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.
[...] 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 [...]
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.
The pain isn’t a way of repressing anger. It’s a consequence.
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?
…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.
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.
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!
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.
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
Great article! (Though I’d dispute your social-means-late assumption about evolution. Mammals have been highly social since before they were mammals.)
Thanks Dale,
My idea was highly social means late, but of course I wouldn’t really know. I guess I just can’t imagine that non primate mammals are little Woody Allens.
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.”
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!
Thanks Seth!
Todd,
Tomorrow’s blog post in Range of Motion at SomaSomple.com is about this thread.
Barrett,
Great I will be sure to check that out.
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
Jim,
Thanks. I have two friends who had huge improvements in back pain right after reading the book. I think right for the wrong reasons is a good way to put it.
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
Antonio,
Thanks for commenting, I think I agree with all your points.
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
Thanks Antonello, looks very interesting, I will put it on the (long) list.
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
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
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.
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.
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….
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.
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
Steph,
Sorry to hear about the pain. Good luck and let us know how it goes.
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.
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.
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
Thanks Michael. That’s a great quote, right on point. Thanks for sharing.
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.
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…
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.
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
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.
Hi Gary,
Thanks for sharing your experience. I’m glad Sarno helped and best of luck on a full recovery.
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).
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.
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
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.
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
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.
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!
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.
Thanks for the reference to Schubiner Matt, sounds interesting. There are many replies to this post, not sure why you can’t see them.
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.
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 ??
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.
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.
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.
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.:)
haha, the good Dr. got owned.
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”.
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…
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”.
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.
Hi Diaconnou,
Inspiring story, thanks for sharing. Congrats on the great result.
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…
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.)
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!!!
Congratulations Stephen, great to hear.
This isn’t ‘skeptical’ — it clashes with what you’re selling…
Hi Kroeger,
I’m not sure I understand your point. Can you explain in more detail?
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?
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.
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.
The claimed mechanisms at work in acupuncture are prescientific. Acupuncture has been proven over and over again to be little or no better than placebo for pain. Sham acupuncture works just as well as the real thing. See the Science Based Medicine blog for many good articles on this subject, including these:
http://www.sciencebasedmedicine.org/index.php/an-acupuncture-meta-analysis/
http://theness.com/neurologicablog/index.php/another-acupuncture-meta-analysis-low-back-pain/
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