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Showing 1-10 of 86 reviews(1 star). Show all reviews
on July 2, 2012
Let's face it: modern medicine doesn't quite have a handle on the nature of pain and its biochemical, psychological and physiological origins. The treatment of spinal pain, particularly the chronic variety, is one of medicine's most vexing problems. Even for the mildly afflicted, it is one of those alarming conditions that tends to rear its ugly head from time to time. About 80 percent of the population will experience back pain at one time or another and it is a leading cause of disability. What is lesser appreciated is this: Long-term studies designed to compare outcomes for back pain sufferers who undergo conservative, non-surgical treatment vs. invasive spinal surgery reveal that pain and disability levels on the whole are a lot more similar a decade or so later than not. All too often, spinal surgery fails to offer a permanent cure. Doing little or nothing at all may also result in a remission of symptoms.

Except that hasn't been my experience.

I have suffered constant, injury-related spinal pain for 14 years. I have the diagnostic tests to confirm my back pain's "discogenic" origin. I have owned Dr. Sarno's book "Healing Back Pain" for more than half as long as I've suffered. Recently I began to reread it.

It still makes me as incensed as it ever did. Only this time I'm here to explain why. (And please bear with the fact that this is my experience/opinion --- each is entitled to his or her own.)

Dr. Sarno's thesis is at turns fascinating and frustrating. It is fascinating in that so many people find relief from simply reading a book that in four words and broad strokes argues "It's in your head". It's useful in that it aims to convince readers who might otherwise live in fear of triggering a flare-up to go on and live life. It's frustrating in that Dr. Sarno, in encouraging a return to normal activity, fails to take credit for what amounts to a very conventional (and credible) approach: Becoming more active is the common denominator to many successful back pain reduction methods! It's ironic in that Dr. Sarno, while mentioning "body" in the title, really doesn't take much stock in the body at all. To the average person, the word "body" conveys a physical, biochemical system, but in Dr. Sarno's world only the mind matters in the quest to alleviate back pain. It is frustrating, finally, in that many of Dr. Sarno's claims pertaining to what medical science does or doesn't validate are outdated; his first book came out in 1984 and his medical training took place 40+ years ago. Consequently, his theories deny more current thought on the role of inflammation in many disease processes: The Anti-Inflammation Zone: Reversing the Silent Epidemic That's Destroying Our Health (Zone (Regan)).

In cases of severe nerve compression or unresolved joint damage (arthritis), tissues tend to hurt -- to what extent or for how long is the question. Pain may be a product of a stress-prone "personality structure", as the doctor argues, but to what degree it may also be a matter of environment, genetics, toxins and one's general health he doesn't address. The answer will no doubt vary according to individual, yet Dr. Sarno rejects the everyone-as-an-individual-case out of hand. He argues that psychological stress triggers a physiological reaction in which oxygen deprivation in the tissues forms the basis for what the doctor has coined "Tension Myositis Syndrome" or TMS. While the oxygen deprivation hypothesis is compelling, without further research Dr. Sarno cannot make an argument in support of his TMS thesis any more than he can disprove competing explanations or treatments on the basis of inadequate evidence. There are still too many unknowns in medicine -- and the understanding of pain in particular -- to issue iron-clad pronouncements about what is or is not to blame.

Dr. Sarno's book is heavily influenced by Freudian thought, minus the license to practice psychiatric medicine. The work relies largely on anecdotal observations wherein back-pain patients who endure an acute period of crisis or stress manage to "hold it together" only to suffer a dramatic pain episode after the fact. He writes of individuals who try to relax on vacation only to end up experiencing severe pain at the very moment they ought to feel footloose and carefree -- and then attributes his interpretation of cause-and-effect to an "overly-conscientious nature". Perhaps so, but the theory needs fleshing out and to my knowledge Dr. Sarno hasn't published the research and for that reason has yet to persuade the mainstream medical community to embrace TMS as a disorder.

Let's take Dr. Sarno's contention that nice people -- the overly-conscientious in his vernacular -- tend to suffer more numerous or persistent forms of pain and discomfort. By inference, those with narcissistic personalities, were they to be studied, should report the most feelings of physical well-being for they are less concerned about making friends and influencing people (or what others may think of them, in any case). Indeed, this would be an interesting psychological study: Do certain personalities experience less pain? Unfortunately, nowhere does Dr. Sarno indicate that such a study has validated his thesis that "personality structure" (quoting his words) is more influential than physiology in the perception of pain. The doctor postulates that repressed anger, specifically, is at the root of all sorts of phenomena from knee, jaw and back pain to allergies, ulcers and migraines. He describes his own experience banishing migraine pain by recognizing it as symptom of repressed anger. Similarly, he has alleviated allergy to cats by acknowledging the sniffles as the mind's particular manifestation of weakness. Someone less charitable might chalk it up to "learned denial"; the problem remains but one is convinced beyond a shadow of a doubt to ignore it at all costs. Not that putting pain out of one's mind is a bad strategy -- providing it's not due to a deadly spinal tumor as another reviewer here reported -- but let's acknowledge it for what it is!

Sans the occasional caveat about chest pain (could be the heart) and head pain (could be a brain tumor), Dr. Sarno's message comes down to a single claim: Acknowledge that pain is in the mind for this carries the power to release the mind from its devious plot to invoke physical symptoms to detract from subconscious mental processes (what Freud called "conversion disorder", otherwise known as hysteria).

Is it a snake-oil cure?

Not exactly. But a case of "too good to be true", it might. If chronic pain were straightforward, wouldn't a lot of us have figured it out already?

Dr. Sarno highlights the medical mysteries associated with the origins of pain, pointing out that it is not uncommon for pain to fail to correspond to objective medical indicators like X-rays and CAT scans. Sarno omits the conventional neurological explanation for this phenomena -- that recent injury can trigger diffuse inflammation in adjacent tissues or that a ruptured disc can leak content into the spinal canal that can inflame otherwise healthy nearby nerves. Instead, the failure of an anatomical abnormality to account for or correspond to patients' reports of pain, Sarno concludes, means that pain must be the mind's way of attempting to distract us from something else -- perfectionism, compulsions and anger to name Sarno's "big three" emotional culprits.

In Dr. Sarno's world, confusion over correlation and causation abound. If you buy this for a back problem, upon reading this you will also learn you have a psychiatric issue to boot! In the same era this book was originally published, recovered memory syndrome was all the rage with thousands of people laying claim to all sorts of repressed and buried atrocities from incest to Satanic cults. For some, such problems are all too real and psychological help is appropriate. And yet, for countless others, how many "healings" of the body have come about as the product of families and friendships split apart by an individual actively searching for a bigger, badder culprit to explain mundane physical and social problems? One of the testimonials printed in the last chapter comes from no less than a psychotherapist who says she looks forward to "healing" of sciatic pain even as she expresses her deepest appreciation to Dr. Sarno for helping her to uncover the real culprit: child sex abuse! Dr. Sarno might have opted to defer to mental health professionals but he doesn't. His book is very much geared toward the self-help reader, and he spells out his belief that all but the rare case is a DIY job. Therein lies the dangerous aspect of this book, all the more so for readers who are repressing deep, dark secrets!

Personally, much of my experience departs from Dr. Sarno's many anecdotes. One of my worst episodes of low back pain -- enough to hospitalize me for three days with absolutely no use of my lower limbs -- occurred while I was in no way, shape or form attempting to repress anger while in the midst of a difficult situation. And yet, here comes Dr. Sarno in his insistence that the physical pain of TMS can be alleviated through emotional honesty: He writes, "I recall a woman with a persistent pain problem who lived with a very difficult brother. Despite pyschotherapy the pain continued. One day she told me that she had done an 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."

Now here's the kicker, even by Sarno's own admission: "Unfortunately, she could not maintain her strong posture and the pain returned".

Seemingly it does not occur to Dr. Sarno that the above-described, or for that matter the soldiers studied in World War II who did not need heavy doses of morphine following serious battlefield injury -- another one of the doctor's cherry-picked examples -- might have another explanation? It's well known that powerful emotions, not unlike intense exercise, can trigger endorphins, oxytocin and adrenaline, among many other chemical states that alter mood and pain perception. It is likely that a biochemical state within the brain carries the power to interrupt or temporarily mask pain. The woman in the example, above, may not have been able to maintain her emotional resolve simply because the brain is unable to maintain a "biochemical high". Biochemical modification is one reason why antidepressants are sometimes used to control Fibromyalgia, among other chronic pain conditions: Meds of this type impact Serotonin and thus play a role in reducing pain in much the same way a powerful mood state or the powerful but temporary "fight or flight" response achieves a similar, performance-enhancing function. (Note that I am not endorsing any particular treatment, only referencing it as a point of contrast.)

Early on in the book the doctor intimates that if pain were a result of age, degeneration in the joints and old injuries no one should be more miserable than those of advanced age -- and yet it is working-age people, he argues, who suffer most. Dr. Sarno observes that most chronic pain originates during the "age of responsibility" between 30-60. His logic goes like this: because one isn't really "old" yet -- never mind that for much of human history living beyond age 50 WAS considered old! -- age and injury-related physiology must not be as important as psychology! If the medical studies do, in fact, confirm that people between 30-60 are more likely to report pain than the elderly -- and I don't know that they do -- there's another potential explanation: Pain in the elderly, compared to the working-age adult, may be less appreciated because A) as one progresses further in life one might not expect to keep up the pace of a working-age person, meaning the older one becomes the less likely one is to seek or receive the treatments offered to or sought by younger people; B) the elderly -- and more notably their doctors -- buy into society's expectation that pain is inevitable, as in "You're old. What did you expect?" Indeed, why complain to one's doctor about what may be perceived as *normal for one's age*? Whatever the reason why the elderly allegedly feel better (or complain less) than working-age adults, Dr. Sarno should have no doubt who struggles more with pain as an age group in their day-to-day lives. One need only observe who is more apt to undergo a hip or knee replacement, buy a walker or install bars in the shower -- stiffness, weakness, immobility -- it entails pain! (Which is why, despite enduring 14 years of pain, I, for one, am not about to visit an old folks home to profess a worse predicament!)

None of this is to say that Dr. Sarno isn't on to something. He's on to the fact that the mind is a very powerful tool. He understands that fear, anxiety and tension is only going to exacerbate "weak" areas of the body (and he admits he doesn't know why they are weak). Indeed, the depression that can accompany incapacitating pain is very real and the fear of returning to normal activity is frequently a handicap in and of itself. Even so, the doctor's hypothesis invokes the old chicken-or-the-egg, correlation vs. causation conundrum. Is a negative state of mind the primary cause of discomfort or is depression -- aka "anger turned inward" -- the byproduct of declining health, which may exhaust one's physical reserves and increasingly put to test one's coping skills?

In the end, Dr. Sarno's entire work pushes the limits of over-generalization and his anecdotes-as-evidence read like a classic case of confirmation bias. One might think the doctor's psychosomatic label would strike more readers than not as patently patronizing. So why is his book so highly regarded? For the same reason, I suspect, nearly *all* books and DVDs purporting to help people with back pain are highly rated: HOPE IS EMPOWERING.

False hope, on the other hand, is no placebo. It's a bitter pill to swallow. And yes, that's my beef!

Dr. Sarno's solution, in a nutshell, is this: Publish a work arguing that bodily pain is the physical manifestation of a repressed mind, market it to "type A" personalities who must feel they are in the driver's seat at all times -- with the turn of a page one can will pain away! -- sit back and hope that self-hypnosis, as conveyed through the pages of this book, kicks in to deliver the much-desired relief. Now don't get me wrong: If it works, more power to you! My main concern -- for which I post this review as a first-time "buyer beware" -- is that Dr. Sarno's work NOT become the basis for harsh judgments, pat answers and the "guilting" or shunning of people for whom it does not work. Yes, there is a mind-body connection to better appreciate in this and many other aspects of health. The problem with Dr. Sarno's take on TMS (pain) as a Freudian manifestation of conversion disorder is that in fixating on what is less-than-agreed-upon in medicine the book backfires on some of the very readers it is designed to reach. This triggers a left-brained, overly analytical or skeptical response rather than the "open minded" one the doctor's adherents claim is necessary! Worse, "Healing Back Pain: The Mind-Body Connection" is weak on solutions. Dr. Sarno spends the overwhelming majority of the book describing his psychosocial clinical observations while offering relatively few techniques to ward off full-fledged TMS. Instruction on meditation, stress reduction and body-awareness aren't provided because, in contrast to the title -- and this is absolutely key to understanding his approach -- the doctor would have his readers *ignore* the body state entirely. The mere realization that one is angry or overly conscientious IS the cure!

With or without this book, studies show most cases of back pain will resolve. My own long-standing experience with chronic pain notwithstanding, back injury is not necessarily a life sentence. Proper body mechanics and a return to an active lifestyle will itself help to improve quality of life. There is no mental magic in that.
2323 comments109 of 143 people found this helpful. Was this review helpful to you?YesNoReport abuse
on November 2, 2006
And yes, I do believe it's a big scam.

The sad truth of being human is that everyone feels anger and stress and fear. It's part of life (though first-worlders may do better at avoiding it than some). If back pain were caused by stress, or even just exacerbated by it, then people in refugee camps, soldiers, and people with serious illnesses like cancer would get it in higher proportion, right? But in all my reading, I've never heard that this is the case.

Doctors don't understand back pain, period. It used to be that they didn't understand stomach ulcers either and therefore also attributed them to stress. In this case also, quite a few patients felt better by adopting a less stressful life or eating bland food. Now we know that ulcers are caused by a bacteria and that this malady completely unaffected by food choice. Yet for years, doctors were convinced that their remedies were effective.

In my opinion, stress is a catch-all "cause" that is applied to many misunderstood diseases (particularly those common in women, but that's another subject). We all know stress is unpleasant, but does it really cause sickness? Couldn't stress just be an easy answer to a tough question? In the 19th century, temperment was thought to cause TB. And in the 17th century, strange illnesses were attributed to witchcraft. The human mind has trouble saying: I don't know. Doctors have trouble saying: I don't know why you're in pain.

Furthermore, Dr. Sarno offers no justification for leaving his theories untested by scientific method. Even a small double-blind study would be illuminating. It doesn't even have to be double-blind--just a study of some kind would be nice. Someday someone will figure out how the back works, and then Dr. Sarno's going to look like a big dummy. Frankly, I hope I'm around to see that.
1414 comments75 of 105 people found this helpful. Was this review helpful to you?YesNoReport abuse
on June 22, 2000
Sarno's thesis, that repressed rage and anxiety cause back pain in almost EVERY case, is ridiculous, unsupported mushy thinking. Just the fact that he lumps all kinds of other pain syndromes such as fibromyalgia and TMJ and bursitis under his umbrella of Tension Myositis Syndrome (TMS) should be a tip off that his theories are vague and unsupported by scientific rigor. Yes, we all have some repressed rage and some anxiety in our psychological makeup, so it is easy to "see one's self" in his typical patient profile. And yes, there surely is a Mind-Body Connection, but Sarno's work doesn't offer any original thinking or even a cogent explanation of what we currently know about this topic. A well-meaning friend sent this book to me. I have had 4 surgeries for a very painful, ongoing degenerative condition. Frankly, I was insulted by this book.
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on December 21, 2012
Twelve years ago....after suffering with a huge herniated disc pressing on the root nerve I decided to visit Dr. Sarno.
I was in a car accident years before the visit which left me with this ascending pain. I was on painkillers, had an MRI and taken physical therapy , all to no avail. The orthopedic surgeon said 85% of back issues will disappear themselves. The body takes car of the herniation and it will go away. I was the 15% that was still suffering after 5 months.

In trying to avoid surgery, my one last hope was Dr Sarno. His exam was quick and he was quite dismissive with the information I was telling him. The second visit was a room with about 50 people he tells to read his book and write down all things that make them sad, anxious and depressed. If this wasn't an embarrassment I don't know what is.. I already speak to a fantastic therapist....who needed Sarno to tell me such an elementary exercise. I do understand how tension, stress and anxiety can exacerbate pain...but turns out, I was the 15% who needed surgery.

Please seek therapy...way before you visit Dr Sarno. He is NOT a therapist and does not have the ability to analyze your mind. If I hadn't had surgery, I would probably be bed ridden and addicted to pain meds. I gave it lots of the time and psychotherapy for years . When the pain was humanly intolerable...surgery fixed the problem and I have never suffered that inhuman pain again.

Be patient with back pain......strengthen your core muscles,and seek therapy for emotional issues. My uninsured visit to Dr Sarno was to date the biggest waste of time and money I have ever experienced.
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on March 10, 2004
I bought this book after being diagnosed with a herniated disk. I understand where he is coming from by saying that the mind causes pain, if you do not face up to emotional problems, however my situation is different. I finished this book 2 weeks ago and my pain is no different. I have thought of everything that could be causing stress in my life and tried to believe that is where my pain came from. It did not work. I go to physical therapy and when I stretch my back, I feel a pinch on the nerve that is irritated. That is a definite mechanical problem. When I stand for a long period of time, I get pain down my leg. When I sit for more than 10 minutes, I get burning down my leg. During some of the most stressful times, my pain actually is better so I can't believe that the pain is only from stress. The book says not to do physical therapy for back pain. It says only exercise for health reasons. I can't do both. If I do physical therapy, then I am believing that my back pain is physical and if I drop it then I am saying it is mental. I don't feel this book works at all. I was very open minded and was let down. With the correct lumbar supported chair, my pain is reduced. Why is that if it is all mental pain?
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on July 12, 2009
Wow! Does this quack work for Kaiser or what? This story sounds familiar. Tell patient the problems resides in their head so you don't have to order potentially expensive diagnostic tests. Unfortunately I had to live this drama. Only after I educated myself and became my own advocate (and obtained different health insurance) did I receive an MRI which revealed, surprise, a massive disc herniation. The disc herniation was severely compressing the right L4 nerve root at the foraminal level causing what could have become permanent nerve damage (oh, you mean actual physical injury happens with great frequency?). After 18 years of misinformation to my parents initially, then to myself, I finally had validation. A minimally invasive microsurgical discectomy was performed by an extremely skilled orthopedic spinal physician more than 4 years ago and surprise, no more pain. This is not an isolated instance. I work with patients who experience this bs all the time. I have no pain or limitations to activity since the surgery was performed. Although the athletic desires of my teenage years and 20s were eliminated by quack medicine, I now feel great and have a rewarding career as a result. Save your money on this myth propagator, and demand improved healthcare instead!
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on April 12, 2001
When I purchased this book I was teaching yoga and was in great shape. I had a history of back trouble, but was managing it well. I was careful to bend my knees in certain postures and babied my lower back. This book convinced me that my back trouble was all in my head and that I shouldn't limit myself. I started working on forward bends to get my head to reach my knee (I had been told by my doctor that this was a no no). This resulted in full blown sciatica and my right foot is still numb 14 months later. Would Dr. Sarno say this numbness is all in my head?? I am now well on my way to recovery, but putting my head to my knee is no longer a goal of mine, nor do I believe it should be. While some illness certainly is psychosomatic, be careful with the information in this book or you may really hurt yourself!
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on May 20, 2009
Your back pain is a psychologically manifested from your problems in life...at least that is what John E. Sarno is trying to convince you to believe. Actually, he has probably gotten a lot of publicity because it give's psychiatrists the ability put people on psychotropic drugs for life. Yes the fact that you are probably over worked and underpaid is probably why you are ticked off and you have back pain. This book completely disregards the fact that people weren't made to sit in front of a computer 8 hours a day. Face it John Sarno- Our back's are messed up from an injury- too much work and not enough time to re-create and exercise.
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on May 8, 1999
My review never appeared here when I posted it two months ago, so I'm posting it again in hopes it will appear this time.
I read this book and faithfully followed everything it suggested, and it didn't work for me at all. In such cases, the book suggests that the reader should consult with a psychologist to see if their back pain might be due to unresolved psychological issues -- I did that and it didn't work for me either. Several years later, my back pain is just as bad, and it has since been diagnosed as fibromyalgia.
Although Dr. Sarno's techniques may work for some people, they certainly don't work for everyone.
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on May 16, 2007
I have had a re-accuring back injury for the past three months (keeps flaring up) so I purchased this book and read it. While I understand that holding tention in one's body can cause problems, he doesn't address that you really can have an injury. Also, he says that there is no right or wrong way to lift, bend or move and that there are no exercises that help. He says that all the pain is emotional pain. Well, there is something called PHYSICS and you CAN move in the wrong way to injure a muscle, tendon, ligament or even cause a herniated disc. Not to mention that am pretty in touch with my emotions. I don't hold a lot of stuff in. The book just seemed liked a bunch of balony with no basis in science. I would not recomment spending the money. Go see a good specialist.
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