Is Your Pain “Just In Your Head”?

The New York Times just published an obituary for Dr. John Sarno, a doctor at New York University who wrote controversial and best-selling books on the psychological origins of chronic pain.

As a chronic pain sufferer myself, I find it interesting that physicians, nurses, other medical professionals, and people in general often dismiss the idea that there can be a psychological component to pain. Dr. Sarno championed the idea that stress can not only make pain worse, but that stress itself can cause pain.

The obituary notes that many people (both doctors and non-doctors) dismissed Dr. Sarno as a quack. Having only skimmed through his most famous book, Healing Back Pain: The Mind-Body Connection, a few years ago, I can’t defend every idea in it. Maybe there were some elements of questionable science, some leaps of logic, or some plain old quackery.

But the basic idea that emotional or mental stress can cause pain shouldn’t be controversial any more. There are SO many scientifically plausible ways that this can work.

Dr. Sarno apparently argued that stress might contribute to “mild oxygen deprivation caused by reduced blood flow to muscles and nerves throughout the body.” That’s just one idea.

Another is that stress can activate your sympathetic nervous system (your so-called “fight-or-flight” system), and turn down your parasympathetic nervous system (your “rest and digest” system). When this happens, the body will not be able to heal as well, since your body is diverting resources to deal with immediate threats (even if those threats are just imagined). Your body doesn’t want to invest in long-term repair when there’s a fire to deal with!

Other research on placebos and “nocebos” (things that make you perceive more pain, even if they are harmless), has repeatedly demonstrated that the mind has an extremely powerful influence on the perception of pain:

The nocebo effect might even be powerful enough to kill. In one case study, researchers noted an individual who attempted to commit suicide by swallowing 26 pills. Although they were merely placebo tablets without a biological mechanism to harm the patient even at such a high dose, he experienced dangerously low blood pressure and required injections of fluids to be stabilized, based solely on the belief that the overdose of tablets would be deadly. After it was revealed that they were sugar pills, the symptoms went away quickly.