The Great Back Debate

If a patient's attitude can help process the pain, can more creative thinking among the experts improve the odds of beating it? Harvard's Eisenberg is spearheading an NIH-funded pilot program to find out. Over 18 weeks, a diverse group of 25 specialists who rarely see each other in clinic corridors--orthopedists, neurologists, chiropractors, massage therapists, acupuncturists and others--met to educate one another on how they diagnose and treat back pain. The goal: to see if there is a more efficient, multidisciplinary way to attack the problem--and to make it cost-effective, too. Next month at Boston's Brigham and Women's Hospital, the first patients will meet with one doctor and one complementary-medicine provider, who will then consult with the rest of the team to devise a treatment plan. "From a caring-physician point of view, I really want to know what we can do to treat people better," says Dr. Stephen Lipson, a team member and Harvard spine surgeon.

To the south, in New York City, a lone crusader thinks he has the answer. Dr. John Sarno, an attending physician at NYU Medical Center's Rusk Institute of Rehabilitation Medicine, believes that almost all back pain is rooted in bottled-up emotions. For 30 years, even as high-tech imaging and fancy surgical interventions have made their way into the discs and vertebrae of millions of American backs, Sarno has thrown every ounce of his energy into the inner workings of the mind. In weekly lectures to his patients, Sarno uses a slide show and a pointer to explain how repressed rage--over your parents' divorce, sexual abuse, trouble at work--can stress the body, leading to mild oxygen deprivation, which he says will eventually manifest itself as muscle spasm, nerve dysfunction, numbness and pain. Recovery begins with recognizing the connection between mind and body. Every new patient is required to attend Sarno's two-hour presentation, and by then most will have read his 183-page book "Healing Back Pain" as well. Alessandro Giangola, 28, says his hourlong office visit with Sarno felt like psychotherapy. The doctor performed some simple tests: running a paper clip up and down Giangola's arm to test sensation, checking his reflexes. "Your health is fine," he told Giangola. Then he began asking questions: How was your childhood? What causes the anger? Patients are assigned "homework," which starts with listing every source of repressed anger in their life. Then every day, in a quiet place, they must meditate for 15 minutes on one item on the list. Tapping into the fury helps alleviate the pain. "Pain is created by the brain to make sure the rage doesn't come out," Sarno tells his patients. "It protects you by giving you something physical to pay attention to instead."

Sarno has published no academic research on his theory and can offer little scientific proof that he's right. But his satisfied patients, who he says number in the thousands, swear by his methods and treat him like some kind of lumbar messiah. Giangola, a tennis instructor and guitar player, has had back pain for 10 years, and yes, he's tried everything, even a vegetarian diet (no real explanation for that one). Several months ago, a friend told him about Sarno's book; Giangola flew through it in two hours. Immediately the pain, which he now believes stems from his parents' divorce, began to lift. "I was floored," he says. Skeptics say that Sarno is offering a placebo, which could miss the true cause of the pain. Giangola says the man "is good for humanity."

After centuries of agony, humanity could certainly use some relief. But more important than the success of any given treatment is the good news that both back-pain sufferers and the medical establishment are embracing bold new ways to think about that most exquisite and frustrating work of art: the spine.

WITH KAREN SPRINGEN, ANNE UNDERWOOD, MARY CARMICHAEL AND ELLISE PIERCE

© 2004