The Emotional Roots of Back Pain

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Disk, nerve, or stress?
It sounds ridiculous at first. To a back-pain sufferer, the agony that can plague every move feels too immediate and real to be caused by negative thoughts. Indeed, many doctors dismiss the notion and label Sarno's approach a placebo. Yet Andrew Weil, M.D., the nation's leading proponent of mind-body medicine, calls himself "a great believer" in Sarno's ideas. And a handful of physicians across the country have begun applying Sarno's techniques with apparent success.

Sarno's theories have evolved over many years. Although he received traditional medical training, he quickly grew disillusioned with the conventional diagnoses and treatment of pain. As head of outpatient rehabilitation at NYU Medical Center in the 1960s, he tried the standard remedies for back pain and "got lousy results," he says. Then he noticed that 88 percent of his back patients also had stress-related problems, such as tension headaches, colitis, or ulcers. He started teaching his patients that tension—not structural problems--was to blame for their pain. "I began getting results for the first time in my career" he says.

Other scientists have observed that structural problems don't account fully for back pain. For example, a major source of trouble is degeneration of the spinal disks—the spongy pads between vertebrae that act like shock absorbers. But in a 1994 study in The New England Journal of Medicine, Maureen Jensen, M.D., at Hoag Memorial Hospital in Newport Beach, Calif., found abnormal disks in two-thirds of pain-free volunteers. By traditional thinking, these people should have been flat on their backs.

The factor that tips the balance may well be emotional distress. In a study published this year in Spine, Eugene Carragee, M.D., director of the Orthopedic Spine Center at Stanford University, reported that two medical imaging techniques, MRI and discography, were less reliable predictors of back trouble than the participants' emotional distress, history of chronic pain, and poor coping skills. Other studies have tied the likelihood of developing back pain to depression or job dissatisfaction. "An interplay of physical factors and emotional well-being is important in almost every patient," says Carragee.