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Saturday, June 18, 2011

In Case You Suffer From Back Pain...


In January, 1981, shortly after the law firm where I worked dissolved, as I was riding a bike through the streets of Eugene, Oregon, I stopped short to avoid hitting the back of a car. I felt something "go" in my back, but it didn't hurt then. A few hours later, I was in agony on the floor in my home. Shuffling and doubled over, I managed to get to the office of a sports medicine physician. He did nothing but examine me. He gave me neither medicine nor any physical adjustment - just told me to take it easy. This made me very anxious, since he didn't seem to think anything of my predicament.

At that time, I thought it was an isolated episode that would go away and not return, for I had not experienced back pain for 20 years. My back was "out" and would return to normal. The pain diminished, but persisted. So, I went to an osteopath, who gave me the physical adjustment I wanted and also a muscle relaxant. Now, I felt "treated." I relaxed, and after a few days of slow going, I was normal. I put the incident behind me.

But not for long. Several months after I returned to New York and my old job, I awoke one morning unable to get up. The pain was quite fierce. Of course, I at once identified the cause: raking leaves in the yard. This time I went to a chiropractor, who adjusted my back and took x-rays. The results were alarming and depressing. He told me I had degenerative disc disease and that the condition was chronic and incurable. But there was hope for a fairly normal life if I followed instructions and took care.

Over the ensuing six years, I went to a chiropractor every time my back "went out," that is, several times a year. Each bout lasted from three to twelve weeks. I could not do many things that I enjoy doing. Physical exercise was dangerous. Running was out of the question. Hiking was problematic; I worried I'd have to be rescued on some ridge in the White Mountains, as once I almost did.

Carrying, lifting, driving, even sitting in a theater became increasingly difficult, painful and fearsome. Doing research in a library was extremely uncomfortable - especially standing in the stacks. Going to meetings anywhere that I did not have the right kind of chair presented significant problems. Every day I had to spend from a half hour to two hours lying on a pad on my office floor. I missed work several weeks a year and almost routinely had to leave early or arrive late. My life was carefully arranged to protect my fragile back. Nevertheless, the pain became continual and worse around 1986. The doctors told me that I could expect a gradual worsening of the condition. I felt pretty bad since I was only in my mid-forties. I wondered about what my condition would be in my fifties.

During one particularly awful episode, I consulted an orthopedic surgeon, who paced, looked very grave and told me I would be in deep trouble without surgery. In desperation, I consulted a neurologist, who assured me I could control the problem with certain exercises and swimming. I followed his suggestions and swam 5 or 6 times a week, though I dislike swimming for exercise.

One day in late '86, coming out of the courthouse in White Plains, someone asked me how I was doing. I didn't lie. She suggested I see the physician that she said had cured her husband of back pain, John Sarno. Dr. Sarno is a professor of Rehabilitation Medicine at the New York University School of Medicine.

Dr. Sarno's theory is that except for rare cases, back pain is caused not by structural defects in the back (which, of course, do appear in various scans). Rather, pain emanates from the back, shoulders, neck or legs, etc., as a result of mild deprivation of oxygen in the affected area of the body. This condition is produced deliberately by the brain for the purpose of distracting one from repressed emotionality, including repressed anger. The name that Dr. Sarno has given to this condition is tension myositis syndrome (TMS). Thus, the tension that causes back pain is not tension of which one is readily aware. In order to sustain the deception, the brain associates back pain with various triggers, such as raking leaves or twisting - almost anything will do. TMS is a stratagem of the brain to protect itself from what the brain considers a threat of an overwhelming nature.

Curing back pain results when one rids oneself of the self-deception involved. Once one understands that the pain is harmless, because it arises from a stratagem of the brain, the syndrome loses its efficacy. What a pleasure it was to lose the fear of deterioration and pain and to realize that I could safely resume all activities. I have done so and I have had no debilitating back pain since 1988, when I attended Dr. Sarno's program.

Dr. Sarno first conducts a physical examination and takes the history. If he makes a diagnosis that the pain is a result of TMS, the patient is asked to return to the N.Y.U. Medical Center to attend a class in which Sarno teaches how and why the pain is produced. It is the knowledge of how TMS works that dissipates the deception and hence the pain, which no longer can serve any function. I was examined by Dr. Sarno in January, 1988. In February, I attended his lectures with about 50 other patients. Subsequently, I attended several of his Tuesday afternoon seminars and within a couple months I no longer had back pain.

In 1988, when I was a patient and student of Dr. Sarno, he avoided the term “psychosomatic,” because, he said, that word was loaded with inaccurate meaning. He focused on back pain exclusively and preferred simply to use “tension myositis syndrome,”or “TMS.” If I recall correctly, his treatment lectures and his 1991 book (Healing back Pain) only tangentially speculated that TMS may be part of larger medical phenomenon. But with publication of The Divided Mind, Dr. Sarno has produced a landmark work encompassing the field of psychosomatic medicine.

If I read Dr. Sarno’s latest book correctly, broadly speaking, there are three ways in which his thinking now is radically different from when I saw him for treatment. TMS describes a benign strategy by which the brain protects itself from what it considers to be dangerous emotional material contained (locked away) in the sub-conscious part of the brain. Other psychosomatic conditions, however, are not limited to the benign pain of TMS; they are capable of damaging or destroying the individual. Secondly, while TMS is caused entirely by psychosomatic processes, other psychosomatic processes can be a partial cause of - or an exacerbating factor in - any illness, including cancer and cardiovascular disease. Thirdly, psychosomatic conditions are universal among humans.

I think that Dr. Sarno’s work is profound. I urge you to read The Divided Mind, The Epidemic of Mindbody Disorders, Harper Books, 2006. I recommend also, Healing Hypertension-A Revolutionary New Approach, by Samuel J. Mann, M.D. Hypertension Center, NY Presbyterian Hosp.-Cornell Medical Center, John Wiley and Sons, publisher, 1999.

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