Avoiding the knife
This approach isn't for everyone. Sarno estimates that 25 percent of back pain does have physical causes, ranging from injuries and accidents to tumors or infections, and he strongly urges readers of his book to see a physician before starting his program. Missing a spinal tumor, for example, could be tragic.
Other specialists insist that chronic pain is most often a combination of physical and emotional factors. "Stress heightens your awareness of pain; it doesn't necessarily create the problem in your back," says Gregory Lutz, M.D., physiatrist-in-chief at the Hospital for Special Surgery in New York. A number of studies support his conclusion. For example, an investigation of Boeing transit workers, published in Spine, found that job dissatisfaction was a predictor of back pain, but so were physiological demands. Cable-car operators, who perform the heaviest labor, were three times more likely than bus drivers to develop back pain. "I worry when people approach back pain as either purely psychological or purely physical," says Carragee. "Both extreme camps may be missing important ways to help patients."
Back pain exacts a huge toll. About 55 million Americans suffer lower-back pain every year, according to the National Center for Health Statistics, and their back-related bills amount to $26 billion annually. So for long-term sufferers who have already explored standard treatments, there may be little to lose by trying Sarno's methodology. After all, it avoids risky and expensive surgery. And it just may help. Giangola, for one, firmly believes that Sarno rescued him from a life of pain. Although his aches haven't completely disappeared, they are greatly reduced. "Maybe there's a cure that has nothing to do with paying doctor bills" he says. "What Sarno's doing is good for humanity."