If sitting doesn’t cause pain, why does sitting cause my pain?
The short answer is what you said: Pavlovian conditioning. Sarno is famous for emphasizing the role of repressed emotions, especially repressed anger, as the cause of TMS pain. But he was hardly unaware of the role of Pavlovian conditioning. He talked about that in his last three books. Here is how he put it in
The Divided Mind:
“One of the prime characteristics of TMS is that the pattern of symptoms will develop as a result of Pavlovian conditioning. People will experience the kind of symptoms they have learned to expect to experience, just as Pavlov’s dogs learned to associate the presentation of food with the ringing of a bell. Elizabeth von R had pain associated with standing and walking, though there was nothing neurologically wrong with her. Another patient with similar pain will say that it is sitting that brings on the pain, while walking relieves it. Experience with large numbers of patients in our clinic makes it clear that these are programmed responses having no relationship to anything beyond what the patient is conditioned to expect. That is why most common psychosomatic disorders are invariably the ones currently in vogue.” (The italicization is Sarno’s; the underlining is mine.)
As far as I am aware, Sarno never offered any particular way to stop pain due to Pavlovian conditioning. My guess is he thought that if a person understands and accepts that the pain is due merely to Pavlovian conditioning rather than anything physically wrong, then his or her brain will stop creating the pain. At any rate, that approach is what has worked for me. Furthermore, that fits superbly with the twelfth of Sarno’s 12 Daily Reminders, namely, “I must think psychological at all times, not physical.” Sarno viewed thinking psychologically more broadly than a focus on one’s emotions. After discussing Pavlovian conditioning in
Healing Back Pain, he wrote: “The specific posture or activity that brings on the pain is not important per se. What is essential is to know that it has been programmed in as part of the TMS and is, therefore, of
psychological rather than physical significance.” (Underlining by me.)
A neuroscience-oriented version of Pavlovian conditioning called predictive processing (or predictive coding) is the new, new thing in both brain science and pain science. Dr.
Howard Schubiner has gotten into predictive processing in a big way in recent years, which is what stimulated my interest in it. Prominent pain neuroscientist Katja Weich has nicely condensed predictive processing into seven words: “What you get is what you expect” because that is just the way the very complex central nervous system works. (I think predictive processing theory explains TMS pain due to repressed anger better than Sarno’s distraction theory does, and so does Schubiner, but that is a topic for another day.)
I think the big question for you, shadowson, is have you become conditioned to expect that after sitting, you will have back pain? If so, that is what you will get until you stop expecting that. Don’t answer my question in the negative just because you do not necessarily remember a time when you consciously and cognitively deduced that after you sit, you will have back pain. Pavlovian conditioning often occurs unconsciously, so you are unaware of having created a causal expectation with no basis in physical reality that is stored in the unconscious part of your brain .
