As the decades have gone by, the role of stress and mental stability in a patient’s life and the role that stress may play in a patient with lower back pain have become increasingly evident as a factor to always remember to consider. Dr. John Sarno did not invent the idea of somatization of stress as pain, but he certainly did a lot to popularize it and bring it to the awareness of patients and physicians alike. With his wildly popular book, The Mind-Body Connection, he introduced to the general population the concept (that he terms “tension myositis syndrome” or “TMS”) that emotional stress can and often does become realized as physical pain.

The notion that stress “causes most back pain” is outdated and ignores decades of meticulous research that has revealed the most common spinal pain generators such as the facet joint, disc, and sacroiliac joint. However, most people—doctors and patients alike—would cede the principle that stress, just as sleep deprivation does, has the potential to make pain feel worse. A patient with discogenic lower back pain is likely to suffer more with that lower back pain if he also just lost his job and is going through a divorce. That is, seen through the prism of a large amount of stress in one’s life, pain feels worse. Similarly, insomnia may magnify a patient’s pain. Some patients have indeed been found to have all of their pain originate from the stress in their life, though this remains a very small minority of patients.