First of all I applaud Dr. Sarno for searching for a reason for back pain.   The results of successful treatment for back pain are less than desirable.  So, any attempt to improve the understanding of back pain and how to treat it are great.  Unfortunately, I don't completely agree with Dr. Sarno's reasoning.

I have treated many people with back pain that have psycho-social issues.  Often these stresses on top of an injury exacerbate the symptoms.  Once the movement patterns are restored pain becomes more of a secondary issue that has to be resolved.  When the patient is confronted about their lifestyle or the conflict is resolved between the employee and employer their back  pain resolves also.

I believe that he has over-generalized the cause of back pain.  Certainly we all have experienced the tension of stress as it accumulates in our bodies in different spots.  This experience does not correlate well with more obvious mechanisms of injury such as lifting too much with poor body mechanics, auto accidents, or slips and falls.  It's almost as Dr. Sarno doesn't even consider the evidence of mechanical low back pain.

I believe that Dr. Sarno misinterprets the NEJM article he quotes.  A better interpretation of that article in my opinion is that having a herniated disc is a condition that can be managed.  Many people with known herniated discs and related back pain effectively manage their back pain and continue to perform at stellar levels.

Dr. Sarno's example of oxygen deprivation as it relates to back pain with radiculopathy is taken out of context.  The brain cannot control the responses to control oxygen deprivation of such specific magnitude.  His use of the results of physical therapy as the increase of oxygen are incorrect.  The benefits of physical therapy arises from primarily movement.  Modalities prepare the tissue for movement by increasing blood flow with heat.  Soft tissue can heal by the stimulus of motion (piezoelectric forces), increased nutrition to tissue by increased blood flow.  Ultrasound can also stimulate fibroblastic activity that helps connective tissue heal.  Electrical stimulation and other modalities help mediate pain through the "gate control theory" presented by Melzak.

I agree that there is a mind-body connection.  Pain is worsened by psychological stressors.  What has worked successfully for me to resolve patient's back pain is through physical therapy.  I use patient specific exercises to improve their physical condition, treat the pain through various modalities, and let them prove to themselves that they can do the activities they need to do to work or play.

Over-utilization of Rehab Services article published in the AWCCA Examiner.

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