Once upon a time, there lived two brothers, John and Steve. John was a television reporter for ABC’s 20/20. Steve was on the faculty of Harvard Medical school. They both had horrible back pain.
They’d searched far and wide for a magical solution to cure their back pain. They tried every contraption and theory supplied by doctors. Unfortunately, nothing helped.
One day John met a shaman (doctor) named John Sarno. John Sarno had a magical cure for back pain. If you just said the magic words and believed them, your back pain would be cured. You had to say:
- There is nothing wrong with my back.
- The pain is all being generated by my head. It’s my brain trying to distract me from the emotional rage that’s I’m feeling based on repressed Freudian memories.
When John woke up the next morning his back pain was cured.
“Steve!” said John, “I have the most amazing news! I found the miracle cure. You just have to say the magic words.”
“John, you know I can’t do that,” said Steve. I’m a doctor and don’t believe in magic. Besides, Freud’s theories on repressed emotions were discredited long ago.”
So John lived happily ever after while Steve stayed in back pain.
(End of fairy tale)
This story is a close adaptation of reporter John Stossel’s segment about John Sarno on 20/20 from 1999. His brother Steve was teaching at Harvard Medical School at the time.
When I first heard the story, I remember thinking that Steve was right. John Sarno was obviously blowing smoke. In the years since then, I’ve realized that it’s not quite so simple.
The basic problem here was that what Sarno said seemed to work even though his theory was tragically flawed. Sarno theory involved Freudian repressed rage — a theory that was discredited a century ago. He was clearly grasping at straws.
But the part that made sense was that the pain wasn’t anatomical. It was coming from your head. This article from Vox does a good job summarizing Sarno. In the article, Cathryn Jakobson Ramin, author of the book Crooked: Outwitting the Back Pain Industry and Getting on the Road to Recovery says, “What he recommended as treatment was essentially cognitive behavioral therapy — elimination of fear avoidant behavior and catastrophizing — before anyone had ever heard of it and it’s exactly what is being used now to treat patients with central sensitization.”
My experience with chronic pain started around 2000. I had horrible wrist pain that wouldn’t go away. Luckily all my doctors told me that I didn’t need surgery. Though they didn’t give me any options of what I should do. Luckily I found Lisa Sattler who is one of the world’s best physical therapists for carpal tunnel. After a year of physical therapy with her, the pain went away.
Though the pain came back, as back pain, a few years later. I found the book Back RX to be very helpful. But as the back pain persisted, I got an X-Ray that showed a bone spur in my hip, “Aha!” I thought, “I’ll have surgery and pain will go away.”
“Not so fast,” said the surgeon. “Why don’t we inject some strong painkiller right into your hip. If the pain goes away we’ll do the surgery. If it doesn’t go away, the surgery won’t help.”
So I went into the doctor’s office and lo and behold, the pain didn’t go away with the painkiller. That got me thinking about Doctor Sarno again. I started to realize that the more stressed I became, the more my back hurt. Also, the pain would move around a lot which doesn’t make a lot of sense from an anatomical perspective. At this point in my life, I still don’t think Sarno’s theory makes sense; however, if I sit down and meditate, I can make most of my soft tissue pains go away.
Note 1 (August 2023): There’s an interesting parallel mechanism for quitting smoking in Allen Carr’s Easy Way to Stop Smoking. It’s a similar placebo pseudoscience that works. There’s a good discussion of this in This American Life’s I Can’t Quit You Baby.
Note 2 (September 2023): David Pogue’s Unsung Science has a very interesting episode on placebos which is spot on for this. The scientists talk about how chronic pain is related to messed up nerve pathways and that placebos can help cure these issues.
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