The word “psychosomatic” is all too often taken to mean “imaginary illness”.
“If you ask people to ease up on you because you’re emotionally overloaded, don’t look for a sympathetic response; but tell them you’ve got pain, or some other physical symptom and they immediately become responsive and solicitous.”― John E. Sarno, Healing Back Pain: The Mind-Body Connection
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. Back pain is a condition that many doctors consider to be psychosomatic. Many, but not all. In fact, many medical doctors, chiropractors, and therapists see back pain as just a physical problem. Some may prescribe rest where others would prescribe exercise and/or analgesics, 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 Dr 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. Dr. Sarno calls this condition “Tension Myositis Syndrome” (Abbreviated 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) 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.
The back, the neck, the joints, happen to be the areas where the effects of this mild oxygen deprivation are most acutely felt. “It’s all in your mind” is almost insulting, implying there’s something strange or weak about you or that the symptoms are in your imagination. This is most unfortunate, since the symptoms are very real, the result of a very physical process.”― John E. Sarno, The Divided Mind