His goal was to cure pain, rather than just manage it. Interested in exploring the role of emotions in causing physical symptoms, he offered a relatively simple approach: recognize that most people with chronic pain have a psychosomatic disorder, change their mindset about the pain, and deal with the emotions that caused the problem. Could it be that we were attributing the vast majority of back pain to disorders like scoliosis, degenerative and bulging discs, and poor posture when the pain had a different source?
Few people in the medical profession were looking at the disconnect between pain and structural abnormalities in the body. A study published in 2009 evaluated more than 1,100 people with acute back pain and followed them for one year after the pain started-only 1 percent of them were found to have a significant structural abnormality in their back. Those numbers are 80 and 60 percent, respectively, for pain-free 50-year-olds, and they rise from there. A study published in 2014 by Waleed Brinjikji from the Mayo Clinic showed that 50 percent of pain-free 30-year-olds have evidence of disc degeneration on MRIs, and 40 percent have evidence of a bulging disc. In fact, most people have “abnormal” X-rays and MRIs, even those with no pain at all.
In other words, many people whose imaging studies appeared normal had severe and chronic pain, while others with significant abnormalities had little pain and recovered quickly. He noticed that the degree of pain and the likelihood of recovery appeared to be unrelated to the degree of abnormalities demonstrated on X-rays, CT scans, and MRI exams. Knowing that I’d started to practice and teach mindfulness meditation a few years earlier, he thought I’d enjoy the book’s exploration of the role our minds play in the production of pain.Īs a rehabilitation physician at New York University, Sarno saw hundreds of patients with back pain every year. Then a year into my new position, a colleague suggested that I read The Mindbody Prescription by John Sarno, explaining that a close friend of his had made a remarkable recovery from chronic back and leg pain after reading it. Although I had no particular desire to delve into the specific issue of chronic pain, which I figured must be one of the most unsatisfying areas of medicine, I just couldn’t avoid it. Physicians, insurers, and the patients themselves were all at a loss. Clashes with patients about their dosages became increasing frequent, and I wondered at times if I was one of the many doctors being scammed and contributing to widespread addiction. We were at the beginning of the opioid abuse epidemic. Often prescribing opioids was the only way to help. And it wasn’t just happening in my small office: the number of people with chronic pain was exploding across the country. Most frustrating, however, was that as an internal medicine specialist, many of the patients I saw regularly suffered from chronic pain conditions that seemed impervious to medical treatments. I found that my frustrations with academia were soon replaced with the irritations of dealing with the modern medical bureaucracy-issues with documentation, billing, electronic medical records, practicing defensive medicine to try to avoid lawsuits, and pressure to see more patients in less time. But the shift turned out to be less gratifying than I’d anticipated. I went from being a well-established teacher, clinician, and researcher at Wayne State University to practicing medicine at a community hospital, where I thought I’d just coast along, helping people feel better, until my retirement. Sixteen years ago, tired of the academic rat race of striving for yet another grant and another publication, I left the only job I’d ever had as a physician.