Though he may not be a household name, Sarno is probably America’s most famous back pain doctor. Before his death on June 22 2017, a day shy of his 94th birthday, he published four books and built a cult-like following of thousands of patients — including Howard Stern and Larry David.
He inspired people — and still does. He managed to write best-selling books and attract patients from across the country to NYU. He’s the subject of a 20/20 feature and a recent documentary, All the Rage: Saved by Sarno, that was screened around the world. Sarno’s followers continue to record their stories on their “Thank You, Dr. Sarno” project. “I know you never liked hearing it, but I owe my life to you,” Ted H. wrote on the blog.
Sarno believed our brain uses pain to distract us from experiencing negative emotions.
Doctors have overwhelmingly failed people with back pain. Many of the most popular treatments on offer — bed rest, spinal surgery, opioid painkillers, steroid injections — have been proven ineffective in the majority of cases, and sometimes downright harmful. Only in the past couple of years, with the rise of the opioid epidemic, has the medical establishment begun to acknowledge this failure and suggest people explore alternatives for their sore backs.
Enter John Sarno. A specialist in rehabilitation medicine, he had very different notions about the causes of back pain than his medical peers. Sarno was most active during the 1980s and ’90s, a time when back discomfort was thought to arise mainly in the presence a mechanical problem (a bulging disc, say, or joint arthritis). Instead, he argued the painwas actually the result of a psychosomatic process and emotional factors.
More specifically, he believed that the brain distracts us from experiencing negative emotions by creating pain. We may not want to accept the uncomfortable truths that we are angry with our children, or that we hate our job, so instead of thinking those thoughts, we focus on the pain.
He also thought that pain was created by reduced oxygen and blood flow to the muscles and nerves of the body. So our brains unconsciously direct blood away from certain areas of our body, and that creates pain. (If this focus on the unconscious mind sounds familiar, it’s because Sarno was heavily influenced by Freud. His book The Divided Mind was all about psychosomatic medicine, including Freud’s pivotal influence.)
Sarno coined a term for his diagnosis — “tension myoneural syndrome” — and believed many people could overcome their pain simply by acknowledging its psychosomatic origins. He instructed many of his patients to journal or seek out psychotherapy to gain a better understanding of the emotions they were repressing that generated their chronic back pain. He also advised they immediately resume physical activity, that it would make them better and not worse.
To get a feel for his approach, here are some of the dos and don’ts from Healing Back Pain, published in 1991:
Back pain dos and don’ts in John Sarno’s Healing Back Pain.
It’s now mainstream to view chronic back pain as a “biopsychosocial” condition — meaning biological factors (such as a person’s weight or spine structure) may play a role but psychological and social factors can too. Researchers have found, for example, that people who are under stress or are prone to depression, catastrophizing, and anxiety tend to suffer more with chronic back pain, as do those who have histories of trauma in their early lives or poor job satisfaction.
“Was [Sarno] the first person to discover the mind-body connection? Of course not,” said Dr Harold Schubiner. “But Sarno popularized it [in the area of back pain].”
Sarno-esque approaches are slowly catching on
There were other things Sarno got right, whether or not the science of his time backed him up. He was also a strong advocate that people with back pain shouldn’t take bed rest and stop their daily activities, which were pretty mainstream remedies in the 1980s and ’90s, when he was publishing his books.
Doctors now think that bed rest is a very bad idea in most cases, and studies comparing exercise to no exercise for chronic low back pain are consistently clear: Physical activity can help relieve pain, while being inactive can delay a person’s recovery.
Sarno-esque approaches are slowly catching on for back pain. The evidence is mounting for “multidisciplinary rehabilitation,” for example. This approach views back pain as the result of the interplay of physical, psychological, and social factors. Practitioners do things like help patients get treatment for their depression or anxiety, or guide them through cognitive behavioral therapy to improve their coping skills as part of their back pain therapy.
Howard Schubiner, MD, is the founder and director of the Mind-Body Medicine Center at Providence-Providence Park Hospital and has co-authored several studies looking at the impact of Sarno-style pain management. The most recent, published in the journal Pain, was the first large-scale randomized controlled trial to show that guiding people with chronic pain (in this case, caused by fibromyalgia) through how to process and express powerful emotions such as anger worked better than regular cognitive behavior therapy at reducing fibromyalgia symptoms.
Sarno also intuitively understood that anatomical abnormalities like lumbar disc bulges are not actually the source of pain for many people — and called these injuries “normal abnormalities.” Research over the past two decades has piled up to prove him right. For example, when you compare people with the same MRI results showing the same back injury — bulging discs, say, or facet joint arthritis — some may experience terrible chronic pain while others report no pain at all.
At the end of the Sarno documentary, his fans from the “Thank You, Dr. Sarno” project present him with a book of people’s healing stories. Sarno says, “All of this because of one simple idea: the fact that the mind and the body are intimately connected. That’s it. That’s the whole story.”
Michael Galinsky, the maker of the documentary, explained why this line from the documentary resonated. “While that might seem to be an obvious truth, the biotechnical approach to medicine essentially negates it in regards to practice,” Galinsky said. That’s now slowly shifting, but it took an unprecedented opioid epidemic — instead of a charismatic doctor — to spur change.