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In the 1970s, John Sarno, a New York physician, wrote a series of best-selling books trying to convince patients that their pain was all in their head. A study published in the December 2015 issue of The Journal of Pain disputes Dr. Sarno’s hypothesis by showing that chronic pain really is all in your head—in fact, it’s located in your shrinking amygdala!

The concept that chronic lower back pain causes certain parts of the brain to shrink and atrophy is not new. Metaphorically, this current research in The Journal of Pain represents perhaps the final nails in the coffin of Dr. Sarno’s idea. If chronic back pain is real enough to cause parts of your brain to atrophy, and this atrophy can be measured on MRI, then the doctors claiming that their patients’ pain is imaginary are far nuttier than the accusations they’ve made about patients.

With all of the objective evidence we now have based on sophisticated imaging that back pain is a real physical, neurobiologic phenomenon, it seems insane that there was a time when most patients with chronic lower back pain were told it was all in their head. I used to call it the “crazy or lazy” hypothesis. Since nothing in our advanced technological world could be found on MRI, the patient had to be crazy if they continued to report symptoms. If they weren’t nuts, they surely were lazy and unwilling to participate in physical therapy exercises that would miraculously make them better (despite the serious lack of any scientific evidence that physical therapy of the types in use back then actually worked). The popular books written by Dr. Sarno represented the apex of this movement. In his books, Dr. Sarno told patients to ignore their pain as it was simply the stress in their lives manifesting itself in their back or neck.

The amygdala are two nuclei or processing centers located on either side of your brain in the temporal lobe. They handle memory, decision-making, and emotional reactions. The study reported in The Journal of Pain looked at the brains of 33 patients with chronic lower back pain and 33 matched control subjects without lower back pain. Special 3D data-processing software was used to map and obtain the exact size of different parts of the brain. The right amygdala was significantly smaller in the group with chronic lower back pain. In particular, no correlations were found between the psychological characteristics of the patient’s pain or depression and the size of the structure. In other words, the atrophy or brain shrinkage was related to the physical aspects of the pain.

These studies connecting atrophy of parts of the brain and lower back pain have been numerous and repeatable across the years. The most prolific author in this area is Apkar Vania Apkarian, a professor of neuroscience at Northwestern University. He pioneered the use of MRI to study the brains of patients with chronic pain. His early work focused on measuring the abnormal chemistry of the brain in patients with lower back pain. By 2008, he had learned that chronic pain disrupted the normal circuitry of the brain. By 2011, he discovered that part of the brains in patients with chronic pain were undergoing very real atrophy. By 2013, his models of the atrophy of certain brain regions could predict which patients would develop chronic pain versus patients who would not.

The continued studies on the imaging of pain and the dramatic structural impacts it has on the brain finally need to force the “it’s all in your head” group to abandon their theories. It’s time that the idea pain is caused by anxiety and poor coping mechanisms be relegated to the dustbin of medical history.


“Your Back Pain Causes Your Brain to Shrink” first appeared as a post on the Regenexx blog.
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