Back pain is perhaps one of the most common health complaints across the globe. Worldwide, 1 in 10 people suffers from lower back pain, and it’s the No. 1 cause of job disability. In the U.S., a whopping $90 billion is spent on back pain each year.1 Tragically, back pain is also a leading cause of opioid use, which now kills more Americans than car crashes.2

Seventy-five to 80 percent of back pain cases do resolve within two to four weeks,3 with or without treatment, although it’s important to note that back pain can also be symptomatic of something else entirely, including an aortic aneurysm, appendicitis, gynecological issues, osteoporosis, arthritis and kidney stones,4 so if your back pain is not the result of an injury or strain, it’s advisable to see a doctor for an assessment.

Few people want to be told that their pain is psychological or emotional in origin, but there’s quite a bit of evidence that backs this up. As noted in a 2014 scientific review:5

“Specifically with regard to pain, studies pointed to the need for a model encompassing the complexity of the pain phenomenon. The biopsychosocial perspective closes this gap by confirming the existence of a dynamic relationship among biological changes, psychological status and social context.

The difficulty to accept the multidimensional nature of pain is largely linked to the widespread acceptance of Cartesian principles separating mind from body. Conversely, the biopsychosocial approach tries to consider physical, psychological, social and spiritual aspects not separately, but as an integrated whole … [S]everal studies show the major role of biopsychosocial factors in triggering chronic pain, in the process of acute pain chronicity and in patients’ incapacity.”

Back Pain — Is It All in Your Head?

The late Dr. John Sarno, a professor of rehabilitation medicine, used mind-body techniques to treat patients with severe low back pain. His specialty was those who have already had surgery for low back pain and did not get any relief. This is a tough group of patients, yet he claimed to have a greater than 80 percent success rate using techniques like the Emotional Freedom Techniques (EFT). A recent Vox article6 discusses Sarno’s unconventional treatment strategies for back pain, citing feedback from enthusiastic patients:

“’Thousands of people, including myself and my husband, cured our chronic back pain using [Sarno’s] methods,’ wrote Karen Karvonen. Another Sarno devotee, Steven Schroeder, said the doctor changed his life. Schroeder’s back pain flared whenever he was stressed — a busy time at work, an illness in his family.

After he absorbed Sarno’s books, the discomfort mostly vanished. ‘I still sometimes have pain now in times of stress — but I can literally make it go away with mental focus,’ Schroeder, a lawyer in Chicago, wrote in an email. ‘It is crazy.’

Though he may not be a household name, Sarno is probably America’s most famous back pain doctor. Before his death on June 22, a day shy of his 94th birthday, he published four books and built a cult-like following of thousands of patients … Many of them claim to have been healed by Sarno, who essentially argued back pain was all in people’s heads.”

Before his death, Sarno was even the subject of a full-length documentary, “All the Rage: Saved by Sarno,” produced through Kickstarter donations. The film is expected to become available on Netflix before the end of the year. He was also featured in a “20/20” segment in 1999.

The Psychological Underpinnings of Pain

As noted by Sarno in “All the Rage” — a four-minute trailer of which is included above — “I tell [my patient] what’s going on, and lo and behold, it stops hurting.” The “what” that is going on is not a physical problem at all — it’s emotions: anger; fear; frustration; rage.

One of the most controversial aspects of Sarno’s theory is that spine and disc abnormalities have no bearing on pain. In this 20/20 segment, Sarno dismisses these issues as “normal abnormalities” that are unrelated to any pain you may be experiencing. Many with back pain have no detectable abnormalities or structural problems while some that do have them suffer no pain.

According to Sarno, you unconsciously cause your own pain. In a nutshell, the pain you’re experiencing is your brain’s response to unaddressed stress, anger or fear. When these kinds of emotions are suppressed, your brain redirects the emotional impulses to restrict blood flow to certain parts of your body, such as your back, neck or shoulder, thereby triggering pain.

This pain acts as a distraction from the anger, fear or rage you don’t want to feel or think about. The pain essentially acts as a lid, keeping unwanted emotions from erupting. You may feel anger at the pain, but you won’t have to face the fact that you’re actually angry at your spouse, your children or your best friend, or that you hate your job, or the fact that you feel taken advantage of.

As noted by Sarno, working hard and constantly trying to do everything perfectly to keep everybody around you happy, “is enraging to the unconscious mind.” The term Sarno coined for this psychosomatic pain condition is “tension myoneural syndrome,”7 and he firmly believed most people can overcome their pain by acknowledging its psychological roots.

Even if you struggle to accept such a concept, the mere knowledge of it can have therapeutic power. In other words, by considering the idea that your problem is in fact rooted in stress factors opposed to a physical problem can allow the pain to dissipate.

While many of Sarno’s patients got well without psychiatric help, he would often recommend seeking out a psychotherapist to explore repressed emotions, or to take up journaling to put your feelings on paper. Dr. David Hanscom, an orthopedic surgeon, also uses expressive writing as a primary treatment tool for back pain. To learn more about this, please see our 2015 interview linked above. Other dos and don’ts listed in Sarno’s book, “Healing Back Pain,” include:

Do: Don’t:

Resume physical activity. It won’t hurt you

Repress your anger or emotions

Talk to your brain: Tell it you won’t take it anymore

Think of yourself as being injured. Psychological conditioning contributes to ongoing back pain

Stop all physical treatments for your back — they may be blocking your recovery

Be intimidated by back pain. You have the power to overcome it