Having suffered from chronic back pain for a long time, this book was recommended to me. A lot of people I've spoken to about it have been very intrigued, so I thought I'd try my best to explain what the book is about.
The best way I can sum up the point of the book is that it is written to deprogram the sufferer of their beliefs about back pain. Dr. Sarno's mantra is that when it comes to the most common, debilitating type of back pain, "Knowledge is the cure."
The condition that Dr. Sarno identified is called TMS, which stands for Tension Myoneural Syndrome. This is a type of either acute or chronic pain that most often manifests in the muscles from the back of the neck, down through the middle back and lumbar area, to the buttocks. However, the pain is not only found in these muscles, but in associated nerves, and even in tendons. His belief was that the pain is caused by a lack of oxygen due to vasoconstriction in the affected areas. The vasoconstriction occurs because the sufferer is trying to ignore what's going on inside themselves, emotionally speaking. Eventually, the brain sends signals via the nervous system which cut off the oxygen supply to these muscles in order to cause pain that is strong enough to distract the sufferer from their unpleasant emotions. As anyone who has suffered from chronic pain will attest, it becomes a permanent part of your life, your personality; you have to factor it into almost every decision you make about what you might do today, or what you might do in the future. With such a big problem in your life, you aren't going to be focused on much else that is going on with you.
So that is Dr. Sarno's explanation for what most back pain is. But he goes into even greater detail about what back pain is not.
It was his contention, first and foremost, that the majority of back pain, which he would diagnose as TMS, is not structural. A common reason given by doctors for back pain is a 'slipped disc'. The disc bulges out from between two vertebrae and presses against the nerves running through the spine. However, Dr. Sarno says that actually, when long term pressure is applied to nerves, those nerves actually send fewer signals, i.e., numbness occurs, not pain. He also mentions in relation to disc problems, such as degeneration, that in the majority of humans, the disc between the L4 and L5 vertebrae actually degenerates by the time the person reaches around 20 years old, yet most people with this disc degeneration do not suffer any pain. Further to this point, there are groundbreaking studies where perfectly healthy people were given back scans. These were people with no back pain at all, but many of them had the physical, structural conditions which many people who suffer from chronic and acute back pain are told is causing it. These conditions, as well as the ones mentioned above, include things like scoliosis, spondylosis, etc. In other words, most structural problems with the human back are simply normal and no cause for concern.
And so, what Dr. Sarno really attempts to drill into the reader, is that TMS is totally benign. The condition is not dangerous; there's nothing physically wrong with you, and you should not worry. One sufferer who went for a consultation with Dr. Sarno was in extreme pain for a long time and had seen three or four specialists who all told him he was going to need serious back surgery (a common story for many of the Dr.'s patients). After doing an in-depth medical examination, medical history, and viewing of the patient's back x-rays, he told the patient there was nothing wrong with him. The patient was incredulous, and they spoke for a few more minutes about TMS. Eventually the man asked what he should do then, and Dr. Sarno asked him what did he liked to do. The man replied, "I like skiing", and Dr. Sarno said, "Then go skiing". He is one of thousands of people who after being exposed to Dr. Sarno and his work experienced a complete recovery from their pain in a short period of time.
Most people with chronic back pain can trace back and attribute it to a specific physical incident, either major or minor - the person was trying to lift something heavy, or was playing a sport, or they may have just been tying their shoelaces. From then on, as their condition worsens and lasts for a long time, maybe for their whole life, the idea of the physical cause is fixed. The associated stress, anxiety and fear caused by the condition itself exacerbate it further. Dr Sarno says that the physical incident was not the cause of the condition, but is more appropriately termed the 'trigger event'. The problem was already there; but the incident was the 'straw that broke the camel's back'.
Due to this physical assumption and explanation for the issue, the real cause is never discovered by the sufferer. They fixate on their physically caused physical condition, it takes over their lives, and the stress, anxiety, panic, fear and depression just continue to prolong the physical agony. As someone who has been confined to bed for long periods of time due to the pain, I can say that the fear of your back going again once you regain your mobility and independence is... 'crippling'.
Dr. Sarno's prescription for what to do when the pain attacks, based on the ideas he presents about the harmlessness of the condition, and ridding oneself of the false assumptions about its causes (sitting for long periods, a physical event, bending and lifting at the waist, having weak back or core muscles, poor posture), is to basically ignore it. Another mantra of his is, 'Don't think physical, think psychological'. The whole point of the pain is to get you to focus on it and to distract you from what is going on inside you. Some sufferers who took his ideas seriously and were cured of TMS have spoken in terms of laughing at the pain when it comes on. The idea is you must decondition yourself from the fear of the pain, from the worry and panic that habitually sets in when one experiences an attack, and start to remember all the ideas presented in the book: It's just pain; it's not serious; it's not structural; it's an emotional issue. The sufferer is encouraged to challenge their thinking, battle with their mind, even get angry at their thinking or angry at the pain: "I'm not gonna take this anymore! I don't need you to distract me from anything now! I'm not going to allow you to rule my life." In the past, the pain would force the sufferer to cancel plans they had or perhaps take time off work, but if they take Dr. Sarno's work seriously, instead they will go about their day as normal, and most find that the pain just goes away.
Another example of how the Dr. says one should go about reprogramming their mind, is that he recommends the immediate cessation of all types of physiotherapy and exercises that were prescribed in order to try to help the condition. It wasn't always his recommendation, and for many years, he worked with teams of physiotherapists to whom he would refer his patients. But eventually, after something of an inner struggle with himself over this practice, he decided that it was in the patient's best interest to not have physiotherapy because the physiotherapy was acting to enforce the patient's beliefs that the problem was a physical one. Dr. Sarno would admit that certain types of exercise, massage or stretching can alleviate the pain that comes from TMS, but it will not cure it. The only cure is to learn to feel and express painful emotions, buried traumas, and the stresses, tensions and anxiety everyone faces throughout their lives. For a minority of patients, some 5%, their emotional traumas were so deep that long-term relief or cure could only be realised through psychotherapy.
The book, and the good Dr. himself, are truly inspirational. Dr. Sarno was a fully qualified medical specialist who practised for years had the strength to admit to himself that the established narrative about back pain must be wrong, because the treatments based on it were randomly effective at best, and the bravery to suggest and implement something radical and novel, regardless of the effect it would have on his reputation and career. For many years, he was ridiculed and ostracized by his peers for his unorthodox approach, and never gained any recognition for his contributions to the science around pain and the power of the conscious and subconscious mind.
But for the many thousands of people who read his book or saw him personally for treatment, his work saved their lives and they all recognise and appreciate him for the stance he took against the medical establishment by putting them first, above anything else.
The best way I can sum up the point of the book is that it is written to deprogram the sufferer of their beliefs about back pain. Dr. Sarno's mantra is that when it comes to the most common, debilitating type of back pain, "Knowledge is the cure."
The condition that Dr. Sarno identified is called TMS, which stands for Tension Myoneural Syndrome. This is a type of either acute or chronic pain that most often manifests in the muscles from the back of the neck, down through the middle back and lumbar area, to the buttocks. However, the pain is not only found in these muscles, but in associated nerves, and even in tendons. His belief was that the pain is caused by a lack of oxygen due to vasoconstriction in the affected areas. The vasoconstriction occurs because the sufferer is trying to ignore what's going on inside themselves, emotionally speaking. Eventually, the brain sends signals via the nervous system which cut off the oxygen supply to these muscles in order to cause pain that is strong enough to distract the sufferer from their unpleasant emotions. As anyone who has suffered from chronic pain will attest, it becomes a permanent part of your life, your personality; you have to factor it into almost every decision you make about what you might do today, or what you might do in the future. With such a big problem in your life, you aren't going to be focused on much else that is going on with you.
So that is Dr. Sarno's explanation for what most back pain is. But he goes into even greater detail about what back pain is not.
It was his contention, first and foremost, that the majority of back pain, which he would diagnose as TMS, is not structural. A common reason given by doctors for back pain is a 'slipped disc'. The disc bulges out from between two vertebrae and presses against the nerves running through the spine. However, Dr. Sarno says that actually, when long term pressure is applied to nerves, those nerves actually send fewer signals, i.e., numbness occurs, not pain. He also mentions in relation to disc problems, such as degeneration, that in the majority of humans, the disc between the L4 and L5 vertebrae actually degenerates by the time the person reaches around 20 years old, yet most people with this disc degeneration do not suffer any pain. Further to this point, there are groundbreaking studies where perfectly healthy people were given back scans. These were people with no back pain at all, but many of them had the physical, structural conditions which many people who suffer from chronic and acute back pain are told is causing it. These conditions, as well as the ones mentioned above, include things like scoliosis, spondylosis, etc. In other words, most structural problems with the human back are simply normal and no cause for concern.
And so, what Dr. Sarno really attempts to drill into the reader, is that TMS is totally benign. The condition is not dangerous; there's nothing physically wrong with you, and you should not worry. One sufferer who went for a consultation with Dr. Sarno was in extreme pain for a long time and had seen three or four specialists who all told him he was going to need serious back surgery (a common story for many of the Dr.'s patients). After doing an in-depth medical examination, medical history, and viewing of the patient's back x-rays, he told the patient there was nothing wrong with him. The patient was incredulous, and they spoke for a few more minutes about TMS. Eventually the man asked what he should do then, and Dr. Sarno asked him what did he liked to do. The man replied, "I like skiing", and Dr. Sarno said, "Then go skiing". He is one of thousands of people who after being exposed to Dr. Sarno and his work experienced a complete recovery from their pain in a short period of time.
Most people with chronic back pain can trace back and attribute it to a specific physical incident, either major or minor - the person was trying to lift something heavy, or was playing a sport, or they may have just been tying their shoelaces. From then on, as their condition worsens and lasts for a long time, maybe for their whole life, the idea of the physical cause is fixed. The associated stress, anxiety and fear caused by the condition itself exacerbate it further. Dr Sarno says that the physical incident was not the cause of the condition, but is more appropriately termed the 'trigger event'. The problem was already there; but the incident was the 'straw that broke the camel's back'.
Due to this physical assumption and explanation for the issue, the real cause is never discovered by the sufferer. They fixate on their physically caused physical condition, it takes over their lives, and the stress, anxiety, panic, fear and depression just continue to prolong the physical agony. As someone who has been confined to bed for long periods of time due to the pain, I can say that the fear of your back going again once you regain your mobility and independence is... 'crippling'.
Dr. Sarno's prescription for what to do when the pain attacks, based on the ideas he presents about the harmlessness of the condition, and ridding oneself of the false assumptions about its causes (sitting for long periods, a physical event, bending and lifting at the waist, having weak back or core muscles, poor posture), is to basically ignore it. Another mantra of his is, 'Don't think physical, think psychological'. The whole point of the pain is to get you to focus on it and to distract you from what is going on inside you. Some sufferers who took his ideas seriously and were cured of TMS have spoken in terms of laughing at the pain when it comes on. The idea is you must decondition yourself from the fear of the pain, from the worry and panic that habitually sets in when one experiences an attack, and start to remember all the ideas presented in the book: It's just pain; it's not serious; it's not structural; it's an emotional issue. The sufferer is encouraged to challenge their thinking, battle with their mind, even get angry at their thinking or angry at the pain: "I'm not gonna take this anymore! I don't need you to distract me from anything now! I'm not going to allow you to rule my life." In the past, the pain would force the sufferer to cancel plans they had or perhaps take time off work, but if they take Dr. Sarno's work seriously, instead they will go about their day as normal, and most find that the pain just goes away.
Another example of how the Dr. says one should go about reprogramming their mind, is that he recommends the immediate cessation of all types of physiotherapy and exercises that were prescribed in order to try to help the condition. It wasn't always his recommendation, and for many years, he worked with teams of physiotherapists to whom he would refer his patients. But eventually, after something of an inner struggle with himself over this practice, he decided that it was in the patient's best interest to not have physiotherapy because the physiotherapy was acting to enforce the patient's beliefs that the problem was a physical one. Dr. Sarno would admit that certain types of exercise, massage or stretching can alleviate the pain that comes from TMS, but it will not cure it. The only cure is to learn to feel and express painful emotions, buried traumas, and the stresses, tensions and anxiety everyone faces throughout their lives. For a minority of patients, some 5%, their emotional traumas were so deep that long-term relief or cure could only be realised through psychotherapy.
The book, and the good Dr. himself, are truly inspirational. Dr. Sarno was a fully qualified medical specialist who practised for years had the strength to admit to himself that the established narrative about back pain must be wrong, because the treatments based on it were randomly effective at best, and the bravery to suggest and implement something radical and novel, regardless of the effect it would have on his reputation and career. For many years, he was ridiculed and ostracized by his peers for his unorthodox approach, and never gained any recognition for his contributions to the science around pain and the power of the conscious and subconscious mind.
But for the many thousands of people who read his book or saw him personally for treatment, his work saved their lives and they all recognise and appreciate him for the stance he took against the medical establishment by putting them first, above anything else.
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