My aching mind

Back pain guru John Sarno touted the mind-body con­nec­tion as the root of chronic aches

Toronto Star - - ENTERTAINMENT & LIFE - JONATHAN FORANI

A phys­io­ther­a­pist once told me I’d be a “train wreck” by 40.

I was a 19-year-old with chronic back pain and no one knew what to do. I stopped run­ning, stopped lift­ing weights and could hardly sit in a chair for more than 30 min­utes. My pre­ferred po­si­tion was hor­i­zon­tal, a heat­ing pad hug­ging my lum­bar.

Noth­ing showed up on X-rays, bone scans, MRIs. I tried chi­ro­prac­tic ad­just­ments, deep tis­sue massage, hot yoga, acupunc­ture, shi­atsu and some more ec­cen­tric treat­ments in­clud­ing one where a woman gen­tly prod­ded “pres­sure points” on my body and in­sisted I’d feel bet­ter in a week.

I did not feel bet­ter. Not un­til I read a book called Heal­ing Back Pain by a New York Univer­sity doc­tor named John E. Sarno.

Sarno, con­sid­ered a hero by thou­sands of pa­tients and read­ers he never met, died June 22 from car­diac fail­ure, a day be­fore his 94th birthday.

He claimed for decades that most chronic pain is psy­cho­so­matic, a mind­body process called ten­sion my­oneu­ral syn­drome (TMS) caused by re­pressed emo­tions. He wrote three con­tro­ver­sial best­selling books — Heal­ing Back Pain, The Mind­body Pre­scrip­tion and The Di­vided Mind — and won the pow­er­ful en­dorse­ment of celebri­ties in­clud­ing Se­in­feld co- cre­ator Larry David and ra­dio per­son­al­ity Howard Stern, who aired a trib­ute to the doc­tor last month.

“He was an amaz­ing man,” Stern said, ac­cord­ing to his web­site. He suf­fered from de­bil­i­tat­ing back pain that had him on the floor for years un­til he read Sarno’s books. “I got a note from his wife . . . I wrote her back. I said, ‘I can’t tell you how sad I am that my hero is gone.’ ”

Sarno re­mained a pariah in the med­i­cal com­mu­nity de­spite thou­sands of suc­cess sto­ries and a grow­ing lack of ev­i­dence for con­ven­tional di­ag­noses and treat­ments that North Amer­i­cans spend bil­lions of dol­lars on an­nu­ally. But recog­ni­tion for his work has grown in re­cent years. In 2012, Sarno tes­ti­fied in Wash­ing­ton be­fore a U.S. Se­nate com­mit­tee called “Pain in Amer­ica: Ex­plor­ing Chal­lenges to Re­lief.” He has been char­ac­ter­ized as “the rock star of the back world” in the new best­selling book Crooked: Out­wit­ting the Back Pain In­dus­try and Get­ting on the Road to Re­cov­ery by in­ves­tiga­tive jour­nal­ist Cathryn Jakob­son Ramin.

“The legacy that (Sarno) leaves is an un­der­stand­ing of the re­la­tion­ship be­tween the mind and the body,” says Jakob­son Ramin, who doesn’t buy into Sarno’s the­ory that most chronic pain is caused by emo­tional phe­nom­ena. “He con­tin­ued to in­sist that the mind and the body were one, they couldn’t be sep­a­rated and that the mind was per­fectly ca­pa­ble of gen­er­at­ing phys­i­cal symp­toms. I think that that is ac­cu­rate. But it’s not the whole story.”

I didn’t buy it at first, ei­ther. I thought he was a Freudian quack when I read about him in a des­per­ate Google search for back pain treat­ments. He claimed to have helped thou­sands re­lieve pain with­out surgery, drugs or phys­i­cal in­ter­ven­tion. His only pre­scrip­tion was knowl- edge: read his books, jour­nal about your emo­tions, ig­nore the pain and re­sume phys­i­cal ac­tiv­ity.

Un­con­scious emo­tions like re­pressed rage are the true cause of chronic pain, he said, once se­ri­ous ill­ness like can­cer and in­fec­tion are ruled out by a physi­cian. You can “think away” the pain be­cause it is a trick of the mind, a dis­trac­tion from emo­tions that the brain has deemed too in­tense to ex­pe­ri­ence. But that doesn’t mean the pain isn’t real, or that it’s all in your head.

“The pain is al­ways real,” he told the Se­nate com­mit­tee in 2012. “In medicine in gen­eral, there’s a ten­dency to look at things from the anatom­i­cal and phys­i­o­logic point of view and per­haps not rec­og­nize the im­pact of emo­tions on the phys­i­ol­ogy.”

But what about those scary ab­nor­mal­i­ties doc­tors point out on X-rays and MRIs? Nor­mal, he said. In­deed, sci­en­tific ev­i­dence backed up some of his claims over the years. A 1994 study pub­lished in the New Eng­land Jour­nal of Medicine showed that 64 of 98 men and women had lum­bar disc bulges and pro­tru­sions, but no back pain. Re­search con­tin­ued to dis­pel years of di­ag­noses, in­clud­ing a 2014 Mayo Clinic lit­er­a­ture review of more than 3,000 peo­ple pub­lished in the Amer­i­can Jour­nal of Neu­ro­ra­di­ol­ogy that found “de­gen­er­a­tive disc dis­ease” is com­mon in all ages and can be asymp­to­matic.

For years, those fright­en­ing ab­nor­mal­i­ties led most physi­cians to pre­scribe rest and a “stop if it hurts” phi­los­o­phy. Those ap­proaches are now out of style, ex­perts say.

“Sit­ting and do­ing noth­ing is not the proper way to deal with back pain,” says Univer­sity of Toronto pro­fes­sor An­gela Mailis, founder of the Pain & Well­ness Cen­tre in Vaughan and author of Be­yond Pain: Mak­ing the Mind-Body Con­nec­tion.

But Sarno’s jour­nal­ing might not be the proper way for many ei­ther. Mailis says ev­ery chronic pain suf­ferer falls some­where on a spect r um: Sarno’s psy­cho­log­i­cal fac­tors at one end and bio­med­i­cal rea­son­ing at the other.

“When it comes to chronic pain, you can’t have a one-size-fits-all,” she says. That’s why an in­te­grated pain­man­age­ment pro­gram is em­ployed at her Pain & Well­ness Cen­tre in Vaughan, where di­eti­tians, chi­ro­prac­tors and massage ther­a­pists work with psy­chol­o­gists and mind­ful­ness ex­perts to pro­vide in­ter­dis­ci­pli­nary treat­ment.

While Sarno never led for­mal stud­ies of his the­ory, much to the de­ri­sion of his col­leagues, Univer­sity of South­ern Cal­i­for­nia re­search by one of his pro­tégés, David Schechter, showed that pa­tients with chronic pain symp­toms who were treated with a mind-body tech­nique ex­pe­ri­enced pain re­duc­tion of 52 per cent on av­er­age.

Sarno didn’t care much for labs and num­bers and long main­tained that the proof was in reader and pa­tient tes­ti­mony. Michael Galin­sky be­gan work­ing on doc­u­men­tary All the Rage, open­ing in Toronto at the Hot Docs Cin­ema July 28, in 2004 when he first met Sarno, but set it aside for other projects. Then, he says, his back pain came back “with a vengeance.” He was on the floor, in ex­cru­ci­at­ing pain. So he turned the cam­era on him­self.

He re­con­nected with Sarno, un­der­went mind-body treat­ment and re­al­ized that his strug­gles with fam­ily, home own­er­ship, and dif­fi­culty pro­mot­ing a pre­vi­ous film were be­com­ing too much to bear, caus­ing him emo­tional and phys­i­cal pain. Mak­ing the film “enor­mously” helped him re­cover.

“It re­ally forced me to con­front these things and re­ally deal with it,” he tells the Star.

But it doesn’t work for ev­ery­one, in­clud­ing Crooked author Jakob­son Ramin. She found re­lief through phys­i­cal ther­a­pies like those ad­vised by Univer­sity of Water­loo pro­fes­sor of spine biome­chan­ics Stu­art McGill. His reg­i­men of strength­en­ing ex­er­cises helped her over­come much of her back pain and get back to an ac­tive life. She even climbed Machu Pic­chu with a friend.

As Jakob­son Ramin puts it, “For some peo­ple, Sarno is not enough.”

For me and thou­sands of oth­ers, Sarno pro­vided a way back to an ac­tive life. Un­til I read Heal­ing Back Pain, I was afraid to move. I sat stiffly in chairs or on sta­bil­ity balls un­til I couldn’t stand it any­more. I al­ways bent my knees and feared any wrong twist could put me out.

Sarno took that fear away. I re­mem­ber the mo­ment I de­cided I could slouch back in my chair if I wanted to. I fell back, al­lowed my mus­cles to re­lax and let the chair sup­port me. It was oddly ex­hil­a­rat­ing to take con­trol of my body again.

I got back to run­ning, lift­ing weights and was liv­ing nor­mally within weeks.

I still get back and neck pain some­times, but I don’t stop ex­er­cis­ing, en­dure drawn-out med­i­cal treat­ment and look in hor­ror at unset­tling MRIs. When my back pain came back re­cently, I treated it as no co­in­ci­dence that it was timed per­fectly with the end of an em­ploy­ment con­tract and a rent in­crease from my land­lord. I be­gan jour­nal­ing and kept lift­ing weights. In a mat­ter of weeks the pain dis­si­pated.

When I learned of Sarno’s death in June, I shouldn’t have been sur­prised that I felt it deeply even though I never met him. He’s the man who from afar man­aged to steer me away from be­ing that “train wreck” I was told my body — and so many oth­ers’ bod­ies — might have be­come.

DREAMSTIME

Dr. John Sarno, who died in June, is said to have helped thou­sands re­lieve pain with­out surgery, drugs or phys­i­cal in­ter­ven­tion.

RUMUR INC.

RUMUR INC. PHO­TOS

In the new doc­u­men­tary All the Rage, best­selling author Dr. John Sarno helps film­maker Michael Galin­sky re­al­ize his emo­tional strug­gles were be­hind his phys­i­cal pain.

Sarno holds a thank-you scrap­book made by read­ers of his book. Like many pa­tients, writer Jonathan Forani found Sarno’s book ground­break­ing.

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