Tension Myositis Syndrome (TMS): Can Your Mind Really Heal Your Back, Neck, Shoulder, Butt, and Leg Pain?

Perhaps it can, if that’s part of the cause

I did’t expect to do another self-indulgent post on my neck & shoulder troubles. So I’m doing this because I think it might be my last or second to last post, once I report full recovery — and just as importantly, might give a clue as to a course for others suffering from chronic, agonizing pain.

I first let the cat outta the bag back here. And then my friend and MD radiologist with specialization in neuroradiology (spine & shit), Dr. Kurt Harris of PaNu commented thusly:

Very sorry to hear about your shoulder girdle pain. Are you under any (perhaps unacknowledged) stress lately? I am a big believer in John Sarno’s conception of TMS. I actually have a quite a lot of clinical experience with this. One clue which many are amazed to hear is that psychogenic or psychosomatic pain is often WORSE than that associated with cervical herniated discs, fractures or tumors!

Your comment “sharp, agonizing pain that had me fantasizing about either cutting off my own arm, or having a .40 caliber for dinner” is typical in patients with TMS type pain.

While I didn’t brush it off entirely, I was under the "sound obvious conclusion" that the cause was simple: I’d been lifting more weight (at 50-yrs-old) than ever before in my life, by a large margin. I overdid it (and in fact, the condition first manifested most prominently at the gym), injured my rotator cuff, and now I have to pay the price.

The thing is — and I didn’t really take stock at the time — but I was already a good month or more into the pain by this point and it just was not improving, but seemingly getting worse. My wife saw Kurt’s comment and would regularly look at me and say: "TMS." Perhaps she knows me better than I know myself or care to acknowledge. We’ll see. At any rate, it simply struck me, at a glance, as a little woo woo and magical.

Fast forward a few weeks and I posted this: This is One Big Ass Pain in the Neck! Here, I revealed that what I had learned in the interim is that I actually had no shoulder injury, which counted as my first error in assigning a cause. From there, MRI results are in, and it’s a narrowing of the spinal canal in my neck as well as narrowing of the nerve root at C5/6. Yesterday at my spinal consult the doctor called it a "pinched nerve." I’m not up on the technical lingo and whether that implies any sort of stenosis or herniation of the disk, I don’t know. What I saw on the MRI myself on the side view was a protrusion about 1/4" in diameter by about 1/32" to 1/16" into the spinal canal. A pimple. The top down cross sectional was more difficult to understand, for me, but apparently, the nerve root is crowded or pinched by the disk protrusion.

So what caused this? Is the disk protrusion causing the pain, or is it a consequence of the pain? Or is it a coincidence altogether?

Actually, I have no idea and the information I have gathered suggests that many or most disk herniations present without symptom. kurt harris in an email told me that half the MRIs he looks at for people of my age have disc herniations and there are no symptoms.

Are we looking for a convenient cause? And when surgery repairs the disk, is that surgical repair the real cause of the amelioration of the pain? Or, does the event of having a surgery and associated expectation invoke another effect altogether? I suspect that both structural repair, especially egregious, does a lot of good and that there are also cases where surgery is expected to improve things, setting the mind at ease and in comfort, and voila: success.

Hmmm, live long enough and become increasingly uncertain of what you think you know.

Alright, some of the foregoing and most of what remains is speculation on my part — it’s a bit of a game; like, when you go to see a movie and because it’s crafted after a formula, you know how it ends but want to see it anyway. In this case, the formula — at least to me — is revealed on page one of the introduction of the book I’m going to discuss.

An article in Forbes magazine in August 1986 reported that $56 billion are spent annually to deal with the consequences of this ubiquitous [emphasis mine] medical disorder. It is the first cause of worker absenteeism in this country and ranks second behind respiratory infection as a reason for a doctor visit.

All this happened in the past thirty years. Why? After a few million years of evolution, has the American back suddenly become incompetent? Why are so many people prone to back injury? And why has the medical profession proven so helpless to stem the epidemic?

Well, even if you’re only a casual reader of this and other "paleo" oriented blogs you will clearly recognize: thems are fightin’ words — in a good sense, of course. Perhaps we’re dealing with something beyond pure diet but that still holds deep evolutionary context? Did our paleolithic ancestors have to get the kids to ballet and soccer, all in one afternoon? Did they own a dozen rental properties, or a business with employees? Did they have a concept of unemployment? What, like the jungle disappears?

So I only read the first three pages or so of the book intro and had one of my best nights of sleep in weeks. I had a staunch conviction I was onto something and to some extent the pain, still present to some extent, had lost a lot of its power to invoke anxiety, perpetuating the cycle and downward spiral of chronic pain.

…I didn’t take this whole event seriously until about 2-3 weeks in. It was a shoulder injury. I took nothing for it, save some ibuprofen when I might wake up in the middle of the night with pain. It would go away on its own, as has every ailment I’ve ever known counting 50 years of life on Earth. And then, weeks later, I found that drugs like Vicodin and Percocet didn’t even touch the pain. Might as well drink water.

And oh, yea, sorry. You want to know: what book? Healing Back Pain: The Mind-Body Connection. That’s by John E. Sarnos, MD. He’s been working at this since only about 1965 at the New York University of Medicine. Feel free to dismiss.

Fast forward; to my best night of sleep in weeks. I still had to get up almost every couple of hours and move around for a few minutes to loosen up (1:30, then 3:30, but then lasted to 6:30 for 3 hours in the final round). But while the pain upon getting up is usually the worst and takes hours to resolve, and then gradually over the course of the day until time to hit the torture chamber once again (bed), this was mostly gone in a few minutes. Bea left, the maids were not due to arrive for another 2 hours, so I decided to read Sarno for a good 30-45 minutes; but really read, integrate. Think hard.

And as I went through the rest of the introduction and got to about page 20, I could literally feel the pain somewhat "melting away" while at the same time, experienced transient tinges as if to ask, are you sure?

Let me cut to the chase. This book immediately raises the possibility that my status in life, my circumstances recently, and the way I have dealt or haven’t dealt with them may be the real, fundamental cause of my chronic pain.

I have never seen a patient with pain in the neck, shoulders, back or buttocks who didn’t believe that the pain was due to an injury, a "hurt" brought on by some physical activity. "I hurt myself while running (playing basketball, tennis, bowling)." "The pain started after I lifted my little girl" or "when I tried to open a stuck window." "Ten years ago I was involved in a hit-from-behind auto accident and I have had recurrent back pain ever since."

The idea that pain means injury or damage is deeply ingrained in the American consciousness. Of course, if the pain starts while one is engaged in a physical activity it’s difficult not to attribute the pain to the activity (as we shall see later, that is often deceiving). But this pervasive concept of of the vulnerability of the back, of ease of injury, is nothing less than a medical catastrophe for the American public, which now has an army of semidisabled men and women whose lives are significantly restricted by the fear of doing further damage or bringing on the dreaded pain again. One often hears, "I’m afraid of hurting myself again so I’m going to be very careful of what I do."

And wow, the very first page of chapter one set a stage for me. If you’ve never experienced any of the foregoing, you’ve heard it a million times from others. And without getting too deeply into the reading, here’s other tidbits that hit me like bolts of lightning. Rather than spend time typing quotes, I’ll bullet; which is, admittedly, not like bolts of lightning.

  • Common "growing pains" in children are unexplained but resemble sciatica in adults.
  • The mind can command a physical reaction over an emotional one. I.e., if you can weep uncontrollably, why can’t you feel physical pain uncontrollably?
  • In a study, 77% of patients for these types of conditions were 30-60 years of age. Only 7% were in their 60s and only 4% in their 70s. If these sorts of maladies are the result of general degeneration and aging, how to explain that? Interesting that the lion’s share of injury takes place during the average stressful, productive years of one’s life.

So here’s how I think it ends, and here’s where I also ask for commenters to chip in. Holy Jesus Facetious did I ever strike it rich with the best commenters in the paleosphere. Just look at that. So many avenues to pursue. I feel deeply fortunate and thank you all for the many insights, suggestions and well wishes (and the emails too). Do know that the high traffic of this blog means that when you give a few minutes of your time like that to share, you are probably helping many people who really need the benefit of your experience. It’s a huge part of why I do this.

…Yes, I have endured various and many faceted stresses in the last few years. Without a total airing of dirty laundry: much money lost in the markets, decided to "strategically" dump a number of rental properties either to foreclosure or short sale; and I had to personally attend to my company and primary source of income after being absent for some years. Once I dug back in there, I realized I should have gone back a few years ago; which caused tremendous anger, directed primarily at myself. …And some anger that would justly be directed at others, potentially repressed and unexpressed explicitly, due to sensitive circumstances. And so maybe, the rage often expressed on this blog just didn’t make up for that.

So what caused my pain? Lifting weights, or my mind? I didn’t ever cry my heart out, I really didn’t. Maybe I should have. Or, maybe I should have laughed at it. maybe I should have said to myself that so long as I have my Beatrice, two doggies, my guns & ammo, I’ll be totally fine even living in a tent.

…And so I sat there; reading, laughing. I laughed & laughed as pain drained. I gathered my stuff and went off to my office with a certain resolve and anticipation and not dread…not the dread that had made me stay home and do minimal work remotely, most days recently. Many dark, very dark days.

And then, I stopped. It was nearly at the top of the 2nd flight of stairs at the office building. I realized I just bounded up them and had a smile on my face the whole way. And I laughed. And I kept laughing.

The thing is, as I see it, faking it will not work. The first step is to totally dismiss the fear and anxiety of your pain. The rest is automatic. Once you’ve done that, you can’t help but laugh.

Alright folks, as I said, I wanted to see if I could guess how the book ends and so Sarno fans, jump in and tell me where I’m wrong, right, or misguided. And get your Facebook and Twitter folks to chip in with the buttons, above. You might really help a friend or loved one.

Since Covid killed my Cabo San Lucas vacation-rental business in 2021, this is my day job. I can't do it without you. Memberships are $10 monthly, $20 quarterly, or $65 annually. Two premium coffees per month. Every membership helps finance this work I do, and if you like what I do, please chip in. No grandiose pitches.


  1. Kurt G Harris MD on February 17, 2011 at 19:42

    A very moving account, and yet, not surprising to those of us who’ve treated patients, family and ourselves with these insights.

    I don’t think the freudian framework Sarno uses is the true foundation of this phenomenon, but his insight that the brain can use severe pain mediated via the autonomic nervous system as an unconscious defense against painful feelings is 100% convincing to me, and I’ve yet to see anything in my reading of modern brain science that would refute it.

    The key thing is just the recognition that this is what is going on, and acknowledgement of these unacknowledged feelings. “Solving” whatever is bothering you is not even necessary.

    Finally, you said “I didn’t ever cry my heart out, I really didn’t. Maybe I should have.”

    When you think about the physiology of “a good cry”, which is a virtual symphony of autonomic processes, and imagine what happens to the actual physical energy that would be discharged by crying, and is not, you can begin to imagine how the process of TMS might work.

    When I wrote my post about “Therapy versus Life” this is exactly what I was talking about. Not everything can be fixed by DIET. What I didn’t emphasize enough though, is that there are other parts of how we live – I would not want to call them “therapies” – that can be just as powerful as diet in making life worth living and weathering its storms.

    What good is perfect eating if you want to eat a bullet?

    Keep us posted – you are in the prayers of the godly and the meditative thoughts of we heathens as well.

    • VW on February 18, 2011 at 07:02

      When I first became a meditator, I couldn’t make it past a couple of minutes without feeling excruciating muscle pain in my mid-back region. After really observing it while sitting, though, I discovered that the pain had no location. It roamed. It wasn’t really there.

    • TMS - an expanded theory on February 18, 2011 at 12:55

      First, I´m a big fan, don´t drop the blogging again.

      Second, I agree completely with the Freudian framework not being optimal. I think a more modern “modular / process”-focused framework works much better. In this case, I suspect that the reason for the pain might be more adaptive than just a “defense against painful feelings”. I´d guess that the process goes more like this (see my post below for my personal experience):

      1: Bad behavioral pattern is established. What is a “bad” behavioral pattern? One good example is short-term/long-term incentive disalignment. I.e. when our evolutionary triggers are mis-aligned, I.e. when what feels good right in the moment leads to us feeling real bad further down the road. Alcoholism, gambling, video game addiction, stuck in a bad job with no escape, etc. etc. You all know the drill.

      2: Various processes in the brain pick up on the fact that we are miserable or stressed out, despite following positive-reinforcement incentives (that should make us content if they worked properly).

      3: These processes (modules, call ’em what you like) in turn attempt to jerry-rig a forced behavioral change.

      4: Pain. Might be targeted against the problematic behavior (was in my case), or might be more of a carpet-bombing effort. A guess is that one mechanism through which pain is induced is a slight reduction of blood flow, leading to a non-damaging, but very painful lack of oxygen. But that´s just a wild guess based on my personal experience.

  2. wilberfan on February 17, 2011 at 19:43

    Welcome to SarnoWorld. I discovered his ideas (and their effectiveness) about 10 or 12 years ago. I had back pain, sciatica, vertigo, so-called “repetitive stress injuries” (not all at the same time)–and a job I absolutely hated. Long story short, I quit the soul-sucking job, and with the help of some folks I found online (who had been helped by his ideas–God bless the Internet) the pain(s) went away.

    I had to smile when I saw how the reading you’re doing is hitting you “like bolts of lightning”. I was hit with waves of deep resonance when I read his book (there are actually others that resonated even more). I think it’s a good sign, Richard…

    • Lute Nikoley on February 17, 2011 at 19:57

      Now Sciatica, that was a problem for me for a couple of years, every time I got into my car after about an hour the sciatica started. So to make a long story short, I wanted to buy a new car that didn’t have a center console so I could stretch out my right leg while driving. Then I started thinking, crap do I really want to do that make payments for another 4 years? Hell no. Haven’t had any sciatica since.

    • Beezy on May 15, 2015 at 10:57

      Hey Wilberfan….I know this is an old post, but can you recommend what other books helped you?


    • wilberfan on May 15, 2015 at 12:11

      Well, two that I see on my shelf at the moment are “Back Sense” by Ronald D. Siegel & Michael H. Urdang and “Healing Back Pain Naturally” by Art Brownstein, MD.

      They’ve both had the shit highlighted out of them! ;)

    • Beezy on May 15, 2015 at 14:41

      Hey thanks man! Got those written down.

  3. Lute Nikoley on February 17, 2011 at 19:48

    I for one, am really happy that your’e feeling so much better. I ordered the book to take care of the other nagging back pain I have, that are not related to the torn disk. Maybe my golf game will improve, I hope. But really, I am happy it’s working for you so far.

  4. Alan M. on February 17, 2011 at 20:02

    So glad to hear Sarno’s book helped, I read it a while back to help with this neck pain I had. The pain seemed to just start going away after the first few pages too.

    I had heard of Sarno from Howard Stern who swears by Sarno’s techniques for curing him of back pain too. I think Stern was actually a patient of Sarno’s.

    Anyways, wishing you continued recovery, thanks for the update, I always look forward to your posts.

  5. Shana A. on February 17, 2011 at 20:16

    Sarno’s book cured me in a day. Never been so happy to find out that the reason 6 months off and several thousand dollars with various doctors couldn’t cure was harmless. The book was suggested to me by a client who healed her own back pain.
    TMS pain is real – and I’m really glad making it go away was as easy as reading a book. I had the same experience with the bounding and the laughing! Sarno is the man for sharing this for $6.99.

  6. Alice on February 17, 2011 at 20:21

    This post made me so happy. I’m new to your site, just as I’m new to Paleo living, and in many ways I feel like what I’m discovering about myself from Paleo is similar to what I discovered through Sarno.

    I spent two years crippled by what was diagnosed as repetitive stress disorder. I was told by several experts that I had the worst case they’d ever seen. I couldn’t write (and that’s a problem, since that’s how I make my living), I couldn’t clean or cook. I couldn’t clip my nails. My husband had to clip them for me. For months I was on disability and spent every day either at therapy or one doctor or another. I was told to get used to using voice recognition software because I would never type again.

    Then I read John Sarno. It took a while, but within six months, my pain was completely gone. Completely. It took me awhile to really believe that it wasn’t a fluke. It wasn’t, and what’s more, I had several friends suffering similar symptoms, and when I told them about the book, they read it–and their symptoms disappeared as well.

    It’s been seven years since I first picked up the Mind/Body Prescription. I had twinges here and there for a couple of years after, but I laughed them off–literally I laughed at my wacky brain inventing pain where there didn’t need to be any–and they disappeared. I’m a full-time writer and blogger, and my first book is coming out in a week. And I will never let anyone else clip my nails for me. Because that was the worst.

    You’ve done a real service, I suspect, with this post.

  7. Todd Hargrove on February 17, 2011 at 20:24


    Congrats on feeling better. I know at least two other people who read the book and got rid of pain upon closing the book.

    By coincidence I just wrote a blog post on the Sarno issue yesterday. My take is that although he is clearly correct about some things, his Freudian theories are off a little, and modern pain science theories offer a better explanation for the results he gets. But I guess its all academic for you if you feel better, that’s the important thing. Congrats again.

  8. Rachel on February 17, 2011 at 20:27

    Hey Richard –

    It’s funny – when I read your “Pain In the Neck” post, I thought to myself “sounds like classic TMS – he should really read Sarno’s book.”

    I had back issues off and on for years until I read “The Mind-Body Connection.” In 2009, I was laid up having thrown my back out deadlifting. I woke up one night at 4am crying from pain and out of vicodin. I had Sarno’s book, but hadn’t read it before because a) I could always point to a specific casual injury, and b) my back REALLY fucking hurt so I was convinced that there was no goddamn way that was in my head.

    Like you, I experienced almost immediate relief just from reading the first few chapters. It was mind-blowing. I haven’t “thrown my back out” since. If I feel any recurrence of pain, I usually read a couple of passages in the book that I found particularly helpful, and that takes care of it.

    Interestingly, since reading “The Mind-Body Connection,” I’ve come to realize that my body is very creative in coming up with new ways of hurting that leave me absolutely convinced that I’ve injured myself when I’m actually experiencing TMS in a new location. Shortly after I stopped having back pain, I started getting really intense shoulder pain ( ready-to-cut-off-my-own-arm levels of pain). Again, I thought I tore something lifting. It hurt like hell until I started considering that it might be TMS. Same thing happened with my knee this year. As Sarno says, awareness and acceptance is basically 99% of the battle. I just thought I’d put that out there in case you experience anything similar as your shoulder pain lessens.

    Glad to hear that you’re feeling better. Hope the trend continues.

    PS: With all of my TMS-associated aches, I’ve gotten really scary diagnoses of structural defects or injuries that “could” be the cause of the pain. I’m certain that these are unrelated to the pain I’ve experienced, since I never have issues once I accept that TMS is the culprit.

    • Richard Nikoley on February 17, 2011 at 22:00

      Rachel, I was going to include this in the post but thought it a bit much, so I didn’t. Just after beginning to draft it, was time to take the doggies on a walk. With no shoulder pain at all we set out and all of a sudden, I have pain in my left knee for absolutely no reasons, as I’m walking.

      I laughed out loud. As we walked it became less and less noticeable. An hour later, gone.

      I’m truly possessed, I guess. But I’ll just keep chasing the demon and laughing at it.

    • Beezy on May 15, 2015 at 11:02

      “I’m truly possessed, I guess. But I’ll just keep chasing the demon and laughing at it.”

      Im keeping this quote…as this is how I feel. Thanks man.

  9. Joseph Dantes on February 17, 2011 at 20:30

    That’s very interesting. I developed my own system for dealing with stress… I think it insulates me from TMS. I will read that book to see whether there are nuggets of voodoo I can use.

  10. Nick on February 17, 2011 at 21:05

    Love that you and Stern are both fans of Sarno. Makes sense, no?

  11. Edwin Boyette on February 17, 2011 at 22:30

    When you go back to deadlifting you may want to look up the Ortmayer/Magnusson routine. I’m enjoying it thouroughly. I am 38, 6’1, 175 pounds and should have a 400 pound conventional deadlift in the bank by the end of March. I just restarted lifting in August 2010, and my last max out in december was 365. I deadlift 2-4 times a week depending on my schedule which is all over the place ( I run my own environmental consulting company).

    Anyway enjoying your blog thouroughly and was happy to see a fellow deadlift enthusiast, hopefully the body cooperates and you get back to deadlifting ASAP.

  12. Chris Highcock on February 17, 2011 at 23:01

    Richard – glad you found Sarno. I’ve been a believer for years and his theories have helped my back pain – which always correlates with periods of stress in my life.

    I must admit I am less absolute on his theories than I used to be – I think there are physical issues at play too – but I believe that most pain really does flow from the psyche. Getting into Sarno is like taking the pill in the Matrix – you start to see the world and other people’s pain very differently. Plus you start to think that most therapists are barking up the wrong tree.

    I’ve had a fair bit on TMS on my blog over the years. I’d recommend a few posts:

    The videos here: http://conditioningresearch.blogspot.com/2009/05/perspectiveback-pain.html

    My thoughts here: http://conditioningresearch.blogspot.com/2009/06/pain-in-your-back-or-in-your-heart.html

    and the interview here: http://conditioningresearch.blogspot.com/2009/06/running-pain-interview-with-monte.html

    • Chris Highcock on February 17, 2011 at 23:03

      Oh I forgot….interestingly another favourite paleo blogger has recently written about Sarno too. Check out Michael Allen Smith: The Psychology of Back Pain

    • Richard Nikoley on February 18, 2011 at 08:56

      Yea, Chris, one of the things I regret is skipping over your back pain and posture posts over the last few years. My bad.

      • Chris Highcock on February 18, 2011 at 13:09

        No worries.

        TMS is a battle too, but once you realise what is going on, even if it hurts you know it is not “serious”.

        Mark Sopher’s book did it for me even more than Sarno – he addresses loads of complaints – eg Carpal Tunnel Syndrome. There is a paleo vibe to it too – that we are not as fragile as we are made to think. We can’t be – we would never have survived. We don’t injure ourselves by sleep or standing…..

        As I said I am not absolutist – it is not all TMS – I dislocated a rib recently and it was very sore until it was put back in place. At first I thought it was TMS but it wasn’t!

      • Chris Highcock on February 18, 2011 at 13:22

        Sorry…I keep remembering stuff I’ve posted on this that you might find useful. The other post I had up was from Adam Rostocki http://tinyurl.com/n58ny2

        He had a great quote there that really sums up:

        The subconscious uses the autonomic system, and other bodily systems, to create pain anywhere in the physical body. However, statistics clearly show that the mind will target areas known to be sites of former injury or regions with an obvious and known abnormality, in order to make the pain seem more “physical”, more convincing, if you will.

        We are conditioned to accept the structural nature of these aches and pains every time we experience them in conjunction with an otherwise innocent activity, such as sitting or bending. These are typically things our bodies have done countless times in the past, but are now agonizing and it is no surprise that these painful activities are most often linked to things we MUST do for work or family responsibility…

      • Kurt G Harris MD on February 18, 2011 at 22:45

        Hi Chris

        I had two teeth with old restorations worked on this winter by the missus – my wife is a dentist and did some very nice porcelain laminates on them.

        I later had poorly localized aching pain in the sinuses – on both sides – for weeks afterwards. We both thought is was either a winter sinus infection or some kind of TMS thing. We were wrong – both teeth ended up needing root canals! They both had probably had bacterial microleakage as the prior restorations were over 30 years old (due to an accident, not poor hygiene by the way)

        Once you’ve had TMS, this can become a hazard too. You don’t want to brush off appendicitis or an aortic dissection because you assume it’s all in your head!

        Oh, and I also broke a rib working in my attic last spring – hurt so much I could hardly breathe for a full day.

      • Chris Highcock on February 27, 2011 at 16:05

        Thanks Kurt. The rib was a killer. Tried to Sarno it……but this was real!

      • Richard Nikoley on February 27, 2011 at 16:57

        absolutely, chris. This can not be overemphasized and I sincerely hope this post does not motivate anyone to ignore pain. But as Doug Mc Guff pointed out, pain exists to tell us something is wrong. Pay attention. However, if it persists and persists, assuming you’ve taken care of structural injury, then it’s time to explore the possibility of your mind.

        II feel safe in that nothing worked over more than 2 months.

        BTW, a little better for me almost every day, occasional setbacks. I figure that’s the way of a causeless universe.

      • Chris Highcock on February 18, 2011 at 13:18

      • Rod on February 18, 2011 at 14:32

        I think we need to careful about using terms like conciousness,subconcious, emotion etc,to try and sense of all this.Using poor models to create new ones seems dangerous to me.I dont know what the solution is but it probably starts with a modern version(s) of pain theory and discarding old and unworkable theories of mind/body. The sense of self is way to real to use as a working model(joke).I sometimes wonder if an evolutionary model is useful. A large aprt of what we are talking about here is pretty reptilian in nature although we like to think we are these advanced life forms. We are the beasts bitch if you like! I try to remind myself that this thing called me is an almost infinite number of interactions between trillions of cells confounded by time, memory,religious beliefs, and cultural context. If Steven Jobs had to create the machine he would leave the room with dick in hand and weeping. Maybe not, he seems pretty arrogant.

  13. Sean on February 18, 2011 at 00:29

    This goes against my engineering brain, but I will check it out, hopefully with an open mind.

    I’ve had back problems (who hasn’t?) since a stint working at UPS in my early twenties, or at least that’s what I’ve always attributed it to.

    Another interesting psychological aspect is how pain can get shifted. In the case of my father, he thought he had chronic knee pain, got arthroscopic surgery, didn’t help. Turned out he needed a hip replacement. This was a very real problem, just feeling it in the wrong place.

  14. Jason Sandeman on February 18, 2011 at 15:36

    Richard – I was going to buy that book a while back, but I put it back on the shelf, and I dismissed it as mumbo jumbo. Well, fuck – I guess I was wrong. I am going to give it another look.
    I got put on Paxil because I was constantly thinking I was having a heart attack, or appendicitis. My job fucking sucked, and the funny part was it went away when I went to sleep. I can’t tell you how many times I have spent a night in the hospital, (with a pissed off wife at home to boot) only to be sent home.
    I am now almost weaned off Paxil against my doctor’s orders. I figure fuck him, he already gets enough money from the government when I visit him… so why get the kickbacks as well.
    Yes, I think looking into that book will be a good idea. Thanks, and speedy recovery!

  15. Gary on February 18, 2011 at 02:02

    Another believer here. A few years ago I had pains in my arms and wrists which I thought was repetitive strain injury. It all seemed to make sense, being a heavy computer user and keen guitarist, and my posture leaving a lot to be desired. Anyway I tried all sorts of physiotherapy, stretching, wrist braces, improving posture and ergonomics, etc. but the pain just got worse and worse. I also got more and more stressed and depressed because of the pain and thinking that because of it I wouldn’t be able to work or play music for the rest of my life (and that was on top of already suffering from depression for various other reasons). Then I read The Mindbody Prescription (very much as a last resort; my engineering mind also wasn’t keen at first!) and the pain went away in weeks. I wish I had discovered it a year before I did, it would’ve saved me a lot of physical and mental suffering… but as they say, the teacher appears when the student is ready and all that. It also got me more interested in psychology and the fact that it’s possible to change how one’s mind works, which encouraged me to go on and get my depression sorted out.

    Anyway this post is starting to sound like a sales pitch… but no, Sarno’s stuff just works, plain and simple. I still get pain from time to time, but it just acts as a signal to make me think about what might be stressing me out, physically or mentally.

  16. Guy on February 18, 2011 at 03:01

    There you go changing my life again Richard. I think that at some level I already knew this but you’ve brought it to the forefront for me.


  17. Becky on February 18, 2011 at 04:57

    Excellent post. Mental pain exists in a strange purgatory in the medical world. During college, my husband began experiencing severe chest pains (at 20!). Finally consulted a doctor, who ran a battery of tests and came back with some bizarre diagnosis. Aha! The culprit! Nope, doc said. You’re just overwrought – that weird thing has nothing to do with it.

    The idea of stress (or sadness or any other negative emotion) causing pain really should be a widespread no-brainer. I suffer from panic attacks when I don’t keep my shit together. If ++ungood emotions can trick my body into fight or flight, why can’t it make my back hurt?

    I’ll definitely be looking into Sarno’s book. The women-folk in the family…we’re all chronic worriers and suffer lots of pain for it.

    • Ryan on February 18, 2011 at 08:19

      Us chronic worry types are definitely the most susceptible to this sort of thing. We spend all our time worrying about the pain and our subconscious realizes that it is a great way to keep us distracted, therefore causing even more pain, in more places. Fibromyalgia can result.

      • Richard Nikoley on February 18, 2011 at 10:05

        That I think is the rub, for me, Ryan. I’m actually not a worry type at all. I just blow up, break a thing or two, yell at the top of my lungs and whatnot. All my life.

        When my wife used to ask my why I had such a foul mouth and explosive (but never violent against others) temper I always responded: it’s therapeutic. And I’m serious.

        But in this case, some sensitive circumstances involving family might have caused me to bottle things up which is not in my nature to do.

    • Richard Nikoley on February 18, 2011 at 09:07


      Good call bringing up panic attacks. I used to laugh them off, until I saw them first hand about 12 years ago in the woman who was to become my wife. She had already had a history with them and with therapy had put them to rest. Then they cam back when she moved in with me and still unmarried, decided to buy a house (she made the down payment). I was this radical, atheist/anarchist entrepreneur still not making much money and spending too much time on the Internet debating ideology. She was a schoolteacher, voter, believer in all manner of things one is taught to believe in.

      Talk about oil & water.

      Anyway, I went to a few group sessions with her and realized panic attacks were very, very real.

  18. Janey on February 18, 2011 at 05:14

    YES!! I’m so happy to hear this!

    Quick story I left out when I recommended Sarno the other day….about five years ago I went to a podiatrist with heel pain which he diagnosed (with x-rays) as bone spurs. He recommended ridiculously expensive orthotics which I politely declined. I remembered Dr. Sarno and decided the pain was just another TMS equivalent. A few days later the pain simply disappeared. Fast forward about three years….I broke a bone in my foot. Went to a different podiatrist. Upon viewing the x-rays and confirming the broken bone, he said “By the way, you have heel spurs. You should be having a lot of heel pain!” LOL.

    Thank God for Dr. Sarno. I’m so happy for you, Richard!

  19. Tom Garnett on February 18, 2011 at 05:51

    My hat is off to you for your probing honesty and willingness to consider that much of what you thought you knew is empty. Fantastic post.

    • Richard Nikoley on February 18, 2011 at 09:18

      Yep, Tom, you’re right. There is plain old liberation in taking a step forward in knowledge. Especially when you recognize that it is a mere step and there’s more to learn and integrate. There’s nothing like the feeling that you just got your life and love of it back.

  20. Jonathan Barnes on February 18, 2011 at 06:02

    I continue to read your stuff…it kindof surprises me. You’re like my own personal Reality Show. Open to everything and closed to nothing…all the answers are out there along with all the BS. The answer is usually “all of the above”. The challenge is to stay alive and keep looking.

    Jon :^) (age 80)

  21. Paul C on February 18, 2011 at 06:45

    Not again. I’ve had too many of these moments here, reading and realizing everything I thought I knew was wrong.

    I’ve had burning shoulder pain, low grade although some days worse than others, for months now, but it is the worst when I’m driving, and 2nd worse when I’m at work sitting at my desk. That happens to be the order of what is most stressful. I could never find a position to shift to that would help the pain, but upon arrival at home the pain disappears, even if I sit in a similar manner.

    It actually began after a co-worker got in a car accident and had severe neck pain. We laugh that it is sympathy pain, and now it seems entirely possible.

    Your story explains what is happening better than anything else. Sarno is going on my book list.

  22. Matthew on February 18, 2011 at 06:50

    Richard, so the pain is totally gone? I admit I haven’t read Sarno’s book, but I intend to now.

    I also think it might be beneficial (if no one else has mentioned) to look into Esther Grokhales book “8 Steps to a Painfree Back.”

    Esther is basically the “paleo practitioner” of the back world. She has studied cultures in Africa and South America and compares natural posture to how we sit in the West. The pain might be mostly mental, but the mechanics are just downright perverted in this country. If you look at an obese person there’s almost a 100% chance that they also have posture problems.

    These problems can manifest as physical when portals and veins delivering nutrients to cells get blocked. I really think you owe it to yourself and your readers to look into this book. Reading it for me was reminiscent of the first time I read about primal/paleo as compared to conventional wisdom.

    Glad your feeling better.

    • Richard Nikoley on February 18, 2011 at 09:39


      “so the pain is totally gone?”

      No, not by a long shot. I still apparently harbor the Pavlovian association that when I lay down to bed my shoulder is supposed to hurt, and it does. Just not as much, and less last night than the night before.

      But there are many clues to suggest I’m really onto something. Yesterday afternoon with no neck & shoulder pain I went out walking the dogs and all of a sudden have pain in my left knee for absolutely no rational reason. Then, having eaten at 8PM for the last time I wake up at 3:30 PM with raging heartburn (but less pain in the shoulder).

      So my attitude is to just keep chasing this demon all around my body until I snuff its fucking lights out.

      Literally, I have begun to see pain dissipate just by 1 and foremost) having no fear or anxiety about it and 2) recognizing that I need to mentally affirm that I understand exactly what’s going on.

      • Matthew on February 18, 2011 at 09:55

        I am 100% behind the psychosomatic solutions that we’re talking about. Mentality is everything.

        That being said. I just want to stress one more time that you acquaint yourself with Esther Grokhale, if not for pain, then just for your general well being.

        I should say that you’ve def. inspired me to look into Sarno for my own back problems.

      • anand srivastava on February 21, 2011 at 01:50

        I also had a back pain without any real reason. It was very sharp debilitating pain. I had difficulty moving breathing. I had an exercise related injury sometime back. Possibly the reason why it happened. I have a tendency to laugh when I am feeling helpless. This probably helped, because it drastically reduced the next day. I have ordered the Sarno book, next time I will have some good bedtime reading ;-).

      • Jon Thoroddsen on March 7, 2011 at 04:29

        I second or third the Esther Gokhale suggestion. Here’s an anecdote of a guy who healed his spinal stenosis with her help.

        She also has a Google Talk video, where she talks a little bit about her research and her paleo approach. She is a bit of a new agey person, but I think her approach has merit.

  23. Joe on February 18, 2011 at 06:55

    It seems to me like psychosomatic type pain usually is, at least initially, a real injury but that what happens is that the pain comes to serve an important function in your psychic economy and so the pain is continued after you have technically recovered entirely at which point the injury is only psychosomatic.

    In my own life, I’ve had a lot of trouble with tinnitus and was amazed when I learned that you could have severe hearing loss without any tinnitus whatsoever and how connected it tends to be to stress conditions. It made me realize that the string of causality is sometimes very uncertain.

  24. Don Matesz on February 18, 2011 at 06:57

    Congrats on losing the pain and discovering the mind-body connection. In Chinese medicine, we have a saying: All diseases arise from the seven emotions. Although overstated, we use it as a reminder, to help patients connect their dis-eases to their worry, anxiety, anger, grief, fear, shock, or sorrow .

    Our paleo ancestors did not have diet-related diseases except in lean times. Yet they had “medicine men,” i.e. shamans. Shamanism focuses on treating dis-ease by altering states of consciousness, the natural choice for people who don’t have diet-related diseases. Welcome to the shaman’s world. Its not “woo woo.” Maybe just “woo” i.e. just outside the conventional world view.

    • Helen on February 18, 2011 at 08:41

      And what an amazing world the shaman’s world is, too.

    • Richard Nikoley on February 18, 2011 at 09:55


      And here’s what’s a bizarro to me: coming from the philosophical premises I do, I long ago rejected the mind-body dichotomy, dualism. Intellectually.

      Perhaps I needed real world example to make it really real and and physical and not just academic. I do know that Frank Forencich of Exuberant Animal has often talked about this subject. Another regret, in putting those lectures into a folder for later review and never getting to them.

      • Joseph on February 18, 2011 at 11:33

        It is fascinating to me how we humans are constantly failing to integrate thought with action. I see this at the university all the time: students learn stuff (grammar, maths, biology, anatomy, physics, probability, philosophy) well enough to pass tests and convince anyone that they have mastered the theory, but revert to unstructured, instinctive behavior when faced with practical tasks where the relevance of their theoretical attainments is not explicit (for all that it might be blatantly obvious). This lag between theory and practice is constantly appearing in my current martial arts practice (grappling), where I take five minutes to understand the theory behind a technique and then spend the next year learning to apply it effectively. In my case, the body-mind as a whole learns more slowly than the tongue’s ability to wag (or my skill at manipulating a life-size dummy or ragdoll of a sparring partner) would suggest.

      • TMS - an expanded theory on February 18, 2011 at 13:01

        Yeah, even worse it seems like a dualism won´t cut it. Most likely, what you have going on in your brain is much more chaotic – a battle for control, with some tracking processes trying to get your life “back on track” using pain to wrest control (I.e. force behavioral change) from other processes. Or something like that.

  25. VW on February 18, 2011 at 06:58

    Your post made me think of this article from early 2010, which I loved: The Americanization of Mental Illness

    It also reminded me of my bout with debilitating neck pain and makes me wonder anew whether the steroid shots that I credit for helping me so much were not merely placebos. When I’ve considered it before, I decided that it matters not in the long run. Perhaps it does matter, though.

  26. Ryan on February 18, 2011 at 08:08

    I’m so glad you posted this. Reading Sarno’s book cured me of my “RSI”. A life saver. It was very brave of you to post this. Many people see the word psychosomatic and will judge you harshly for it. Despite how Dr Sarno helped me, I never recommend his books. People are too prone to taking it the wrong way.

    • Richard Nikoley on February 18, 2011 at 10:00

      Hey, Ryan, well, “fuck that bullshit” can manifest in myriad ways. I’ll never have a regret in the world about posting this, no matter what.

      Indications via comments so far are that my instincts win out: honesty is the only policy.

  27. Scotlyn on February 18, 2011 at 08:22

    I don’t know why this is a mystery – as far as I’m concerned the mind begins in the brain and finishes at the fingertips and the toes. The mind can’t think about the world unless the body gets out to look and feel and hear it, and the mind cannot act on whatever it thinks about without also mobilising the body. It is all of a piece.

    All we have to do to get the adrenalin flowing, heart pumping, palms sweating, etc (all of these effects happen in the body) is watch a scary movie! So why should our shoulders not react with pain to thoughts such as “my troubles are so heavy.” You think such a thought WITH your shoulders as much as inside your head. Just watch anyone’s body as they go through different thoughts and emotions – these happen everywhere in their bodies, not just in the invisible “space behind the eyes.”

  28. Helen on February 18, 2011 at 08:42

    I’m so glad that you are feeling better, Richard :)

  29. Cynthia K on February 18, 2011 at 08:48

    Hot dang, Richard! I thought of TMS immediately as well, when I read your recent Pain post. I had complete relief from years chronic pain within two weeks of discovering Sarno myself, many years ago. My body occasionally tries to trigger me again with something, but I’m an old hat at the Sarno “therapy” now. Sometimes all I have to do is mentally scream the word “RAGE!” (just inside my head, not aloud) and — Poof. Gone.

    What really drives me crazy is that I want to help others understand this syndrome and people are so closed minded about it. Invariably, they will say something like, “that’s interesting, and I do have a lot of anger right now about stuff in my life, but this is a pain *that’s real*.” Hello!!! That’s right, it’s real. Your brain is “really” cutting off circulation to some part of your body and, yes, it “really” hurts.

    Folks, if you have chronic pain, please believe this: human bodies heal. Bullet wounds, broken bones, paper cuts — they heal. They don’t keep opening up and hurting. We never could have survived as a species if our backs/joints/tendons were so fragile.

    Quick tests: Does the area show any swelling or bruising? Does the pain move around at all? Does it go away when you are distracted by something pleasant? Does it get worse when you dwell on something unpleasant? Does it get worse when you are worrying about it? (ie sharp stabs of pain, sudden muscle cramping) Does it remain in spite of resting the body part in question? (ie it “doesn’t heal”) Does it flare up at odd times, like when you’re not even moving that part of the body? Does it feel better with light massage and warmth and worse with ice?

    I hope those who even slightly suspect they might be suffering from TMS will get Sarno’s books and spend some time thinking about this. If you use your library, it costs nothing but a bit of your time. :)

    • Richard Nikoley on February 18, 2011 at 10:28


      Pg 13, which I had noted to quote in the post but forgot & didn’t. Thanks for reminding me.

      “There is another reason to doubt the role of injury in these cases of back pain. One of the most powerful systems that has evolved over millions of years of life on this planet is the biologic capacity for healing, for restoration. Our body parts tend to heal very quickly when they are injured. Even the largest bone in the body, the femur, only takes six weeks to heal. And during that process there is pain for only a very short time. It is illogical to think that an injury that occurred two months ago might still be causing pain, not to mention one of two or ten years ago. And yet people have been so thoroughly indoctrinated with the idea of persistent injury that they accept it without question.”

  30. Elysa on February 18, 2011 at 09:07

    I haven’t gotten around to reading Sarno’s book, but I did read a synopsis of some sort a few years ago and I realized that any back pain I have is directly proportional to stress in life, particularly at work.

    Now I take back pain (spasms between the shoulder blades for me) as a sign that I need to fix something in my life. If that means finding another job or dumping a “friend” so be it. Life is too short to walk around in excruciating pain.

    Oh, and I looked at your post on Bea’s progress for the first time…she’s stunning. Absolutely stunning. I hope I look half as good in 10 years.

  31. David Csonka on February 18, 2011 at 10:07

    Richard, this is huge. Not just for you, but for everybody reading this. Are we all so deeply disconnected from our minds and bodies that our brains are stabbing us with pain to get us to take notice? To get us to relax and enjoy life? Fascinating.

    • Richard Nikoley on February 18, 2011 at 10:39

      David: no doubt it opens up a whole knew realm of inquiry for us inquiring minds, not afraid of what we might learn.

  32. Heather on February 18, 2011 at 10:22

    I often get tension headaches that clear up with a bath or good massage. Recently they’ve diappeared, but I’ve had this terrible hip pain on my left side (a couple of months ago after a very stressful holiday visit with family I had terrible hip pain on my right side). Then yesterday out of the blue I broke down and sobbed my little heart out for hours, for no apparent reason – unless “hormonal pregnant lady” counts as a reason. When my husband came home, he held me as I wept and finally verbalized every stress, care, and worry in my life.

    I’ve been pain-free since that. Thanks for the timely post, otherwise I might suddenly have knee pain by tomorrow :)

    The funny thing is that I’ve been doing an awful lot of reading about the mind-body connection during birth, as I’ll be giving birth in a facility that doesn’t have pharmaceutical pain relief available (emergency hospital transfers are available, though). How is it that some women describe unmedicated birth as the most awful, painful, terrible moment of their lives, and others actually orgasm during it? It comes down to the same mind-body pain you talk about here.

    • Richard Nikoley on February 18, 2011 at 10:42

      Heather, in this men and women are equal: the mind is the true sex organ. The hardware is merely input and in the case of males, output devices

  33. pecanmike on February 18, 2011 at 10:42

    I rank this among your finest posts. I too have chronic shoulder pain and have followed your writings about this closely. You expressed your anger and aggravation over the pain very well and I related. This to me is an aha moment much like when I found your site about 18 months ago and began eating real foods. Taking care of our bodies might be relatively simple as compared to containing our minds. Gracias.

  34. Keith Thomas on February 18, 2011 at 11:57

    Back pain, like headache, has a wide variety of causes – which should be matched with a variety of treatments. There have been 450 reviews of Sarno’s book posted on Amazon. The ‘one-star’ reviews – unusually – are as thoughtful, scientific and critical as the ‘five-star’ reviews. A very good physiotherapist once told me that if I am working out to a sufficient density and intensity, I can expect to have lower back pain once or twice a year and that this kind of back pain heals itself over the following, excruciating week. This has worked for me over the past 15 years, but I have to say that your post made me realize my incidence of back pain diminished when I retired at 55 yo, seven years ago (I have also since then spent a much greater part of my day on my feet). Trigger point (not pressure point) therapy is very effective for this sort of pain, if skillfully applied with adequate pressure and without skimping on the time required – possibly for years. Unfortunately – well, fortunately – I have had no back pain like you are describing, so I will refrain from advice apart from that implied by the above: back pain is not a single malady; the lower back is a critical part of the body where pain due to a variety of unrelated phenomena (some a sudden injury, some chronic deterioration, some psychological, most a combination of these) manifests itself. Thus there will be conflicting advice, including uncritical endorsements of one treatment over another. Let me just add, from a palaeo perspective, that many researchers point to the human spine as the most unfit-for-purpose major part or process of the human body; it is, thus, vulnerable in more than one way. In the next million years we may have improved its function. My sincere best wishes for complete recovery – and may it be one you understand.

  35. TMS - an expanded theory on February 18, 2011 at 12:35

    When reading this post, I experienced a tingle of disbelief: “You too?”. I´m a longtime reader, and when reading about your neck troubles, I just assumed you´d busted something lifting weights.

    I used Sarno´s theory to (completely) cure multi-year intense pain (arms), and have applied it to at least one friend suffering some bad neck pain, with success. That Harris picked up on Sarno´s work merely confirms my initial impression of him, I.e. he´s a bright guy.

    In my case, the cause of the pain was my addiction to MMO:s (I.e. World of Warcraft). Yes, pathetic. And very unhealthy. The (intense) arm pain associated with computer use was completely gone after I had:

    1. Accepted that the pain was psychosomatic (I read Sarno, and a letter regarding his theory that I found searching the web).

    2. Destroyed all physical and virtual association with the self-destructive behavior.

    My take is that sometimes a process of the brain will intently cause pain, in order to break a behavioral pattern that has been deemed unhealthy. This would occur when the process(es) lacks the power to shut down the behavioral pattern directly.

    Instead, it does what it can to de-incentivise self-destructive behavior, I.e. causes pain, perhaps directly associated with the stressful/self-damaging activity, perhaps not. A lot of thinking remains to be done in this area.

    In any case, stick to it, it sounds like you´ve gotten pretty far down the road already.

  36. Haig on February 18, 2011 at 13:13

    Without reading Sarno I can already tell you that the ‘mind over matter’ approach to pain (and other affective irregularities) definitely has a basis in neuroscience. The famous neuroscientist V.S Ramachandran offers a particularly striking example with the curing of his patients’ excruciating phantom-limb pain by just looking at a mirror (http://en.wikipedia.org/wiki/Mirror_box). More technologically advanced techniques are rapidly being developed based on neuroimaging techniques, particularly real-time fMRI (http://neuropsychological.blogspot.com/2007/08/omneuron-and-fmri.html) Omneuron, the company in the previous link, is also currently looking for volunteers (though unsure of eligibility requirements).

  37. Michelle on February 18, 2011 at 13:35

    This makes sense to me. When I was undergoing treatment for thyroid cancer I had several bouts of terrible tendinitis in my feet/ ankles that I attributed to overuse from running even though I was running fewer miles than before and had backed way off on the weight room. I will definitely check out his book thanks for posting.

  38. Cynthia K on February 18, 2011 at 15:10

    I just want to add another key thought, for those who are struggling with the notion of a mind-body dichotomy that conflicts with their logic: blushing. (I believe Sarno uses this to demonstrate as well.) I am a terrible blusher. I can blush from just thinking about blushing. I hate it. Takes all the fun out of hearing a dirty joke too. But there we see a thought causing an immediate, physical change.

    • Liz Downunder on February 18, 2011 at 21:44

      I don’t know how anyone can NOT believe in the mind-body connection. As Richard (who was a non-believer?) says: “the mind is the true sex organ”. Anyone who has felt physical sexual arousal from a mere thought, or fear in the pit of their stomach or as goosebumps, or the physical need to lash out when angry, or nervous butterflies on their tummy…I could go on. These are all manifestations of the mind-body connection. How can anyone acknowledge these reactions but not believe the connection exists?!!!

      Richard, as a sufferer of chronic sciatica and lower back pain (and I do suffer terribly, partly why I find myself reading your blog at 3am rather than sleeping), your post is a revelation to me, so thank you. Off to buy the book… :)

  39. rob on February 18, 2011 at 16:25

    I like to take a Valium now and then.

  40. Jen on February 18, 2011 at 18:11

    While suffering from my first serious episode of lower back pain (in my mid-20s) I happened to see Dr. Sarno on TV. I thought the whole thing was, to put it mildly, mumbo-jumbo. Despite my skepticism, by the end of the segment my pain was gone. After the stunned disbelief wore off, I laughed, for hours.

  41. Doug McGuff, MD on February 18, 2011 at 19:26


    This is just a theory….but it is my theory and I like it. In these sorts of circumstances, I believe the initial pain resulted from acute injury. A plausible explanation would be nerve root traction at the level of your stenosis. Deadlifts may have been a precipitating event. It doesn’t really matter. What I think happens after the acute injury phase is that a redundant feedback loop begins to occur. The neurological event would be something like the neurological feedback loop that occurs during OCD (obsessive-compulsive disorder).

    The solution is to acknowledge the pain signal from the initial injury, but disregard its utility beyond 24-48 hours. Essentially place a mental standing order of “OK…I get it, but this serves no further protective service this far out from the injury…please leave me alone”. Once you have placed this mental standing order, carry on as if no pain is present. Carry out movements that are normal even is the exacerbate pain. Every time the pain enters your consciousness, restate your mental standing order. Within half a day the pain will usually abate.

    I like my theory because it acknowledges a true source for the pain without any stigma, but also acknowledges the neurosis of the feedback loop that causes the pain to persist. I have used this with success in myself and others. The book “Mind and Brain” by Schwartz describes a similar technique for managing OCD.

    It is better to not get hurt in the first place, but once the horse is out of that barn, I have found the “mental standing order” to be the best way to get the horse back home. Hope you feel better soon.

    • Kurt G Harris MD on February 18, 2011 at 22:30


      Great comments. I like that kind of self-talk approach. There is no doubt acutely herniated discs, torn menisci, etc. can be painful. But any pain lasting longer than a few weeks is likely an autonomous pain pattern that your psyche (parts of your brain) are using in service of pyschological motives that are unconscious.


      As I told Richard, I have sat and consulted with patients with cervical fractures (missed by radiologist at the local ER) and with metastatic tumors destroying the spine. They are never in as much pain as the TMS patients – and almost never as upset about the pain.

      A patient with a massive acutely herniated lumbar disc – the biggest I had ever seen – with numbness in the leg was quite calmly laying on the floor of my waiting room before his scan as it was more comfortable that way. He was on no medications and told me the pain was not too bad, just annoying. OTOH, I have had patients with totally normal MRIs literally pacing the floor, in tears and threatening suicide – they probably had TMS.

      So a site of injury can be the focus of pain years after the acute injury has healed, because your brain has “learned” to use that site as a focus. Or the body part may have zero structural abnormality at all visible on modern imaging.

      I’ll also echo the warnings of Sarno about TMS equivalents – headaches, vasomotor rhinitis, asthma, GE reflux, IBS, carpal tunnel – any of these can pop up as a substitute for the primary symptom when you’ve succeeded in making it go away. In addition, I view as a sign of progress the substitution of more traditioanally psychological symptoms (that are also “physical” actually) like anxiety, panic attacks, anger, depression, as this means you are probably getting closer to the root cause of what is bothering you.

      (Sarno says it is usually anger, but what lies behind anger? The evolutionary reason for anger is FEAR.)

      I call this phenomenon “psychosomatic cycling” – observe yourself and you might find pain in other body parts alternating with no pain but a feeling of unease, etc. Just keep on top of it, and remind yourself that your conscious brain refuses to fall for such tricks.

      Anyone having financial events to deal with these past few years and has had no stress symptoms has rocks in their head or more likely, something like TMS instead. I know, as I had my own business put down by the recession and government policies. This was not financially significant for me for a variety of fortunate reasons, but it was stressful nonetheless. I just tried my best to be conscious of what I was feeling about it.

      • Susan on February 19, 2011 at 22:18

        I was going to ask if this could be applied to chronic illnesses or conditions. I have shortness of breath that is “caused” by pectus excavatum and aggravated by food sensitivities. Only, on rare occasions, it goes away and I can breathe fine. I’ve always thought, if it was gone for that moment, it should be able to be gone all the time. But I don’t know how to make it happen. Will be reading the book for sure!

    • Kurt G Harris MD on February 20, 2011 at 15:23

      Howard Stern claims he cured his OCD in the same way he cured his back pain- with Sarno’s technique.

      • Richard Nikoley on February 20, 2011 at 15:48

        No surprise to me. Having witnessed first hand how if I persist at it I can have the pain melt away (be patient, I’m learning; doesn’t ALWAYS work as well or as quickly as I’d like), but I have definitely begun to consider other applications for ridding myself of bad behaviors I don’t like but persist at.

      • Dr.BG on February 22, 2011 at 00:13


        I think what you describe in evolutionary terms makes a lot of sense.

        Congratulations on your spectacular progress!

        Warning: TMI! I noticed heeeyyyge mind/body experiences when I was lactating — almost on command when the baby cried or if I was at work and THOUGHT about the baby, milk would spontaneously come forth… (at untimely moments, even meetings). Had to mentally block sometimes but could also lactate for the electronic pump on demand as well. Humans are vastly different than dairy cows I realized on this level.

        I learned at a talk by Bruce Lipton PhD that our brains run 95% subconsciously and only 5% consciously. What we fill our subconscious is more important than thinking! Unfortunately some of it is pre-programmed like the Apple or Dell we buy… and prior to age 6-7 yo, children do not possess consciousness. This must have been an evolutionary advantage at some point.

        Other than laughing, the only other way I’ve found to permanently affect my subconscious is yoga/meditation and therapeutic massage.

        I should ck out Sarno! Thank you so much for sharing!!


  42. Pip on February 18, 2011 at 20:47

    A very interesting post and a great example of why I read your blog – I had no idea there was even such a thing as TMS. But I am definitely familiar with unhealthy stress having adverse physical consequences. If stress, or more specifically your reaction to stress, is a major contributor to your pain you will probably need to figure out why you react to stressors the way that you do and figure out some coping strategies in order to completely rid yourself of the problem. The cause might be something not so obvious. In my case, I was constantly feeling stressed out and irritable and was also frequently depressed and anxious. I was also disorganized and forgetful. I struggled with all of this for years until I happened to catch a radio show on adult ADHD and I finally put all the pieces together. It had never even occurred to me or anyone around me that I might have ADHD because I have very little of the “H” – I am primarily inattentive, not hyperactive.

    Anyway, Richard, a person such as yourself with a variety of projects going on, a short fuse and an obvious love of learning about new things might want do a screen for ADHD. Your history as a day trader is also a clue – I know from personal experience that kind of activity is extremely appealing to people with ADHD. PsychCentral has a quick diagnostic test here: http://psychcentral.com/addquiz.htm. In less than 10 minutes you can either rule it out or decide you need to learn more. For me, getting a diagnosis and doing everything I can to address the problem has greatly reduced the stress in my life and has been incredibly beneficial. Don’t know if you will consider this info helpful, but I thought I would throw it out there, FWIW. Hope you find your permanent relief soon.

    • Richard Nikoley on February 19, 2011 at 09:06

      “PsychCentral has a quick diagnostic test here: http://psychcentral.com/addquiz.htm. In less than 10 minutes you can either rule it out or decide you need to learn more.”

      10 minutes to take an online quiz? No way! :)

      Seriously, thanks for the insights.

    • anand srivastava on February 21, 2011 at 02:42

      Thanks Pip. Now I know that I have ADHD. I suspected my son to have it, but never considered myself.

  43. Primitive on February 18, 2011 at 21:01

    Richard, I’m so glad you’re defeating the pain and feeling better.
    I’ve never dismissed the mind-body connection, but let it be forgotten many times, when it could’ve explained things. The power of mind over body does manifest itself also in our limitations.
    I had mentioned, here on your blog, the very real loss of my right thumb’s muscle due to a surgery almost 24 years ago, which severely impairs gripping, and has affected handling heavy weights. For many months, I struggled with dead lifting more than 185 lbs; however, after your joint post with Martin about Leangains approach, I shifted my focus on adding just that extra 5 lbs, instead of worrying about my grip (or lack of), and now I’m at 235 lbs and adding, thanks to your post.
    Unpropotionate calluses on my right hand are the proof of its physical weakness, but now I know its limit is much higher than I had believed before.
    Sometimes, you change lives in subtle ways Richard, many thanks for making mine better.

  44. Frank Dawson on February 18, 2011 at 21:08

    I am really glad that you decided to read Sarno. I am also pleased that Dr. Harris and Dr. McGuff as well as several other bright readers of your blog are generally in agreement with Sarno’s key insights. You are providing a great service to people by writing about your experience — helping to spread good ideas.
    I would point out that one thing Sarno may overstate is how quickly symptoms resolve in most patients. To be sure, some people “cure” themselves in a matter of days. However, for others it can take a looong time to get completely better. In fact, I was on the long end of time to recovery. It took me a few years to recover completely from my pain syndrome once I began following the Sarno approach.
    The key is to understand what is really happening and to lose the fear. Don’t pay attention to how long the recovery takes. You already have the insight about the true cause of the pain. It will get better. Please keep us posted, and stay the course. You will feel better because you have an open mind and a desire to keep learning.
    Frank Dawson

  45. Michael Reopelle on February 19, 2011 at 06:35


    I am pleased to hear you have made a tremendous leap in the direction of full recovery. Reading stories such as yours lifts my spirits as well.

  46. Adrian on February 19, 2011 at 13:31

    Great post richard. Sounds like a very interesting book. My own experience a few years ago doing a 10 day vipassana meditation course tells me sarno’s theory might be along similar lines. I’d suffered chronic low back pain for over a decade. No amount of chiro, massage or stretching seemed to provide anything but temporary relief.

    5 days into the course, and with nothing but meditation for 10 hours a day to attribute the results to, I was completely free of pain. How can this be explained any way but by the mind? Sitting for 10+ hours a day is something I had been doing for a long time at a desk, so it certainly wasn’t that.

    No, it was the approach this practise teaches you – if you feel pain, just observe it, don’t react. It was a wonderful eye opening experience. Certainly one of the hardest experiences of my life, but also the most rewarding.

    I highly recommend you try it.

  47. Emily Deans MD on February 19, 2011 at 14:10

    I’ve done research in this area – behavior therapy promoting the positive and consistent self-talk in combination with mindfulness exercises – meditation and yoga – has been found to be helpful in small trials. Due to my experience I often get referrals of this nature after the patient has been to the orthopod, the neurologist, the endocrinologist… They are generally demoralized by the time they show up at the psychiatrist. If they can accept that the mind and body are connected, we can generally do a lot of good.

  48. Todd Hargrove on February 20, 2011 at 09:32

    I don’t want to undermine anyone’s enthusiasm for trying or continuing Sarno’s approach, because it obviously works amazingly well for many people. But the theory as to why it works is a separate issue from its efficacy. Because this is a crowd interested in science, I just want to make that anyone who is interested knows that there is some excellent science explaining Richard’s results which is, in my opinion, more convincing than Sarno’s speculations about Freud and repression.

    Sarno’s work is a step in the right direction because he understands that the brain is involved in pain and that a great many complaints of pain do not have any real correlation with actual physical harm or tissue damage in the body (as Drs. Harris and McGuff have both noticed in their practices.) There are many studies showing that huge percentages (often over 40%) of pain free shoulders, backs, knees and hips show big problems on an MRI, such as bulging discs, torn rotator cuffs, torn mensicii, etc.

    But Sarno’s books do not cite any modern pain science which is highly relevant to explaining why his treatment works. The pain neuromatrix theory explains a wide variety of previously unexplainable evidence related to pain, such as why placebos work, why someone can experience pain with no tissue damage, why someone can have significant tissue damage without pain, phantom limb pain, allodynia, and why pain can be significantly affected by non-nociceptive sensory information, thoughts, memories, emotions, and social interactions.

    Lorimer Moseley has a website at bodyinmind.au and two excellent books called Explain Pain and Painful Yarns. The current post from his site has a great 3 min. video on placebo: http://bodyinmind.com.au/placebo-101-in-three-minutes). Neal Pearson has three great videos from a presentation on pain:

    Given the well developed science that explains Sarnos’ observations, there is no need to rely on his speculative theories based on freudian repression.

    Again none of this means that the therapy doesn’t work! It just means that there are better explanations out there for why it works than what Sarno offers. I think the chances for spreading the word are better if it is based on the best available science.

    • Richard Nikoley on February 20, 2011 at 10:34

      Hey Todd:

      Thanks a lot, man, and sorry your comment got hung up in the approve queue.

      I just read this on your site:


      That looks to be right in line with what I’m gathering from Kurt & Doug (thanks Doug, I was going to reply but didn’t get a chance so now I can lump it all into one).

      Yes, as I read the book the repression thing simply makes no sense to me but the fact that I’ve gone through a lot of stressful situations and setbacks lately does make sense (however that works out). But I’ve hardly repressed these. Hell, in some ways I have probably been too vocal to some family members about some of my anger with respect to other family members. And I have certainly dwelled on the negative aspects and disappointments of all of the issues I confront.

      Or, maybe it’s just the fact of an acute event in the gym that didn’t diminish in pain as quickly as I thought it should, I got stressed about the fact of the pain itself, making it worse, then got fearful because it was messing with my sleep then almost into a panic as it got even worse and affected virtually everything. When I finally considered this as a chain of events, just that simple recognition began to make a difference. And that was virtually immediately.

      Yes, there are still issues but if anything those lingering issues convince me all the more that it’s my mind that’s the “enemy,” here, and not some acute injury from over 2 months ago (hell, a fractured femur would’ve largely healed by now).

      So, yea, some pain still lingers but way, way less intense and it totally dances around from neck to trapezius to deltoid to bicep. And when I have no pain anywhere there I will often get pain in my left knee (not intense) for absolutely no reason. Or, I may wake up with awful heartburn at 3am even though I hadn’t eaten anything since 8pm and had no adverse affect then.

      The worst issue is that I still can’t seem to shake all the pain away to get to bed. It’s far, far less intense and I no longer have only one single position to lay in and can even lay on my back once again whereas before, that would cause an intense hot knife right to the right of my spine in the trap. I can even _almost_ lay on my right side, though not in a super comfortable way, for the first time since this happened.

      So, it is still interfering with sleep. Even if I have little to no pain when I get off to sleep I invariable wake up 2-3 hours later with an uncomfortable level, at which point I get up, move around, read more of Sarno. But now here’s the really weird thing. Because I’ve been a bit tired I have taken to napping the last two days and guess what? Napping in the day I’m actually sleeping more soundly and restfully (never the case in my whole life — I’m a “nap hater”) and when I awake, I have zero pain.

      So, yea, the good thing here is it doesn’t really matter what the fundamental thing that’s going on in my mind to cause this but it’s pretty sure that’s what’s causing it. So far, my best success with making the pain go away is outright verbal orders to myself (brain/mind), spoken out loud, and laughing out loud at my own brain/mind.

      • Kurt G Harris MD on February 20, 2011 at 12:43

        “some pain still lingers but way, way less intense and it totally dances around from neck to trapezius to deltoid to bicep. And when I have no pain anywhere there I will often get pain in my left knee …”

        This is practically diagnostic of TMS as it has no other plausible explanation – a herniated disc affecting on nerve root does not cause pain that moves around like that, especially to the knee!

        And other commenters who have emphasized that it can take a long time to be totally pain free are correct. In my experience, it is something that may take a few months and may pop up again from time to time in the future – you just deal with it in the same way.

  49. 02/21/11 – “Diane” on February 20, 2011 at 19:02

    […] TMS – Can your Mind Really Heal Your Back…. – Free The Animal […]

  50. Todd Hargrove on February 20, 2011 at 11:25


    Yeah you don’t seem to be the repressing type. If Sarno was right, it would be Stephan with the massive back pain right now:)(assuming he ever feels anger at all.)

    Seems like you are on the right track. If you think that your pain is the result of some big bulging or herniated disc or torn rotator cuff or some other unhealed damage, that can be a real nocebo (opposite of placebo.) Realizing that the damage has probably already healed can reduce your sense of threat, which reduces pain. Sounds like you’ve got this all figured out. Interesting about the napping/sleeping thing.

    I was hesitant to point out what I think are some weaknesses in Sarno’s theory, given the great success you and others have got from his books. But I heard at least one person say that he was embarrassed to recommend the approach to others, and clearly many people seem to think the whole idea is new age voodoo, at least at first glance. I just wanted people to know there is hard science showing that the brain can cause major pain without actual tissue damage. Good luck with continued recovery.

    • Kurt G Harris MD on February 20, 2011 at 12:30

      I think a better heuristic than “repression” is just to think of the pain generation as on unconscious learned response. We know there are such things, and it is well established that perception and emotion occurs prior to its conscious perception (See Antonio Damasio for a good summary)

      Sarno points out that the culprit emotions are usually ones that are most socially unacceptable and that just because you express anger verbally a lot does not preclude other feelings outside your awareness engendering TMS.

      I have my own theories about TMS that are more compatible with modern brain science, but frankly for someone in acute pain its like making someone learn music theory to play a song by the Sex Pistols. I just tell people to take the Freud with a grain of salt but try to think about unconscious or below awareness feelings that may be at play. In my experience there is always something.

      I disagree that Stephan would be more susceptible to this than Richard or that a tendency to express anger would minimize the tendency to TMS. I’ve seen patients with a broad spectrum of emotional expressive styles have TMS and conversely a broad spectrum that is free of TMS.

      Awareness of feelings is a skill that can be learned, and in many families lack of awareness of feelings is trained, and we learn to do more socially acceptable things with the physical energy they generate, like get psychosomatic illnesses. Learning to be aware of what you are feeling is what prevents TMS, not verbal or demonstrative expression of some (which may not be ALL) of your feelings. Punching teddy bears and such does nothing except make you more likely to punch things…

      You can probably tell my interpretation of Sarno is influenced by mindfulness and buddhist teachings, but I have read extensively of Sarno’s sources and some of their influences as well.

      • Liz Downunder on February 20, 2011 at 14:35

        This is a fascinating, and very helpful, discussion.

        I am learning to use mindfulness techniques with my children and have found that acknowledging and talking about how they are feeling has huge benefits. The feelings are felt, acknowledged, talked about and pretty much dealt with, and the child moves on. It’s not an easy thing for me to learn after a lifetime of conditioning to ignore or repress feelings, especially when their strong emotions elicit a response in me, which I also need to acknowledge and deal with.

  51. Kurt G Harris MD on February 20, 2011 at 12:37

    I should add that despite the Freudian influence (actually it was Franz Alexander), Sarno is not new age in the sense of embracing any alternative medicine. He considers chiropractic, acupuncture, and even physical therapy to be harmful (but not more harmful than surgery) in that they perpetuate the idea that you are physically broken and that the pain is “in” the non-brain part of your physical body.

    • Richard Nikoley on February 20, 2011 at 13:25

      Regarding chiropractic, many years ago because some family members were such fans I went to one. I considered it ridiculous. Xrays, seemingly meaningless lines drawn on them about how I was out of alignment and some prescribed regular visit regimen that included “adjustment” of my neck & back that amounts to popping or cracking joints.

      But then I some point I used to periodically get aching pain in my right trapezius, same place as now, though never in the shoulder or arm as now. It was of the sort where the pain was the worst when lifting my head & shoulders up from laying down. I had it a couple of times and it would take 1-2 weeks to go away.

      Then one time I had it pretty intensely, this was perhaps 15 years ago and someone suggested I just try a chiropractor. And it definitely helped. Once he did that neck adjustment I felt immediate relief by about half and then it cleared up completely in a few days. Fluke, perhaps, and I can’t recall whether it happened in between time again, but perhaps about 4 years ago, just before I began my weightlifting and weight loss program I got the thing again, but really badly. I was down south at the parents in law and writhing in pain asked them to look up a chiropractor in the YP. I went to one and before the neck adjustment she had a tech do a deep massage of the trap area with some device that vibrates and gives off heat.

      Again, it worked. Immediate relief in the 50% range, cleared up in days from there.

      This time, it first manifest as pain in the shulder so I did not even consider chiropractic until someone mentioned ART, Active release Therapy, I think. So I went in for that. There was no neck adjustments or anything, but I was getting worse and eventually began feeling the intense pain in the trap just like recounted above, in addition to the shoulder, neck, arm. This is when I suggested to the chiropractor he do the neck adjustment, hoping I would have the same experience as the times before. No luck. In addition, then did the decompression machine which only made me feel worse. That is, I would have slight pain, then the added pain in my neck/trap from laying on my back, then moving onto my arm in addition — until the machine was turned on and pulling 30 pounds and holding for 40 seconds, releasing, pulling, for a total of 20 minutes. During that, the pain would all go away. But when it stopped the pain in the right trap immediately adjacent to the sine would be worse than ever for a few minutes.

      At any rate, needless to say I have become very skeptical of chiropractic adjustment in any capacity (still open to ART, as it’s really just a form of intense muscle massage), especially when I saw how easy it was in general to ameliorate my pain just with my own mind.

  52. Todd Hargrove on February 20, 2011 at 15:31


    I agree that pain is an unconscious response and that it can be learned in the sense that the more often it occurs the more facilitated the neural pathways creating the response become.

    If a certain emotion is currently networked into a bunch of related thoughts, movements, sensations and pain responses, then just feeling that emotion can be enough to activate the pain network and cause pain, perhaps even without nociceptive inputs from the body. If you are able to practice feeling the emotion in a less reactive or more mindful way, as taught by buddhists, perhaps you could start to inhibit the reflexive connections between that emotion and various other reactions, including the pain reaction. So that is a way that meditation or buddhist practice could help.

    Good line about the sex pistols and music theory, point well taken. However, there may be some aspiring music theorists reading this section, and I want them to know that there are other teachers out there than Johnny Rotten and Sid Vicious.

    I was just joking about Stephan of course (I took out the line about you being immune to back pain.)


    I think with chiro, ART, Sarno, almost any therapy (even including surgery sometimes), it works by making changes in your brain not your body. For example, chiro doesn’t work by realigning bones, but it can create some very novel sensory information that changes the way your brain “thinks” about the area being adjusted.

    • Richard Nikoley on February 20, 2011 at 16:01

      “I think with chiro, ART, Sarno, almost any therapy (even including surgery sometimes), it works by making changes in your brain not your body. For example, chiro doesn’t work by realigning bones, but it can create some very novel sensory information that changes the way your brain “thinks” about the area being adjusted.”

      Yes, as I said in the post, paraphrasing. Suppose you feel better after a surgery. How do you know it’s because you actually fixed some harm, or because you simple expect to feel better?

      That said, I am mindful of both Kurt’s and Sarno’s admonitions that none of this should be taken to mean that “everything is TMS,” to use my own gist. To put it another way, one thing that I think set me up for success here is seeing the very well spoken, young, Indian ancestry spinal doc who laughed out loud when I told him my friend Kurt told me to consider very hard the possibility of surgery, unless I could not walk, or get it up — neither of which is a problem; and there’s something to be said for the male alarm clock. :)

      …Anyway, he did what I consider a thorough round of physical tests to ensure I had absolutely no compromise of motor function or coordination. So, it was easy to get to the place where I could begin to believe that there’s nothing physically “wrong” with me, that 8 have nothing more than a minor disc herniation, most of which people don’t even know they have because they cause no symptoms.

      I read another post on your blog, Todd, about a recent study to that effect with young guys. 20-somethings with herniations. No pain.

    • Kurt G Harris MD on February 21, 2011 at 08:52

      What I meant was that you don’t need theory to learn a 3-chord progression and you don’t really need to understand the brain science to make the Sarno technique work.

      “If you are able to practice feeling the emotion in a less reactive or more mindful way, as taught by buddhists, perhaps you could start to inhibit the reflexive connections between that emotion and various other reactions, including the pain reaction. So that is a way that meditation or buddhist practice could help.”

      Yes it does help this way, as long as you are trying to be mindful of whatever comes up – zen calls this shikantaza . But if you practice a more one-pointed meditation, with repetitive phrase or such, this can serve as more of an escape and not bring you any closer to awareness (in the western sense).

  53. keithallenlaw on February 20, 2011 at 18:08

    Though L Ron Hubbard’s religious side is very controversial, I believe the science
    part of it, though the works of Dianetics, touches on these very same concepts.
    Basically the mind is making the body sick and painful through past emotional
    experiences, getting keyed up in the present time. Once the reactive mind keys in,
    it only thinks in similarities, A=A=A=A=A. Self awareness to this is key.
    Actually, being aware of being aware is who we really are. We are not our pains.

    So Richard, very good job of this discovery on your own. Many people will struggle
    their whole life with this right under their noses and not see it. Thanks you for your
    contribution. And Kurt as well.

    • keithallenlaw on February 20, 2011 at 18:09

      Don’t have a clue why my sentences are broken to pieces, sorry.

    • Richard Nikoley on February 20, 2011 at 18:21


      I want to be clear. In no way am I the least bit interested in religious or cult (I know, I’m often redundant) interpretations of my condition.

      Final answer.

      You see, I’ve understood the con for far too long, having grown up in one aspect of it. It’s about appropriation of the real for the benefit of the bullshit.

      Scientology is a fucking dogshit scam that steals from people ’round the world and ought to properly be a laughing stock at it’s mere mention. Please don’t waste the good time of the people here with its mention ever again. It’s garbage, and if you hold stock, you’re a fucking fool.

      • keithallenlaw on February 21, 2011 at 18:20

        As always I respect you your ideas. Didn’t mean to offend you on your turf.
        My apologies.

        No worry, I hold no stock. It just seemed like the mechanics had some slight
        relation. Nuff said about that. I guess I need to educate myself on this
        Deepak Chopra chap? Or maybe not.

      • Richard Nikoley on February 21, 2011 at 21:20


        You caught me at a bad time. Because I have no patience for mysticism, I am often known to overdo it.

        No worries here.

      • keithallenlaw on February 22, 2011 at 10:54

        You say, “I am often known to overdo it.” But you see, that is why
        you are loved and listened too so much. I happened to like the no
        holds barred honest approach you exercise throughout your
        musings here.

        Just keep up the writing, and maybe I should do more listening,
        and a little less posting…LOL.

    • Kurt G Harris MD on February 21, 2011 at 08:53

      Dianetics uses repressed memories the way Deepak Chopra uses quantum mechanics.

  54. rob on February 21, 2011 at 05:12

    The mind/body thing is why I continue to believe that endurance sports are extremely beneficial though they are looked at askance by many Paleos (“chronic cardio”).

    Clearly if it is an endurance activity you are going to have to endure SOMETHING, what exactly is it that you are enduring? In large part it is the curveballs that your CNS throws at you. When you are 75 miles into riding a century and you lose the ability to think straight and your legs don’t want to work anymore, you have to be able to distinguish between what is real (“Yes I can ride the final 25 miles”) and what is not real (your brain telling you to cease and desist this foolish activity).

    I’ve never participated in endurance sports because they are “healthy,” I’ve participated in them because they clear away all the bullshit that is running through my brain. I get the same thing from a grueling session in the gym.

    These days it is popular to minimize the time you devote to grueling physical activities (“The 4 Minute Body”) which is all well and good, but if the reason you are participating in the grueling physical activity is to unload the emotional crap that makes you feel like you are carrying a 200 pound load on your shoulders, minimizing it is the last thing you want to do.

    Meditation is great too but to me there’s not much difference between meditating and going for a good long pre-dawn run.

    • Kurt G Harris MD on February 21, 2011 at 08:41

      This is exactly why I run and why I think running is good for you – it’s for your brain, not your heart. I run no more than 5K , (without music!) which takes about the same length of time as a half hour sit. I can get the same relaxing effect riding a motorcycle, as it pretty much forces you to pay attention to what you’re doing.

      • Rod on February 21, 2011 at 09:20

        On long days in the mountains I slip into the “time passes but I dont notice” phase after several hours, although there are days when I just suffer.Another phenonenon I have noticed over the years is that the ascent is often associated with kind of turbulence but the long way home is a calm,peaceful, acceptance of fatigue and fear that you kind of see through.

  55. Skyler Tanner on February 21, 2011 at 06:11

    This is all very interesting. My zen meditation instructor mentioned this well over a year ago. I put it to the back of my skull, likely in the “woo-woo” category, and got back to sitting. Glad to hear others have taken bits and pieces, putting it to good use.

  56. Eric on February 21, 2011 at 13:16


    Great series of posts on your neck/shoulder pain, and especially this one on the TMS connection. I’ve had a lot of back/neck pain as well as hip and knee pain, for decades. A few years ago I read Sarno and the lightbulb went on–two months later I was backpacking in the Sierra with no pain. For a long time I was hiking, biking, lifting doing all shorts of stuff with no pain but gradually I stopped “believing” in Sarno, stopped tracking my emotions and my best guesses as to the emotions that I wasn’t expressing, and all the pains came back, and then some. Ironically this process began when I saw a doctor who is a Sarno trainee, for some reason I felt that he was not reliable and started to doubt that it really was all psychosomatic. I had done far better on my own that I did after I saw this guy, and I gradually lost the clarity. So reading your post and the many, many helpful comments has been really useful and inspiring, and gotten me fired up to go at the Sarno approach again. So a big thank you to you and all those who have commented. I’m eager to get back into the TMS approach and see what happens.

  57. Paul C on February 22, 2011 at 09:26

    Here is my experience from this weekend. I have two sorts of chronic back pain, lower back and a burning shoulder/trap, both low-level pain most of the time, unless I ‘overdo it’ then the pain can grow quite a bit. It mostly hurts while driving a 50 mile commute and sitting at my desk at work. However it always puzzled me how I could deadlift 250 pounds multiple times without injury pain, but bending over to pick up some cardboard would cause a flare up of this chronic pain. This really really puzzled me because I didn’t see a mechanical difference in the movement.

    I downloaded Sarno’s book Thursday night to my Kindle and read the first few chapters, and experienced the laughing episodes that so many related. Friday’s drives were virtually pain free. Friday at my desk, not much pain. This chronic pain was not present on Saturday. Saturday I deadlifted a set of 233×8 and felt a bit of pain in the lower back. Sunday a blizzard dropped a foot of snow and I hand-shoveled it all, laughing the whole time. Afterwards my lower back hurt, but it had a different flavor to the pain. It hurt in a different place than usual, and I didn’t give in to it. I wasn’t laid up for 4 days by it, I just ignored it. I didn’t limit my movement and didn’t need to. Today, 2 days later, a small lingering pain is still there, and I’m still laughing at it.

    • Paul C on February 24, 2011 at 11:09

      Following up another 2 days later. The burning shoulder/trap has almost disappeared completely, down from extremely annoying to almost nothing. I was dreading having to live with that feeling every day. I had thought to myself “at least it’s not anywhere near as bad as Richard’s pain”, and if it wasn’t making me want to eat a bullet then I could live with it. I really thought I had entered a new phase of my life where I was going to have to live with some sort of degrading joint issue. Lower back pain is gone completely.

      Because I purposely ‘overdid it’ and the result is just a much reduced burning in one spot 4 days later, I have to give some credence to Sarno. If I were injured or broken somehow, I’d be in the worst pain of my life, and yet, it is better than it has been in months. F U, brain.

  58. Splint Chesthair on February 22, 2011 at 12:26

    This is the first I’ve heard of Sarno, but I had a similar discovery about a decade ago. I had crashed while bicycling in the mountains, I broke my collarbone (that was real) and about a week after the crash, my lower back, buttocks and hamstrings felt like they were on fire. Stretching only provided a modicum of relief, same with a hot bath, the pain always came right back. Two months of agony (no sleep, thinking about eating a bullet) went by before I tried yoga poses for the first time. Up until that time I was afraid of the pain but the yoga made me really aware of it and I had a realization that there wasn’t really anything injured. After my first 20 minutes of yoga, I was completely pain free for maybe an entire hour. Then it would build back slowly over the next few hours and I would do these poses again and it would go away, longer and longer each time. In a few days the pain stayed away forever. I’ve always had a suspicion that it was a mind thing and the time I spent being aware of the pain somehow signaled my brain that “Ok, message received, stop the pain.”

  59. Suse on February 22, 2011 at 16:52

    fascinating. Clearly I need to read up. I’ve been having long ongoing problems with my upper back/shoulder, now have frozen shoulder that no amount of different therapies seems to be helping, physiotherapy, chiropractic, myofascial trigger point release. I’m not in excruciating pain, but it’s just there and wearing me down. I need to look at a different approach but cant help but admit to some degree of skepticism. But given you’ve achieved some relief and from what I’ve seen through your writing, you seem to be a pretty bit skeptic as well, who knows… I’ll certainly repost here if I experience a change

    • Richard Nikoley on February 22, 2011 at 17:23

      Suss, I’m too much of a nice guy not to immediately get something out there on your behalf.

      Thing is, you’ll have no idea if there’s a there, there, until you give it a try.

      I’ll likely post again, because, I am experiencing daily, important improvement. Last night I slept for 4-5 hours straight. Haven’t done that in months.

  60. Becky on February 25, 2011 at 20:46

    How many women CAN’T relate to Dr. Sarno’s suggestion that bearing most of the responsibility for elder care, child care, daily meal prep, home upkeep, holiday and birthday meal and celebration prep, etc. etc., sometimes in addition to a full-time job, puts many women into a state of suppressed rage that expresses itself in painful muscle tension! I laughed out loud, too, as I read that and my pain melted away.

    Men have their own list of rage producers.

    Dr. Sarno helped me realize that I can’t make everybody happy.

  61. ben s on March 1, 2011 at 07:49

    A site that I would highly recommend is Paul Ingraham’s “Save Yourself From Aches and Pains” at http://saveyourself.ca/ He and Todd Hargrove have guest posted for each other before, so if anyone is looking for some more readable information on pain science and the like you should check it out. There are some great articles and blog posts, as well as a few very in depth and well researched tutorials (for a bit of cash). I know my dad found the pay-for tutorial on back pain very worthwhile.

  62. […] came across John E. Sarno’s theories on TMS via Richard Nikoley’s blog. Richard had been experiencing debilitating shoulder pain and after some hesitation and skepticism, […]

  63. Mark on January 31, 2015 at 09:45

    Great initial posting and some excellent comments here as well…….there are naysayers with respect to the mind-body connection; however, one only has to experience unexpected bad news one time and the immediate severe nausea that occurs (even though it was only something that went into your ear), and that should remove all doubts. I am dealing with pain and other symptoms right now and I can often make them worse but just focusing on the pain and the possible health problems it can signify…..if that doesn’t show a connection, nothing will.

  64. Yvonne on May 24, 2015 at 06:31

    I had a herniated disc that caused me about 5 years of pain. It was debilitating at times. During an “attack” I’d have to just lay on the floor for days and wait it out. I did chiropractic, pilates, yoga and even had a cortizone shot in my back. I am in excellent shape and a very active person.
    I read Dr Sarno’s book and I have been 100% symptom free for the last 6 years.
    This book works. Once I read it it took me about 4 weeks to really process it all and internalize the ideas, but once I did, there was no looking back. I now run 1/2 marathons, lift heavy equipment, stand for hours, sit for hours, you name it. I literally have zero issues with my back.

    • Richard Nikoley on May 24, 2015 at 07:54


      Glad Sarno worked for you. Worked great for me for the cervical herniation. Over the past few months I’ve been blogging about a lumbar herniation, L4-5 that causes intense pain in left butt, hip, calf, ankle and big toe. Sarno did help to make it more manageable, but I ultimately couldn’t escape the reality that there was a physical cause too (as a chiropractor told me: it’s both). Plus, my dad and two brothers had exact same injury, all got discectomies about 5 years ago and all recovered fully.

      So, I just had the procedure nearly three weeks ago, and so far so good.

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