Some two decades ago, when I was dealing with the stress of running an upstart PR firm in New York City, I developed back pain so excruciating I couldn’t put my pants on from a standing position. To get dressed, I had to lie on my back, put my legs in the air, and then pull my pants down overhead. I walked like an old man, shuffling and hunched over.
One of my clients was a prominent psychiatrist, who suggested I read Dr. John E. Sarno’s “Healing Back Pain,” which argues that most back pain is psychological in origin and that most back surgery is unnecessary. As I was certain that my injury stemmed from a pulled muscle I sustained doing hot yoga, I dismissed my client as trying to sell me on some psycho mumbo jumbo that wouldn’t heal my condition.
When I mentioned my back pain to another medical client who was consistently ranked as one of the top ENT docs by New York magazine, he, too, suggested I read Sarno’s book. The client told me that after 9/11 he developed back pain so agonizing he was forced to cancel all his surgeries. After reading Sarno’s book, the clientd told me he got out of bed and went back to work.
I rushed over to Barnes & Noble to buy Sarno’s book. Within days, I was back on my feet. Sarno’s book changed my life and saved me, along with millions of other people around the world, from a spine surgeon’s scalpel.
Sarno’s book immediately came to mind this morning when I read this report in an industry trade journal that spinal fusion surgery is one of the fastest growing medical specialties. That’s great news for hospitals and doctor-owned ambulatory centers, which are looking to lucrative procedures to make up for lost revenues because of the pandemic. But it should give chronic back sufferers and their loved ones serious cause for concern. I’ve known a few people who have undergone back surgeries over the years, and none of them experienced positive or meaningful results. One of them requires a walker, and he’s only in his mid-sixties.
Sarno, who died in 2017, was no quack. He earned his medical degree from Columbia and later became director of outpatient services at what was then known as the Howard A. Rusk Institute of Rehabilitation Medicine, now part of the NYU Langone Medical Center. The Rusk Institute for decades consistently ranked as one of the top rehabilitation hospitals in the country.
While working at Rusk, Sarno noticed large numbers of patients coming in with neck, shoulder, back and buttock pain. Speaking with these patients, he observed one commonality: All of them were undergoing very stressful situations that made them anxious or depressed. That’s how he came to develop the term tension myositis syndrome (TMS), which holds that most pain, particularly back pain, is psychosomatic.
Put very simply, Sarno believed that humans have varying capacities to withstand stress and negative emotions, and when the psychological burden becomes overwhelming, they need to create a distraction from what’s really bothering them. The distraction is pain, usually in the back but sometimes in the neck, shoulder, or buttock. The pain is very real and often debilitating.
Many back sufferers argue will instinctively argue, as I initially did, that Sarno’s TMS theory doesn’t apply to them because they know exactly how and when they injured themselves. Sarno explained that the perceived “injury” moment was actually the moment when a back sufferer could no longer deal with their underlying emotions.
I’ve experienced occasional bouts of debilitating back pain since my first incident decades ago and rereading Sarno’s book always allowed me to recover. The last two incidents were particularly brutal and required me to undergo a regime of steroids before I could mend. What also aided my recovery was exercise and Iyengar yoga, which focuses on alignment. As I’ve written previously, practicing Iyengar yoga is as exciting as watching paint dry, but the level of training required for a teacher to get certified is unrivaled and the benefits of the practice are magical. The two most inspiring Iyengar teachers I’ve found, Christine Stein and Becky Patel, teach online classes.
Tellingly, my most recent back pain bout was last summer, five months into the pandemic. The orthopedic surgeon I saw required me to undergo an MRI as a condition for giving me a steroid prescription. Reading the results of my MRI it’s a wonder I’m able to walk at all. “Severe degenerative disc disease” appears in multiple places. The orthopedic surgeon, who specialized in knee replacements, advised me I needed surgery and gave me a few referrals. I opted to continue exercising and practicing Iyengar yoga, and eventually resumed my rigorous fitness regime.
Here’s why I didn’t trust the surgeon. While waiting in his exam room I noticed he had a pamphlet holder with the Stryker logo. Stryker is a Michigan-based medical device company I knew something about.
Weeks earlier I reported a story for Deadline Detroit about how Beaumont Health, a once renowned regional hospital network in southeastern Michigan where patient care standards have fallen dramatically because of aggressive cost cutting, was requiring its orthopedic surgeons to use Stryker products for trauma procedures, despite objections from surgeons who said the products were inferior. The reason for the product usage mandate: Beaumont received a rebate if it used Stryker products for 75 percent of its trauma procedures.
The enforcer of Beaumont’s Stryker usage mandate was a spine surgeon who received more than $900,000 in “consulting” fees from the medical device company. Beaumont suspended its Stryker use mandate after I reported on it.
Sarno said that some back surgery is indeed necessary and perhaps I will ultimately need it. But I’m going to be awfully selective and diligent in choosing a back surgeon if that time comes. It will be a formidable task.
More than a dozen Dallas hospital administrators and doctors were sentenced to serious jail time for accepting “kickbacks” for referring patients to an area hospital. Three of the doctors were spine surgeons. I’m not suggesting that spine surgeons are inherently dishonest or compromised, but it’s one medical specialty where doing a big volume of business might in itself be a warning sign.