BOSTON – Chronic back pain is the leading cause of disability worldwide. In the United States, patients spend up to $300 billion each year to treat the condition, according to a 2012 study published in the Journal of Pain. However, common therapies such as surgery and steroid injections intended to address physical origins of back pain have not been clearly proven to work in randomized clinical trials, and a growing body of evidence suggests that psychological factors may be associated with of some forms of back pain.Physician-scientists from Beth Israel Deaconess Medical Center (BIDMC) developed a 12-week mind-body program that takes a new approach to chronic back pain. The novel intervention – which is not yet available at BIDMC to the general public – is based on an idea pioneered by the late John Sarno, MD, a professor of rehabilitation medicine at the New York University School of Medicine. In a new publication appearing in journal PAIN, the team demonstrated that the mind-body intervention was highly beneficial for treating back pain when compared to standard care, with 64 percent of research volunteers reporting being 100 percent pain free six months later.
“The current paradigm of pain management focuses mostly on treatment of a physical origin of pain, however, in many cases of chronic back pain a physical source of pain cannot be identified,” said corresponding author Michael W. Donnino, MD, a physician in the Departments of Critical Care and Emergency Medicine at BIDMC. “Our group focused on the hypothesis that non-specific back pain is the symptomatic manifestation of a psychological process, substantively driven by stress, repressed emotions and other psychological processes. The exact mechanism remains unclear, but an analogy could be made to other known effects of acute emotional states on acute physiological changes, such how the emotion of embarrassment may result in the capillary vasodilation we know as blushing.”
Donnino and colleagues’ experimental program, termed Psychophysiologic Symptom Relief Therapy (PSRT), is designed to address underlying stressors and psychological contributors to persistent pain as well as conditioned pain responses and fear avoidant behaviors. Treatment strategies include educating patients about the links between stressors and pain, as well as the relationship with emotions. Armed with this knowledge, participants learn healthier ways to process stress and express emotions. The program also focuses on desensitization or reverse conditioning to help patients break the associations that often are formed with triggers of pain such as bending or sitting.
“Often these triggers are assumed to be cause of pain, but they are perhaps better described as associations that can be unknowingly conditioned in a way that is similar to how Pavlov conditioned dogs to salivate to a bell by pairing the bell with food,” Donnino noted. “Our program works to reverse these conditioned responses and thus improve pain and pain disability.”
The program’s final eight weeks focus on mindfulness-based stress reduction, or MBSR, the goal of which is to provide the tools to better process current and future stressors, while allowing time to practice the techniques from the first portion of the program.
To assess whether PSRT can reduce symptoms and pain-related anxiety in patients with non-specific chronic back pain, Donnino and colleagues enrolled 35 participants, 18 to 67 years old with chronic back pain that lacked a clear physical origin. Participants were randomly assigned to receive either the novel 12-week PSRT intervention, eight weeks of MBSR only, or usual care under the guidance of their physicians without influence from the study team. All participants filled out pain-related questionnaires prior to the interventions and periodically up to six months after the interventions to assess changes in functional limitations or disability, back pain bothersomeness and pain-related anxiety.
After just four weeks, researchers saw an astonishing 83 percent decrease in reported pain disability in the PSRT group compared to 22 percent and 11 percent in the MBSR and usual care groups respectively. With regard to pain bothersomeness over the same time period, the PSRT group had a 60 percent drop compared to 8 percent and 18 percent decreases in pain bothersomeness for the mindfulness and usual care groups, respectively.
The PSRT group was superior to both usual care and MBSR for the primary endpoint of pain disability at every time interval and at the end of the 6-month monitoring period. Moreover, at the end of the 6-month period, 64 percent of patients with chronic back pain in the PSRT group were completely pain free (reporting 0 out 10 on a pain scale) whereas only 25 percent and 17 percent reported being pain free in the mindfulness and usual care arms, respectively.
“Within four weeks, differences between PSRT, MBSR, and usual care were apparent across multiple domains including the primary outcome measure of functional disability as well as pain bothersomeness,” Donnino said. “When patients recognize the relationship between the mind and their physical pain, this orientation sheds new light and provides them a basis to engage with the multifaceted program that works interchangeably to improve pain and disability. This study shows that our program has the potential to be highly beneficial when compared to both usual care as well as usual care plus additional treatments such as MBSR.”
Co-authors included Garrett S. Thompson, Shivani Mehta, Patricia Howard, Lakshman Balaji, Long H. Ngo, and Anne V. Grossestreuser of BIDMC; and Myrella Paschali, Robert Edwards, Sofie B. Antonsen and Suzanne M. Bertisch of Brigham & Women’s Hospital. This work was supported by a philanthropic donation from Adam D’Angelo. The authors have declared no conflicts.

The underlying concept behind the SIRPA approach is that pain and many other persistent health conditions are often triggered, or perpetuate, as a result of the build-up of unresolved emotions related to past or current chronic stress or trauma. These symptoms are part of the brain’s primal protective/‘fight or flight’ response.  These days though ‘threats’ are generally more of the psychological kind, rather than potentially life-threatening situations, like facing a lion or a sabre-toothed tiger. For example, a result of how we react to what is going on in our lives (e.g. over-analysing, ruminating, worrying etc), rather than just what is actually happening........

​Georgie Oldfield is a physiotherapist in the UK who trains health care practitioners in Mind-Body medicine . Please read
her story. 

A SIRPA practitioner in the UK recently posted this account of her 'aha!' moment regarding her IBS. Read the story here. 
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Anyone who is experiencing prolonged symptoms following Cvid 19 infections (or knows someone who is ) may be interested in the first hand stories of some individuals who have recovered from it. 

A very useful and informative resource for people experiencing irritable bowel or other functional gastro-intestinal symptoms is a book by a paediatrician and a psychologist called Trust Your Gut. The information contained in it is very similar to the advice we give. One of the authors also uses clinical hypnosis for IBS. 

If the only experience one has had or observed about hypnosis is a stage or other entertainment venue, or perhaps from cartoons (such as Scooby-Doo) or movies, one may not be aware of how gentle, yet powerful, respectful and effective clinical hypnosis can be in a medical setting. In this video, Dr. Rob McNeilly in Australia is working with a young girl who wanted to get rid of her fear of dogs.The interaction is playful, enjoyable, and safe, and released her permanently from that old phobia. 

Have a look at their very instructive and enlightening infographic and explore further. You may also like to look at the Curable App. 
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Dr Hanscom presents part 2 of this discussion. ​

Dr. David Hanscom talks with Penny George and Dan Hindsley, based in Fife, Scotland and Lancashire, England, respectively. Penny shares her story of battling and overcoming Chronic Fatigue Syndrome.  Dan talks about his struggle with and recovery from severe sciatica and back pain for over a decade. They met (virtually) in mid-2020 after both participating in online recovery interviews with Georgie Oldfield and have joined forces to raise awareness of the mind-body approach to health among medical practitioners in the UK.
Penny George is based in Fife, Scotland and became ill with Chronic Fatigue Syndrome in 2017 during a particularly stressful period in her life, including the loss of two friends to suicide, and a highly toxic work environment.  She was told about the work of Dr Sarno by a Buddhist nun, and experienced an overnight 'book recovery' after reading the first half of the Divided Mind in August 2019. 
Dan Hindsley is based in Lancashire, England, and was diagnosed with degenerative disc disease in his 20s following an MRI scan. He was sent away to 'manage' the pain and suffered with severe sciatica and back pain for over a decade before discovering the work of Dr Sarno where he made the link between the pain and repressed grief.  Following the methods described in Georgie Oldfield's book Chronic Pain: Your Key to Recovery, he made a full recovery which culminated in him completing an Ironman 70.3 Triathlon in 2019, after years of believing he was unable to run. 
They encourage people that have recovered through a Mindbody process to go back and contact their doctors and tell their story and share any material that helped them, be it books, podcasts or at https://mindbodymedicineinfo.org.