Being somewhat of an expert in this field (as patient and as Dr.), I must admit that I have seen my share of patients who just did not heal or get significantly better over the course of a laid out treatment plan. For those falling into that category, I certainly would not hesitate to make a referral to this Medical Dr.in the 20/20 special.
However, I think that he is overstating the case since he can not speak for the greater percentage of patients who actually improve and recover under the care of a good Osteopath, Chiropractor and/or Physical therapist, and who never make it to his office since they didn't need him in the first place: they actually recovered using standard practice.
I believe that John Stossel and the Dr. are completely forgetting that there are millions that have been healed and never went on to debilitating chronic pain syndromes.
Watch the 20/20 video on Tamar Yona's Blog here.
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Hi Arnold,
As a healthcare professional (physical therapist) who like you has devoted a great deal of my professional work helping people with back pain, I agree with what you say here. I wrote about John Sarno, the doctor that Tamar Yonah refers to, in my book Back Pain Solutions, still available for free download at backpainsolutions.net
Below is an adaptation of what I wrote about Sarno in my book:
John Sarno, M.D., a physical medicine (rehabilitation) specialist, advocates the view that most back pain has a primary psychological origin.
Sarno contends that internal conflicts, anxieties, etc., often get translated directly into muscle tension in the back which then causes pain. He believes that this accounts for a large proportion of back problems.
According to Sarno, the best treatment for such a problem consists of convincing the patient that his symptoms are due to psychological conflicts. According to him, accepting this ‘diagnosis’ often seems sufficient to solve the problem, although he does recommend providing some level of counseling at times. With this approach, physical therapy or chiropractic therapy may serve as an adjunct to help promote general mobility. However, for the most part, patients are advised to forget about special exercises, body mechanics, etc., to stop worrying about pain, and to simply return to normal activity.
Sarno’s view of psychogenic back pain has some merit in that it points to the importance of attitudes, anxiety and guarding in perpetuating back problems. Quite likely, some of his
successes have been with individuals who had became so fearful about reinjuring themselves that their self-imposed guarding became a major part of their ongoing disability. In some of these cases, anxiety reduction leading to normal, unguarded
movement may have sufficed to correct minor soft tissue contractures.
However, sometimes a change in attitude, although necessary, may not in itself be sufficient to get better. I have worked with a number of people who, prior to seeing me, attempted
to exert their ‘minds’ over their back problems. They felt like failures when they did not succeed in getting rid of their supposedly ‘psychologically-caused’ pain. This obviously didn’t help their ability to cope.
Advocates, like John Sarno, of the psychogenic approach to back pain have oversimplified the relations among emotional factors, movement
and pain. They also underestimate the importance of the kinds of soft tissue changes in the joints and muscles that can occur with musculoskeletal problems. Emotional factors, soft tissue
changes and postural factors all work together to perpetuate a circle of pain and disuse that often require specific postural-movement interventions, including patient specific exercises, mobilization, manipulation, etc.
Mechanical Diagnosis and Therapy which any number of physical therapists and chiropractors provide, and which includes considerations of psychological factors, seems to me like a much better way to go.
You're absolutely correct Bruce, and that's the reason that I mentioned that Dr. Sarno and John Stossel are OVERSTATING THE CASE.
Thanks for your input.
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