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I am glad to see the above comments on Moseley and Butler's Explain Pain approach. They prompt me to say the following about their approach and Sarno's approach.

Sarno’s approach, which is based on Freudian structural theory (id, ego, superego), worked very well for me for many years. I started with it in 1991 when Sarno published Healing Back Pain. Within six weeks I was able, mainly by becoming attuned to when I was angry at my wife but did not realize it, to rid myself of over two decades of low back pain completely and permanently. I later dealt with what Sarno called the symptom imperative, also usually successfully. The exception being that I had three right knee surgeries and two left foot surgeries for chronic pain. I had the surgeries because of imaging studies that showed structural “abnormalities.” Unfortunately, the surgeries did little to stop the pain.

Years later I discovered Moseley & Butler’s Explain Pain approach. Their biopsychosocial pain model and neuroscience explanation of pain enabled me to overcome the knee and foot pain (and other pain I won’t go into now). This had nothing to do with uncovering repressed anger. Instead it had to do with learning contemporary pain science. It was a real revelation for me to learn that the peripheral nervous system can send only three kinds of information to the brain regarding actual or potential tissue damage, namely, thermal, chemical, and mechanical data. Then it is up to the brain to assess this incoming data in light of everything else it knows, including things the person thinks and believes, and then decide whether to create pain to protect the person.

This forum states at the top of the page that it is “in honor of Dr. John Sarno,” so I will comment on a link I see between Sarno and Moseley & Butler.

Moseley has long focused on the role that the peripheral and central nervous systems play in creating pain, especially chronic pain. More recently, Moseley has gotten into how the immune system modulates the nervous system in ways in ways that ramp up the transmission of thermal, chemical, or mechanical danger data to the brain. Moseley details this in his latest book with Butler, Explain Pain Supercharged, which is aimed at healthcare providers (of which I am not one). Chapter 3, which contains most of the new neuroimmunology, is daunting to say the least. Moseley introduces it as follows: “This chapter contains some pretty hardcore biology and some brand new ways of making sense of it. . . . We know that this chapter is tough going and hard reading for everyone. Dave [Butler, his coauthor] has read it five times and almost gets it!)."

One topic Moseley discusses in chapter 3 is sensors in the central nervous system called toll-like-receptors (TLRs). Some TLRs detect, remember, and respond to dangerous molecular patterns in the bloodstream. Importantly, these TLRs detect, remember, and respond not only to molecular patterns associated with present or potential trauma to body tissue but also to molecular patterns associated with present or potential psychological/emotional trauma. These TLRs respond to dangerous molecular patterns by producing proteins called proinflammatory cytokines that ramp up synaptic transmission of the danger data to the brain and transmission within brain circuits. When the brain receives the input, it processes the incoming data in light of all the information it already holds in storage, including what the person thinks and believes about pain. This generally happens outside of conscious awareness. If the brain concludes the person is in danger, it will create pain; otherwise it will not. This TLR activity is one reason why the brain can create pain even though there is no danger at all of tissue damage.

What does this have to do with Sarno? Sarno regarded repressed anger as the main cause of TMS. In Healing Back Pain, he explained why some of us habitually repress anger as follows:

I remember a mother telling me proudly how she had stopped the temper tantrums of her little fifteen month old. The “wise” family doctor suggested that she splash ice water in the child’s face when he started to have a tantrum. It worked beautifully—he never had another tantrum. At the ripe age of fifteen months, he had learned the technique of repression. He had been programmed to repress anger because it produced very unpleasant consequences, and he would carry that dubious talent with him throughout his life. (Emphasis added.)​

An obvious “very unpleasant consequence” for the fifteen month old was the ice cold water on his skin. A perhaps less obvious but highly important "very unpleasant consequence—as psychiatrist John Bowlby of attachment theory fame taught us—was the psychological/emotional trauma of disruption of his relationship with his (otherwise) loving mother. In short, anger at his mother was dangerous to his attachment relationship with her.

The emotion of anger consists biologically of an aggressive behavioral impulse (in essence, to fight or flee) plus accompanying physiological changes that support aggressive action. In the paradigm of contemporary pain science, the fifteen month old’s TLRs detected the molecular pattern of his anger at his mother in his bloodstream and also learned from her response that anger at her was dangerous to his psychological/emotional wellbeing. Later in life, when those TLRs detect much the the same molecular pattern, e.g., anger at a spouse, they will release proinflammatory cytokines that ramp up the transmission of danger data to his brain and can induce his brain to create pain in his body even though there is no danger at all of damage to his body tissue.

Sarno’s cure for TMS pain from repressed anger, as he once put it succinctly in an interview, was: “Know about the anger, and know why it’s there. And if you do those two things, your pain will go away.” Under the contemporary pain science paradigm, the reason this works is that if you can identify the stimulus for your anger, your brain can then process what is happening, i.e., it can determine whether the anger puts you in any actual physical or psychological/emotional danger. If not, your brain will turn off the pain.

Sarno was a keen observer of what worked and did not work to treat TMS. He naturally sought an explanation for why his treatment approach worked. Since his work long predated contemporary pain science, he had nothing to rely on except Freudian theory. A key Freudian tenet is that people, without realizing it, use defense mechanisms to repress frightening emotions. Upon the suggestion of Freudian analyst Stanley Coen, Sarno concluded that TMS pain is one such defense mechanism. My take away from this is that Sarno was a truly brilliant clinician. Starting without any theory to guide him, he figured out what worked for so many of his TMS patients. To me, this is clinical genius. The fact that nowadays some people (including me) find contemporary pain science more compelling than Freudian theory to explain TMS takes nothing away from Sarno’s pioneering genius. I would add that when Moseley & Butler state that DIMs can hide in hard to find places, they might have made it clearer than they do that repressed anger is one such hidden (typically deeply hidden) DIM.