in the book “Saam Medical Meditation”.

  36. Diaconnou says:

    I am a 38-year old who’s had severe, debilitating lower back pain since I was rear-ended by a car back in 2003. The pain began gradually and it intensified over the years both in magnitude and in frequency. I had also developed really bad knee pain on my left leg. I read Dr. Sarno’s book entitled “The Mind-Body Prescription” back in 2010 and have stopped having back pain and knee pain altogether. I started training in Muay Thai a couple of years ago and I am in the best shape of my life. I was the biggest skeptic but this man has made my life pain free without needing surgery and without any medical visits. If you have back pain, and you are thinking of having surgery, I suggest you read one of his books.
    Your mind is more powerful than you can ever imagine – even more powerful than your brain. If you have difficulties understanding that last statement, i suggest you read the book.

  37. Stephane says:

    Lame article. Sarno made an incredible discovery back in the 70′. He just hasn’t found the words to express it to the mainstream. No one has. The words “repressed feelings” don’t ring well with most people. But let’s be clear: when it comes to chronic pain, Sarno’s techniques works better than any other therapy, from Percocet to surgery. I can personally testify.

    Neuromatrix. Please…

    • Todd Hargrove says:

      Hi Stephane,

      Many people have found the “words to express” Sarno’s discovery that pain can go away simply by changing your thoughts. This phenomenon is easily explained by the neuoromatrix theory of pain, which states that cognitive inputs such as thoughts and beliefs can modify outputs such as pain. That is the point of the article – that Sarno ignores good explanations for his findings that are well supported by scientific evidence, and instead favors outdated Freudian concepts.

      If you have any research to support your claim that Sarno’s therapies work better than any other therapy, please provide it. You should know that your “personal testimony” does not prove anything except what works for you as an individual. (In fact, it doesn’t even prove that.)

  38. Stephen Weiner says:

    IT WORKS!! Before I finished reading Dr Sarno’s book, “Mind Over Back Pain”, 4 years of intense, chronic neck pain came to an end. The range of lateral movement iof my neck is increasing on a daily basis. I was skeptical about it at first, but once I identified the exact moment that the pain actually started and what was going on in my life that caused tstress, both then and now, my pain virtually stopped. Simplicity itself! Thank you Dr Sarno for giving me my life back!!!

  39. Kroeger Johannesson says:

    This isn’t ‘skeptical’ — it clashes with what you’re selling…

  40. Bob Spez says:

    Thanks so much for the blog. I’ve just recently become aware of Sarno and read his book and am researching online for more info. From what I can see, Sarno’s approach is faith healing, or maybe a form of reprogramming the mind. Believe in the pain it will stay with you. Believe it’s in the mind and change your mental habits and it will go away. I’d say there are too many people claiming it works for me to dismiss it. Is the language, explanation valid? I guess it doesn’t matter. Much of science is merely a different kind of explanation than was used prior. But if it works, it works. Seems like there is definitely something there in terms of getting the mind to change your discomfort. Can you recommend a practical book or website to explain how to use the neuromatrix theories or others to reprogram the subconscious mind to eliminate symptoms?

    • Todd Hargrove says:

      Hi Bob,

      Thanks for your comments.

      Yes I can recommend a book. Explain Pain by Larimer Moseley and David Butler. The product I sell on this sise here has a 50 page book and movement lessons that are oriented towards the same goal.If you look in the Pain section of this blog you will see many free articles that are oriented toward the same goal.

  41. The Asian medical approach has helped people for millenia. It is an historic medical approach that is especially associated with relief of pain. Why is that? Because it recognizes a very understandable connection (if you are willing to understand the comprehensive foundational material) between detoxification and blood management (especially in the Liver and liver channel) and our tendons, ligaments and muscles. As well it recognizes the connection between the emotional intensities in the body and those same tendons, ligaments and muscles through their common ground the liver channel. Most important, the Asian medical model recognizes and is based on an understanding of the energetic aspect of our mind-body-spirit system. This medical approach has grown as a medical model for centuries by absorbing new paradigms. And its safety and non-invasiveness has allowed practitioners to rediscover its validity with each new patient. Perhaps Western medical professionals could take the time to register and absorb the information that fills other outstanding and historic models. And perhaps they could recognize that the legal profession has played a trick on them, with their now culturally-accepted imperative that doctors must work within a rigid evidentiary model even though the patient is interested not so much in evidence as effectiveness. Acupuncture approach has been effective for centuries. It acknowledges the connection between the emotions and suffering, but more important to the patient, it also creates the desired relief. Dr. Sarno is one of those people who has rediscovered what has been know for a long long time, and I think that is especially wonderful in that he is a teaching Western medical professional. A quick 3 year masters degree in acupuncture and Asian medicine, $60,000 in tuition, add a few years of serious hands-on work with hundreds of patients, and you too can have a ground level understanding that explains Dr. Sarno’s work.

  42. Amy Logue says:

    I am a former subscriber to Dr Sarno’s theory of back pain. I was pain free for 15 yrs after reading his books. A year ago I had a bad fall and have had low back pain ever since. Thinking it is TMS and
    trying not to repress/suppress anything is not helping.
    Thats why I looked up a forum. I need help!
    Thanks. Amy

  43. Hi Todd,
    I recently discovered your blog – I’m enjoying it very much! I’m a Feldenkrais practitioner and a clinical social worker, mostly working with trauma recovery with my clients. I’ve had similar questions about Dr. Sarno’s work.

    I recently completed the first year of training in Sensorimotor Psychotherapy, and this helped me develop a slightly different perspective about what Dr. Sarno might be observing. I wonder if this kind of pain might be better described as a trauma response rather than repressed emotions. Peter Levine’s Somatic Experiencing and Pat Ogden’s Sensorimotor Psychotherapy are two approaches that see this kind of pain not as the body “putting” pain somewhere to distract from painful emotions, but rather as a physiological response to trauma. That is, in the moment of the trauma, there was something that the person’s body “wanted to do” (run away, fight back) but could not, either because it was physically impossible or because it would have been unsafe to do so. The pain can come up years later because of subtle reminders of the trauma, and can seem unrelated to the past trauma.

    In this kind of scenario, Cognitive-Behavioral and insight-oriented approaches are not sufficient to address the problem, at least not long-term, because the process of the symptom is “bottom-up” – happening in the autonomic nervous system which is largely outside conscious control and difficult to observe and analyze. Body-oriented methods like SE and SP don’t use catharsis (which can be re-traumatizing and increase trauma symptoms), but spend time first teaching the client to self-regulate and be able to mindfully observe their own somatic/psychic state. From there, it’s much more possible for the person to feel “what wanted to happen” and to be able to do the movement while mindfully observing the traumatized state (called state-specific processing) and allowing the brain to process the memory as any other memory.

    These body-centered approaches are more like Feldenkrais in that there needs to be curiosity and willingness to experiment, but there is no need to “believe” that it will work. In fact most of my clients continue to seek medical explanations for their pain while also learning skills in self-regulation and self-observation.

    If anyone is interested in a more detailed, well-documented description of this kind of trauma theory, an excellent book is “Trauma and the Body” by Pat Ogden, Kikuni Minton, and Claire Pain. Also books by Peter Levine.

    • Todd Hargrove says:

      Hi Johanna,

      Thanks for getting in touch. My wife is a psychotherapist and very interested in the work of Pat Ogden. So we have a lot to talk about! I think that one way or another one of the key fundamentals of all these different methods (but not Sarno’s maybe) is that pain, including some kinds of emotional pain, results from overactivation of the brain systems that seek to protect us from perceived danger. One way or another, pain goes away when we reduce perceived threat and convince the brain that all is well. I think that Ron Melzack and Pat Wall had an idea about movement that parallels Levine’s thoughts about resolving trauma through a reenactment that involves taking protective action. They thought taking acton to move away from pain should resolve it in many cases, and that sometimes the reason for pain persisting is that the action was never taken. Barrett Dorko writes about this. I discuss Barrett’s ideas in my articles on ideomotion if you are interested.

      • Hugo says:

        Hi Todd,

        You say: “I think that one way or another one of the key fundamentals of all these different methods (but not Sarno’s maybe) is that pain, including some kinds of emotional pain, results from overactivation of the brain systems that seek to protect us from perceived danger. One way or another, pain goes away when we reduce perceived threat and convince the brain that all is well.”

        I have a hard time understanding why you should exclude Sarno in your statement. For in these few lines you describe is EXACTLY the point Sarno makes and the thing he tries to achieve!

        His books may be a little long winded (especially his last one) and at times overly simplistic (although not more than other self help literature). However, he keeps his message quite clean.

        Two weeks ago I was still in morphine, among other things, to be able to cope with debilitating back pain. I was unable to tie my own shoes. Today I have most of my mobility back and was able ton run three miles.
        (It took me a while to see that you yourself sell a solution for chronic pain through this site…)

        • Todd Hargrove says:

          I said that “maybe” Sarno’s theory is that pain is about protection. That is because his claim is that TMS type pain serves as a distraction, not a protection. Now I suppose one could argue that the purpose of the distraction is to protect you from emotional pain, and that is why I said “maybe.”

          I am glad that you have had success with Sarno’s methods, that is fantastic. But as I have repeated in the post and many times in the comments, what I am challenging here is not the efficacy of Sarno’s treatments but his explanations for why they work. I think neuromatrix theory provides a better explanation for your results.

          Further, you are right that I sell a product, but I do not make the bold sounding claim that it provides a “solution” for chronic pain. Instead, I say that it can help reduce chronic pain, which I think is quite defensible.

          • Hugo says:

            Hi Todd,

            In his latest book “the divided mind” Sarno states over 30 times that the pain serves to protect the individual from emotions that are perceived to be dangerous.

          • Todd Hargrove says:

            Yes that is my understanding and that is what I said in the post and in my immediately preceding comment. To be clear, I think it is correct to say that according to Sarno, TMS pain is to protect you from certain emotions through distraction. Not to protect from perceived harm to the body (the mainstream view) but from certain emotions. So I’m not sure what point you are trying to make here.

  44. I’ve been fairly sympathetic to Sarno’s approach for quite some time now, but my primary concern is this: If in fact pain is signaling or distracting from a deeper psychic conflict and Sarno’s approach eliminates the pain but fails to address the underlying conflict, has any real progress toward healing been made? Could the psychic conflict not proceed to manifest itself through other physical means, perhaps even organic disease, if pain is eliminated as a viable option for distraction/ somatization? In light of this concern, if we opt to implement Sarno’s approach, coupling it with psychotherapy would seem the most responsible approach. Otherwise we are merely playing whack-a-mole with symptoms without really addressing the deeper source.

  45. Pamela Jane says:

    I have no idea if Dr. Sarno’s theories are correct or not, but I was totally cured of debilitating back pain after seeing him once, about 20 years ago. It could be placebo but I’m not complaining! I have friends who were helped by him and others not.

  46. Pamela Jane says:

    PS Dr. Sarno told me the ultimate placebo for back pain is surgery

  47. Leon Foro says:

    This post, as funny as it was, might be good in the long run to quell many misunderstandings about TMS, and Dr. Sarno. The author of this article certainly doesn’t understand it, and neither do those who agreed with him. But they all have an interest in seeing that TMS is marginalized. But that will never happen because it works, for all the right reasons.

    It makes no sense when this author says, “this post is not about whether Sarno’s methods work, but whether his explanations make any sense.” He made that statement a couple times; that the people who healed were not proof that TMS works! The people who are increasingly healing are THE proof that it works. We can’t see love or hate under a microscope but we know they exist through observation. The only thing that matters is that healing occurs, the mechanism is un-important unless people want to make money from it.

    Another curious response was from the lady who wrote, “Dr. Sarno like all of us thinks his experience of a group of patients in American rehab centres tells us about all patients with back pain when it doesn’t.” Yes, it does. You either have a real structural problem or you have a mind/body effect. It’s simple but they want to keep it complex, and people confused. Who is she to make a claim that Sarno’s worldview was too small to see the larger picture? She lives in New Zealand for gods sake. Sarno worked for 50 years in NYC, one of the largest cities in the world. He healed surgeons, psychiatrists, oncologists, actors, Secretaries of State, Senators, athletes and musicians. People flew in from around the world to see him for decades, to be healed. So why would an obscure rheumatologist make a claim that his was just an American rehab center with a narrow view? And what about the rheumatologists that were healed by Sarno, and who are practicing TMS with great success?

    There has never been a more open minded and experienced pain physician than Dr. Sarno. He simply went where the truth took him. What he discovered goes against the grain of what some people are studying so they must bring him down. If they were in it for the sufferer they would follow what was working and push their egos aside. There are wellness centers opening up using Sarno’s work, and newly opened pain clinics based on TMS.

    It’s curious why this article’s author would state that Freud, ego, superego, were archaic metaphorical concepts? Has he discovered something beyond Freudian ego and superego that the world doesn’t know about yet? There are statues and institutes created after Freud. His concepts and contributions to our health were priceless, and as relevant as ever. Just because someone says something is outdated doesn’t make it true.

    Have you once pondered that Dr. Sarno might not have mentioned neuromatrix because he thought it was stupid? We know more about the human body than we’ve ever known in history, and yet the pain epidemics increase every decade because they’re looking to treat the cells, instead of the heart.

    Dr. Sarno found the magic bullet with his astronomical success. I’ll make you a bet that none of us will see, but that maybe someone who reads this in the future might bemuse upon. Your neuromatrix model will fall by the wayside to a newer discovery that also doesn’t help people in pain. There will be many more great advances in science and not one of them will stop the pain because the body is either injured, or it’s reacting to Freudian unconscious emotions.

    There will also be a statue, or statues somewhere honoring Dr. Sarno for his brilliance in medicine. Rarely a day goes by that someone doesn’t contact me from around the world to say Dr. Sarno cured them of their pain, or gastro problems, or skin, or vision, or infections, etc. The reason he was successful was because he discovered the body wasn’t the problem, it was simply reacting to life, and belief. If you believe, as we are taught, that the body is falling apart, then it is. If you believe that your body is ok, as Sarno showed us, then you heal. But if you don’t believe you are ok then you won’t heal for all the reasons Sarno proved. It’s not Sarno’s theory that failed, you simply didn’t believe it, and so it didn’t work, due to that same “outdated” Freudian ego and repression.

    Where interest lies honor dies. It’s clear that this author has an agenda to promote something called neuromatrix, and/or Feldenkrais. Dr. Sarno’s work, as successful as it is, stands in opposition to much of what this author has put his time and effort into. So he had to set up a straw man to be knocked down. There are many errors in his understanding and in his statements. The one responder, James Alexander hit the nail on the proverbial head. Forbes magazine also got it right, Dr. Sarno is America’s best pain doctor, and it wasn’t by accident.

    Let’s take a look at the mischaracterizations of Sarno’s work. The first one that jumps out is when the author said that Sarno ignored scientific findings that contradicted his work. Where? Where did he ignore it, or anything, which ones? He actually used science to support his theory on hypoxia, with rheumatology studies, showing 49% reduction in blood flow in fibro sufferers’ cells. Beyond that, and the autonomic nervous system, the rest is psychological in nature. As long as science ignores the person it will fail.

    This author also wrote, “According to Sarno, once the client recognizes the symptoms for what they really are, they go away.” That is not true, and Sarno never said that in such a simplistic manner. There were some very rare cases where the sufferer had read the work, and suddenly became pain-free. As a good scientist he reported it, but it was rare. Most of the people had to do extensive work to progress through their symptoms, but they virtually all healed, or got much better after stopping things like acupuncture, chiro, PT, and Feldenkrais . The body itself is fine.

    Another falsehood; “TMS proposes that the purpose of chronic pain is not to protect the body, but to repress emotion.” Not true. Sarno described it for 40 years as a “protective mechanism.” Since mind and body are one, that mechanism protects both, body and mind. The author then contended, that TMS “raises several questions from an evolutionary perspective.” Where? Man evolved to a point that he would rather not kill his neighbor over a disagreement, but through development, learned to try to get along. Part of that evolutionary process includes disagreeing without harming, trying to do, and to be good without hurting others feelings. And to do this one must repress (there’s that outdated Freud guy again. TMS fits perfectly into evolutionary thinking, along the lines of things like depression. The brain evolves beyond killing as a primary instinct.

    Author also said,” I could imagine that the brain would choose pain to get attention or sympathy, but not as way to repress emotion.” Skeptics have no imagination, that’s why they’re skeptics. They don’t believe what they can’t understand, its the Argument of Incredulity. I don’t understand it, so that’s proof that it can’t be true.

    In his conclusion, the author said, “But don’t think that proves that TMS is a real disease, or that Sarno’s methods work by curing it.” Wow. Where to begin. TMS is not a disease, Sarno never said it was. It’s a syndrome, a collection of symptoms. And what was that last thing he said? “…don’t think that Sarno’s methods work by curing it?” Is he saying, that if you use Dr. Sarno’s method, to heal from the disorder that Dr. Sarno discovered, that people need to understand that Dr. Sarno’s methods didn’t work to heal his own discovery, with his own method? It’s like a circular firing squad.

    But this all stems from a deep lack of understanding of Sarno’s work, and of course vested interest in an opposing concept. The proof stands with Dr. Sarno. I’ve helped hundreds, if not thousands of people to heal with TMS knowledge. Not one of them ever healed and said, ”but it’s the wrong way to heal, give me my pain back!”
    The statement “right for the wrong reasons” is a conundrum. Have you considered that Dr. Sarno is right for all the right reasons?
    Instead of taking Sarno’s work apart, why don’t you look to see why it works? Why do you feel the need to dissect the patient? Does it matter what the mechanism is?

    The only thing that matters is that people are healing, most likely by the millions, from his work. Why does the cure have to have “numbers” and “equations assigned to it?” I see it every day. People in pain telling me Dr. Sarno is wrong, as they limp away in pain. And right next to them are the people who were healed from TMS and living happy free lives. Who are the wise ones?

    If people want to heal, they must ignore the skeptics. Skeptics have held learning back since the beginning of time. They are the naysayers, the ones who cannot see the miracles in front of them, the forest for the trees. All learning has come from breaking new ground, and Dr. Sarno was the pioneering farmer of the century.

    Leon Foro

  48. Andrea says:

    Hi Todd,

    I just finished “Explain pain” by Butler and Moseley and it has nicely complimented what I’ve seen and read about pain from a modern neuroscience perspective. I am also reading Sarno’s book “Healing back pain” but I am not sold on the TMS explanation, Butler and Moseley’s explanations seem more plausible and are very elegant, like an equation. At any rate, I think Sarno was onto something, my pain started in a highly stressful situation, or specifically, after the situation was over. Then got better, and a week later returned worse, when I tried to soldier on and ignore the pain. It only got worse over time. One thing both neuroscience and Sarno have said is that discs are not that delicate structures and research does show, as both state, that there’s no conclusive evidence that abnormalities in the spine always correspond with pain. Now, this perhaps is a question of a different order, but knowing what I do about pain and about the human body and how strong it is, knowing that for example bone is “rebuilt” and often a bit stronger, if discs (which don’t look like discs!) do heal as well, does that scar tissue make them stronger or not? Upon showing my MRI to the doctor that showed a small posterocentral bulge in L4/L5, doctor said that’s new, but I know that it isn’t cos I have an MRI from 2003 that shows that I had it, so he said that I “re-injured” the disc, now I wonder, is this even possible? Or, is it more possible that I’ve been led to believe all my life that discs and backs are weak structures, easily hurt and that my brain tries to protect it at all costs? Pain this time was different to other times, I had back pain, waist and buttocks and lots of leg pain, I even didn’t think it was my back at first, so perhaps the back got tense as defense and compressed the muscles giving me different symtpoms, all of which didn’t enable me to move properly, which is what my brain wanted anyway.
    If anyone have any idea whether it is possible to reinjure discs, I’d like to know if this is possible and what’s the evidence for it. I’d like to believe the pain explanation, of course, but I did hurt my back at one point, the discs did bulge but these are old injuries and I don’t see scar tissue on my knees just opening easier when I fall, unless I fall while it’s healing. Moseley does say “discs are a bit tatty around the edges” so maybe they’re a bit sensitive. Anyway, happy to hear answers and points of view.
    Thanks,
    Andrea

  49. Philip Golden says:

    Re: natural selection –

    How is it that millions of years of bipedalism would produce huge populations of humans with chronic pain that would (presumably) have created negative selection factors throughout course of human evolution? Only argument that I could think up is that genes passed along at earlier age than back pain manifests, but this is countered by my own experience of back pain to point of not being able to get out of bed at 24 years old.

  50. Christos says:

    Great article. I will print it off and read it in full later along with all the replies.
    I will say however that using Freudian concepts doesn’t constitute something to worry about. It can sometimes be a very useful way of looking at things.

  51. steven gary says:

    I can verify that Dr Sarno cured me of a crippling conversion/somatization disorder that incapacitated me for ten years, and unfortunately i relied on so called mainstream medicine which ( i believe) only prolonged the illness -permanent migraine, permanent back neck pain and muscle spasm dystonia IBS and always sick.
    One doctor i thankfully visited informed me of the psychosamatic medicine available which really angered me because i didnt believe him, that it could be in my mind as though he was insinuating im a malingerer or hypochondriac (which was my mistaken impression!) after two weeks i reconciled to his recomendation and researched the net and read books including dr Sarno Dr Schecter etc and healing began just straight away it took 3 years to heal with no recurring episodes.
    Those ten years were hellish in permanent pain from the moment i awoke till i slept and i took all different medicines scans stretches routines everyday yoga nothing worked or helped but sarnos books and shecters did, I dont know if his hypothesis of how the biological mechanics of it works is totally correct but he is definately onto something that works, how,exactly is yet to be discovered.
    Unless you have been tormented by a chronic psychosamatic illness that you fight everyday to get rid of but cant seem to rationally solve for yourself its hard to get the insight of the illness and the Dr Sarnos medical epiphany that he conveys for others to comprehend and heal the mysterious sickness.

    • Todd Hargrove says:

      Steven,

      Thanks for sharing and congrats on your recovery, that is fantastic.

      • Jim says:

        What about the people like myself who were given this book to read by a doctor that also caused them to have a severe adverse drug reaction because he didn’t properly titrate that person or warn them of the possibility? That was me and I did have a spinal injury that could be verified. I’m glad to hear that some people feel better but what about the neglect? Here, read this book because you have repressed anger… And that’s it? The real crime is not the concept that some people may have unresolved issues involved in their pain syndrome but the suggestion that unresolved issues are almost always the cause and if you read the book and don’t get better maybe you didn’t read it with the right intention. That’s very similar to religious people who tell someone who prayed for healing and didn’t receive instamically that they have “weak faith”. With the newer knowledge of DNA and newer diagnosis Sarno has been proven to be a hack, who in some cases may have given some helpful insights… Like the doctor I mentioned who also described some helpful “body scan” meditations. Yeah, but he also was the prime reason I had a severe case of Serotonin Syndrome. That experience made Dante’s Inferno look like a walk in the park.

  52. Jim says:

    I disagree with the statement that if it works for you that’s fine. How is that a scientific approach? Sarno’s work is dangerous because it set the tone for many physicians to blame patients who they could not find a matching diagnosis. As someone who has an illness that was difficult to diagnose I have been surprised at the poor thought processes of many doctors and how they spread and propagate myths about pain disease… in a way that always places the burden on the patient… I suppose that is why they call us patients because of the enormous tolerance we have to have for people who are too lazy to explore or consider other possibilities. One of the cruel hoaxes perpetrated on patients is that of generalizing about causes, triggers and cures. If someone has headaches and they also consume caffeine the patient’s irresponsible use of coffee products must at least be a contributing factor, right? While that is something that most neurologists are promoting currently they have no proof that that is the case in every instance, for example.

    • ben kelley says:

      “Post hoc ergo propter hoc” has plagued science and medicine since early times, and no doubt will continue to do so. But what is dangerous in Sarno’s work? Nothing that I can discern, except that for some subjects it may not work – as is true of any procedure.

    • Danielle says:

      I see that I am responding rather late, but thank you Jim for your post. And to Todd for the article.

      • Danielle says:

        I just read this quote on Wikipedia’s TMS page

        “According to Schechter, the education allows the patients to “learn that their physical condition is actually benign and that any disability they have is a function of pain-related fear and deconditioning, not the actual risk of further ‘re-injury.”

        As someone who has fought tirelessly for diagnoses for my pain, despite many initial examinations/doctors sending me away with nothing, I find this quote idiotic and terrifying.

        How does Sarno know that the tests we have available today, or are most common, just aren’t good enough to determine what the patient’s problems are? Look at the history of medical science! there are so many conditions that were misdiagnosed for centuries/decades until the right diagnostic tests were developed and all of a sudden, “Oh yes, now we know exactly what’s wrong.” And in previous decades those patients were told they were insane, or attempts were made to cure them through methods we now know weren’t even close to touching the real problem. The audacity and arrogance of modern doctors/healers to think we currently have ALL the answers to every ailment and therefore any ailment with unknown etiology and treatment must be psychosomatic is disgusting.

        I’m a prime example. By not giving up, and not taking doctor’s “oh i don’t see anything wrong” for an answer to my pain, I have learned that I have all kind’s of structural issues that are the roots of my pain. Many required more extensive and less commonly used imaging and testing to discover. Some of my doctors were just lazy, and it was easer for them to blame me and send me home than to pursue answers with me.

        I had a blocked maxillary sinus on the right side, a deviated septum, nasal polyps, and pretty darn big turbinates that were causing me all kinds of sinus problems. But for two years I suffered and was told that systemic candida was the cause of my sinus pain (naturopaths), or that there was nothing wrong with my sinuses at all (ENTs). All it took was a CT scan to show the blocked sinus and deviated septum, and surgery to correct the problems.

        I spent years getting injections in my SI and Facet joints that did nothing for my back pain. My X-rays, MRIs, and CT scans all looked normal. I didn’t have ankylosing spondylitis. I was told there was nothing causing my pain. I wasted thousands of dollars and my precious time with alternative medicine. I finally convinced a doctor I had piriformis syndrome, and a kind of MRI called a neurogram showed that I am one of a small percent of the population that has a split sciatic nerve through the piriformis. That is what causes my symptoms.

        In both of these examples, no amount of emotional venting or cognitive behavioral therapy would change the sources of my chronic pain. They have physical structural sources. But that didn’t stop pretty much all of the alternative health practitioners I saw from telling me I WAS CAUSING THE PAIN WITH MY THOUGHTS.

        If pain that can’t be easily diagnosed is automatically attributed to the mind, it absolutely is dangerous to the patient’s health and well being. They will never improve if the problem is, in fact, physiological. They WILL risk rein jury, and they will waste precious time and energy that could be spent actually finding out the causes of their pain, which would allow them to better treat and manage it. Not to mention the psychological frustration and suffering that comes from the invalidation of ones pain that is NOT coming from an emotional source.

  53. ben kelley says:

    Interesting essay. I have tried to read it with the same skepticism I bring to Sarno’s work.

    You state:

    “TMS proposes that the purpose of chronic pain is not to protect the body, but to repress emotion. To accomplish this goal, the brain harms the body by inducing hypoxia – on purpose! Here we have two polar opposite explanations of the brain’s intentions in relation to chronic pain – one is that pain is intended to protect the body, the other that pain is the result of the brain’s attempt to harm the body. Sarno’s view seems completely counterintuitive and raises several questions from an evolutionary perspective.”

    You importantly mischaracterize Sarno’s view as I understand it. He does not assert that pain induced by TMS harms, or is intended to harm, the body. On the contrary, he believes it does not harm the body in any way and therefore can be ignored. In fact, he seems to believe that the brain’s generation of TMS pain is, in a sense, meant to protect the whole person – protect her/him from the psychic pain of exposure to “unacceptable” emotions which are being repressed.

    If one subscribes, even tentatively, to the idea that the psyche and the soma are interactive in ways that are not clearly understood but are discernible experientially, Sarno’s approach cannot be written off on the bases offered in this essay. More to the point for pain sufferers, its downsides seem minimal and its potential benefits suggest it is worth a try. It clearly is not quackery and – unless one believes that Sarno and his colleagues have simply invented case histories and small-group statistics – it clearly has some merit.

  54. peter s says:

    Very informative post and comments. I thought the comment by Leon Foro was particularly well reasoned, and I would love to know who he is and contact him, but perhaps it is a pseudonym because a Google search comes up empty. Does anyone know?

  55. Malia says:

    Hi, I have not used dr sarno,s book yet, but I am thinking about it. I have fibromyalgia
    And before i. Developed fibromyalgia , i was going through a lot of stressful events in
    My life . And even after, even now . I know lots of people have stress in their life but don’t
    Develop fibromyalgia . But most people suffer from some kind of disease or other.
    Even if you have heard of Vipassena Meditation , they tell you to observe. All. Your emotion. And. Feelings and the sensation in your body without any judgement and watch
    It till. It disappears. If you do that continuously. Then all your negative emotions will disappear , and your bodily pain will go away too. Also , how often you hear that. Stress
    Is The mother of all diseases . The mind or brain. Might not do this selection . But may be is the nature of the body that when, the emotion. Is suppressed. In the body , it . Causes. Disease in the body , naturally Where else ? So. It is not that strange that releasing the negative emotions could bring well being And health .

  56. Gene S says:

    I am not a Dr. nor scientist I’m an Electrician. I have been suffering with Sciatic pain for months. After being given Sarno’s book by a friend and taking the leap of accepting the idea “it could all be in my head” I’m pain free. I am not knocking but thankful. To my point: Dr. Atkins was telling us Bacon Good Pasta Bad!. Today we realize that there is credibility behind what Atkins was saying but to a degree. Most all physicians tell us low carbs diets and healthy fats. But to have bacon on a bacon hero with a side order of bacon with a tall glass of bacon fat will just simply put us right in the grave. Moving forward will there be combined treatments of mental and physical therapy with surgery as a last resort? Homeopathy, naturopathy, energy medicine and acupuncture are forms of eastern medical approaches. They don’t work for all ailments but do have benefits for other ailments. When I tell my doctor I go to Acupuncture his response is “What ever helps”. I just feel that we all have bottled up rage, anger, to varying degrees. Does the brain protect itself by masking the emotions and sending signals to other parts of the body in the form of pain signals, I don’t no? But when people go on these starvation diets doesn’t the brain have the ability to sense this and burn muscle and not the fat up to a point? I just think the brain has many programs running in the background that we still haven’t downloaded and won’t for many years to come. We need to be more accepting of mind body healing. If it works don’t knock it.

  57. John Skicewicz says:

    Never read anything that Sarno wrote.
    Had recurring and sometimes debilitating back pain from the time I was 16 until early 30s.
    Saw the 20/20 segment on Sarno.
    I was astounded.
    The next time I had the familiar twinge in my back, I reminded myself that my back is strong, I’m not falling apart, and it will feel better soon.
    Next day better.
    Next day, pain free.
    This has been the pattern ever since.
    I tweak my back occasionally, but. I’ve never had the floor hugging debilitating pain since I saw the TV segment.
    Almost ashamed to admit that this wacky story is true.
    Glad that bright minds are trying to figure out why!

  58. Levi Z. says:

    Interesting and thoughtful post. However, I think that all this academic analysis about why the mind creates or perpetuates the pain is meaningless and unhelpful to people who are actually dealing with daily chronic pain. I fear that people using Sarno’s TMS model may become discouraged by reading this and may start viewing the process skeptically which may then lead to an unnecessary continuance or worsening of pain.
    Whether or not Sarno’s Freudian hypothesis about the unconscious mind using pain as a distraction from repressed emotion is precisely accurate — well, to me it makes sense — and others may disagree.
    But the key points here is that (A) the mind is needlessly creating the pain and (B) that there is nothing physically wrong or ‘broken’ in the body, and therefore C) the person should go about doing their usual physical activity without fear of further pain or re-injury. That is what matters to the person experiencing the constant pain, everything else is essentially irrelevant and academic.

  59. Albert says:

    I had lower back, upper back and neck pain for years. In 2005 I found out about Dr. John Sarno, applied myself accordingly, got rid of my pain quickly, and haven’t had pain since. My old pain used to include stabbing pains in my lower back. I take a mind/body/spirit approach. When I meditate I can feel my spirit energy flow within me. I noticed the energy flow would be blocked right by where I felt pain. If I found out what psychological issue caused the pain and let it go, the block would clear and the pain would away. This happened more than once. Regarding supposed pinched nerves, isn’t it true that the dendrites of a nerve cell need to receive a chemical signal before a nerve is activated? Things such as bulging discs and collapsed vertebrae don’t make contact with dendrites.

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