The Psychology of Back Pain

In the posts How I Figured Out the Cause of My Back Pain and Back Pain and Learned Helplessness, I briefly mentioned the psychological aspect to back pain. I want to elaborate on this topic because the first time I was exposed to this idea I misunderstood it.

Dr. John Sarno specializes in patients that deal with chronic back pain. He believes that stress is the major cause of back pain. When we go through periods of chronic stress, the brain uses a diversion tactic to protect us emotionally. That diversion is to manifest REAL PHYSICAL pain, often in the lower back region. The pain is real. It is not in our heads. The roots however are psychological.

The Mindbody Prescription: Healing the Body, Healing the Pain
The Mindbody Prescription: Healing the Body, Healing the Pain by John E. Sarno M.D. is a better book than The Divided Mind. I have not read his 2010 release Healing Back Pain.

The stresses in life are supposed to episodic and not chronic. Episodic stressors teach us how to both physically and mentally overcome life’s challenges. We are wired for success. In earlier days, we would respond quickly to a threat such as a tiger by picking the right tree to climb and acting fast. Once the tiger left, the stress was removed and life returned to normal. Modern life stressors such as long commutes or bad bosses are predictable and chronic. The brain still craves success, so it diverts our attention away from the stressor. Enter back pain.

How does stress manifest as true physical pain? According to Dr. Sarno, the brain uses mild oxygen deprivation to the regions where the pain will surface. It doesn’t have to be the back. It could be your neck or feet or something else. If you are solving the pain problem physically, you can try and block the pain signal to the brain via painkillers or push oxygen back into the regions of pain (massage, acupuncture, chiropractic).

However, validating a pain with psychological roots with a physical response is not the best long term solution for back pain. In fact, it often just makes the problem worse later. We get addicted to the pills and massages because of the very relief they provide, but because the stressors remain, the pain will eventually resurface. The worst part is it validates a helplessness strategy for dealing with our pain. Pain + $$$ = no painBeing healthy and pain-free is your birthright. It should not a consumer choice.

Photo by Tony Hall

It took me a while to fully grasp the concept of psychological stress as the root cause of back pain. It wasn’t until I studied where I was at emotionally during each of my back pain flare-ups did it all make sense. Dr. Sarno says that people with the most back pain tend to be perfectionists or have control issues. The brain is just trying to emotionally protect you from an environment for which you have no control over.

What is the first step in eliminating back pain? Stop validating the physical symptoms and begin reflecting on the psychological causes. I’ll go into greater detail on strategies that I’ve used in a future post. In the meantime, read the post Perspective…back pain on Conditioning Research. Also, read the comments.


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  1. Thanks for the link. Did you read my interview with Monte? Lots of related and relevant material:

  2. @Chris – Yes, I read it when you first published it. Great interview. Thanks for sharing the link.

    I also read Dr Marc Sopher’s book which Conditioning Research discussed in this post.

  3. I think Sopher’s book is the most accessible and challenging presentation of this material. He really gets to the heart of it and is funny too. I remember reading and re-reading chapters of Sopher the night before I was doing a half marathon in Ireland. I had a bad back but “knew ” there was nothing really wrong and I needed to convince myself. It all worked out fine and I ran the race OK.

    The other relevant thing on my blog was this:

    but I think Sopher and Monte come across better

  4. Sorry – just realised you’d already linked to the Rostocki interview…..doh!

    By the way my back is generally pretty good now. Occasionally flare ups but I manage it OK…..and it is always aligned with stress – in my work, family or whatever.

  5. @Chris – Thanks again to Conditioning Research for setting me on the right path with back pain.

  6. Wow. Just … thank you for writing this. I won’t bore you with the year-long intense left arm & shoulder pain that magically disappears every time I’m (rarely) able to take an extended break from work … but I will say it makes a lot more sense now.

  7. I had nearly crippling back pain for about 10 years – from aged 25 to about 35. Now I have none.

    I had plenty of psychological reasons to aggravate the pain. And I received lots of psychotherapy and related treatments. I trained and qualified to be a psychotherapist (and am still registered as one) But I don’t think psychotherapy is all that helpful, except over the short-term to give people guidance and focus to make behavioral changes, especially in sleep, diet and exercise.

    For awhile I was convinced that the secret to my back pain elimination was MSM, but I now realize it was probably only the fact that MSM increased my vitamin and mineral absorption.

    Now that I’m about 90% “pure Paleo” I don’t take MSM anymore – and I still have almost no back pain ever.

    I row on an indoor rowing machine almost everyday and have steadily built up strength over the past six years or so. My sprint times are at or close to world records for my age and weight group.

    Just a couple of months ago I discovered much to my surprise and delight that I can, for the first time in my life, do wide-grip pull-ups, and now I can even do them with added weight (about 40 pounds).

    The only supplement that I think is helpful for eliminating my back pain is magnesium (as I’ve said before) and even better is consuming lots of home-made bone broth.

    I know you’re a believer in the Sally Fallon Nourishing Traditions approach -I would encourage even more of it – especially bone broth, bone marrow and organ meats.

    To your roaring good health,


  8. @Glenn – Glad to hear you conquered your back pain.

    I’ve been doing lots of homemade broths recently and I now consume organ meats weekly. I wonder how much my dietary changes helped with the pain? I don’t suspect it was the major factor. I give Nourishing Traditions credit for my immune system, but most of my back pain was eliminated before I made those diet changes.

    For me it was episodes where I felt I was in control and then things didn’t go my way. The pain would surface shortly afterward. Learning how to play the role of observer and recognizing that I wasn’t in control was the biggest factor in pain reduction for me.

  9. Thanks MAS.

    I should also say that over the years I’ve learned to breathe mindfully (slowly, deliberately, deeply) whenever I feel out of control. I can imagine that’s also helped reduce my backpain. The mindful breathing has become such a habit that I (somewhat ironically) don’t really reflect much over it.

    Best regards,


  10. @Chris – Thanks for the link. Looks like a great site.

  11. @Chris – Thanks for the link. I really respect Dr. Kurt Harris. I am working on two more back pain posts for this site, but another project is delaying their release.

  12. I read Sarno’s book over a year ago and it has helped tremendously. I first started getting back pain at 18 and I’m now 24. The only thing I still have lingering pain. I haven’t been able to eliminate it 100%. I’m still stiff with back pain at times in the morning. One of the recommendations was to journal. I found out that after tons of researching and journaling my mind was only focusing on the pain and making it worse. Ever since I stopped thinking about it and just accepted it as psychological it has decreased. What have you guys done to eliminate it completely?

  13. @Tom – I do something that Sarno disagrees with. A few times a week I will do mobility work. Very brief – maybe 10 minutes. Doing this, I believe, tells the brain that we aren’t constricted and we can move freely without pain. I don’t do the mobility work to warm up, as I believe that is not necessary.

  14. I’ve eliminated it completely with:
    1- magnesium
    2- MSM
    3- Indoor rowing

  15. Thanks MAS. I will give it a try. I use to workout a lot before the back pain but have laid off since. GWhitney, did you take magnesium and MSM internally? This kind of confuses me as it seems it goes completley against the psychological approach Sarno mentions.

  16. Yes, I take the MSM and magnesium orally, every day, twice a day. If I skip a day or two I feel the pain coming back.

    I am sympathetic to mind-body arguments and indeed I am a fully qualified (and practicing) psychotherapist with two masters degrees. I also meditate regularly and practice other forms of stress reduction. However…

    IMHO it’s never possible to pin-point the exact origin of these kinds of ailments. But it’s not always necessary to know or understand the cause to find a solution.

    Also to clarify, when I get “my dose” of supplements right I experience 0% pain and my indoor rowing performances are in the top 1% in the world for any age category (I’m 46). For that I need a strong and resilient back!

  17. Ok thanks I will give the supplements a try. I have heard of magnesium helping people but not MSM. Can you clarify exactly what MSM is and what it does? Is it as important as magnesium?


    It seems to help mineral absorption and joint flexibility

  19. Sarno rocks! I completely cured 22 years of severe back pain in 2 months by doing the exercises in his book.

  20. Sarno’s technique has achieved miracles for hundreds and thousands. Simply check out the reviews for his books on Amazon. A vast majority were completely relieved of their pain within days or maximum a month or so. Most of them had been suffering from severe back, leg, foot and groin pain for years and had undergone almost every possible treatment including operation. My own experience with Sarno technique is that my pain of more than a year has now reduced by 80% and I can feel improvement on daily basis. You only need to convince yourself (from his arguments and evidence of course) that there is nothing wrong with you physically. It’s simply some muscles in your body that have been mildly deprived of oxygen by your mind because you’ve been stressing yourself out by thinking too much. This oxygen deprivation is totally harmless but it can be extremely painful and the pain sticks around because you keep paying attention to it. The moment you grasp the concept and have full confidence in it, your recovery will start immediately. The pain can return at times as you recover but will disappear again and eventually disappear for good. Today I ran for two miles after almost a year, thanks to Sarno technique. Please use it if you have chronic back, leg, neck or groin pain and also recommend it to others. It works like a miracle !

  21. So an injury 15 years ago caused back pain. Ive had many treatments and 5 MRIs and 2 discograms. Finally medications helped. Now doctor says its psychological manifestation – only because other treatments aside from medication didnt work. DIdnt believe anything I said – previous MRIS showed hernations, extrusions, IVe had sciatica at times or havent been able to stand up straight. Other doctors wanted to do spinal fusion and IVe had unsucessful injections and outpatient surgeries. The pain didnt start around a stressor – yet the doctor compared it to molested women who have pelvic pain. I havent been molested. Pain didnt start when someone died, or I went to college, or got a new job, or changed jobs, or movED to another state. Im sure some people have psychological roots to their pain – and IM sure everyone can benefit – Ive been in therapy for other illness PRIOR to any pain – PRIOR to being an adult as I had serious anxiety as a kid. But the pain didnt start until age 30…People have always said you can have 2 MRIs looking the same – one persons in pain – one isnt. Or then Im told discogenic deterioration is normal as you age. 30 is not OLD. Been told MRIs cant get better – yet clear history of herniation one time, then gone 2 years later, then back 2 years after that and then not seen again. So every doctor says the same and now Im gonna be dead cuz I cant deal with it and no doctor will listen

  22. So people are saying convince yourself pain isnt real..oxygen blah blah. So dont pay attention to MRIs or discograms or any other tests. Just pray your cancer away because despite tumors, its a psychological source. Theres no broad brush for everyone and this is the problem with doctors. I actually was told by a doctor that the medication Im on has no proof of helping long term pain. Im sure whatever study hes referring to is not 100% of people. Im standing before him telling him the medicine makes me get out of bed and otherwise Ill kill myself for no quality of life and he says Im wrong. Ok, so the medicine helps within 15 minutes. Give me a placebo and youll see the difference as other medicines that were less strong didnt work while those more strong did.

  23. @MATT – I don’t believe Dr. Sarno is referring to back pain caused by an injury. He is speaking to those that experience back pain without a root physical cause.

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