A while back, I spent a lot of time on this blog discussing the theories of Dr. John Sarno. Sarno argues that a lot of pain, specifically back pain, is psychologically induced. This argument is obviously contentious and goes against the conventional wisdom of back doctors. Being a fan of Sarno’s ideas, I was intrigued when I saw the following headline on Vox.com
In the article, we learn that the American College of Physicians has come around to the conclusion that drugs don’t really help lower back pain, even though this type of pain is very prevalent. That, in and of itself, doesn’t really give any credence to Sarno’s claims. But check out these two paragraphs.
Obesity, being overweight, smoking, depression, and anxiety have all been linked with lower back pain. But the cause is usually more complicated. “Our best understanding of low back pain is that it is a complex, biopsychosocial condition — meaning that biological aspects like structural or anatomical causes play some role, but psychological and social factors also play a big role,” said Chou, who wrote a big evidence review that helped inform the new ACP guideline.
For example, in patients who have nearly identical results from an imaging test like an MRI, those who are depressed or unsatisfied with their jobs tend to have worse back pain than people who aren’t, Chou said. Partly for this reason, doctors don’t generally recommend doing MRIs for acute episodes of low back pain, since they can lead to overtreatment — like surgery — that also won’t improve health outcomes.
I imagine Sarno is feeling pretty vindicated right now.
(BTW, I wrote about other observations that MRIs often lead to unnecessary surgery here.)