When back pain continues, it is natural to look for a physical explanation.

You may wonder whether a disc has deteriorated, a joint has shifted, a nerve remains irritated, or an old injury never fully healed. An MRI may reveal disc bulges, degeneration, arthritis, narrowing, or other spinal changes.

Sometimes those findings are clinically important.

But an MRI does not measure pain directly, and structural findings do not always explain why one person hurts while another person with similar findings does not.

Research has found that disc degeneration, bulging discs, protrusions, and other age-related spinal changes are common even among people without back pain. These findings become increasingly common with age and must be interpreted alongside symptoms, examination findings, and the person’s overall medical history. 

This leads to an important question:

What else may be contributing when chronic back pain is not fully explained by structural damage alone?
 

Modern pain science offers a broader way of understanding that question.

Back pain is generally considered chronic when it lasts longer than three months or continues beyond the expected period of recovery.

Some people can identify a clear beginning:

• A lifting injury 
• A fall 
• A car accident 
• A sports injury 
• Surgery 
• A sudden painful movement 
• A period of illness or inactivity 

For others, the pain appears gradually.

Low back pain may be classified as specific when it can be linked to a particular disease, injury, or structural condition. It may be classified as nonspecific when no single disease or structural explanation adequately accounts for the symptoms.

The World Health Organization reports that approximately 90% of low back pain is nonspecific. This does not mean the symptoms are vague, unimportant, or imaginary. It means that one clearly identifiable structural cause cannot be established in many cases. 

Chronic back pain may involve a combination of:

• Tissue irritation 
• Muscular tension or guarding 
• Joint or nerve sensitivity 
• Physical conditioning 
• Sleep disruption 
• Stress 
• Fear of movement 
• Learned pain responses 
• Nervous-system sensitization 
• Beliefs about the condition 
• Previous experiences with injury or pain 

The relative importance of each factor differs from person to person.

A mind-body perspective should never be used to dismiss symptoms, avoid testing, or replace appropriate medical treatment.

Back pain may sometimes be related to an infection, fracture, inflammatory disorder, progressive neurological condition, cancer, or another medical problem requiring prompt attention.

Seek urgent medical evaluation for symptoms such as:

• Loss of bladder or bowel control 
• Numbness around the groin or saddle region 
• Progressive weakness in one or both legs 
• Back pain following significant trauma 
• Fever accompanying back pain 
• Unexplained weight loss 
• A history of cancer with new back pain 
• Rapidly worsening symptoms 
• New or progressive neurological changes 

Once serious and progressive causes have been appropriately evaluated, it may be useful to consider whether the nervous system has remained protective even when the level of danger has changed.

MRI scans are valuable diagnostic tools.

They can help clinicians identify fractures, tumors, infections, severe nerve compression, significant structural abnormalities, and other conditions.

However, an MRI is a picture of anatomy.

It does not show the full pain experience.

A large systematic review found that many degenerative findings are common in pain-free people. For example, disc degeneration, disc bulges, and facet-joint changes become increasingly common with age, even when no back pain is present. 

This does not mean every MRI finding is harmless.

It means a structural change should not automatically be treated as a complete explanation for chronic pain.

A scan may reveal what is present in the spine, but it does not always reveal:

• Why the pain changes from day to day 
• Why symptoms worsen during stress 
• Why pain may move or spread 
• Why some movements hurt at one time but not another 
• Why pain sometimes continues after tissue recovery 
• Why two people with similar scans may have very different symptoms 

The most accurate conclusion is:

Imaging is one part of the clinical picture, not a direct measurement of pain or danger.
 

Pain is a genuine biological experience.

It is not imagined, exaggerated, or invented.

At the same time, pain is not simply a signal traveling from damaged tissue to the brain. It is a protective experience shaped by the interaction of the brain, spinal cord, nerves, body, and surrounding context.

The nervous system evaluates sensory information alongside many other forms of information, including:

• Previous injuries 
• Memories 
• Expectations 
• Fear 
• Stress 
• Sleep 
• Emotional state 
• Movement habits 
• Beliefs about the body 
• Environmental cues 
• Past medical experiences 

The brain then makes a rapid, largely unconscious judgment about how much protection may be needed.

When danger appears likely, pain can increase.

When the nervous system experiences greater safety, pain may decrease.

This does not mean thoughts alone create pain.

It means the pain system is influenced by far more than tissue condition alone.

The nervous system is capable of learning.

That ability allows us to develop skills, remember danger, form habits, and adapt to new experiences.

It can also contribute to persistent pain.

Following an injury, the brain may learn that certain movements, positions, or situations are threatening.

For example, pain may become associated with:

• Bending forward 
• Lifting 
• Sitting at a desk 
• Driving 
• Exercising 
• Getting out of bed 
• Standing for long periods 
• Returning to work 
• Particular locations or environments 

At first, these associations may be connected to genuine tissue irritation.

Later, the body may have recovered while the nervous system continues reacting as though the same level of danger remains.

The pain is still real.

The protective response has simply become more sensitive and easier to activate.

Pain naturally creates fear.

A sudden back spasm can make anyone cautious.

But when fear continues, it may begin reinforcing the nervous system’s protective response.

A person may start thinking:

• “My spine is damaged.” 
• “Bending will make the injury worse.” 
• “My back is fragile.” 
• “This sensation means I am harming myself.” 
• “I cannot trust my body.” 
• “One wrong movement could disable me.” 

These beliefs may lead to guarding, reduced movement, activity avoidance, and constant monitoring of the back.

Avoidance can feel protective in the moment.

However, over time, it may prevent the nervous system from receiving new evidence that ordinary movement can sometimes be safe.

This does not mean people should push through every symptom or disregard medical advice.

It means that, when medically appropriate, gradual and supported experiences of safe movement may help reduce unnecessary protection.

When the nervous system perceives danger, muscles surrounding the back may tighten automatically.

This guarding response can be useful immediately following an injury.

It helps reduce movement and protects the area.

But prolonged guarding may contribute to:

• Stiffness 
• Fatigue 
• Restricted movement 
• Reduced confidence 
• Increased awareness of the back 
• Additional soreness 
• Fear of movement 

Muscle tension does not necessarily mean a person is anxious or emotionally distressed.

It may simply reflect a nervous system that remains prepared for danger.

Helping the brain and body experience greater safety may allow some of that unnecessary protection to soften over time.

Dr. John E. Sarno was a rehabilitation physician who became widely known for his work with chronic back, neck, and musculoskeletal pain.

He developed a theory he called Tension Myositis Syndrome, later known as Tension Myoneural Syndrome, or TMS.

Sarno believed that some persistent pain could not be adequately explained by structural abnormalities. He proposed that stress, emotional tension, personality patterns, fear, and unconscious emotional processes could contribute to real physical symptoms.

His books, including Healing Back Pain and The Mindbody Prescription, introduced many readers to the possibility that chronic pain could be influenced by interactions among the brain, emotions, nervous system, and body.

Sarno emphasized several ideas:

• Structural findings do not always correlate with pain. 
• Fear may reinforce chronic symptoms. 
• Emotional stress may influence physical pain. 
• Understanding the nature of pain may reduce fear. 
• Resuming ordinary activity may help reverse protective patterns. 

Sarno’s work was influential, but his full theory was not validated through large, rigorous clinical trials.

It would therefore be inaccurate to claim that all chronic back pain is TMS, that all pain is caused by repressed emotion, or that Sarno’s complete explanation has been scientifically proven.

However, several themes in his work overlap with areas now examined in modern pain research:

• The imperfect relationship between imaging and symptoms 
• Fear-avoidance patterns 
• Learned pain responses 
• Stress-related symptom changes 
• Neuroplasticity 
• Nervous-system sensitization 
• The influence of beliefs and expectations 
• The value of pain education 

Sarno helped popularize the idea that chronic back pain may involve more than damaged tissue alone.

Modern pain neuroscience has expanded that idea using more detailed biological, psychological, and neurological models.

Research directly testing Sarno’s complete TMS theory remains limited.

A 2007 case series examined a mind-body treatment program for chronic back pain influenced by Sarno’s approach. Participants reported improvement, but because the study did not use randomization or a control group, it could not establish that the treatment itself caused the outcomes. 

More recent research has evaluated related—but not identical—mind-body approaches using stronger study designs.

A randomized clinical trial tested Pain Reprocessing Therapy in 151 adults with primary chronic back pain. The therapy focused on helping participants reinterpret pain as arising from nondangerous central nervous-system processes while using cognitive, somatic, and exposure-based methods.

After treatment, 66% of participants receiving Pain Reprocessing Therapy were pain-free or nearly pain-free, compared with 20% in the open-label placebo group and 10% in the usual-care group. Improvements were largely maintained at one-year follow-up. These results apply to the carefully selected study population and should not be generalized to every form of back pain. 

Psychophysiologic Symptom Relief Therapy has also been studied as a mind-body intervention for chronic back pain. This approach includes pain education, emotional awareness, reassurance, and other strategies intended to address psychophysiological contributors to symptoms. It was influenced in part by the clinical ideas associated with Sarno, though it is not identical to his original method. 

Taken together, the evidence does not prove that Sarno’s complete theory was correct.

It does support a more modest and clinically useful conclusion:

For some appropriately evaluated people with primary or nonspecific chronic back pain, reducing fear, changing beliefs about danger, and retraining responses to bodily sensations may contribute to meaningful improvement.
 

Stress does not explain every case of back pain.

It does not cause every disc problem, nerve injury, inflammatory disorder, fracture, infection, or spinal disease.

However, stress can influence many systems involved in persistent pain.

During prolonged stress, a person may experience:

• Increased muscle tension 
• Reduced sleep quality 
• Greater fatigue 
• Heightened vigilance 
• Shallower breathing 
• Reduced recovery 
• Increased sensitivity to physical sensations 
• More frequent symptom monitoring 
• Greater fear about pain 

Back pain itself can also become a major source of stress.

This may create a reinforcing cycle:

Pain creates fear → fear increases protection → protection increases sensitivity → sensitivity increases pain.

This does not mean the person is causing the symptoms.

It means pain and nervous-system protection can influence one another.

One of the most important ideas in modern pain education is that hurt does not always equal harm.

Pain can indicate tissue damage.

But persistent pain may also reflect sensitivity, protection, and learned threat responses.

A painful movement is not automatically a damaging movement.

Likewise, a movement that is medically safe may still feel threatening to a sensitized nervous system.

The goal is not to ignore pain or assume every movement is harmless.

The goal is to interpret sensations within the complete medical context and, when appropriate, help the nervous system learn that certain movements and activities no longer require the same degree of protection.

Somatic Tracking is a practice of observing medically evaluated physical sensations with curiosity rather than immediate fear.

A person may gently notice:

• Where the sensation begins and ends 
• Whether it feels tight, warm, sharp, dull, heavy, or mobile 
• Whether it changes from moment to moment 
• Whether it moves 
• Whether it responds to attention or breathing 
• Whether it feels different during calm or enjoyable activities 
• What thoughts or emotions arise alongside it 

The purpose is not to scan the back constantly.

It is also not an attempt to force the pain away.

The practice helps the person experience the sensation without automatically treating it as proof of immediate damage.

Over time, this may provide the nervous system with new information about safety.

Pain Threading™ is Walton Hypnotherapy’s conversational hypnosis framework for exploring possible influences connected to persistent pain.

The process may explore:

• Thoughts 
• Emotions 
• Beliefs 
• Memories 
• Learned associations 
• Stressful experiences 
• Internal conflicts 
• Protective reactions 
• Subconscious influences 

Pain Threading™ does not assume that a particular emotion caused the pain.

It does not tell clients that they must be repressing anger, trauma, or another hidden feeling.

Instead, it follows the individual’s experience with curiosity.

The process explores thoughts, emotions, beliefs, memories, and experiences that may be meaningfully connected to the pain experience and/or the “fuel” behind the chronic condition.

Pain Threading™ is not the same as Dr. Sarno’s TMS treatment, although both approaches recognize that persistent physical symptoms may sometimes be influenced by emotional, psychological, and nervous-system processes.

Clinical hypnosis may be used as a complementary approach to help a person:

• Reduce stress and muscular guarding 
• Shift attention 
• Develop pain-management skills 
• Change pain-related imagery 
• Build greater confidence in the body 
• Explore subconscious associations 
• Practice calming responses 
• Strengthen an internal sense of safety 
• Reinforce helpful coping and movement patterns 

Hypnosis does not repair fractures, reverse structural disease, or replace medical treatment.

It may help influence attention, expectation, emotion, stress, and the way physical sensations are processed.

Responses vary from person to person, and no specific result can be guaranteed.

The Walton Mind-Body Pain Program takes an individualized and complementary approach.

It does not assume that every case of back pain is psychological, caused by stress, or entirely neuroplastic.

Instead, the program helps appropriately evaluated clients explore whether nervous-system sensitivity, learned protection, fear, stress, and other mind-body influences may be contributing to their symptoms.

Depending on the individual, the program may include:

Learning how pain can be influenced by protection, prediction, fear, learning, and nervous-system sensitivity.

Using focused attention and therapeutic suggestion to support relaxation, confidence, and changes in the pain experience.

Exploring thoughts, emotions, beliefs, memories, learned associations, and subconscious influences that may be connected to the pain experience.

Developing skills that may help the brain and body move from unnecessary protection toward greater flexibility and safety.

Learning to observe medically evaluated sensations with curiosity and reduced fear.

Recognizing how pain, fear, attention, avoidance, and guarding may reinforce one another.

Developing individualized practices that support continued learning between sessions.

The goal is not to convince you that nothing is wrong.

The goal is to help you understand the full pain experience and explore whether your nervous system may be capable of learning a less protective response.

A complementary mind-body approach may be worth discussing when:

• Back pain has continued beyond the expected recovery period. 
• Appropriate evaluation has not identified a dangerous or progressive condition. 
• Symptoms change significantly with stress, attention, environment, or emotional state. 
• Pain moves, spreads, or varies in ways not fully explained by tissue damage. 
• Fear of movement has become a major part of daily life. 
• Imaging findings do not fully explain symptom severity. 
• Conventional care has provided incomplete relief. 
• The person is interested in pain neuroscience, hypnosis, and nervous-system education. 

This approach is not appropriate for every condition or every person.

Suitability should be considered individually and, when appropriate, alongside medical care and physical rehabilitation.

No.

A normal or mostly unremarkable MRI does not mean the pain is unreal.

Pain may involve nervous-system sensitivity, muscular guarding, movement patterns, stress, sleep, fear, or other factors that are not fully visible on a scan.

Some findings may be clinically significant, while others may reflect common age-related changes.

Research shows that many degenerative spinal findings are present in people without pain. Imaging should therefore be interpreted alongside symptoms, examination findings, and medical history rather than treated as a stand-alone explanation. 

No.

Pain is a real biological and neurological experience.

The brain is involved in all pain, including pain associated with injury. Recognizing the brain’s role does not make pain imaginary.

Some of Sarno’s broader observations overlap with modern pain science, particularly his emphasis on fear, stress, structural findings, and the brain’s role in persistent symptoms.

However, his complete TMS theory has not been conclusively validated as a universal explanation for chronic back pain.

He is best understood as an influential pioneer whose ideas anticipated several areas now being investigated more rigorously.

No.

Some people find emotional exploration helpful. Others benefit more from pain education, nervous-system regulation, Somatic Tracking, appropriate movement, sleep improvement, or changing beliefs about damage.

Pain Threading™ does not assume that one hidden emotion or memory is responsible for the pain.

No responsible practitioner should promise a cure.

Hypnosis may help some individuals reduce stress, alter attention, address fear, reduce guarding, and change their relationship with physical sensations. Individual responses vary.

No.

The Walton Mind-Body Pain Program is complementary. It should not replace appropriate medical diagnosis, prescribed treatment, emergency care, or physical rehabilitation.

The brain and nervous system retain the ability to learn and adapt throughout life.

Research on certain mind-body therapies shows that meaningful improvement is possible for some appropriately selected people with primary chronic back pain. However, no result or timeline can be guaranteed. 

You do not have to choose between believing your pain is physical and recognizing that the brain and nervous system may influence it.

Both can be true.

Your pain can be real while also being shaped by stress, fear, attention, learning, emotion, expectation, movement habits, and nervous-system protection.

An MRI may provide important information about your spine.

It may not tell the entire story.

The Walton Mind-Body Pain Program offers a complementary framework for exploring the broader picture through pain education, clinical hypnosis, Pain Threading™, nervous-system regulation, and Somatic Tracking.

📞 757-339-6603

📧 waltonhypnotherapy@yahoo.com

🌐 WaltonHypnotherapy.com

Walton Hypnotherapy provides complementary hypnotherapy, pain education, and wellness services. The information on this page is educational and is not intended to diagnose, treat, cure, or prevent any disease or medical condition.

New, severe, unexplained, or worsening back pain should be evaluated by a qualified healthcare provider. Do not delay medical assessment or discontinue prescribed treatment based on this information.

Every individual is different. Responses to hypnosis, pain education, nervous-system regulation, Somatic Tracking, and mind-body approaches vary. No specific outcome can be guaranteed.

• World Health Organization. Low Back Pain. 
• Brinjikji W, et al. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. 
• Schechter D, et al. Outcomes of a Mind-Body Treatment Program for Chronic Back Pain. 
• Ashar YK, Gordon A, Schubiner H, et al. Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain. 
• Donnino MW, et al. Psychophysiologic Symptom Relief Therapy for Chronic Back Pain. 
• Sarno JE. Healing Back Pain. 
• Sarno JE. The Mindbody Prescription