Full Annotated References 
From Back Sense

Chapter 1

Research demonstrating very low incidence of serious medical disease as a cause of back pain:

Bigos S, Bowyer O, Braen G, et al. Acute Low Back Problems in Adults. Clinical Practice Guideline No. 14. AHCPR Publication No. 95‑0642. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services. December 1994.

Deyo RA; Diehl AK. Cancer as a cause of back pain: Frequency, clinical presentation, and diagnostic strategies. J Gen Intern Med 1988 May‑Jun;3(3):230‑8.

Deyo RA; Rainville J; Kent DL. What can the history and physical examination tell us about low back pain? JAMA 1992 Aug 12;268(6):760‑5.

Waddell G; Main CJ; Morris EW; Venner RM; Rae PS; Sharmy SH; Galloway H. Normality and reliability in the clinical assessment of backache. Br Med J (Clin Res Ed) 1982 May 22;284(6328):1519‑23.

Dr. John Sarno’s treatment methods (discussed in story):

Sarno J. Healing back pain: The mind-body connection. New York, NY: Warner Books; 1991.

Sarno J. The Mindbody prescription: Healing the body, healing the pain. New York, NY: Warner Books; 1998.

Chapter 3

Back pain usually appears “out of the blue:”

Hall H; McIntosh G; Wilson L; Melles T. Spontaneous onset of back pain. Clin J of Pain 1998 Jun;14(2):129‑133.

Structural “abnormalities” are found in people without pain. Study described in the New England Journal of Medicine:

Jensen MC; Brant‑Zawadzki MD; Obucowski N:Modic MT; Malkasian D; Ross JS. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med 1994 Jul 14;331(2):69‑73.

A few of the many other studies showing widespread structural “abnormalities” in pain-free subjects:

Wiesel SW; Tsourmas N; Feffer HL; Citrin CM; Patronas N. A study of computer‑assisted tomography. I. The incidence of positive CAT scans in an asymptomatic group of patients. Spine 1984 Sep;9(6):549‑51.

Stadnik TW; Lee RR; Coen HL; Neirynck EC; Buisseret TS; Osteaux MJ. Annular tears and disk herniation: prevalence and contrast enhancement on MR images in the absence of low back pain or sciatica. Radiology 1998;206:4‑55.

Boden SD; Davis DO; Dina TS; Patronas NJ; Wiesel SW. Abnormal magnetic‑resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg [Am] 1990 Mar;72(3);403‑8.

Patients with back pain who have no clear structural abnormality when tested:

Frymoyer JW. Back pain and sciatica. N Engl J Med 1988 Feb 4;318(5):291‑300.

MRI study of patients one year after surgery showing no consistent relationship between the state of their disk and current pain level:

Tullberg T; Grane P; Isacson J. Gadolinium‑enhanced magnetic resonance imaging of 36 patients one year after lumbar disc resection. Spine 1994 Jan 15;19(2):176‑82.

MRI study ten years after surgery where over a third still had herniated disks but this had no bearing on whether or not they had pain:

Fraser RD; Sandhu A; Gogan WJ. Magnetic resonance imaging findings 10 years after treatment for lumbar disc herniation. Spine 1995 Mar 15;20(6):710‑4.

Review of medical records of surgeries that found nothing out of place, but were followed by relief almost half the time:

Spangforte, EV. The lumbar disk herniation: a computer aided analysis of 2504 operations. Acta Orthop Scand 1972;142(supp):1‑95.

Review of medical literature showing that poor, rural farmers have much less back pain than people in developed countries:

Volinn E. The epidemiology of low back pain in the rest of the world. A review of surveys in low middle‑income countries. Spine 1997 Aug 1;22(15):1747‑54.

Back pain disability is rare in developing countries, probably due to different cultural attitudes:

Sinel MS; Deardorff WW; Goldstein TB. Win the battle against back pain: An integrated mind‑body approach. New York, NY: Dell; 1996:45-46.

Study showing widely disparate rates of back surgery and other procedures in different U.S. cities (Sidebar):

In the U.S., All Medicine is Local. New York Times.1996 Feb 4.

It takes time for doctors to adopt up to date treatments:

The Long Shelf Life of Medical Myths. New York Times.1996 Dec 5.

Outdated Views on Ulcers Hinder Cures. New York Times.1999 May 25.

Chapter 4

Very low incidence of serious medical causes of back pain, red flags for diagnosing serious diseases:

Bigos S, Bowyer O, Braen G, et al. Acute Low Back Problems in Adults. Clinical Practice Guideline No. 14. AHCPR Publication No. 95‑0642. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services. December 1994.

It is safe to exercise if you do not have a serious medical cause of pain:

Mayer TG; Gatchel RJ; Mayer H; Kishino ND; Keeley J; Mooney V. A prospective two‑year study of functional restoration in industrial low back injury. An objective assessment procedure [published erratum appears in JAMA 1988 Jan 8;259(2):220] JAMA 1987 Oct 2;258(13):1763‑7.

Chapter 5

Boeing study showing that psychological stress was more important than physical factors in predicting who developed back pain:

Bigos SJ; Battie MC; Spengler DM; Fisher LD; Fordyce WE; Hansson TH; Nachemson AL; Wortley MD. A prospective study of work perceptions and psychosocial factors affecting the report of back injury [published erratum appears in Spine 1991 Jun;16(6):688] Spine 1991 Jan;16(1):1‑6.

Examples of the many other studies from around the world linking back pain to psychological stress at work:

Ahlberg‑Hulten GK; Theorell T; Sigala F. Social support, job strain and musculoskeletal pain among female health care personnel. Scand J of Work, Environ & Health 1995 Dec;21(6):435‑439. (Sweden)

Papageorgiou AC; Macfarlane GJ; Thomas E; Croft PR; Jayson MI; Silman AJ. Psychosocial factors in the workplace‑do they predict new episodes of low back pain? Evidence from the South Manchester Back Pain Study. Spine 1997 May 15;22(10):1137‑42. (Britain)

Van Poppel MNM; Koes BW; Deville W; Smid T; Bouter LM. Risk factors for back pain incidence in industry: A prospective study. Pain 1998 Jul;77(1):81‑86. (Netherlands)

Williams, RA; Pruitt, SD; Doctor, JN; Epping-Jordan, JE; Wahlgren, DR.; Grand, I; Patterson, TL; Webster, JS; Slater, JA; Atkinson, JH. The contribution of job satisfaction to the transition from acute to chronic low-back pain. Arch Phys Med Rehabil 1998; 79; 366-74 (U.S.A)

Examples of studies showing that other psychological stressors lead to back pain:

Raising kids is a pain in the… The Back Letter 1994 Dec;9(12):140.

Back pain under fire: Do police in a war zone suffer an increased risk of back problems? The Back Letter 1996 Oct;11(10):111.

Lampe A; Stollner W; Krismer M; Rumpold G; Kantner‑Rumplmair W; Ogon M; Rathner G. The impact of stressful life events on exacerbation of chronic low‑back pain. J Psychosom Res 1998 May;44(5):555‑63.

Examples of reviews of medical literature indicating the many health problems caused by stress:

For Professionals:

Gatchel RJ; Blanchard EB (Eds.). Psychophysiological disorders: Research and clinical applications. Washington, DC: American Psychological Association; 1993

For Lay People:

Domar AD; Dreher H. Healing mind, healthy woman: Using the mind‑body connection to manage stress and take control of your life. New York, NY: H. Holt & Co; 1996.  

Sapolsky RM. Why zebras don't get ulcers: An updated guide to stress, stress‑related diseases, and coping. New York, NY: W.H. Freeman Co.; 1998.

Goleman D; Gurin J (ed). Mind and body medicine: How to use your mind for better heatlh, vol. 1. Yonkers, NY: Consumer Reports Books; 1993.

Stress makes wounds heal more slowly:

Kiecolt‑Glaser JK; Page GG; Marucha PT; MacCallum RC; Glaser R. Psychological influences on surgical recovery: perspectives from psychoneuroimmunology. Am Psychologist 1998 Nov;53(11):1209‑1218.

Case of woman whose nausea was cured by syrup of ipecac (normally used to induce vomiting):

Wolf S. Effect of suggestion and psychological conditioning on the act of chemical agents in human subjects: the pharmacology of placebos J Clinical Investigation 1950; 29:10‑109.

Blood pressure responded powerfully to expectations:

Agras WS; Horne M; Taylor CB. Expectation and the blood‑pressure‑lowering effects of relaxation. Psychosomatic Medicine 1982 Sep;44(4):389‑95.

Studies showing that seemingly effective surgical “cure” for angina pectoris was actually a placebo response:

Cobb LA; Thomas GI; Dillard DH; Merendino KA; Bruce RA. An evaluation of internal‑mammary‑artery‑ligation by a double‑blind technic. N Eng J Med 1959; 260:1115‑1118.

Dimond EG; Kittle CF; Crockett JE. Comparison of internal mammary ligation and sham operation for angina pectoris. AM J Cardiology 1960; 5:483‑486.

Sham tooth grinding cured TMJ symptoms 64% of the time:

Goodman P; Greene CS; Laskin DM. Response of patients with myofascial pain‑dysfunction syndrome to mock equilibration. J Am Dental Associaton 1976; 92:755‑758.

Placebos have extensive negative side effects:

Turner JA; Deyo RA; Loeser JD; Von Korff M; Fordyce WE. The importance of placebo effects in pain treatment and research. JAMA 1994 May 25;271(20):1609‑1613.

Chapter 6

Vast majority of acute back pain episodes heal themselves within a month or two without special treatment:

Waddell G. 1987 Volvo award in clinical sciences. A new clinical model for the treatment of low‑back pain. Spine 1987 Sep;12(7):632‑44.

Back pain often starts “out of the blue:”

See citation in Chapter 3, Hall.

Study showing that many anxiety and tension related problems that appear to come from “out of the blue” actually follow emotionally upsetting events that we don’t connect to them:

Vuksic‑Mihaljevic Z; Mandic N; Barkic J; Mrdenovic S. A current psychodynamic understanding of panic disorder. Br J Med Psychol 1998 Mar;71(Pt 1):27‑45.

Study with four different exercises showing that back pain patients in particular show increased back muscle tension when talking about emotionally upsetting events:

Flor H; Turk DC; Birbaumer N. Assessment of stress‑related psychophysiological reactions in chronic back pain patients. J of Consultng & Clin Psychology 1985 Jun;53(3):354‑364.

Additional studies demonstrating that people with back pain tense their back muscles when emotionally stressed more than others do.

Dickson‑Parnell B; Zeichner A. The premenstrual syndrome: psychophysiologic concomitants of perceived stress and low back pain. Pain 1998 Aug;34(2):161‑169.

DeGood DE; Stewart WR; Adams LE; Dale JA. Paraspinal EMG and autonomic reactivity of patients with back pain and controls to personally relevant stress. Perceptual & Motor Skills 1994 Dec;79(3 Pt 1):1399‑1409.

People specifically tense the area where they generally suffer pain, but not other areas, when emotionally stressed:

Flor H; Birbaumer N; Schugens MM; Lutzenberger W. Symptom‑specific psychophysiological responses in chronic pain patients. Psychophysiology 1992 Jul;29(4):452‑460.

Depression is three to four times more frequent in people with chronic back pain than in the general population:  

Sullivan MJ; Reesor K; Mikail S; Fisher R. The treatment of depression in chronic low back pain: Review and recommendations. Pain 1992 Jul;50(1):5‑13.

As many as 92% of people with chronic back pain have at least mild depression:

Swami DR; Nathawat SS; Vyas JM; Upadhyay JP. Depression and chronic low back pain. Indian J of Clinical Psychology 1991 Mar;18(1):35‑36.

Freud’s famous 1917 paper describing how anger turned against the self causing depression:

Freud S. Mourning and Melancholia. In Strachey, J. (Ed). The standard edition of the complete psychological works of Sigmund Freud. London: The Hogart Press; 1974; Vol XIV

Examples of recent scientific studies showing a connection between holding anger in and depression:  

Brody CL; Haaga DAF; Kirk L; Solomon A. Experiences of anger in people who have recovered from depression and never‑depressed people. J of Nervous & Mental Disease 1999 Jul;187(7):400‑405.

Tschannen TA; Duckro PN; Margolis RB; Tomazic TJ. The relationship of anger, depression, and perceived disability among headache patients. Headache 1992 Nov;32(10):501‑503.

Begley TM. Expressed and suppressed anger as predictors of health complaints. J of Organizational Behavior 1994 Nov;15(6):503‑516.

Research on developing learned helplessness (Sidebar):

Seligman, MEP. Helplessness: On depression, development, and death. A series of books in psychology. San Francisco: WH Freeman;1975.

Chapter 7  

Examples of research showing that fear of activity and fear of pain, rather than pain itself, leads to disability:  

Waddell G; Newton M; Henderson I; Somerville D. A fear‑avoidance beliefs questionnaire (FABQ) and the role of fear‑avoidance beliefs in chronic low back pain and disability. Pain 1993 Feb;52(2):157‑168.

Crombez G; Vlaeyen JWS; Heuts PHTG; Lysens R. Pain‑related fear is more disabling than pain itself: Evidence on the role of pain‑related fear in chronic back pain disability. Pain 1999 Mar;80(1‑2):329‑339.

Programs of vigorous activity reduce pain by 50% without even addressing the role of stress:

Rainville J; Sobel JB; Hartigan C; Wright A. The effect of compensation involvement on the reporting of pain and disability by patients referred for rehabilitation of chronic low back pain. Spine 1997 Sep 1;22(17):2016‑24.  

Workers with acute back pain who were encouraged not to rest but to continue normal activity had the best outcomes:

Malmivaara A; Hakkinen U; Aro T; Heinrichs ML; Koskenniemi L; Kuosma E; Lappi S; Paloheimo R; Servo C; Vaaranen V; et al. The treatment of acute low back pain‑‑bed rest, exercises, or ordinary activity? [see comments] N Engl J Med 1995 Feb 9;332(6):351‑5.

Subjects assigned to two days of bed rest returned to work 45% sooner than those who rested for seven days:

Deyo RA; Diehl AK; Rosenthat M. How many days of bed rest for acute low back pain? A randomized clinical trial. N Engl J Med 1986 Oct 23;315(17):1064‑70.

Systematic review of studies showing that normal activity is superior to rest for acute back pain:

Waddell G; Feder G; Lewis M. Systematic reviews of bed rest and advice to stay active for acute low back pain. Br J Gen Pract 1997 Oct;47(423):647‑52.

Large study showing that vigorous exercise was far superior to conventional treatments for helping people to recover from back pain and return to work.

Mitchell RI; Carmen GM. Results of a multicenter trial using an intensive active exercise program for the treatment of acute soft tissue and back injuries. Spine 1990 Jun;15(6):514‑21.  

Study showing that patients could significantly improve their physical capacity without any significant increase in pain, even though they believed that the exercises would cause more pain:

Rainville J; Ahern DK; Phalen L; Childs LA; Sutherland R. The association of pain with physical activities in chronic low back pain. Spine 1992 Sep;17(9):1060‑4.

Study of 4000 postal workers that showed no benefit from extensive back school program that included professional training in back safety:

Daltroy LH; Iversen MD; Larson MG; Lew R; Wright E; Ryan J; Zwerling C; Fossel AH; Liang MH. A controlled trial of an educational program to prevent low back injuries [see comments] N Engl J Med 1997 Jul 31;337(5):322‑8.

Additional study showing back care education had no effect on people who had already developed pain:

Berwick DM; Budman S: Feldstein M. No clinical effect of back schools in an HMO. A randomized prospective trial. Spine 1989 Mar;14(3):338‑44.

Review of medical literature on back school programs showing that they have no apparent benefit:

Linton SJ; Kamwendo K. Low back schools. A critical review. Phys Ther 1987 Sep;67(9):1375‑83.

Chapter 8

Examples of how phobias are cured with exposure and response prevention— snake phobia example (Sidebar):

Russell RK; Mathews CO. Cue-controlled relaxation in vivo desensitization of a snake phobia. J of Behavior Therapy & Exper. Psychiatry 1975 Apr; 6(1): 49-51.

Hepner A; Cauthen NR. Effect of subject control and graduated exposure on snake phobias. J. of Consulting & Clinical Psychology 1975 Jun; 43(3):297-304.

Gate-control theory of pain:

Melzak R; Wall PD. Pain mechanisms: A new theory. Science 1965;(50):971-979.

Fear of pain involves different brain regions than the pain itself (Sidebar):

Fear of Pain May be Worse than Pain Itself. New York Times 1999 Jun 22.

Chapter 9

Research showing that even short bouts of back pain make people feel frustrated:

Philips HC; Grant L. Acute back pain: A psychological analysis. Behaviour Research & Therapy 1991:29(5):429‑434.

Research showing suppressing anger has serious health consequences:

See sources under Chapter 10, first four citations.

Research showing that people suffering from depression and chronic pain think negatively, often catastrophizing:

Sullivan MJL; Stanish W; Waite H; Sullivan M; Tripp D. Catastrophizing, pain, and disability in patients with soft‑tissue injuries. Pain 1998 Sep;77(3):253‑260.

Estlander A;Haerkaepaeae K. Relationships between coping strategies, disability and pain levels in patients with chronic low back pain. Scand J of Behaviour Therapy 1989;18(2):59‑69.

Research showing that people with chronic pain make other cognitive errors, such as overgeneralizing, which lead to a negative outlook:

Smith, TW; Follick, MJ; Ahern, DK; Adams, A. Cognitive distortion and disability in chronic low back pain. Cognitive Therapy & Research 1986 Apr 10(2) 201-210.

Lefebvre MF. Cognitive distortion and cognitive errors in depressed psychiatric and low back pain patients. J of Consulting & Clinical Psychology 1981 Aug;49(4):517‑525.

Chapter 10

People who don’t notice their negative emotions have increased heart rates, weakened immune system reactions, feel physically ill, and visit the doctor more than those who acknowledge these feelings:

Schwartz GE. Psychobiology of repression and health: A systems approach. In Singer, JL (Ed) Repression and dissociation: Defense mechanisms and personality styles: Current theory and research. Chicago, IL: University of Chicago Press; 1990:405-434.

Study showing that suppressing anger in particular contributes to chronic, disabling headaches:

Hatch, JP; Schoeinfeld, LS; Boutros, NN; Seleshi, E et al. Anger and hostility in tension-type headache. Headache 1991 May;31(5):302-304.

Study showing that back pain sufferers who suppress anger have the greatest increases in back muscle tension when put in anger provoking situations.

Burns JW. Anger management style and hostility: predicting symptom‑specific physiological reactivity among chronic low back pain patients. J Behav Med 1997 Dec;20(6):505‑22.

Research showing that anxiety problems are most common in people who don’t acknowledge or express negative emotions:

Shear MK; Weiner K. Psychotherapy for panic disorder. J of Clin Psychiatry 1997;58(suppl 2):38‑45.

Research indicating which life events are generally the most stressful:

Holmes TH; Rahe RH. The social readjustment rating scale. J of Psychosomatic Research 1967;11(2):213‑218.

Panic attacks don’t actually come on “out of the blue,” but are preceded by events that cause sadness, anger, or fear:

Shear MK; Weiner K. Psychotherapy for panic disorder. J of Clinical Psychiatry 1997;58(supp 2):38‑45.

Milrod B; Busch FN; Hollander E; Aronson A et al. A 23‑year‑old woman with panic disorder treated with psychodynamic psychotherapy. Am J of Psychiatry 1996 May;153(5):698‑703.

Examples of studies suggesting that assertiveness reduces stress responses:

Petrie K; Rotheram MJ. Insulators against stress: Self‑esteem and assertiveness. Psychological Reports 1982 Jun;50(3, Pt 1):963‑966.

Tomaka J; Palacios R; Schneider KT; Colotla M; Concha JB; Herrald M. Assertiveness predicts threat and challenge reactions to potential stress among women. J of Personality & Social Psychology 1999 Jun;76(6):1008‑1021.

Study indicating that assertiveness augments the benefits of social support for psychological adjustment:

Elliott TR; Gramling SE. Personal assertiveness and the effects of social support among college students. J of Counseling Psychology 1990 Oct;37(4):427‑436.

Study showing that more assertive people have fewer health problems:

Williams JM; Stout JK. The effect of high and low assertiveness on locus of control and health problems. J of Psychology 1985 Mar;119(2):169‑173.

Study showing that training in assertiveness helps to reduce stress:

Lee S; Crockett MS. Effect of assertiveness training on levels of stress and assertiveness experienced by nurses in Taiwan, Republic of China. Issues in Mental Health Nurs 1994 Jul‑Aug;15(4):419‑432.

Venting anger is fraught with difficulties (Sidebar):

Letting Out Aggression is called Bad Advice. New York Times 1999 Mar 9.

Personal Health. New York Times 1996 Nov 20.

Journal writing reduced visits to health services and enhanced immune system functioning:

Pennebaker JW; Keicolt‑Glaser JK; Glaser R. Disclosure of traumas and immune function: Health implications for psychotherapy. J of Consulting & Clinical Psychology 1988 Apr;56(2):239‑245.

Journal writing produced lasting improvements in asthma and arthritis symptoms:

Smyth JM; Stone AA; Hurewitz A; Kaell A. Effects of writing about stressful experiences on symptom reduction in patients with asthma or rheumatoid arthritis: A randomized trial. JAMA 1999 Apr;281(14):1304‑1309.

Examples of other studies showing positive effects of journal writing on health measures:

Petrie KJ; Booth RJ; Pennebaker JW. The immunological effects of thought suppression. J of Personality & Social Psychology 1998 Nov;75(5):1264‑1272.

Francis ME; Pennebaker JW. Putting stress into words: The impact of writing on physiological, absentee, and self‑reported emotional well‑being measures. Am J of Health Promotion 1992 Mar‑Apr;64(4)280‑287.

Study showing that people who become disabled by chronic back pain tend to have a family history of the same problem:

Pollard CA. Family history and severity of disability associated with chronic low back pain. Psychological Reports 1985 Dec;57(3 Pt 1):813‑814.

Examples of studies showing that spouses of people with chronic back pain themselves become depressed and experience marital dissatisfaction:

Ahern DK; Follick MJ. Distress in spouses of chronic pain patients Int J of Family Therapy 1985 Win;7(4):247‑257.

Schwartz L; Slater MA; Birchler GR; Atkinson JH. Depression in spouses of chronic pain patients: The role of patient pain and anger, and marital satisfaction. Pain 1991 Jan;44(1):61‑67.

Study showing that sexual difficulties following back pain cause marital stress:

Ferroni PA; Coates R. Blue‑collar workers: Back injury and its effect on family life. Australian J of Sex, Marriage & Family 1989 Feb;10(1):5‑11.

Study indicating that marriages generally survived despite the far reaching effects of chronic back pain:

Humphrey M; Jones N. Chronic pain and marital stability Stress Medicine 1987 Oct‑Dec;3(4):261‑262.

Stressful interactions with a spouse cause back pain patients to give up on physical activity:

Schwartz L; Slater MA; Birchler GR. Interpersonal stress and pain behaviors in patients with chronic pain. J of Consulting & Clinical Psychology 1994 Aug;62(4):861‑864.

Positive social interaction allowed chronic back pain patients to persist with a lifting task:

Fisher K; Johnston M. Emotional distress as a mediator of the relationship between pain and disability: An experimental study. Br J of Health Psychology 1996 Sep;1(part 3):207‑218.

Chapter 11

People with back pain often suffer from other muscle or joint pain, and have high rates of health care use:

Rekola KE; Keinaenen‑Kiukaanniemi S; Takal J. Use of health services by patients seeking care for low back pain symptoms: A population‑based prospective study of consultations with primary care physicians. J of Musculoskeletal Pain 1993;1(2):55‑64.

Non-restorative sleep is common in a variety of muscle pain disorders:

Davidson P. Chronic muscle pain syndrome. New York, NY: Berkley Publishing Group; 1994.

A good review of insomnia:

Kupfer DJ; Reynolds CF 3rd. Management of insomnia N Engl J Med 1997 Jan 30;336(5):341‑6.

Study showing that 60% of women with chronic back pain reported having been sexually abused as children:

Pecukonis EV. Childhood sex abuse in women with chronic intractable back pain. Social Work in Health Care 1996;23(3):1‑16.

Holocaust survivors report more chronic pain than other subjects:

Yaari A; Eisenberg E; Adler R; Birkhan J. Chronic pain in Holocaust survivors. J of Pain & Symptom Management 1999 Mar;17(3):181‑187.

Vietnam combat veterans with posttraumatic stress disorder had high levels of chronic back pain:

Beckham JC; Crawford AL; Feldman ME; Kirby AC; Hertzberg MA et al. Chronic posttraumatic stress disorder and chronic pain in Vietnam combat veterans. J of Psychosomatic Research 1997 Oct;43(3):379‑389.

Examples of further studies showing higher reports of childhood abuse in adults suffering from chronic back pain:

Linton SJ. A population‑based study of the relationship between sexual abuse and back pain: Establishing a link. Pain 1997 Oct;73(1):47‑53.

Blair JA; Blair RS; Rueckert P. Pre‑injury emotional trauma and chronic back pain. An unexpected finding. Spine 1994 May 15;19(10):1144‑1146.

Schofferman J; Anderson D; Hines R; Smith G; Keane G. Childhood psychological trauma and chronic refractory low‑back pain. Clin J Pain 1993 Dec;(4):260‑5.

People with a number of anxiety, or stress-related problems are more likely than other people to have suffered through difficult times as a child:

Shear MK; Weiner K. Psychotherapy for panic disorder. J of Clinical Psychiatry 1997;58(supp 2):38‑45.

Examples of research studies showing that disability payments interfere with recovery from chronic back pain:

Gatchel RJ; Polatin PB; Mayer TG. The dominant role of psychosocial risk factors in the development of chronic low back pain disability. Spine 1995 Dec 15;20(24):2702‑9.

Gentry WD; Shows WD; Thomas M. Chronic low back pain: A psychological profile. Psychosomatics 1974;15(4):174‑177.

Rainville J; Sobel JB; Hartigan C; Wright A. The effect of compensation involvement on the reporting of pain and disability by patients referred for rehabilitation of chronic low back pain. Spine 1997 Sep 1;22(17):2016‑24.

Rohling ML; Binder LM; Langhinrichsen‑Rohling J. Money matters: A meta‑analytic review of the association between financial compensation and the experience and treatment of chronic pain. Health Psychology 1995 Nov;14(6):537‑547.

Chapter 12

Research involving the health benefits of the relaxation response:

Benson H; Klipper MZ. The relaxation response Avon Books; 2000. New York, NY.

Research demonstrating that mindfulness meditation is helpful for chronic pain.

Randolph, PD; Caldera, YM; Tacon, AM; Greak, BL. The long term combined effects of medical treatment and a mindfulness-based behavioral program for the multidisciplinary management of chronic pain in West Texas. Pain Digest 1999; 9:103-112.

Kabat-Zinn, J; Lipworth, L; Burney, R. The clinical use of mindfulness meditation for the self-regulation of chronic pain. J of Behavioral Medicine. 1985; Jun 8(2) 163-190.

Research demonstrating the mindfulness meditation is helpful for other stress-related problems.

Miller, JJ; Fletcher, K; Kabat-Zinn, J; Three-year follow-up and clinical implications of a mindfulness meditation-based stress reduction intervention in the treatment of anxiety disorders. General Hospital Psychiatry 1995 May;17(3):192-200.


Kabat-Zinn, J; Wheeler, E; Light, T; Skillings, A; Scharf, MJ; Cropley, TG; Hosmer, D; Bernhard, JD. Influence of a mindfulness meditation-based stress reduction intervention on rates of skin-clearing in patients with moderate to severe psoriasis undergoing phototherapy (UVB) and photochemotherapy (PUVA). Psychosomatic Medicine 1998 Sep-Oct;60(5):625-632.

Dealing with pain through distraction may actually make the pain worse later:

Cioffi D; Holloway J. Delayed costs of suppressed pain J of Personality & Social Psychology 1993 Feb;64(2):274‑282.

“If you have a mind, it is going to wander.” Quote from Jon Kabat-Zinn found in:

Domar AD; Dreher H. Healing mind, healthy woman: Using the mind‑body connection to manage stress and take control of your life. New York, NY: Doubleday; 1997:63.

People who feel supported by their religion have better odds of recovering from many illnesses (Sidebar):

Paths to a Higher Plane and Longer Life. New York Times 1999 Aug 17.

Religious practices positively influence health:

Levin JS. Religion and health: Is there an association, is it valid, and is it causal? Social Science & Medicine 1994 Jun;38(11):1475-1482.

Larson, DB. The faith factor: An annotated bibliography of systematic reviews and clinical research on spiritual subjects. John Templeton Foundation 1993;Vol. 2.

H.M.O.s are using mindfulness techniques to treat stress-related disorders (Sidebar):

Health Maintenance Organizations Turn to Spiritual Healing. New York Times 1995 Dec 27.

Chapter 13

Research supporting safety and efficacy of aggressive exercise programs:

See citations under Chapter 7, Rainville; Mitchell; and Mayer.

Overviews of exercise prescription:

SAM-CD The Scientific American Medicine CD Rom. New York, NY: Scientific American 1999; chap IV Diet and Exercise.

Guidelines for exercise testing and prescription/American College of Sports Medicine-6th edition. Philadelphia: Lea and Feibiger; 2000.

Appendix 1

Reviews of back pain diagnosis and treatment; including demographics, findings, prognosis:

Bigos S, Bowyer O, Braen G, et al. Acute Low Back Problems in Adults. Clinical Practice Guideline No. 14. AHCPR Publication No. 95‑0642. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services. December 1994.

Waddell G. 1987 Volvo award in clinical sciences. A new clinical model for the treatment of low‑back pain. Spine 1987 Sep;12(7):632‑44.

Frymoyer JW. Back pain and sciatica. N Engl J Med 1988 Feb 4;318(5):291‑300.

Appendix 2

Comment on that back pain treatment follows “fads”:

Deyo RA. Fads in the treatment of low back pain [editorial; comment] N Engl J Med 1991 Oct 3;325(14):1039‑40.

Reviews of back pain treatments:

See citations under Appendix 1.