Healing Back Pain: The Mind-Body Connection – John E Sarno

Date read: 2019-10-30

Rating: 10/10

Amazon page.

If you’re conscientious, hard-working, responsible, perfectionist, ambitious, it’s likely that your brain uses back pain (or other symptoms) to avoid experiencing powerful negative emotions like anger, anxiety, and low self-esteem. Worst-case scenario, if this book is a placebo, then it’s cheaper than chiropractor/acupuncture/massage/physical therapy/surgery.

Source: “All The Rage” Documentary, and through Jody Kurilla.

Daily reminders or Summary for Psychosomatic Symptoms (back pain, trouble swallowing, panic attacks):

  • This is a harmless condition, caused by my repressed emotions
  • The principal emotion is my repressed anger
  • It exists only to distract my attention from the emotions
  • Since my body is basically normal, there is nothing to fear
  • Therefore, physical activity is not dangerous
  • And I must resume all normal physical activity
  • I will not be concerned or intimidated by the pain
  • I will shift my attention from the pain to emotional issues
  • I intend to be in control—not my subconscious mind
  • I must think psychological at all times, not physical

Book Notes:

I began to think that back pain was psychosomatic.

On back pain: over one hundred million people are now affected at a total cost in the United States exceeding one hundred billion dollars per year, of which two-thirds is lost to wages and reduced productivity.

The 2010 Global Burden of Disease study of 291 conditions ranked low back pain as the highest cause of disability.

The pertinent bias here is that these common pain syndromes must be the result of structural abnormalities of the spine or chemically or mechanically induced deficiencies of muscle.

Of equal importance is another bias held by conventional medicine that emotions do not induce physiologic change.

88 percent of the people seen had histories of such things as tension or migraine headache, heartburn, hiatus hernia, stomach ulcer, colitis, spastic colon, irritable bowel syndrome, hay fever, asthma, eczema, and a variety of other disorders, all of which were strongly suspected of being related to tension.

Experience has shown that the only successful and permanent way to treat the problem is by teaching patients to understand what they have.

Pain syndromes must always be properly studied to rule out serious disorders such as cancer, tumors, bone disease, and many other conditions.

If one has persistent pain anywhere, it is imperative to see a doctor so that appropriate examinations and tests can be done.

If the pain starts while one is engaged in a physical activity, it’s difficult not to attribute the pain to the activity. (As we shall see later, that is often deceiving).

But failure to treat the primary cause of the disorder is poor medicine; it is symptomatic treatment, something we were warned about in medical school.

TMS (Tension Myositis Syndrome) is a condition that usually leaves no physical evidence of its presence. There is a temporary constriction of blood vessels, bringing on the symptoms, and then all returns to normal.

A command decision by the mind to produce a physical reaction rather than have the individual experience a painful emotion.

The years between thirty and sixty are the ages that fall into what I would call the years of responsibility. This is the period in one’s life when one is under the most strain to succeed, to provide and excel.

TMS can manifest itself in a variety of locations, and it tends to move around, particularly if something is being done to combat the disorder.

It is as though the brain is unwilling to give up this convenient strategy for diverting attention away from the realm of the emotions.

40 percent of a typical group of patients reported that the pain began in association with some kind of physical incident.

Some of the reported incidents were trivial, such as bending over to pick up a toothbrush or twisting to reach into a cupboard, but the ensuing pain might be just as excruciating as that experienced by someone who was trying to lift a refrigerator.

Physical happening was not the cause of the pain but was merely a trigger.

Many patients apparently don’t need a trigger; the pain just comes on gradually or they awaken with it in the morning. In the survey mentioned above, 60 percent fell into that category.

One of the most powerful systems that has evolved over the millions of years of life on this planet is the biologic capacity for healing, for restoration.

Our body parts tend to heal very quickly when they are injured.

Even the largest bone in the body, the femur, only takes six weeks to heal. And during that process, there is pain for only a very short time.

It is illogical to think that an injury that occurred two months ago might still be causing pain, not to mention one of two or ten years ago.

Once the diagnosis of TMS is made, it is common for patients to begin to recall all of the psychological things that were going on in their lives when acute attacks occurred, like starting a new job, getting married, an illness in the family, a financial crisis, and so on.

Or the patient will acknowledge that he or she has always been a worrier, overly conscientious and responsible, compulsive and perfectionistic.

Perhaps the most common, and undoubtedly the most frightening, manifestation of TMS is the acute attack.

The most common location for these attacks is the low back, involving the lumbar (small of the back) muscles, the buttock muscles, or both.

People often report that at the moment of onset, they hear some kind of noise, a crack, a snap, or a pop. I threw my back is a common explanation.

In fact, nothing breaks, but the patient will swear that there has been some kind of structural damage. The noise is a mystery. It may be that it is similar to the noise elicited by a manipulation of the spine.

It is not the occasion itself but the degree of anxiety or anger that it generates that determines if there will be a physical reaction. The important thing is the emotion generated and repressed, for we have a built-in tendency to repress unpleasant, painful, or embarrassing emotions.

Then there’s the person who says, “There was absolutely nothing going on in my life when this began.” But when we begin to discuss the trials and tribulations of daily life, it is usually clear that this person is generating anxiety all the time.

Once it is pointed out to them, these patients have little trouble recognizing that they are the kind of perfectionist, highly responsible people who generate a lot of subconscious anger and anxiety in response to the pressures of everyday life.

Delayed onset reaction, when the pain comes after a stressful situation:

  • It seems as though they rise to the occasion and do whatever they have to do to deal with the trouble, but once it’s over, the accumulated anxiety threatens to overwhelm them, and so the pain begins
  • Another way of looking at it is that they don’t have time to be sick during the crisis; all of their emotional energy goes into coping with the trouble
  • A third possibility is that the crisis or stressful situation is providing enough emotional pain and distraction that a physical pain isn’t necessary

The pain syndrome seems to function to divert the person’s attention away from repressed undesirable emotions like anxiety and anger.

Not uncommonly, people will report that they almost always have an attack of pain when they are on vacation, or if they already have pain that it gets worse on weekends.

They are very anxious about their work or business when they are away from it. It’s a bit like the delayed reaction; as long as they are on the job, they may be “burning up” the anxiety, but when they are away from it, supposedly relaxing, the anxiety accumulates.

Unless the relaxation process succeeds in reducing repressed anxiety and anger, people will develop things like TMS and tension headaches despite the attempt to induce relaxation.

Another explanation, often difficult for people to admit to themselves, is that there are great sources of anxiety and anger in their personal lives, like a bad marriage, trouble with children, having to care for an elderly parent.

One day she told me that she had done a very unusual thing; she had gotten furious at her brother, had shouted and ranted at him and stormed out of the house. And with that—the pain disappeared.

Big holidays usually mean a lot of work. Usually they are completely unaware that they are generating great quantities of resentment, and the onset of pain comes as a complete surprise.

They have been told and they have read that the back is fragile, vulnerable and easily injured, so if they try to do something vigorous, like jog or swim or vacuum the floor, their backs begin to hurt. They have learned to associate activity with pain; they expect it, so it happens. That is conditioning.

Occasionally I am called upon to advise someone having an acute attack; as stated earlier in the chapter, it’s essentially a question of waiting it out. I may prescribe a strong painkiller but not an anti-inflammatory drug, since there is no inflammation.

Except for the very brave few, most people who have had such an attack never again engage in vigorous physical activity with an easy mind.

That is the purpose of the syndrome—to create a distraction so that undesirable emotions can be avoided.

The kinds of feelings referred to are anxiety, anger, and low self-esteem (feelings of inferiority).

Stress can be either external or internal to the individual. Examples of external stress are your job, financial problems, illness, change of job or home, caring for children or parents.

However, the internal stressors appear to be more important in the production of tension. These are one’s own personality attributes, like conscientiousness, perfectionism, the need to excel, and so forth.

Typically, they are more critical of themselves than others are of them.

She may also tell you that it is important to her that everyone like her, that she gets very upset if she feels that anyone is displeased with her. (This compulsion to please is, of course, not limited to women; a middle-aged man expressed identical sentiments in my office recently).

You also know that you are conscientious, hardworking, a worrier, perhaps compulsive and perfectionistic.

Like stomach trouble, colitis, hay fever, tension headache, migraine headache, acne, hives, and many other conditions that seem to be related to tension.

Someone said that every night when we go to sleep, we all go quietly and safely insane, because that’s when the remnants of childish, primitive, wild behaviors that are a part of everyone’s emotional repertoire can show themselves without being monitored by the waking, conscious mind.

The human mind is something like an iceberg—the part that we are aware of, the conscious mind, represents a very small part of the total.

We generally overcompensate for bad feelings, so if we feel weak, we act strong.

It is likely that for most of us, the compulsive need to do well, succeed, and achieve is a reflection of deep-seated feelings of inferiority.

As soon as he became aware that the source of his symptoms was inner tension, the pain disappeared. As will be seen later, awareness is the key to recovery from TMS.

Anything that makes us anxious (all unconscious) will tend to make us angry as well.

An important source of anger and resentment, of which we are usually unaware, stems from our sense of responsibility to those who are close to us, like parents, spouses, and children.

Though we love them, they may burden us in many ways and the resultant anger is internalized. How can one be angry at elderly parents or a baby?

But he was a good man, and his parents couldn’t help it if they were getting old. So his natural (intrinsic, unconscious, narcissistically inspired) annoyance (anger, resentment) was completely repressed and, for reasons that shall be clarified shortly, gave rise to the recurrence of back pain.

The combination of real concern and love for the family member and inner resentment of the duties and responsibilities associated with the relationship is a source of deep conflict, the stuff of which TMS is made.

He was probably more than angry—he was in a rage, and the need to repress it, both unconsciously and consciously, necessitated some kind of reaction, hence the panic attack.

I have learned that heartburn means that I’m angry about something and don’t know it. So I think about what might be causing the condition, and when I come up with the answer, the heartburn disappears.

From Freud Biography: “Rather, the unconscious proper resembles a maximum-security prison holding anti-social inmates languishing for years or recently arrived, inmates harshly treated and heavily guarded, but barely kept under control and forever attempting to escape”.

The role of the pain syndrome was not to express the hidden emotions but to prevent them from becoming conscious.

To be successful, it must occupy one’s attention, and it works even better if you are totally preoccupied or obsessed by whatever it is. That is why physical defenses are so good: they have the ability to really grab one’s attention, particularly if they are painful, frightening, and disabling.

A patient can transfer from one to another. For example, excellent drugs have been found to reverse the pathology of peptic ulcer. As a result, the mind simply shifts to another physical disorder.

The back surgery and ulcer treatment didn’t alleviate his basic problem; they merely acted as placebos and mandated a shift in the location of his physical symptoms.

What one sees is truly a physicophobia, a fear of physical activity.

People who were abused as children, emotionally or physically, but especially sexually, tend to have enormous reservoirs of anxiety and anger.

It is at this point that the patient will say, “All right, you’ve convinced me. I understand why I’ve got this pain. Now how in the world do I change my personality, solve my problems (especially the insoluble ones, like my ninety-year-old mother), stop generating anger and anxiety, and stop repressing my feelings?”

A small number of patients will have to be in psychotherapy to recover, but they represent less than 5 percent of the total.

The rest will get better simply by learning all about TMS and changing their perceptions about their backs.

Repressed emotions like anxiety and anger set in motion a process in which the autonomic nervous system causes a reduction in blood flow to certain muscles, nerves, tendons, or ligaments, resulting in pain and other kinds of dysfunction in these tissues.

It has long been recognized that heat, introduced into muscle by diathermy or ultrasound machines, will relieve back pain temporarily. So will deep massage and active exercise of the muscles involved.

All three of these physical measures are known to increase blood flow through muscle. Increased blood flow means more oxygen, and if that relieves pain, it is logical to assume that oxygen deprivation was responsible for the pain.

It is of great interest that both muscle spasm and this chemical buildup can be observed in long-distance runners, whose muscles suffer from oxygen deprivation.

The most important factor in recovery is that the person must be made aware of what is going on.

Some patients will respond to physical therapy and/or the physical therapist with a placebo reaction.

From a strictly physical point of view, TMS is harmless; therefore, they had nothing to worry about physically.

It’s a bit like blowing the cover on a covert operation. As long as the person remains unaware that the pain is serving as a distraction, it will continue to do so, undisturbed. But the moment the realization sinks in (and it must sink in, for mere intellectual appreciation of the process is not enough), then the deception doesn’t work anymore; pain stops, for there is no further need for the pain.

It will no longer have the ability to attract the attention of the conscious mind; the defense is a failure (the cover is blown, the camouflage is removed), which means the pain ceases.

What one must then do is develop the habit of “thinking psychological” instead of physical.

I suggest to patients that when they find themselves being aware of the pain, they must consciously and forcefully shift their attention to something psychological, like something they are worried about, a chronic family or financial problem, a recurrent source of irritation, anything in the psychological realm.

Resume Physical Activity. Perhaps the most important (but most difficult) thing that patients must do is to resume all physical activity, including the most vigorous.

It means unlearning all the nonsense about the correct way you are supposed to bend, lift, sit, stand, lie in bed, which swimming strokes are good and bad, what kind of chair or mattress you must use, shoes or corset or brace you must wear, and many other bits of medical mythology.

“There’s nothing like a little physical pain to keep your mind off your emotional problems.” Charles M. Schulz.

Discontinue All Physical Treatment. Another essential for full recovery is that all forms of physical treatment or therapy must be abandoned.

Manipulation, heat, massage, exercise, and acupuncture all presuppose a physical disorder that can be treated by some physical means. Unless that whole concept is repudiated, the pain and other symptoms continue.

Exercise for the sake of good health is of course something else, and it is strongly encouraged.

Daily reminders or Summary:

  • The pain is due to TMS, not to a structural abnormality
  • The direct reason for the pain is mild oxygen deprivation
  • TMS is a harmless condition, caused by my repressed emotions
  • The principal emotion is my repressed anger
  • TMS exists only to distract my attention from the emotions
  • Since my back is basically normal, there is nothing to fear
  • Therefore, physical activity is not dangerous
  • And I must resume all normal physical activity
  • I will not be concerned or intimidated by the pain
  • I will shift my attention from the pain to emotional issues
  • I intend to be in control—not my subconscious mind
  • I must think psychological at all times, not physical

Patients are instructed to give it two to four weeks and then call me if they have not made sufficient progress.

If the someone hasn’t improved after attending the lectures. Some of the possible reasons are:

  1. They accept 90 percent of the diagnosis but still have some concerns that the herniated disc demonstrated on the CT scan or MRI has something to do with the pain
  2. They find it hard to believe that this thing can go away with just an education program
  3. They accept the diagnosis but can’t get up the courage to begin physical activity

The secret of getting over TMS is not changing oneself but simply recognizing that the combination of the realities of life and personality generate an enormous amount of anxiety and anger.

Yes, anger too. She has probably never acknowledged the fact that although she adores her three little girls, she is simultaneously angry at them for what they require of her.

But the occurrence of an acute spasm means that there has to be something psychological going on, because TMS is an emotional barometer.

It’s always reassuring to know that there are others going through the same thing you are.

Although about 95 percent of our patients go through the program without psychotherapy, some will need such help. This means simply that they have higher levels of anxiety, anger, and other repressed feelings

These are not people suffering mental illness; these are people who are leading normal, productive lives but who have subconscious emotional baggage that they have never been aware of.

The reality is that only a small proportion of the back pain population would be open to the diagnosis, and it is a waste of time and effort to try to treat someone who could not accept the TMS diagnosis.

One of the reasons I know the TMS program does not induce a placebo reaction is the fact that almost all patients have permanent resolution of symptoms.

A second reason is that the placebo effect is based on blind faith; patients know little or nothing about the disorder they have and the rationale for treatment. They simply trust the treating practitioner. The educational program employed in the treatment of TMS is the very opposite. I teach patients literally all I know about the disorder.

Running is not bad for the spine; weak abdominal muscles do not cause back pain; strong back muscles do not prevent back pain; it is perfectly all right to arch the back, swim the crawl or breast stroke; man was meant to walk upright

I don’t treat pain! That would be symptomatic treatment, and it’s poor medicine.

Chronic pain is a separate disease entity, an exaggeration of the pain of some persistent structural abnormality that develops because patients derive what psychologists call “secondary gain” from the pain. That is, the pain brings them some psychological benefit, like attention, money, or escape from the world.

It’s essential to know that almost all of the structural abnormalities of the spine are harmless. With that in mind, let’s take a look at the common conventional diagnoses.

Pain is, has been, and always will be a symptom. If it becomes severe and chronic, it is because that which is causing it is severe and has gone unrecognized.

Proclaiming that emotional ills were the result of chemical abnormalities of brain function and that all that one had to do was discover the nature of the chemical defect in each disorder and then correct it with a pharmaceutical product.

According to them, depression and anxiety are simply derangements of brain chemicals.

If you treat the patient with chemicals, you are practicing poor medicine by treating the symptom rather than the cause.

TMS is equivalent to peptic ulcer, spastic colitis, constipation, tension headache, migraine headache, cardiac palpitations, eczema, allergic rhinitis (hay fever), prostatitis (often), ringing in the ears (often), and dizziness (often).

Anecdotally, I have seen laryngitis, pathological dry mouth, frequent urination, and many others serving the same purpose.

Alexander suggested doing away with the term psychosomatic medicine since it was redundant—everything medical is influenced in some way by the emotions.

It is important to make it clear that people do not do these things to themselves.

Their emotional patterns were well established long before they reached the age of responsibility and that what they are now is a result of a combination of genetic and developmental-environmental factors over which they had no control. Might as well take responsibility for how tall you are or the color of your eyes.

They say it is cruel to suggest to patients that emotions may have contributed to the onset of the cancer; it makes them feel guilty and responsible.

It makes a world of difference how you introduce the subject to patients. You don’t bludgeon them with the information and make it sound as though they are emotionally defective.

Book for further research:

The Healer Within by Steven Locke, MD, and Douglas Colligan (New York: Dutton, 1986).

The same thing is at the root of all of them—repressed, undesirable emotions.

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