Back pain is a condition that many doctors consider to be psychosomatic. Many, but not all. In fact, many medical doctors, chiropractors, and physical therapists see back pain as just a physical problem. Some may prescribe rest where others would prescribe exercise, but these professionals believe in focusing treatment on the physical pain.
But it is also true that there has been a growing movement in the medical community, over the past few decades, to deal with back pain as essentially a psychosomatic phenomenon. This approach was initiated by John Sarno. While Dr. Sarno has impeccable credentials — Professor of Clinical Rehabilitation Medicine at the New York University School of Medicine, and Attending Physician at the Howard A. Rusk Institute of Rehabilitation Medicine at New York University — his approach is not generally shared by mainstream medicine. Part of the problem may be that it is difficult for the medical community to shift to a totally different paradigm. Part of the problem is also that, while Dr. Sarno has successfully treated thousands and thousands of patients, his approach has never been validated through standard clinical trials.
The purpose of this article is not to argue whether or not the medical establishment should endorse Dr. Sarno’s approach. We are not concerning ourselves with the issue of whether or not back pain is always psychosomatic. The important word in the previous sentence is “always”. What we definitely know from Dr. Sarno’s work is that back pain is psychosomatic at least some of the time.
The word “psychosomatic” is all too often taken to mean “imaginary illness”. So it bears reaffirming that, while back pain is a very real pain, the “psychosomatic” hypothesis means that this very real pain is originally initiated by emotional factors.
Dr. Sarno calls this condition “Tension Myositis Syndrome” (Abbrevaited as “TMS”). He describes it in such books as “Mind Over Back Pain” (1982), or “Healing Back Pain: The Mind-Body Connection” (1991). He further expanded on the topic in “The Mindbody Prescription: Healing the Body, Healing the Pain” (1998) and “The Divided Mind: The Epidemic of Mindbody Disorders” (2006).In the following paragraphs, I will attempt to summarize these works.
According to Dr. Sarno, what is causing the pain is not a structural problem, but a mild oxygen deprivation which causes pain in the affected muscle. TMS affects not just the upper back or lower back, but also the neck, the knees or even the feet. For instance, oxygen deprivation in the sciatic nerve is what, according to Dr. Sarno, causes numbness, tingling, pain and weakness in the leg; this is in contrast to the traditional understanding of sciatica, assumed to be due to a structural cause, such as a herniated disc. According to Dr. Sarno, oxygen deprivation will also cause painful tendons in the knee, or rotator cuff “injuries” in the shoulders.
What is confusing is that modern methods of inquiry, such as MRIs, often show some structural abnormalities, for instance in tendons or in cartilage. Noticing this, it is tempting to assume that there is a causal link between the structural abnormality and the pain. However, Dr. Sarno quotes studies showing that similar structural abnormalities are present in people who suffer no pain. Therefore, it cannot be assumed that these abnormalities are the cause of pain in people who experience pain.
Dr. Sarno’s thesis is that this oxygen deprivation is a side effect of the same mechanisms that help people “cope” with some emotional issues (we will discuss these in the next paragraph). The back, the neck, the joints, happen to be the areas where the effects of this mild oxygen deprivation are most acutely felt.
Based on the large numbers of people that he has treated over time, Dr. Sarno has developed a sense of what psychological problems are more likely to create this response of oxygen deprivation. Essentially, we are talking about a dysfunctional response to stress, including self-inflicted pressure. This affects perfectionists, who tend to be self-critical (as opposed to “Type A” people, who are very aggressive toward others). This also affects “people pleasers” who put a lot of pressure on themselves by putting others first. Lastly, Dr. Sarno also sees TMS as the result of residual anger, developmental and otherwise. The oxygen deprivation is part of the coping mechanism that helps these people cope all-too-well, thereby repressing their pain or anger. Intuitively, it makes sense to think of this as “swallowing your emotions” or “not breathing to avoid feeling”.
There is an additional layer of complexity. As a result of the back pain (or shoulder pain, or neck pain, etc.), people develop phobias about the affected areas; they’re afraid of getting into activities that might involve their back, or shoulders, etc. When they do get involved in such an activity, they’re very tense, and this further increases the risk of pain. In fact, Dr. Sarno has raised the hypothesis of what he calls “physicophobia” – a pervasive fear of activity which may be partly a result, and partly a cause, of TMS. es to being a perfectionist, a people pleaser, or somebody with a lot of repressed anger and rage, or somebody who has “physicophobia”…
In any case, the goal of this article is not to prove or disprove the diagnosis of TMS, or the wisdom of always/never dealing with it as a psychosomatic condition. And certainly not to suggest that you not seek medical attention for pain. It is just to suggest that there may be a different perspective about your back pain, shoulder pain, neck pain, knee pain… That there may also some physical consequences to being a perfectionist, a people pleaser, or somebody who represses anger, or somebody who has “physicophobia”…