However, my pain was unusual (did not fit the usual symptoms people normally have). There are other types of back pains. Sarno was always insistent that a physiological cause always be investigated, and if one is found, to treat it accordingly. Absent that, he would recommend a psychological approach. One thing he highlighted that I've anecdotally found to be true when discussing with others[1]: The pain often disappears near/after retirement. And almost all physiological problems get worse with age - not better.
Me personally: Sarno's approach didn't work with other pains (ones he claims are within the scope of this type of pain). I don't know what the cause is - doctors never found anything and physical therapists have told me they've never dealt with my types of pains. Maybe it is psychological, but I must emphasize: Sarno's approach didn't work for me.
[1] A former boss is an example. He said he had severe back pain on and off for so many years - had to take time off from work, etc. Nothing really worked. But eventually, in his mid 50's it went away and he doesn't know why. He's near retirement (senior guy with money), kids all grown up and graduated from college (or near graduating). Once a lot of his life worries got resolved, so did his pain.
His story is fairly common.
That is much different the what post I responded to claims tho. Or what title claims too. The comment I responded to frames these issues being primary about psychological being and then maybe some few exceptional people having physical cause. And even that is supposed to have strong psychological component as well.
This is quote:
> Yes, some back pain is due to repetitive stress injuries or physical structures out of place or whatever. But as this study shows, looks like it has a strong psychological component as well
What you say in your cment is "when all attempts to find and fix physical issues failed, remaining patients have more luck trying psychological treatment then physical one again".
Which is much weaker claim. It does not imply that psychological is strong component nor that only some back pain is cause by physical. It implies some of it, when you exclude all known physical causes, might be psychological.
[1] This here is pure speculation. The changes you described affect also lifestyle and behavior, not just stress. That story does not prove original issue was psychological, it just shows we can't always tell what the cause was.
My PCP doesn't bother treating back pain that isn't due to an obvious injury. He said that in his decades of looking into it, he's observed:
1. None of the treatments out there show good evidence of actually working vs a placebo.
2. While it often recurs, each episode almost always resolves on its own.
He does not believe it has a psychological cause - he's just frustrated with the current state of medicine regarding it and doesn't want his patients to go through a treatment believing they're actually treating the underlying condition. He will prescribe whatever the patient asks for (pain killers, physical therapy, etc).
The only time he pays attention is when the pain extends to the legs, which is the minority of the times.
That is anecdotal and clear source of back pain in your story requires one big event. Mine experience is anecdotal too. For people I know, it was bad posture causing damage over time (when sitting mostly) and the physiotherapy with rehabilitation exercises helped.
> Fair enough, but do you have any actual evidence that actual physiological causes are the majority?
Do I need to do hunt for that since the original claim was "majority is psychological" was not just without proof, but with blatantly bad logic in it? "We excluded people where physical treatment helped" does not lead to results you can use about overall efficacy of any treatment.
> he's just frustrated with the current state of medicine regarding it and doesn't want his patients to go through a treatment believing they're actually treating the underlying condition. He will prescribe whatev
This honestly sounds like a bad doctor. He does not even makes attempt at diagnosing known physical causes of back pain. The physiotherapy/rehabilitation exercises that were recommended to me and people I know were simple and did helped. It required maybe 10 minutes a day.
I understand that there might be different causes and unknowns, but doctor who is not even trying being unable to improve any patients is not exactly an argument.
The back pain being cause by physical issues is not exception. The doctors and physiotherapists that wrote articles I read, had talks I has seen and the ones people I know visited never mentioned that. Instead, they recommended to fix the posture a set of "exercise" routines for rehabilitation. They also explained back damage as a mechanism.
And those actually worked. Back pain can be very often helped, if you fix posture and do rehabilitation. It is not exception for it to be purely physical.
The moment you claim it is psychological, the people who have fixable mechanical issue, won't get any help. And that help, quite apparently, actually makes difference. And not just with back pain.