The psychology of pain

Psychological distress may not necessarily be the cause of back pain, but the longer the pain persists, the more psychological factors will predominate and the more psychological methods should be used in treatment (Clin J Pain, 1989; 5: S35-S41; J Nerv Ment Dis, 1982; 170: 381-406).

Failure to appreciate the psychological component in back pain on the part of the physician or the sufferer can eventually lead to more aggressive but not necessarily more effective treatment, such as surgery (Pain Mgmt, 1990; 3: 35-43; Spine, 1989; 14: 838-43).Maverick practitioners like Dr John Sarno, a clinical rehabilitative expert at the New York University School of Medicine and attending physician at the Howard A Rusk Institute of Rehabilitative Medicine, maintain that almost all back problems are caused by (usually unresolved) emotions.

Sarno maintains that 95 per cent of his patients cure themselves of their back ailments by resolving emotional stress, and without the help of psychotherapy.

In his book Healing Back Pain: The Mind Body Connection (Warner Books, 1991), Sarno quotes a study of those of his patients who, within the last two years, had CAT scans showing the presence of a herniated disc.

Researchers randomly phoned 109 patients who had followed Sarno's programme instead of opting for surgery. Results showed that 88 per cent of them were free or nearly free from pain and had unrestricted physical activity. Ten per cent were improved with some physical limitation, and only 2 per cent were unchanged.