Time For A Paradigm Shift About Pain
All the Rage: A film about a medical revolutionary, Dr. John Sarno
Posted November 5, 2016
The musical, Hamilton, explores the life and legacy of Alexander Hamilton, the revolutionary hero and founder of the federalist form of government. The final number asks the question,“Who tells your story?”
This moving piece led me to think of one of my heroes, John Sarno, MD. Dr. Sarno retired from medical practice 2 years ago and is now 93. He practiced rehabilitation medicine at New York University and pioneered a revolution in the treatment of back and neck pain. He found that many patients had severe back pain with mild or no abnormalities on X-rays or MRIs. And he noted that many people with significant or severe imaging abnormalities had little or no pain. Since then, multiple studies have confirmed this lack of association.
Furthermore, Dr. Sarno also began to see associations between emotional distress, early life adversity, and certain personality profiles (notably perfectionism and the need to please) and the onset of back pain and other so-called functional syndromes, such as headaches and irritable bowel syndrome. And most importantly, he found that when a patient is diagnosed with having a psychosomatic illness and given a clear understanding of that process, many people have dramatic resolutions of their symptoms, even if they were of a long-standing nature. (He also clearly recognized that many patients with chronic pain have a physical reason for the pain.)
Dr. Sarno wrote four books (Mind over Back Pain, Healing Back Pain, The Mindbody Prescription, and The Divided Mind) that have attracted a wide following all over the world. Yet, relatively few physicians who see patients with chronic pain are familiar with his work. I know Dr. Sarno and have worked with him. I admire him for his great contributions. His work has helped thousands of people rid themselves of chronic pain. Despite his accomplishments, he has been frustrated that these ideas, which now form the basis of my practice, have not been recognized or accepted in mainstream medicine.
To people like me who work with patients with pain and see the powerful connections between the mind and body, it is shocking that Dr. Sarno’s work continues to be ignored by mainstream medicine.
How does this happen?
To understand this, one has to understand how medical doctors (and the public) change their minds. You may be familiar with the story of Ignaz Semmelweis, an Austrian physician who discovered in 1847 that when he washed his hands between delivering babies, fewer women developed serious infections and therefore fewer died. This straightforward yet brilliant discovery was the result of careful observation and Dr. Semmelweis proved his theory by seeing the results in clinical practice.
How was this life-saving discovery greeted by the medical establishment of the time?
With derision. He was called naïve and his findings were challenged and ignored. No local doctors even tried the simple act of hand washing to see if they could also reduce infections and death. Semmelweis was, understandably, frustrated. He couldn’t explain why hand washing saved lives, as this was before the discovery that bacteria cause diseases and are contagious. Sadly, his career got derailed and he ended up in a mental institution.
Over 50 years ago, Thomas Kuhn wrote about the history of scientific advances and how paradigms changed. Most new ideas are resisted initially, especially when they challenge the status quo. Think Galileo.
In the 1980s, Dr. Sarno was in the same position as was Dr. Semmelweis. Dr. Sarno had figured out that many of his patients did not have a physical condition to explain their pain (unlike virtually all of his colleagues). Furthermore, he found that many of them could be cured by making an unequivocal diagnosis and carefully explaining it to the patient. These ideas challenged the orthodoxy of the time and few people believed him despite impressive results.
Kuhn described several steps in the process of new ideas becoming accepted. First there is derision and neglect, which can last for years or decades. Then a variety of discrepancies occur, i.e., bits of clinical and research information that suggest that the old beliefs don’t hold up. Why did so many of Dr. Sarno’s patients get better, when traditional medical interventions didn’t work? Why were MRIs inaccurate in determining who would have pain and who wouldn’t? Dr. Sarno also found that other disorders without clear physical tissue damage, such as migraine and tension headaches, and irritable bowel syndrome, responded to his educational interventions.
Over time, a few other physicians and therapists began using Dr. Sarno’s methods and they had equally impressive results. Research studies came out showing that most people with chronic back pain do not have a clearly defined medical explanation and that MRIs are abnormal in the majority of adults who do not have back pain. Studies of surgery for back pain have not shown better results than non-surgical interventions. Injections for back pain have not been shown to be better than placebo injections. Studies of brain imaging show that physical pain and emotional pain are equivalent and that emotionally laden regions of the brain (rather than somatosensory areas) are activated in chronic back pain. And emerging research shows that psychological interventions that target emotions are showing significant results.
The final step towards acceptance of new scientific ideas is when influential people begin recognizing that the new idea is truly an advance.
It seems that this is beginning to occur. On November 12, a documentary film entitled All The Rage premieres at the NYC Doc Film Festival. This movie, about Dr. Sarno and his ideas, has been over ten years in the making. The directors and producers, Michael Galinsky, Suki Hawley, and David Beilinson, have created a moving and dramatic film.
The film features several physicians (Drs. David Clarke, David Schechter, Gabor Mate, Andrea Leonard-Segal, Andrew Weil, Ira Rashbaum, Roy Seidenberg, and me), some therapists (Drs. Arlene Feinblatt, Frances Anderson, and Eric Sherman, and Nicole Sachs), and a few celebrities (media personalities Howard Stern, Larry David, John Stossel, Jonathan Ames, and golfer Ben Crane) who are all supporters of these ideas.
Over the past three decades, the number of people who suffer with back pain and other conditions treated by Dr. Sarno has increased. However, more people are also discovering these ideas. There is no doubt in my mind that the simple concept that many people suffer with disorders that are caused by the brain will become common knowledge.
(Side note: Of course, this idea is not at all new. Doctors have known that the mind affects the body for centuries. Of course, Freud wrote extensively about this and another of my heroes, Dr. George Engel, did as well. This common sense knowledge just seemed to get lost in the major medical advances of the second half of the 20th century.)
As with Alexander Hamilton, Dr. Sarno’s story will be told by many. If you get a chance to see All The Rage, you will see an amazing film and you will be a witness to an emerging paradigm shift in the history of medicine. Sometimes, a good idea at the right time can turn the world upside down.
To your health,
Howard Schubiner, MD