Healing Back Pain by John Sarno

Rating:
6
/10

🚀 The Book in 3 Sentences

  1. Sarno argues that lower back pain and sciatica is a physical manifestation of repressed anxiety and anger - what Sarno calls Tension Myositis Syndrome (TMS)
  2. TMS can be treated by resuming physical activity (the more vigorous the better), cognizance of the emotional issues causing the pain, and removing the fear of relapse from your thinking.
  3. TMS is not recognized by much of the medical world, and Sarno himself recognizes this - he advises this type of treatment only after seeing a doctor and ruling out major medical problems (e.g., Tumors, etc.)

🎨 Impressions

Going into reading this book I didn't expect much, but thought it was worth a shot.

While I'm open to alternative medicinal approaches, I had a hard time believing that the way that you view pain, or your mindset, would have any effect on the physical pain you experience (I've dealt with recurrent back pain for ~3.5 years now).

I had a similar disbelief of Sarno's assertion that repressed anger was the main culprit of my back pain. For the record, I 100% believe in science.

That being said, I was pleasantly surprised with what I read.

While I can't accept all of Sarno's assertions - especially that TMS is the cause of most pain manifestations of muscles, nerves, and tendon-ligaments - I do think there is credibility in not letting the fear of back pain relapse guide your daily actions.

If nothing else, the mindset shift of resuming physical activity and meeting your pain with an emotional perspective was helpful for me personally.

Looking back at the times where my pain receded the fastest, it was when I resumed activity (walking, lifting weights, etc.) and wasn't beholden to the pain. Conversely, when I babied everything I did and felt at the mercy of the pain, my recovery slowed or even reversed.

I don't think this book is for everyone, but as chronic back pain sufferers can attest to, there is a certain feeling of desperation that manifests after dealing with chronic pain. You're willing to try anything to rid the pain and have a permanent solution. In that view, Sarno's book is worth reading.

After reading this book, I immediately ran a mile and went to go lift weights for the first time in a month. I slept on a mattress for the first time in weeks (previously sleeping on the hard floor with a yoga mat). And that day I recorded the lowest pain score in a month of acute back pain.

Do I think the book "cured" me? No - but it accelerated my mindset shift, which I think is putting me down the right path.

Yes, it is repetitive. You should skip/skim most chapters (most of 3, 5, 6, and 7 in my opinion). And yes, you should try to see through Sarno's disdain for most conventional medicine.

If you can see past the above, I think the book is worth reading - if nothing else, for the the mindset shift.

👤 Who Should Read It?

People suffering from chronic back pain and have found conventional physical therapy and other types of physical treatment ineffective.

If you are someone who is receptive to the power of positive psychology and a link between the mind and body. Without an openness to that idea it's hard to read.

☘️ How the Book Changed Me

How my life / behavior / thoughts / ideas have changed as a result of reading the book.

  • Mindset Shift: This book changed how I viewed my pain. Instead of relying on bed rest and questioning how I sat and whether my chair had a soft/hard back - I took ownership of taking the fear head on. So far this has worked for me.
  • Return to Physical Activity: Within 30 mins of reading this book, I was running and lifting weights again. Which made me much happier almost immediately.
  • Emotional Recognition: I realized that when I feel back pain or leg pain (sciatica) I now actively speak to my brain and say that this is a physical response to emotions the pain recedes. I feel a bit crazy, but so far this has been working for me.
  • Attribution of Pain to Injury: For the past 3 years I was never really able to attribute my back pain to any specific injury, it just seemed to appear out of the blue. I did recognize that it would reappear when I was stressed. While I'm not attributing the pain to repressed anger/anxiety, the book did make me question whether the pain was from one specific injury.

✍️ My Top 3 Quotes

  • "The sad reality is that the patient with back pain is a prisoner of pervasive fear—and fear is a prime perpetuator of the pain syndrome."
  • "One has to confront TMS, fight it, or the symptoms will continue. Losing one’s fear and resuming normal physical activity is possibly the most important part of the therapeutic process."
  • "As long as the person remains unaware that the pain is serving as a distraction, it will continue to do so, undisturbed. But the moment the realization sinks in (and it must sink in, for mere intellectual appreciation of the process is not enough), then the deception doesn’t work anymore; pain stops, for there is no further need for the pain. And it’s the information that gets the job done."

📒 Summary, Notes, & Highlights

My Highlights

DO: • Resume physical activity. It won’t hurt you. • Talk to your brain: Tell it you won’t take it anymore. • Stop all physical treatments for your back—they may be blocking your recovery.

Location: 48

DON’T: • Repress your anger or emotions—they can give you a pain in the back. • Think of yourself as being injured. Psychological conditioning contributes to ongoing back pain. • Be intimidated by back pain. You have the power to overcome it.

Location: 51

It has been my observation that the majority of these pain syndromes are the result of a condition in the muscles, nerves, tendons, and ligaments brought on by tension.

Location: 225

TMS involves three types of tissue: muscle, nerve, and tendon-ligaments.

Location: 357

people have been so thoroughly indoctrinated with the idea of persistent injury that they accept it without question.

Location: 380

As far as they are concerned, there has to be a physical cause.

Location: 383

This idea is one of the great impediments in the way of recovery. It must be resolved in the patient’s mind or the pain will persist.

Location: 383

Perhaps the most common, and undoubtedly the most frightening, manifestation of TMS is the acute attack. It usually comes out of the blue, and the pain is often excruciating,

Location: 391

The most common location for these attacks is the low back, involving the lumbar (small of the back) muscles, the buttock muscles, or both. Any movement brings on a new wave of terrible pain, so the condition is very upsetting, to say the least.

Location: 393

There is not a great deal one can do to speed the resolution of such an episode.

Location: 417

I advise my patients to remain quietly in bed, perhaps take a strong painkiller, and not agonize over what has happened. They are further instructed to keep testing their ability to move around and not assume they are going to be immobilized for days or weeks. If one can overcome one’s apprehension, the duration of the attack will be considerably shorter.

Location: 419

It is not the occasion itself but the degree of anxiety or anger that it generates that determines if there will be a physical reaction. The important thing is the emotion generated and repressed, for we have a built-in tendency to repress unpleasant, painful, or embarrassing emotions. These repressed feelings are the stimulus for TMS and other disorders like it. Anxiety and anger are two of those undesirable emotions that we would rather not be aware of, and so the mind keeps them in the subterranean precincts of the subconscious if it possibly can.

Location: 434

Once it is pointed out to them, these patients have little trouble recognizing that they are the kind of perfectionist, highly responsible people who generate a lot of subconscious anger and anxiety in response to the pressures of everyday life.

Location: 441

They have been told and they have read that the back is fragile, vulnerable and easily injured, so if they try to do something vigorous, like jog or swim or vacuum the floor, their backs begin to hurt. They have learned to associate activity with pain; they expect it, so it happens. That is conditioning. The specific posture or activity that brings on the pain is not important per se. What is essential is to know that it has been programmed in as a part of the TMS and is therefore of psychological rather than physical significance.

Location: 516

Except for the very brave few, most people who have had such an attack never again engage in vigorous physical activity with an easy mind. They have been sensitized by the experience and all that it is supposed to imply, and they see themselves, to a greater or lesser degree, as permanently altered. They fear another attack and eventually it comes. It may be six months or a year later, but the prophecy is fulfilled and the dreaded event occurs again.

Location: 534

And to some the pain becomes the primary focus of their lives. It is not uncommon to hear people say that the pain is the first thing they are aware of when they awaken in the morning and the last thing they think about when they go to sleep. They become obsessed with it.

Location: 551

To sum up, the word tension will be used here to refer to repressed, unacceptable emotions.

Location: 606

It is likely that the majority of emotional reactions occur in the unconscious. Feelings that remain there do so because they are repressed, and it is these that are responsible for the sequence of events that cause TMS. This condition begins and ends in the unconscious.

Location: 658

the role of the pain syndrome was not to express the hidden emotions but to prevent them from becoming conscious.

Location: 852

the pain of TMS (or the discomfort of a peptic ulcer, of colitis, of tension headache, or the terror of an asthmatic attack) is created in order to distract the attention of the sufferer from what is going on in the emotional sphere.

Location: 853

The sad reality is that the patient with back pain is a prisoner of pervasive fear—and fear is a prime perpetuator of the pain syndrome.

Location: 955

As long as the person remains unaware that the pain is serving as a distraction, it will continue to do so, undisturbed. But the moment the realization sinks in (and it must sink in, for mere intellectual appreciation of the process is not enough), then the deception doesn’t work anymore; pain stops, for there is no further need for the pain. And it’s the information that gets the job done.

Location: 1177

The occurrence of pain in TMS always signifies the presence of repressed bad feelings, like anger and anxiety.

Location: 1207

The treatment program rests on two pillars: 1. The acquisition of knowledge, of insight into the nature of the disorder. 2. The ability to act on that knowledge and thereby change the brain’s behavior.

Location: 1222

I suggest to patients that when they find themselves being aware of the pain, they must consciously and forcefully shift their attention to something psychological, like something they are worried about, a chronic family or financial problem, a recurrent source of irritation, anything in the psychological realm, for that sends a message to the brain that they’re no longer deceived by the pain. When that message reaches the depths of the mind, the subconscious, the pain ceases.

Location: 1228

Perhaps the most important (but most difficult) thing that patients must do is to resume all physical activity, including the most vigorous. This means overcoming the fear of bending, lifting, jogging, playing tennis or any other sport, and a hundred other common physical things. It means unlearning all the nonsense about the correct way you are supposed to bend, lift, sit, stand, lie in bed, which swimming strokes are good and bad, what kind of chair or mattress you must use, shoes or corset or brace you must wear, and many other bits of medical mythology.

Location: 1250

I suggest to patients that they begin the process of resuming physical activity when they experience a significant reduction in pain and when they are feeling confident about the diagnosis.

Location: 1267

One has to confront TMS, fight it, or the symptoms will continue. Losing one’s fear and resuming normal physical activity is possibly the most important part of the therapeutic process.

Location: 1278

The pain is due to TMS, not to a structural abnormality. • The direct reason for the pain is mild oxygen deprivation. • TMS is a harmless condition, caused by my repressed emotions. • The principal emotion is my repressed anger. • TMS exists only to distract my attention from the emotions. • Since my back is basically normal, there is nothing to fear. • Therefore, physical activity is not dangerous. • And I must resume all normal physical activity. • I will not be concerned or intimidated by the pain. • I will shift my attention from the pain to emotional issues. • I intend to be in control—not my subconscious mind. • I must think psychological at all times, not physical.