Dr. Sarno's book Healing Back Pain is fantastic, however for some reason getting people to read it seems to take an effort. How can you dismiss something without even reading it? Anyway I have been looking for a good website that can explain TMS without it sounding like rubbish. Sadly only Sarno's book manages this, every website I have seen so far is so vague that is makes it sound like complete BS. I decided to try and write down an explanation that any enquiring scientific mind could read, understand the premise and hopefully critically appraise what I have written without an instant dismissal.
What is pain?
Well in a basic sense your pain is your brains interpretation of signals from the nerves. If you were to remove the pain receptors in the brain you would not experience pain. Although this is a pretty basic explanation I am sure that in a general sense every one agrees and this is not controversial.
What is psychosomatic pain/illness?
EVERYONE has experienced psychosomatic illness! Normally when people talk of psychosomatic illness they think of severe symptoms and people who are "mentally weak", delusional etc. BUT just as most illnesses can be severe or barely noticeable so too can psychosomatic illnesses. This is an example I believe most people have experienced...
You have an exam, this exam is very important. How do you feel? Well most people will feel nervous and have "butterflies in the stomach". Now you know you are nervous, you are emotionally worried about failure about how this exam effects your future, but you are generating physical symptoms. Everyone accepts these physical symptoms of an emotional problem without a second thought. At best your emotional distress has minimal physical symptoms, just butterflies in the stomach, maybe feeling a little sick, perhaps sweating a little more, however, it can easily cause diarrhoea. Everyone knows that the physical symptoms that they have experienced are not caused by some other illness, but then do not carry this information on further.
Hopefully by now you will realise hey I too have experienced physical symptoms from emotional causes. But there is a huge body of scientific literature on the placebo and the nocebo (negative placebo) effects. There are some fascinating studies showing how effective the mind is in healing and illness. The placebo effect has been shown to cause amazing positive effects in patients, where as the nocebo effect has been shown to be strong enough to kill, yes that is right essentially the belief that you are dying appears to be enough to kill you! It is impossible to dismiss the effects of the brain on the cause and cure of illness and every doctor is quite aware of the placebo and nocebo effects and would not dispute this.
Why do we ALL have physical symptoms to emotional problems?
In fact I would go so far as to assert that the people that are the most likely to experience a physical response to emotional problems are the exact same people who will be quick to dismiss the notion that a physical symptom can be caused by an emotional issue. People who are perfectionists, high achievers, controlling, self critical etc. These are the sorts of people that are most likely to experience this. What is actually happening is that the brain is causing physical symptoms to distract your mind away from the problem. In my exam example your brain is making you feel sick to distract you away from your thoughts of failure, of how imperfect you are etc. These physical distractions are great at distracting your thoughts and because they are effective your brain continues to use them.
Back pain is the number 2 reason why people go to the doctor behind cold and flu and 85% people people suffer moderate to severe backpain at some point in their lives. Backpain is a very modern aliment. Reports of back pain are growing 14 times faster than the population! 100 years ago backpain was an uncommon problem, but apparently evolution of the human spine over the last 100 has caused such structural weakness and anomalies that everyone suffers.
The reason is TMS!
Is the problem all in my head?
Strangely the answer is Yes and No. In fact this is the bit that annoys me the most about people, there in ability to accept a logical argument! People actually start automatically dismissing this argument without a logical argument, they start with weird preconceptions such as
"maybe this is common in weak minded idiots, but not an intelligent strong person like me!"
"pain in your head is pathetic, but a structural deficiency is not"
As mentioned before your mind is distracting you from your emotional problems. As a "strong minded person" you probably view yourself as intelligent, and able to control your emotions well, hard working, selfless (to some extent) etc. These are all the things your own mind uses to obscure the fact that it is doing this to hide your emotional problems from you.
Dr. Sarno's theory is that in order to distract yourself from emotional issues you brain actually reduces the oxygen supply to specific areas of your body, this lack of oxygen causes you to report real pain signals which can be extremely painful. The cause of the pain is this lack of oxygen to the soft tissue, and the root cause of this is the brain distracting you and diverting your focus from emotional issues.
Frequent defensive / dismissive statements
"I go to a chiropractor / acupuncture / alternative medicine / surgery and a feel better / in cured me"
As I have already stated placebos have an amazing effect, you can read more in numerous medical journals and become astonished at their effects. However, you might notice the following
1. It is not a permanent cure, you need to go back.
2. Your back pain was cured, but now you are suffering from ankle / wrist pain / tension headaches etc.
3. Your emotional issues were resolved
"But I have abnormalities in my spine, bulging discs, whiplash"
Lots of studies suggest that there is not a strong causal link between spinal abnormalities and pain. This article for example suggest that spinal curvator does not effect neck pain. Numerous other MRIs show severe disc bulges in patients with no pain and "perfect" spines in people with a lot of pain. It seems logical to look for structural causes to pain, but studies repeatedly suggest a weak link between abnormalities and pain. In essence numerous abnormalities are very common and do not lead to pain. Please consider this possibility and see if it logically fits your situation. You have back pain. Your doctor says you have a bulging disc. Your mind reinforces the pain has a structural cause. You go to a chiropractor who says he will manipulate your spine to correct the bulge. You instantly feel relief. A few weeks or months later it plays up again, you think hey its that old injury and your mind reinforces the pain, you go to the chiropractor and he manipulates your spine again, and again you feel relief. This relief still fits inside Dr. Sarno's theory, now if Dr. Sarno's theory was untrue there would be strong evidence that chiropractors and surgery is more effective than placebos. This is not the case meta analysis of chiropractors which shows they are no more effective than placebos. Further more surgery such as vertebroplasty is no more effective than placebo surgery.
What becomes even more amazing is when you consider evidence that many "whiplash" injuries might not even be a phyical condition. We are not talking just about people trying to scam insurance, no people who are in rear end collisions who do not suffer severe injury and yet have chronic neck pain. Of course whiplash can be real, you can for example kill a baby shaking them and this is an extreme example of whiplash, but whiplash injuries are practically non-existent in Lithuania and yet in Norway account for 2% of the population!
Having experienced this myself having witnessed people get better from JUST READING A BOOK I am certain of this, and I feel strongly that anyone with back pain which is clearly not caused by a tumour or infection should read Dr. Sarno's book.
I could not possibly go into the depth that Dr. Sarno does with his book, but there is significantly more evidence and citation that is far more convincing than my writing. Please read the book before you dismiss it...I am not on any commission and in fact I recommend you find this book at your local library so you do not even have to pay any money. Seriously zero cost and the worst that happens is you read a relatively short book that you do not agree with, and the best that can happen is that you permanently cure your back pain, RSI or tendonitis. Lets face it only an unenlightened stubborn fool can still dismiss this without reading the book...sadly there are a few too many of those individuals in our society today.
If you wish to criticise what I have written please do so objectively and constructively I am only trying to help people in the way my friend helped me. I hope that these ideas are tested in large controlled randomised studies as I am sure they are accurate and I hope them to be proven and adopted into standard medical practice.
Some interesting additional reading and viewing