Book Highlights: Healing Back Pain by John Sarno

Completed Book on: 12th November 2025

Why I Read This Book

I went through a rough patch with back and neck pain. Which started of as a minor twitch and then eventually to the point where i could not get up without pain. The doctor showed me x-rays, pointed at compressed discs, and prescribed painkillers. I thought the problem was purely physical - years of hunching over a laptop had done the damage.

After spending some time at the physiotherapist and getting a go-ahead from the doctor that the spine and the discs are all good, i still felt unbearable pain.

Some days the pain was heavy, other days it was barely there. Same spine, same discs, completely different pain levels. That's when a friend recommended this book.

I'll be honest - I was skeptical. A book claiming that back pain is caused by your emotions? Sounds like pseudoscience. But I was desperate enough to try anything.

Main Summary about the book

Dr. John Sarno was a professor at New York University Medical School who spent decades treating patients with chronic back pain. His central argument is quite interesting: most chronic back pain isn't caused by structural problems like herniated discs or pinched nerves. Instead, it's caused by Tension Myoneural Syndrome (TMS) - where your brain creates real physical pain to distract you from repressed emotions, particularly rage and anxiety.

Sarno argues that the medical industry has it wrong, and that understanding the psychological root of your pain is often enough to cure it. No surgery, no painkillers, no endless physical therapy.

These are pretty controversial statements but thousands of patients swear by it.

In my case, the realization that my back pain is not due to structural issues rather psychological was something which eventually tuned down the pain and after a while, i was literally pain free.

Highlights

"The pain is real. It is not imaginary."

This is important. Sarno isn't saying your pain is "all in your head" in the dismissive way doctors sometimes say it. He's saying your brain is creating real, physical pain as a defense mechanism. The pain you feel is 100% real - it's just that the cause isn't what you think.

"TMS exists to serve a protective purpose: to divert attention from frightening, threatening, and often deeply buried emotions."

Here's the core idea. Your unconscious mind would rather you focus on physical pain than deal with emotions like rage, fear, or sadness. The pain is a distraction. Your brain says "focus on your back, not on that anger you've been suppressing."

I found this fascinating. Think about it - when you're stressed at work, when deadlines pile up, when that production bug keeps you up at night. Where does the tension go? For me, it was always my neck and lower back. The body keeps score.

"People who get TMS tend to be perfectionists, people who put a lot of pressure on themselves."

This one hit close to home. Sarno describes a typical TMS personality: driven, self-critical, wants to be seen as good and competent. Sound like anyone you know?

He calls these people "goodists" - people who want to be seen as good, helpful, and responsible. They suppress anger because anger isn't "nice." But that suppressed rage has to go somewhere. I saw this trait in myself and can point to so many people who carry this burden on them.

"The structural abnormalities that are often blamed for back pain - herniated discs, spinal stenosis, arthritis - are usually not the cause of the pain."

This is where Sarno gets controversial. He points to studies showing that many people with "abnormal" MRIs have zero pain, while people with "perfect" spines suffer terribly. The correlation between structural problems and pain is weaker than we assume.

My initial x-ray showed some minor compressions and possibily a stress fracture. But according to Sarno, that might just be normal wear and tear. Once i recovered physically, the pain was still there, pointing to the fact that Sarno is right, the pain is not because of the back, its root is somewhere else.

"Knowledge is the cure."

Sarno's treatment approach is surprisingly simple: understand TMS, accept that your pain is psychosomatic, and the pain often disappears. No pills, no surgery. Just awareness.

It sounds too simple. But his argument is that the pain exists specifically to keep your attention away from emotions. Once you understand the trick your brain is playing, the distraction no longer works. The brain gives up.

"Resume all physical activity. Do not fear the pain."

This goes against standard medical advice. Usually you're told to rest, take it easy, avoid movements that trigger pain. Sarno says the opposite: resume normal activity immediately. The fear of movement reinforces the pain cycle.

For me, this was hard to accept. When my back hurt, every instinct said "don't move, protect yourself." But avoiding activity only made me more afraid of the pain, which made it worse. I have seen many people in my life who are stuck in this pain cycle, and they have convinced themselves that they cannot ever lift a heavy object. This fear, enforces the brain to continue sending pain signals to the back.

"The purpose of the pain is to divert attention from emotions. As long as you are focused on the physical, the pain wins."

This creates a frustrating paradox. The more you obsess about your back pain, the worse it gets. That's the whole point - keeping you focused on the body instead of your emotions.

Sarno recommends journaling about your emotions, thinking about what might be making you angry or anxious, and actively shifting your attention away from the physical pain. Talk to the pain. Tell it you know what it's doing. Sounds weird, but the logic tracks.

"Think psychologically, not physically."

Whenever the pain flares up, Sarno tells you to ask: "What am I angry about? What am I anxious about? What emotion am I avoiding?" Instead of reaching for painkillers or booking another physio appointment, look inward.

As programmers, we're trained to look at systems and find root causes. This book asks you to apply that same debugging mindset to your own psychology.

My Take

I'm not going to lie - some of this book feels like a stretch. Sarno dismisses a lot of physical treatments that have helped people. And his evidence is mostly case studies rather than large-scale clinical trials.

But.

There's something to it. After reading this book, I started noticing patterns. My back flared up during stressful sprints at work. It calmed down on vacation. The same "damaged" spine, wildly different pain levels depending on my stress. I slowly started resuming all the activities which i paused since the back pain, working out, started doing deadlifts, but taking baby steps. Sure, i was cautious, using a spine belt, but i didnt look back. Eventually i built the confidence that my back is absolutely fine and viola! the pain literally went away completely.

However, I'm not saying throw away your standing desk or ignore your doctor. But if you've tried everything physical and nothing works, plus the doctor has already cleared you that structurally everything is fine, then maybe the problem isn't physical. This book gives you a different lens to look through.

For engineers especially - people who sit all day, who put pressure on themselves, who suppress frustration when the codebase is a mess - this is worth reading. The mind-body connection is real. Your brain can absolutely create physical symptoms.

Whether TMS is the whole answer? I don't know. But awareness of this possibility has been helpful for me.

If you're dealing with chronic pain and nothing seems to work, give this book a shot. Worst case, you've spent a few hours reading. Best case, you understand something about yourself you didn't know.

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