Sciatica Part 3: The Diagnosis-and-Treatment Disconnect
November 22, 2023 11:29 AM Subscribe
I'm deep in the sciatica pain hole, as documented in these previous two questions. Many people have recommended John Sarno to me, and after reading his book I'm curious about a tangential question: what are examples from the health sciences where a treatment program worked but the underlying theory of "why" was off?
So Dr. Sarno's basic theory is that a lot of chronic pain is caused by what he called Tension Myositis Syndrome (TMS), which is basically your brain suppressing anger and stress and other emotions by reducing blood flow to certain organs or tissues and causing pain that distracts you from your feelings.
His prescription for relief is basically learning about this diagnosis, accepting it as real, and maybe doing some journaling about your feelings.
Dr. Sarno gets a new 15 minutes of fame every 18 months I think--I've been hearing about him from friends off and on since forever ago--so his name stays in the mainstream even though his theorization of back pain never gained any traction in the health care industry.
I read one of his books with an open mind and am doing the journaling. My general sense is that maybe the journaling and inner psychological confrontation works for people and is one answer to the mystery of back pain. But I'm skeptical of the TMS concept as an underlying diagnosis--not just that he over-extended his idea to explain too many types of pain but that the physiological mechanism of TMS (oxygen deprivation to tissues) seems just dreamed up and untested (there's very little peer reviewed science on his ideas).
Anyway my question isn't so much about Sarno and back pain, it is, again, what are examples from the health sciences where a treatment program worked but the underlying theory of "why" was off? I'm just curious about the topic.
So Dr. Sarno's basic theory is that a lot of chronic pain is caused by what he called Tension Myositis Syndrome (TMS), which is basically your brain suppressing anger and stress and other emotions by reducing blood flow to certain organs or tissues and causing pain that distracts you from your feelings.
His prescription for relief is basically learning about this diagnosis, accepting it as real, and maybe doing some journaling about your feelings.
Dr. Sarno gets a new 15 minutes of fame every 18 months I think--I've been hearing about him from friends off and on since forever ago--so his name stays in the mainstream even though his theorization of back pain never gained any traction in the health care industry.
I read one of his books with an open mind and am doing the journaling. My general sense is that maybe the journaling and inner psychological confrontation works for people and is one answer to the mystery of back pain. But I'm skeptical of the TMS concept as an underlying diagnosis--not just that he over-extended his idea to explain too many types of pain but that the physiological mechanism of TMS (oxygen deprivation to tissues) seems just dreamed up and untested (there's very little peer reviewed science on his ideas).
Anyway my question isn't so much about Sarno and back pain, it is, again, what are examples from the health sciences where a treatment program worked but the underlying theory of "why" was off? I'm just curious about the topic.
A recent episode of Radiolab concerning the interstitium, a "new" organ/system/tissue. It's a great story.
One of the messages of the podcast is the interstitium may help bridge western medicine as a way to understand eastern health and wellness practices such as acupuncture.
It doesn't exactly fit your question but seems related. I don't mean to imply that traditional or non-western medicine is "off".
posted by KevCed at 1:22 PM on November 22, 2023 [2 favorites]
One of the messages of the podcast is the interstitium may help bridge western medicine as a way to understand eastern health and wellness practices such as acupuncture.
It doesn't exactly fit your question but seems related. I don't mean to imply that traditional or non-western medicine is "off".
posted by KevCed at 1:22 PM on November 22, 2023 [2 favorites]
Do they need to be contemporary examples? If not: vaccines were developed before anyone knew what viruses were.
posted by unknowncommand at 2:10 PM on November 22, 2023 [1 favorite]
posted by unknowncommand at 2:10 PM on November 22, 2023 [1 favorite]
Response by poster: They don't need to be contemporary! That is an interesting example.
posted by kensington314 at 2:11 PM on November 22, 2023
posted by kensington314 at 2:11 PM on November 22, 2023
Citrus fruits, especially limes, were used used successfully to prevent scurvy in the British navy and merchant marine without anybody knowing about Vitamin C. Some decades later, they lost this practice and decided to feed sailors lots of organ meat instead. Scurvy started up again.
That's what I can remember off the top of my head.
posted by dum spiro spero at 5:15 PM on November 22, 2023
That's what I can remember off the top of my head.
posted by dum spiro spero at 5:15 PM on November 22, 2023
MedLife Crisis: Why do People Fall for Things That Don't Work? Dr. Rohin Francis is an Interventional Cardiologist in the UK with a deep interest in medical treatments, clinical trials, placebo effects and related topics. He has a couple of offerings on different topics on his channel. It's a philisophically, clinical critique based deep dive into drawbacks of medicine and the psychology of people who seek treatments outside of conventional Western medicine. You may find some of his works relevant to your interests.
posted by effluvia at 10:08 PM on November 22, 2023
posted by effluvia at 10:08 PM on November 22, 2023
Hello again, fellow sciatica sufferer; I was one of the people who answered your recent question.
I know there is a lot of literature, much of it of questionable variety, about somatizing feelings. Not all of it is of questionable variety, but books that I personally found convincing/useful on this topic are more in the "The Body Keeps the Score" vein rather than in the "this is how to deal with back pain" vein.
Having said that (your mention of journaling reminded me of it), when I was in the throes of my sciatica, between steroid shots #2 and #3, and in parallel with PT, I tried the much-lauded Curable app, which is based on neuroscience research into pain and its perception, but if I remember right, is inspired by Dr. Sarno's work in a distal way. I was skeptical about whether it would do anything, but I read a lot about the science behind it and was persuaded by it first intellectually (especially the notion that pain creates anxiety and fear, which exacerbates pain, in a loop where even the word "pain" itself can activate and amplify pain), and then practically because it ended up helping. It didn't remove the biomechanical causes of my pain, and it wasn't a magic cure, but during the months of getting better, it provided noticeable pain relief when, for example, I had a hard time going to sleep. It involved guided meditation/mindfulness exercises, expressive journaling, and cognitive-behavioral "hacks" like re-naming pain something else (I started calling it "banana"). I would say that on bad days, the Curable approach reduced my pain by 30-35% which was definitely very helpful -- enough of a difference to help me get to sleep, for example. I Once I got the hang of using it, I also was able to make do with less Ibuprofen (after a couple of months when I lived on 3200 mg per day).
In my experience with the app, the cognitive-behavioral focus of it centered around how physical pain can change your emotions, which can then create a pain loop (and how that negative feedback can be hacked), rather than how physical pain is a result of somatizing negative feelings or getting to the roots of those feelings, which I guess is Dr. Sarno's main thesis? But there is also a similarity in the mind-body approach, and in that acceptance and journaling techniques (among others) are involved.
posted by virve at 2:42 AM on November 23, 2023 [2 favorites]
I know there is a lot of literature, much of it of questionable variety, about somatizing feelings. Not all of it is of questionable variety, but books that I personally found convincing/useful on this topic are more in the "The Body Keeps the Score" vein rather than in the "this is how to deal with back pain" vein.
Having said that (your mention of journaling reminded me of it), when I was in the throes of my sciatica, between steroid shots #2 and #3, and in parallel with PT, I tried the much-lauded Curable app, which is based on neuroscience research into pain and its perception, but if I remember right, is inspired by Dr. Sarno's work in a distal way. I was skeptical about whether it would do anything, but I read a lot about the science behind it and was persuaded by it first intellectually (especially the notion that pain creates anxiety and fear, which exacerbates pain, in a loop where even the word "pain" itself can activate and amplify pain), and then practically because it ended up helping. It didn't remove the biomechanical causes of my pain, and it wasn't a magic cure, but during the months of getting better, it provided noticeable pain relief when, for example, I had a hard time going to sleep. It involved guided meditation/mindfulness exercises, expressive journaling, and cognitive-behavioral "hacks" like re-naming pain something else (I started calling it "banana"). I would say that on bad days, the Curable approach reduced my pain by 30-35% which was definitely very helpful -- enough of a difference to help me get to sleep, for example. I Once I got the hang of using it, I also was able to make do with less Ibuprofen (after a couple of months when I lived on 3200 mg per day).
In my experience with the app, the cognitive-behavioral focus of it centered around how physical pain can change your emotions, which can then create a pain loop (and how that negative feedback can be hacked), rather than how physical pain is a result of somatizing negative feelings or getting to the roots of those feelings, which I guess is Dr. Sarno's main thesis? But there is also a similarity in the mind-body approach, and in that acceptance and journaling techniques (among others) are involved.
posted by virve at 2:42 AM on November 23, 2023 [2 favorites]
People figured out that you should wash your hands before delivering babies before germ theory was well developed.
Pain is a complex and remarkably poorly understood phenomenon and it's not surprising that certain interventions may have an effect without our understanding why, or misunderstanding why.
posted by praemunire at 3:54 PM on November 23, 2023
Pain is a complex and remarkably poorly understood phenomenon and it's not surprising that certain interventions may have an effect without our understanding why, or misunderstanding why.
posted by praemunire at 3:54 PM on November 23, 2023
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So how do those antidepressants act? That's a controversial subject, to say the least. Some people think that antidepressants act by stimulating neurogenesis in a particular part of the brain called the hippocampus. Another school of thought is that antidepressants work via an effect on other neurotransmitters, such as norepinephrine and/or dopamine. Still other people (myself included) believe that antidepressants are essentially glorified placebos. The article from that last link highlights a woman who had suffered from depression for years. She participated in a clinical trial for a new antidepressant, and she felt remarkably better. At the end of the trial, she found out that she had been enrolled in the placebo arm of the double-blind study.
posted by alex1965 at 12:55 PM on November 22, 2023 [1 favorite]