Hi Dr Hanscom,

I have been meaning to check in with you for a while now and let you know that the DOC program seems to have worked for me. My lower back & leg pain has disappeared and I’m a firm believer in the process, especially the concept that anxiety is the driver of tension and pain in many cases. I picked up the book, Forgive for Good at your recommendation back in the winter and found it to be excellent. I’ve also been doing mindfulness training and it’s been extremely helpful.  If you aren’t familiar with the book, The  The Mindful Way through Depression, I’d definitely recommend checking it out.

I hope you are doing well and enjoying the summer now that it’s finally arrived.

Best, Jean

My Perspective

This patient is the daughter of an esteemed colleague of mine. She had burned out of practicing law and had embarked on a pre-med pathway at the age of 38. She had experienced low back pain for over two years. There was also significant pain, numbness, and tingling throughout her right leg. She had a normal MRI of her thoracic and lumbar spine. Electrical testing of her leg did not show any specific problems with the nerves. As I knew her father so well, I was especially anxious not to miss anything that might be serious. I could not find a structural cause for her symptoms.

I first saw her about 18 months ago, and on our last visit six months ago, she was just a little better. I tried not to be too discouraged but, I was not sure she was going to improve.

What is remarkable about her recovery is that it was truly self-directed. She did not see me in follow-up nor did she see another physician. I had recommended a mental health professional, as I thought she might be depressed. But she wouldn’t engage in that conversation. She did use the Feeling Good book and was diligent writing in David Burn’s three-column format. She also pursued obtaining a good night’s sleep, utilized the re-programming tools such as active meditation, and worked out regularly in the gym. Two years later she is re-pursuing her medical school dream.

This story is not an exception. With full engagement with a structured program the results are consistent.

The post Depression Masking as Pain first appeared on Back in Control.

The post Depression Masking as Pain appeared first on Back in Control.

Prehab

We decided that if the surgical results were so much better, we would have all of our patients engage in at least 8 to 12 weeks of “prehab” before any surgery, regardless of the magnitude. Our protocol included:

• Learning about chronic pain through my book, Back in Control: A Spine Surgeon’s Roadmap Out of Chronic Pain.
• They were sleeping at least six hours a night (often required meds).
• Addressing their stress.
• Engaging in the expressive writing exercises.
• Learning and using active meditation.
• Noting some improvement in their mood and pain.
• Narcotic medications were defined and stabilized.

We encouraged them to return, but we weren’t going to perform surgery without them engaging in a prehab process.. The data shows that not addressing these issues significantly compromises surgical outcomes. (1)

What Happened?

I am enjoying my practice at a level that I could not have imagined. Our patients are doing well and excited about their progress. What I didn’t expect was that so many patients would become pain-free without undergoing surgery I thought they needed. We presented a research paper reporting on a group of patients who’d come in for their final preoperative visit, and their pain was gone. Of course, we canceled the surgery.

What was even more surprising was the severity of the problems. Normally, the diameter of the spinal canal is about 15 mm. I don’t schedule surgery unless the canal is less than 8 mm, and the patient has leg pain. I have one patient who avoided surgery with a four mm canal.

Janet’s Story

The following letter is from a woman whom I saw last summer with a large synovial cyst. This is a problem where a sac of fluid is formed off a facet joint off the back of the spine. It was not only pinching her sciatic nerve, but it was calcified, which means it couldn’t shrink. I immediately offered her a small operation to remove it. The outcome of removing the cyst is predictably positive with few complications. It is one of my favorite procedures. I offered her the prehab process through my book and website. I also thought the pain center would help. I was surprised that she did not immediately take me up on surgery. She never returned to see me, and I received this letter from her about eight months later.

Dear Doctors,

Last summer, an MRI scan revealed a synovial cyst in my back. I had severe pain from cramps in my butt and calf muscles. My family doctor referred me to your office.

I am writing to update you on my status, which is greatly improved. On my initial visit at the Pain Center, the doctor asked me to keep a journal of what I couldn’t do.

What I cannot do because of pain

I cannot get up in the morning in a flash. I need to exercise and stretch my right leg in bed, roll carefully out of bed to ice my butt and calf, do stair-step exercises, and then finally do a 20 to 30 minute “working with pain” meditation. I can’t sit in any chair I want because my butt muscle will spasm. Car seats are hard to sit in. I have to get out at least every 45 minutes to stretch. I was on Gabapentin, Cyclobenzaprine, and Ibuprofen. I followed the Back-in-Control program, writing down my thoughts and beginning to focus on what I wanted to do, including returning to dance class. In early October, I began sleeping in a semi-upright position, with a pillow under my legs, and the cramping began to subside. I also had biofeedback training. By mid-November, I was able to get off all pain medications and start lifting weights again.

I have very occasional twinges in my right butt when sitting or walking, but I am basically pain-free. I am so grateful for the chronic pain management program and extremely grateful that you offered the program rather than immediate surgery on the synovial cyst.

Many, many thanks.

Sincerely,

Janet

Do Surgery Now??

I had forgotten about her case, so I reviewed her MRI scans and was shocked to see the size of the cyst. However, I have been surprised at the severity of the pathology with every surgical patient I have witnessed becoming pain-free without an operation. In fact, in the first edition of my book, I comment that if a patient has a significant structural problem with matching symptoms, surgery should be performed quickly so as to move forward with the comprehensive rehab program. I thought the pain would be too distracting to be able to participate. The opposite scenario occurred in that when I performed surgery in the face of a fired-up nervous system, the pain would frequently be worse. I eventually discovered this problem has been well-documented in the medical literature. (1) Chronic pain can actually be induced or worsened as a complication of any surgical procedure, including painless ones such as a hernia repair. One of the risk factors is pre-existing chronic pain in any part of the body.

I now have dozens of stories similar to Janet’s. There are many times that I do perform urgent surgery for compelling problems. But if there’s any room to have my patient participate in the prehab, that is what we have them do.

Video: Get it Right the First Time

Ask for This Approach!

I’m excited about this turn of events, although it is becoming a little challenging maintaining a surgical practice. The medical literature has clearly documented that this process is effective. Ask your doctor to help you out with setting up your own program. You don’t need a major pain center, as the necessary resources are readily available.

Every surgery has risks, and no one thinks a complication will happen to him or her. I have seen them all. They are unpredictable, and the outcomes can be catastrophic. Also, why would you not want to maximise your odds of success. Do you really need surgery? Be careful!!

Are You Kidding Me?

Perkins FM and Henrik Kehlet. “Chronic Pain as an Outcome of Surgery.” Anesthesiology (2000); 93: 1123-1133.

The post Optimizing (Avoiding) Spine Surgery first appeared on Back in Control.

The post Optimizing (Avoiding) Spine Surgery appeared first on Back in Control.

Feeling safe

The DOC Journey is based on our three and five-day workshops that we have held since 2013. From the beginning we were amazed how many people would break free of their pain within time frame of the workshop. We always warned them that they would dive back into The Abyss when they returned home to their “triggers.” But somehow they had reconnected to the part of their nervous system that was safe and relaxed. Once they tasted that deep sense of peace and connection, they had a sense of what was possible. They would learn their own ways to return to that state. Many moved on to a life they had never before experienced.

I had not expected such a response and did not understand what had happened. But every workshop was a similar experience. I finally concluded that I wasn’t doing that much, but the shift was because people were learning and sharing enjoyable experiences in a structured and safe environment. Several participants described it as being in an adult summer camp.

Research shows us that loneliness causes many physical symptoms including chronic pain and, of course, being in pain is isolating. (1) Social connection is a deep basic human need and the foundation of how we developed language and human consciousness. It is tragic that over 50% of Americans are lonely and socially isolated. (2) Social isolation is crushing to your soul.

Characteristics of success

There is never an exact answer to a given person’s specific situation, since each one of us is so unique. However, there are some patterns that have emerged in patients who have done well.

• Back in Control: A Surgeon’s Roadmap Out of Chronic Pain provides a foundation and framework for moving forward.
• The sequence of learning is critical in that you have to understand the nature and parts of a problem before you can solve it.
• You can’t move forward until you have broken the links to the past.
• It is critical to implement the strategies that work the best for you into your day-to-day life. They are not difficult, but just passive learning doesn’t work.
• Re-engaging with friends, family, and your community is a powerful aspect of healing.

All these variables are important. Chronic pain is a complex problem and simplistic isolated treatments can’t and don’t work.

Our online Q&A

What I again did not anticipate was how effectively a community could be created online. It almost seems have had more impact than our in-person workshops. Here is one participant’s email.

The Q&A sessions I attend 2x per week are such an important part of my support system as I’ve started navigating The DOC Journey. I’ve suffered with chronic pain for over three years, and after two spine surgeries that provided no relief of my symptoms, I felt very alone and confused. I found this special community during a time when I felt little hope, and I know the timing was providential. As I process my journey with others that understand what I’m going through, I am able to give and receive support and encouragement, along with obtaining many tools that are making a significant difference in how I am able to show up in my life. This community is something I will always be grateful for!

Overview of the sessions

The Q&A format is a powerful force in creating change. We know that human connection is essential for health and that being socially isolated has detrimental effects on your health. One of the consequences is chronic pain. There are other manifestations and the effects are estimated to be equivalent to smoking 3/4 of a pack of cigarettes per day. (2)

Rules of Engagement

Much of the effectiveness of The DOC Journey is stimulating the formation of new circuits in your brain that bypass those that are creating pain. Your brain will develop wherever you place your attention and one of the reasons that any patient of mine was never allowed to EVER discuss his or her pain with ANYONE except their medical providers.

• The cardinal rule of participating in this group is never discussing your pain or medical care – even if asked.
• Ask yourself what you can do to be of help to others on the Q&A.
  • Specifically, please be mindful that each person in the small group breakouts of 3-4 has a chance to share.
• Understand the concept of mirror neurons-your mood has a direct mirror neuron effect on others. The term is called “co-regulation.” (3)
  • I have personally found that a little expressive writing, active meditation, or breathing exercises before the session is a big help if I am a bit out of sorts.
• Although your participation with comments and questions is welcomed, please don’t feel obligated. We want you to feel comfortable with the group.
• The sessions are intended to deepen your skills and answer questions. It is not focused on teaching. Reading my book, Back in Control: A Surgeon’s Roadmap Out of Chronic Pain will provide the framework for you to move forward.
• The DOC (Direct your Own Care) Journey provides a sequence that will keep you moving forward and it is based on our workshops. The sequence is:

• • Awareness
  • Hope
  • Forgiveness
  • Play

Meeting Agenda

• 11:50 – noon – Informal discussion/ catching up
• 12:00-12:05 – Relaxation exercise
• 12:05 to 12:15 – Didactic session/Sharing successes and challenges
• 12:15 to 12:30 – Open discussion and questions
• 12:30 – 12:50 – Small group breakout sessions – discussions will be based that day’s topic or what may have been brought up in the sharing session.
• 12:50 to 1:00 – Closing discussion

I will be prompt regarding time and will stop the didactic/ sharing at 12:15 – 12:20 and we will begin the open discussion. Please email me at dnhanscom@gmail.com with questions you’d like addressed or if you would like to share your perspective. You don’t have to be pain free to share. Small victories are the key to all of this. We would like to find out what you have found useful.

Letting go

The DOC Journey is a paradoxical one at almost every step. Repeated conversations are helpful in learning to process your environment in a different manner. Hearing about other approaches is helpful, but the best part is sharing your challenges and success with others.

References:

1. Cacioppo, John and William Patrick. Loneliness: The Need for Social Connection. Norton, New York, NY, 2008.
2. Cigna US Loneliness Index 2018. Report published by Cigna Insurance Company.
3. Porges, Stephen. The Polyvagal Theory. Norton, New York, NY, 2011.

The post People – The Most Powerful Part of The DOC Journey first appeared on Back in Control.

The post People – The Most Powerful Part of The DOC Journey appeared first on Back in Control.

I plateaued for about six months but now had some hope. I had always perceived myself as “cool under pressure” and felt that most things weren’t worth getting upset about. I could not have more wrong. What I was highly skilled at was suppressing anger. It exploded and I did not process it well.

I first had to admit that I had a lot of anger, but since “I was right”, I didn’t perceive it was a problem. So, I wasn’t progressing much and my life continued to disintegrate. Over about six months, I was finally able to learn some basic anger concepts and skills and began to rebuild my existence. What I did not expect is that my all of my physical symptoms began to improve and six months later, they had all but disappeared. I was shocked and still did not understand the role of sustained anger and elevated stress hormones/ cytokines causing inflammation.

From reactive to creative

Many people get to this spot of a dramatic turnaround and stop the journey, which is fine. They are excited, as am I, and they usually continue to do well. However, I also think that they have missed the best part. Instead of having to fight your way out of The Abyss, you have the opportunity to further connect to who you are, move forward from your center in a powerful way, and experience life at a level you never knew was possible. That is what this phase, Expanding Your Horizon is about.

The healing journey is based on connecting to your own capacity to heal, learning tools to optimize your body’s chemistry, feeling safe, and then creating the life that you want. As you move towards your idea of what you want your life to look like, you’ll be shifting off the pain circuits and nurturing ones that bring you pleasure and satisfaction. As you move into regaining your life perspective, connecting with your passions, play, and giving back, you’ll be spending much less time reinforcing your pain circuits and thrive.

Here are the areas to address that will enable you to experience the best part of your journey:

• Sleep – still the cornerstone
• Effectively processing stress – Life never stops coming at us
• Physical conditioning – is simply one of the best ways to feel better
• Medication management – a thoughtful approach will simplify this aspect of your care.
• Life outlook – is one of the most critical aspects of your journey. You have to know where you want to go to get there. How you do it is also important.
• A deeper understanding of chronic pain – will allow you to be innovative in dealing with it and allow you to have more control of your care.
• Family dynamics – turned out to be maybe the most powerful force in holding people back, but when addressed with a structured approach was remarkably helpful in healing – for the patient and the whole family.

Moving forward

Addressing sleep was the first step in the evolution of the DOC process. Twenty years ago, only a small percent of physicians dealt with sleep issues. I took an aggressive approach and would begin with “sleep hygiene” measures. But if a patient wasn’t responding within a couple of weeks, I would use combinations of sleep medications. Most people would respond within six to eight weeks. A significant percent of patients experienced a dramatic improvement in their pain. It wasn’t until years later, that I read a major paper showing that lack of sleep could induce chronic pain. (2) Unfortunately, it is still common to have major risky interventions done or recommended before sleep is addressed.

Processing stress became inherent in my practice as I worked with patients dealing with the problems created by being in chronic pain. I had experienced a lot of benefit with the book, Feeling Good, as I mentioned above and I had my patients use it. I quickly noticed that the only ones who responded were those who did the recommended writing. Other stress management approaches emerged over time. I eventually learned that stress is not the problem, as much as your reaction to it.

Addressing Physical Factors is basic to musculoskeletal care.

• Physical therapy must be tailored to a patient’s specific needs.
• Aerobic conditioning has long been documented to improve pain.
• Weight training not only increases strength but also stimulates the release of hormones that enhance your sense of well-being. It also seems to have a neurological component in that you are on the offensive, taking charge instead of being at the mercy of your pain.
• Nutrition is critical. For example, an anti-inflammatory diet can quickly lower your pain. Intermittent fasting consistently lowers inflammation.
• Bone health – osteoporosis (low bone density) creates havoc with the quality of your life and is both preventable and treatable.

Medication management is critical. You need symptomatic relief to give you “the space” to learn and implement the tools to heal. They will become much less important as your pain resolves and no one really wants to be dependent on medications. They are expensive and a hassle.

My approach was the reverse of what is usually done. I would keep patients on the same medications, including narcotics. Medication discussions were always face-to-face. Although, the goal was to wean down, the patient always had the last say regarding how quickly this would occur. Anxiety is the pain and going to war over medications is counter-productive. With the patient in charge, he or she had control (an antidote to anxiety) and I rarely had a problem with patients coming off of their meds. In fact, as the pain dropped, the side effects increased and they were anxious to stop taking them. The only criteria I required was that they had to be actively engaged in the other aspects of the structured care approach.

Life outlook is one the most important aspects of healing. Goal setting is a core aspect of stimulating neuroplasticity. Your brain will develop wherever you place your attention. It is similar to learning a new language. You have to decide what you want your life to look like, what you want in it, and then pursue it. Otherwise you are still focused on the problem and not the solution. A corollary aspect of this is forgiveness. You can’t move forward until you can let go.

Awareness of the nature of chronic pain is important because it is so complex and each individual is unique. The traditional approach is to manage it, not solve it. Random simplistic treatments are used to treat symptoms and not address the core problem of a fired up nervous system and sustained exposure to elevated stress chemicals. The DOC process is a framework that allows you break down pain as it relates to you into its components. It allows you to address all of them simultaneously. It is this multi-pronged approach that is what is so effective in successfully treating chronic pain.

The final component regarding family dynamics came about over the last few years of my practice in Seattle. We had known that chronic pain takes a terrible toll on the family. It became clear that a patient could engage in many aspects of the DOC process but the family dynamics would sabotage everything. Conversely, by addressing the family interactions around pain, patients would often experience powerful healing. We began to set up rules around pain in the household. The basic one was that the patient could not discuss their pain with anyone – ever – especially with their family. The corollary was no complaining, giving unasked-for advice, or criticizing. Basically – be nice.

From reactive to creative

Don’t stop now when you are really just beginning. It is a triumph to be out of The Abyss, but there is much more to life than just surviving. Most people have been fighting the pain for so long that they have forgotten what it is like to relax and enjoy it.

If you take the word, reactive and move the “c” to the front, you have the word creative. If you can “c” first, you have some space to look at your options and create your reality.

1. Burns D. Feeling Good. Avon Books, New York, 1999.
2. Agmon M and G Armon. “Increased insomnia symptoms predict the onset of back pain among employed adults.” PLOS One (2014); 8: e103591. pp 1-7.

The post Expanding Your Horizon–Your New Life first appeared on Back in Control.

The post Expanding Your Horizon–Your New Life appeared first on Back in Control.

• Her pain originally arose from severe arthritis of her hip. Historically, I have approached this is a simple structural problem that is best treated with an artificial hip replacement. What else can be done? Turns out there is plenty.
• She healed herself in spite of medical advice. Taking charge and being persistence are important aspects of healing.
• She recognized that pain is the result of sensory input and that the final signal arises in your brain. Her story is remarkable in how quickly she figured this out and re-routed around her pain circuits.

Here is her letter.

Dear Dr. Hanscom,

I’m really grateful to have a substantial, extended break from my relentless routine of the last few years. I am, finally, getting more than 5-6 hours of sleep…more like 7-8 every night. I do not have the physical demands of my job navigating a huge high school campus. I do not have the weekly organizational demands of coordinating work, shopping, laundry, family, household management, paying bills, home and car maintenance, concern for a parent living alone in another state, as well as concern for grown children and grandchildren…and on and on. Many of us experience the unrelenting demands of daily modern life and its effects can be exhausting.

Her childhood experiences

Reflecting on my life back to my earliest remembered childhood, I realized that I do have the type of personality that wrestles with the double bind of being a perfectionist, people pleaser, fixer, peacemaker, problem solver, responsible “adult” (among other adults who readily relinquish responsibility). I have always set a very high bar for myself. Even the thought of failing sparked a cascade of anxiety and panic. As I child, I was repeatedly reminded that “a job worth doing is a job worth doing well.” Also, “Smile and the world smiles with you, weep and you weep alone,” along with “You’ll get more with honey than you get with vinegar” and “If you can’t say something nice, don’t say anything at all.” (many of those from my Irish Grandmother who drummed them into my mother….sincerely well meaning, who, in turn, reinforced those messages for me.)

Emotions will be expressed–either physically, mentally, or both

Thanks to Dr. Hanscom’s work, I can see relationships between chronic physical conditions such as (Irritable bowel Syndrome) IBS, fainting, panic attacks, acute anxiety… that plagued me throughout childhood and into adulthood, and the messages and beliefs I internalized that were also combined with my innate temperament and personality traits.

My dad suffered from clinical depression and my mother intellectualized her emotions, suppressed negative feelings, and managed the overflow with relentless activity. The more I reflect on the elements of my life and continue to do expressive writing, the more patterns and clues gradually emerge.

Hip arthritis pain resolved

I had been diagnosed with “severe bone on bone osteoarthritis” in my left hip 10 months ago. I had such severe pain starting last May, that I had an ultrasound on my hip and then after seeing a series of doctors (having to wait 2-3 months between appts) had a hip xray which definitely showed the damage in my hip. I was told, by my Doctor, that the hip could send pain down the thigh to the knee but that pain below the knee was probably due to the L4L5 nerve compression that was revealed by my MRI. These diagnostic tests confirmed my condition was much worse than I had believed. After 16 weeks of various treatments and physical therapy I was advised to get a hip replacement. I was 61 and was really not keen on that idea and decided to wait a bit and see if it improved. By December, after doing stretches and mild strengthening exercises, my hip stopped hurting. It has been pain free for more than 4 months. I don’t think I miraculously grew new cartilage! It just does not hurt.

Pain from her brain

Now, fast forward to the past 3 weeks when, intermittently, I started to experience severe throbbing, aching, and burning pain in my left leg. The pain I was experiencing would migrate from the top of my left foot, hover around the ankle, sometimes jump to the side of the leg just below the knee….occasionally jump to the thigh and then zip back down to the ankle. The pain was a 10/10 and it woke me at night for hours. I was quite frustrated, angry really because I know that my foot, ankle and knee are fine. There is no structural damage or deterioration in those parts and I’ve had no prior issues. I completely committed to the belief that these symptoms were coming from somewhere in my brain that was generating pain due to some unconscious impulses to which I had no access with my rational prefrontal cortex.

She healed herself

I followed Dr. Hanscom’s prescription of expressive writing, reminding myself often that I am fine and safe, continuing to move, stretch, and maintain a mild exercise regimen, along with meditation. One night I woke with severe pain and my immediate impulse was to get up and take Aleve for the pain, but instead, I practiced breathing, relaxation, and focused attention instead, on the right leg which was completely pain free. Within 15 minutes the pain began to decrease and I was able to doze off. When I woke I was pain free. The following day the pain returned….I repeated the same routine and continued the writing. by the fifth day, I experienced no pain in the left leg. I found this experience very illuminating because the pain commands attention, but the more attention it gets, the greater the intensity.

Classic symptoms

This is a phenomenal insight and it allows a whole new way to frame this kind of migratory, fluctuating, recurring pain. I realized, as well, that I was repressing feelings of anger, frustration, overwhelm, and chronic stress over the need to excel constantly, without granting myself rest and reward time. I felt frustration and hopelessness as I had spent way too much time and effort in the past years pursuing various “therapies” without appreciable results. I would be encouraged by very temporary relief and then disappointed when symptoms soon returned and the cycle would repeat.

I now react to pain in my body without anxiety and fear but rather with understanding that I have, inadvertently, reinforced neural circuits for years by focusing on the pain. I can now practice responding rather than reacting when existing neural circuits are triggered. This has reduced my fear and anxiety from the sensation of pain. I am able to move my focus elsewhere, calm my nervous system with breathing or active meditation, and reduce my chemical stress response. This immediately reduces the pain sensation, sometimes eliminating it.

As I explore more of Dr. Hanscom’s website and began the DOC program, I feel empowered rather than vulnerable. I finally feel like I am regaining control over my outcomes and can work towards reclaiming my autonomy without depending on others to “fix me.” The result is I no longer feel resigned to pain. I am hopeful again.

My perspective

I originally thought that an obvious source of pain, such as her severe hip arthritis, just had to be fixed. The research shows that there is little correlation between the severity of hip, knee, or shoulder arthritis and pain. (1) Often people with severe arthritis have no pain, and patients with a lot of pain have minimal or no arthritis. The pain was more correlated with stress. How can this be? Under threat, mental or physical, your body is full of hormones that fire up your nervous system, which increases nerve conduction. You will feel more pain. Pain is also a significant source of stress.

I have now seen over 100 patients who I felt needed spinal surgery because there nerves were pinched so tightly. They cancelled the operation when their pain resolved from structured rehab before surgery. I had few resources to help, so I helped them through the DOC process they implemented from the book and website. I also had some of them see excellent pain physicians that used a similar approach. My team was wonderful in providing skilled and compassionate guidance and support. It was mostly self-directed process. We became disciplined in following established medical recommendations to address all the factors that portend a poor outcomes for at least eight weeks prior to surgery and that is when patients began to cancel their operations. If surgery was performed, the outcomes were more predictably positive.

Before you make any elective surgical decisions to relieve pain, please take the time to understand chronic pain. A failed surgery of any kind can destroy your life.

1. Bedson, J and Peter Croft. The discordance between clinical and radiographic knee osteoarthritis: A systematic search and summary of the literature.BMC Musculoskeletal Disorders (2008);  9:116.

The post Never Too Late for Hope first appeared on Back in Control.

The post Never Too Late for Hope appeared first on Back in Control.

But more surprising to me was that not only would they improve, many would experience a nearly complete recovery. Patients who had been disabled for quite a while would have a remarkable resolution of their pain, come off narcotics, and resume an almost normal lifestyle. Frequently the new lifestyle was more active and satisfying than anything they had experienced before. This level of recovery went well beyond both my patients’ and my own expectations.

Changing my practice

When I moved to Sun Valley, ID in 1999, I was in the worst part of my own 15-year ordeal with chronic pain. I was experiencing many physical symptoms, including migraine headaches, thoracic back pain, tinnitus, burning in my feet, and over a dozen of the other known 33 physical symptoms of a stressed nervous system. My practice changed from being that of a complex spine surgeon at a major medical center, to becoming a primary care physician caring for all aspects of a patient’s spine problem. There weren’t many resources, so I orchestrated most of the care.

I had always been diligent in doing what I could to help patients avoid surgery, but I did not understand chronic pain. I applied a surgeon’s mindset to non-operative care. Whatever aspect of the issue arose, my goal was to solve it – and quickly. Eventually, a predictable pattern evolved as well as a structure. As I personally tried this approach, I also began to heal. When I left Sun Valley to return to Seattle in 2003, I had largely broken free from the grip of chronic pain.

The DOC project

 Here is the core of the DOC project:

• Sleep
• Effectively processing stress
• Physical conditioning
• Medication management
• Life outlook
• Education as to the nature of chronic pain and the principles behind the solutions
• Family dynamics

1. The first step that clearly made a significant difference was addressing sleep. Back then, only a small percent of physicians dealt with sleep issues. I took an aggressive approach and would begin with simple “sleep hygiene” issues. But if a patient wasn’t getting adequate sleep within a couple of weeks, I would use different combinations of sleep medications. Most people would respond within six to eight weeks. A significant percent of patients experienced a dramatic improvement in their pain. It wasn’t until years later, that I read a major paper showing that lack of sleep could induce chronic pain. (1)
2. Dealing with stress was the next concept that emerged, which I discovered through expressive writing. I did not have access to a pain psychologist, so I recommended that patients read David Burn’s book, Feeling Good. Many refused to read it or they would read it but not engage in the writing exercises that he strongly recommended. The book presents a program of self-directed cognitive behavioral therapy. His research had shown that 85% of people would respond with an improvement in mood. I liked using the book because patients could immediately engage with it, whereas it would usually take weeks and months to get into a pain psychologist. Then I noticed that the only ones who responded were those who did the recommended writing.
3. The physical conditioning aspect of the DOC process was not a new concept and I did have the privilege of working with superb physical therapists right next door to my office. I was introduced to a high level of evaluation and care. We were also close to an athletic club and working out with resistance training quickly became part of the program. Weight training increases strength, so there is less stress on the body. It also stimulates the release of hormones that enhance your sense of well-being. But it also seems to have a neurological component in that you are on the offensive, taking charge instead of being at the mercy of your pain.
4. Medications are a significant aspect of healing, although eventually most people came off of them as their sleep and pain improved. My approach was the reverse of what is usually done. My sense was that people needed some symptomatic relief in order to engage in the other parts of the DOC process. I would keep patients on the same doses of medications they came in on, including narcotics. All medication discussions were done face-to-face. The goal was to wean down but the patient always had the last say regarding how quickly this would occur. What I did not realize at the time that anxiety is the pain and going to war over medications is counter-productive. With the patient in charge, he or she had control (an antidote to anxiety) and I rarely had a problem with patients coming off of their meds. In fact, as the pain dropped, the side effects increased and they were anxious to stop taking them. I also realized that no one really wants to be dependent on meds. The only criteria I required was that they had to be actively engaged in the other aspects of the DOC process, although I did not have a name for it back then.
5. Life outlook turns out to be maybe the most important aspect of healing although it began accidentally. I had been working hard with a middle-aged woman to help her with her pain and get her back to work. It was a bit of a struggle, but she steadily pulled out of her chronic pain. When it became time to have her return to work, she told me that she never had any intention of returning to work. I became upset and realized that I had never set any goals with her. I began to ask every patient exactly why they were seeing me and what they wanted. What eventually became apparent was that goal setting is a core aspect of stimulating neuroplasticity. Your brain will develop wherever you place your attention. It is similar to learning a new language. You have to decide what you want your life to look like, what you want in it, and then pursue it. Otherwise you are still focused on the problem and not the solution. A corollary aspect of this is forgiveness. You can’t move forward until you can let go.
6. Education about the nature of a problem is essential in any realm before you can solve it. This is particularly true with chronic pain because it is so complex and each individual is unique. The traditional approach to chronic pain is to manage it, not solve it. Random simplistic treatments are used to treat symptoms and not address the core problem of a fired up nervous system and sustained exposure to elevated stress chemical. My book, Back in Control: A Surgeon’s Roadmap Out of Chronic Pain evolved from my need to explain the problem to my patients. Its main role is to provide a context of care and it is helpful to be able to understand why and how different treatments work – or not.
7. The final component regarding family dynamics came about over the last few years of my practice in Seattle. We had known that chronic pain takes a terrible toll on the family. It became clear that a patient could engage in many aspects of the DOC process but the family dynamics would sabotage everything. Conversely, by addressing the family interactions around pain, patients would often experience powerful healing. We began to set up rules around pain in the household. The basic one was that the patient could not discuss their pain with anyone – ever – especially with their family. The corollary was no complaining, giving unasked-for advice, or criticizing. Basically – be nice.

The DOC process provides a framework for you to organize your thinking around your pain, figure out your individual set of issues, and pursue your own journey. I have watched hundreds of patients break free from the deep Abyss of pain. There is no beginning or end point, as you will learn tools that will help you deal with day-to-day stresses. As your anxiety drops, pain decreases and creativity and joy returns. Helping people out of pain has become the most rewarding and enjoyable phase of my career.

One story

A few years ago, I began to work with a woman in her 30’s, who had been experiencing severe anxiety when she was ten and developed widespread pain over most of her body. She continued to push forward, in spite it all. She was a talented musician but had to put a hold on it because of her pain. Her life became progressively smaller as she kept pursuing different treatments without any success.

She began to work with me on the DOC process, beginning with expressive writing and learning about pain. Sleep was a major problem and it took months to bring that under control. However, a few weeks after she began writing, she noticed an improvement in her anxiety. She also had access to a somatic therapist who was able to help her relax. Over a period of six months, her anxiety dropped dramatically, her pain resolved, she came off all medications, and she is re-engaged with her music career. She can’t express in words how happy she is to be not only free from chronic pain and anxiety, but also that she is thriving.

1. Agmon, M and G Armon. “Increased insomnia symptoms predict the onset of back painamong employed adults.” PLoS ONE (2014); 9(8): e103591. doi: 10.1371/ journal.pone.0103591.

The post Evolution of the DOC Project first appeared on Back in Control.

The post Evolution of the DOC Project appeared first on Back in Control.

I am excited to be able to offer her services to you. She has been able to help people out of the Abyss that simply needed some extra support and guidance. Her level and type of expertise is not widely available and one of our projects is teaching other medical professionals these concepts and skills.

She shares an understanding of the depths of misery you can experience when trapped by mental and/or physical pain that has allowed us to help others find their own way out. Here is her story.

How Chronic Pain Saved My Life: From a Fishbowl to the Ocean 

Chronic pain patients usually end up in my office because they feel trapped and out of options. The same reasons are what finally brought me to the table with Dr. Hanscom. At the time I was so anxious I knew I wouldn’t last more than a year if something didn’t change. I had a successful practice as a Somatic Psychotherapist, studying neuroscience and was increasingly devastated that no matter what I did, no matter how much I learned—my anxiety was only getting worse.

What I was surprised to find on this journey with David, is that the pain of my anxiety turned out to be my greatest teacher and opportunity once I finally found the right frameworks, structure, and support.

Just last week, I received a glowing email from a woman who has suffered for two years with debilitating headaches that have taken her out of her life as a well-known surgeon. What lit up her message to me was the freedom in realizing that she had been basing everything off a problematic definition of success her whole life—a logical one rooted in everything she had experienced in a neglectful and cruel household, but not one that allowed for sustainable health, peace, or enjoyment. Although the pain of her headaches have not yet gone away fully, she wrote to me from a place free from suffering.

I am grateful to be able to say that although sometimes my pain flares back up for a few days, I have also been suffering-free for almost 2 years.

In working with clients, I share the belief that we are all born with the innate ability to thrive. However, our access to this innate ability can become blocked over time.

As we grow in the first few years of life, some of our developmental needs are met and others are missed. The blank slate of our nervous system uses the interactions in our early caregiving environment to build a sense of who we are, what we must do to get love (which is the equivalent of safety for us vulnerable baby monkeys), how to have emotions, what we can express, and what to expect from people and the world. These patterns and beliefs passed on to us by our family creates the foundation that determines how our brain unconsciously interprets everything we encounter. In an effort to keep us safe the brain wires primarily on fear and negativity, so privileges those lessons. Our internal worlds can quickly become small and uncomfortable.

It’s similar to being born into the ocean, and unknowingly put into a fishbowl…believing we are still in the ocean. The situation becomes more severe when some of these self-reinforcing fear patterns become like bacteria and algae overgrowing the tank, clouding the water with no good filtration system—things become toxic. We fish are trapped in an environment with no clue it’s the water we are swimming in that’s making us sick because it is all we have ever known. Until one day someone suddenly lifts us out for a moment, and we feel the ocean again.

Chronic pain is an indication of how the levels in our bowl are off—quite literally in terms of our bodies’ stress chemicals connected to the anxiety, anger, and sensitization at its root. Not only is the water “clouded”, every cell in our body is bathed in toxic chemicals. By coming to our pain with an understanding of the ocean and how to get there—the toxicity that forces us out can actually become our greatest hidden gift.

I would have perished in my fishbowl—as I see with clients in my practice every day. Helping others use these tools and strategies to find freedom is an honor and I am inspired by peoples’ capacity to thrive even under the most dire of circumstances.

For more information about my approach or working with me please check out www.KendraBloomTherapy.com. You are welcome to book a coaching session.

The post Back in Control Coaching first appeared on Back in Control.

The post Back in Control Coaching appeared first on Back in Control.

My vision is to bring the DOC (Direct your Own Care) principles into mainstream consciousness. It has become clear that the DOC project is one that is best implemented by primary care physicians. Back in Control is a wellness book, not a “solving chronic pain” one. Most of you know that you can’t solve chronic pain because your attention is still on your misery. You have to move toward your vision of how you want to live your life with or without your pain. Paradoxically, as you become healthier, your pain will abate or resolve. We have witnessed this phenomenon hundreds of times. I also practice these concepts daily.

My focus will be in several areas:

• Building a business structure that scales the DOC process to reach a much wider audience.
• Teaching medical providers in any realm how to treat chronic pain. Only about 20% of physicians are comfortable treating chronic pain and less than 1% enjoy it. We aren’t trained correctly in spite of recent neuroscience research providing many answers.
• Educating the public to take responsibility for their own care. This requires learning about chronic pain.
• I am writing three more books:
  • Do You Really Need Spine Surgery?
  • Chronic Pain and Your Family
  • Optimizing Performance In and Out of the OR Applying Athletic Performance Principles
• We are scaling the workshops that we have held at the Omega Institute. It turns out that the group setting is a powerful resource we have seen to move people out of pain.
• I am starting a movement around physician wellness. The burnout rate among physicians is between 50-60% and steadily rising. It has a tremendous impact on patient care. The DOC process is just a framework of care that allows productive discussions to occur and the patient is able to create their own solutions. However, the doctor/ patient relationship is a critical piece of it. It is hard to reach out to patients when you are trying to personally survive. Physicians have 2-4 times the suicide rate of the general population depending on gender and specialty.
• Finally, my biggest focus is on changing the fee structure for medical care. Many recommended interventions in spine care and other specialties have been documented to be ineffective while most effective treatments are generally not covered by insurance. The most necessary part of care is for your physician to listen and you to be heard. It is the one aspect of care that that has been taken from all of us. Creating a fee schedule that allows providers to take the time to get to know you will change the nature of medical care.

Grassroots effort

I am asking for your help. It’s clear that change is going to have to occur from the ground up. The business of medicine has firmly embedded a production approach to your care. It is not going to change. Here is a quote sent to me by one of my mentors.

A new scientific truth does not triumph by convincing its opponents and making them see the light; but rather because its opponents eventually die, and a new generation grows up that is familiar with it.

–Max Planck

How can you contribute?

People often ask me how they can pass on what they have learned. Here are some suggestions that would be of great help to my efforts.

• Continue on your own healing journey. The concepts presented in the DOC process are ones that need to be practiced for a lifetime. Patients often feel well enough that they stop at Stage 2. Stages 3 and 4 are the creative parts of it and where it all really happens. Don’t stop.
• Your personal transformation will have a strong healing effect on those you are close to. There is a direct mirror neurons effect.
• Encouraging friends and family to sign up for the weekly email updates on backincontrol.com.
• Share links on social media.
• Write a quick review of Back in Control on the Amazon or Barnes and Noble websites.
• Let your providers know about the DOC concepts and that they can contact me. My intent with the combination of the book and website is to enable the patient to take control of his or her own care and form a partnership with your physician and other medical professionals. Not only are your visits productive, but are more enjoyable. There isn’t a day in clinic that I don’t emerge more energized and inspired.
• Share your personal success on the “Stories of Hope” section of this website. Hope is a powerful force in healing pain.

Thanks to all of you for your interest and support. It’s what keeps me moving forward. For me, it is truly a new horizon and adventure and I am looking forward to seeing how it evolves.

The post Moving Forward – A New Horizon first appeared on Back in Control.

The post Moving Forward – A New Horizon appeared first on Back in Control.

I have also witnessed several families re-uniting. Here is one of these stories.

Needed Surgery

Bill was a middle-aged executive who has experienced many stress-related physical symptoms. He had a structural low back problem that required a multiple-level decompression. He had severe pain in both of his legs that completely resolved with the operation.

He initially was not open to any of the ideas of the DOC project, but his pathology was so severe that I proceeded relatively quickly instead of having him go through the rehab prior to surgery (prehab). About a year later all of his pre-op symptoms recurred. I offered him a three level fusion to relieve his leg pain, but I was also suspicious he had triggered his old pain circuits. Although he was initially resistant to the rehab concepts, the magnitude of the recommended operation cause him to reconsider and he felt he had nothing to lose. Surgery was still on the table because his bone spurs were quite impressive.

WHEN A PRIOR PAIN CIRCUITS ARE TRIGGERED YOU CANNOT TELL THEM APART FROM THEM BEING CREATED BY A STRUCTURAL PROBLEM. THE PAIN IS IN EXACTLY THE SAME LOCATION AND HAS THE SAME INTENSITY – OR WORSE.

Within two weeks his pain abated and by six weeks it disappeared. What had fired up his nervous system and pain were problems at work, as well as serious issues with his marriage. A few months later his wife left him. Although he accepted his responsibility for her needing to leave he had a difficult time dealing with it. However, his pain didn’t return and he was becoming more proficient at using his tools to keep his nervous system calmed down. For me, this was all surprising because I had assumed that we would still be performing a surgical procedure.

Waking Up – his wife returned

Over the next couple of years he worked with a pain psychologist, psychiatrist, and with the DOC concepts. I saw him about every 4-6 weeks. Not only did his pain continue to remain minimal, his entire personality transformed from being obsessive and controlling to extremely warm and engaging. (Of course, it was always there) He came off all of his psych meds. One day he came to the office and he was beaming. His wife was coming back. This was the second couple I had seen re-united over a short period of time.

His letter

Dear Dr. Hanscom,

Fantastic to see you. During our meeting today, Sarah e-mailed me her travel plans. She leaves Wisconsin Monday, driving the car I bought her before we wed. Nevertheless, my outlook is “open hands”. (David Burn’s concept) I can be and am happy (enough) on my own with or without Sarah. Or with or without any romantic partner, I stand on my own.

I checked the DOC site for the printed version of Back In Control and I just bought it. As a DOC project participant, I want to share some of my experience.

I’ve nearly eliminated my physical pain and my residual “background” pain from psoriatic arthritis NO LONGER HURTS. This pain no longer gets to my emotions, UNLIKE the princess in The Princess and the Pea. But I still feel exquisitely vulnerable to emotional pain. To me, emotional pain really hurts badly. There’s just no other way to describe it.

But I have made progress. And just as in life my progress is NOT a straight line. I’ve had setbacks followed by advances then a stumble – just like real life. Here is what I credit, first and foremost.

First, without a doubt: Writing and throwing away the paper IMMEDIATELY afterwards. I regard throwing away the paper as equally important as purging the bladder & bowel. Writing and throwing away the paper MUST BE done to avoid systemic toxicity (My analogy is that it is similar to brushing your teeth).

Second: Physical exercise. Three times a week minimum of vigorous “break-a-heavy-sweat” exercise. It also MUST BE done to avoid systemic toxicity.

Third: I read. (For the record, the very first book that I read was: Back in Control.  Were it not for Back In Control by David Hanscom I wouldn’t have been nearly as motivated to read all these other books:

• The Pain Chronicles – Melanie Thernstrom
• Forgive for Good – Fred Luskin, PhD
• The Talent Code – Dan Coyle
• The Traveler’s Gift – Andy Andrews
• Epictetus and The Art of Living – Sharon LeBell
• Full Catastrophic Living – John Kabat-Zinn
• Journey into Love – Kani Comstock
• Demystifying Love – Stephen Levine
• Man’s Search for Meaning – Viktor Frankl
• Awareness – Anthony De Mello
• Thanks – Robert Emmons
• Feeling Good Together – David Burns, MD

Needless to say, I hadn’t read a single one of these books before embarking on the concepts presented in The DOC Journey.

Lastly I’ve got a personal recommendation –  cry. Not like an actor on TV, I mean really cry. And cry hard. You will feel better. It might take 3 hours or 3 days, but you WILL feel better. Show me a man with no cry in him and I’ll show you a severe case of deadly fired up nervous system and denial!

Best Regards,

Bill

P.S.

One item:  The “think positive” myth:

I know it’s just bull but I can clearly describe why…it’s about phonyness… or trying to pretend something bad is actually good? I mean this section on DOC delves into the fallacy of positive thinking:

• “Positive thinking is another way of suppressing negative thinking. This is a tricky concept in that by committing to a process of true forgiveness the results are very positive. You first have to go through the steps (allowing yourself to feel pain) to achieve the positive result.”

Can I convince my dad to stop saying, “think positive son!?” Maybe I’ll let him say his thing and ignore it. I once tried to articulate this point to my dad, but I couldn’t clearly describe the fallacy of the “power of positive thinking”.

My perspective on Bill’s journey

There are numerous points I could emphasize about his transformation, as it has completely enveloped him. I would like to touch on a few.

1 – Do you need your pain?

The first point is that he clearly expressed what I have observed for a long time: Humans consciously and unconsciously will do whatever it takes to avoid emotional pain. That includes experiencing physical pain, even if it is self-inflicted. I feel this is one of major reasons that patients won’t engage in that you have to learn to feel pain in order to move through it.

2 – Anyone can get better

The second is that with persistent engagement in the healing principles most people improve. It’s a matter of time and commitment. He was in as bad a mental and physical state as anyone I have worked with. Now he is pain free and thriving.

3 – The absolute block – Obsessive thought patterns

The third is that one of the core symptoms of NPD is obsessive thought patterns. This is a huge problem in that it also the symptom that blocks treatment. The one variable that predicts success is openness to engagement. In chronic pain, you’re legitimately angry and your mind is going a thousand miles an hour. It interferes with rational thinking. Some of the more common thoughts I hear are:

• “I’m feeling the pain right here. It’s not imaginary.”
• “The doctor is missing something. There has to be a reason for my pain.”
• “I’ve tried everything you’ve suggested, and it hasn’t worked. Why should I try this?”
• “I’m not angry!”

“You don’t believe me”

Then when I tell them that their spine has degeneration that is normal for their age and surgery isn’t indicated, they will often explode with anger. As I am not offering them an operation or a procedure I must not really believe that they are experiencing severe pain. I do believe them, but there doesn’t seem to be anything I can do to convince them to at least learn about the nature of chronic pain. I feel badly, but I have to let go quickly and hope they’ll circle back around again.

It took Bill over a year to be open and a few months to really immerse himself in NPD principles. I don’t know why he decided to engage, and I don’t think he does either. I do know that he is one of many examples that keeps me fired up about moving forward with this project.

The post A Couple Re-united first appeared on Back in Control.

The post A Couple Re-united appeared first on Back in Control.

Mark Owens’ Story

This is a video that we shot of Mark Owens, who wrote the Forward of my book. I’d like to give you some additional background to his story, both from his and my perspective. He is a PhD scientist who has spent his life addressing environmental issues. At age 29, driving a battered 3rd-hand Land Rover, he and his wife found their way into some of the most remote reaches of the Kalahari Desert of Botswana, and later, the Luangwa Valley of Zambia. There they conducted wildlife research on lions, elephants, hyenas and migrating antelope, and established model programs to protect these animals from commercial poachers while raising the living standards of indigenous people. After 23 years, he accomplished his vision, and his work still continues on through the structure he put into place and the local people he trained to carry it on. His story is reflected in his books, Cry of the Kalahari, The Eye of The Elephant, and Secrets of the Savanna .

Back in Idaho after more than two decades, he purchased and restored a large piece of land and its wetland in Idaho as a wildlife preserve for wolves, grizzlies and other wildlife. He also reversed much of the environmental damage done by indiscriminate ranching and logging practices. His commitment to making the world a better place is remarkable.

The horse accident, as he related in the Forward of my book, occurred while searching for grizzles on his ranch in the Cabinet Mountains of Montana, and his injuries were severe. A fractured spine represents severe trauma, but it isn’t nearly as painful as a crushed chest wall. After the surgery, he developed severe chronic pain for over nine years. Why?

My perspective 

Here are some points that I want to add to his remarkable story of healing.

Although this was a major injury, the usual post-operative course for a fractured spine is moderate to severe pain for a couple of weeks and then it usually resolves in about six weeks. From a surgeon’s perspective, he was the “ideal surgical candidate.” He was extremely motivated to get better, which is true for almost everyone in pain. However, there were a few details that were missed, and no one asked him the right questions.

First, he was under a large amount of stress. He left Africa after corrupt government officials and poachers had plotted his assassination for the third time.  And in Idaho, hunters and ranchers resented his conservation efforts on behalf of predators that they perceived as a threat to their domestic stock. Under less stress, it’s unlikely he would have developed such severe chronic pain. He’s really tough. Few people on this planet would have attempted what he accomplished in Africa.

Second, after he developed chronic pain from the first operation, a second one was performed to address degeneration at the lumbar 2-3 level just below his prior thoracic surgery. The surgeons performed a fusion with a known success rate of less than 30% for disc degeration. It has been well-documented that disc degeneration is not considered a source of pain.

Additionally, it has also been demonstrated that performing surgery in the presence of ongoing chronic pain of any kind, can induce pain at the new surgical site or worsen the pain at the surgical region. (1) His pain become dramatically worse.

Third, several surgeons had recommended surgically breaking his spine in two, re-aligning it and fusing him from his neck to his pelvis. One surgeon referred to the procedure as the “Blue Plate Special.” If a one-level fusion had made him worse, what do you think a 12-hour procedure with a high complication rate would have done to him? From my perspective, the decision not to recommend surgery was easy. His spine showed disc degeneration that was normal for his age. There was nothing to operate on.

Fourth, although he was not without some hope, he was quite skeptical and he didn’t really believe me that his pain was solvable, with or without surgery. The DOC project is not about believing in it or not. It is simply a framework that allows the patient to more clearly and readily sort out his or her scenario, and find a solution. The principles are universal and hold true regardless of how you feel about them. The key is to engage and move forward.

Fifth, his healing was dramatic, which many of my patients find discouraging because they don’t have an immediate response. Most people don’t, and I have observed that the process generally begins to create change over three to four months. Maybe one out of twenty people experience such a rapid response. The key is persistence.

Sixth, there are over 1000 research papers that document the effectiveness of expressive writing. (2) There is no debate that it improves mood, performance and lessens over 30 possible physical symptoms. The issue is how and why it works. Conversely, there is little evidence that a spine fusion is a solution for back pain. The success rate is less than 30% at two-year follow up and has never been compared to carefully structured non-operative care, such as the DOC program. (3) Unfortunately, insurances don’t cover most of the treatments that have been demonstrated to work.

Finally, his life wasn’t perfectly pain free after the initial healing. Unpleasant circumstances will cause your body to be full of stress chemicals, which increases the speed of nerve conduction and increases pain. (4) We worked through several major flare-ups together and eventually he acquired the skills to pull out of these flares on his own.

We have become close friends and we now support each other. Not only is he doing well over four years later, he’s thriving. The cost of healing was negligible for him and society. The risk was zero. I feel privileged that I was able to give back what I learned through my own ordeal with chronic pain. Watching people connect with their own healing capacity continues to be a remarkable experience.

Forward to Back in Control

1. Perkins FM and Henrik Kehlet. Chronic Pain as an. Outcome of Surgery. Anesthesiology (2000); 93:1123-33.
2. Smyth JM and James Pennebaker. Exploring the boundary conditions of expressive writing: In search of the right recipe. Br Jrn of Health Psychology (2008); 13:1-7.
3. Carragee EJ, et al, A gold standard evaluation of the “Discogenic Pain” diagnosis as determined by provocative discography. Spine (2006); 18:2115-2123.
4. Chen X, et al. “Stress enhances muscle nociceptor activity in the rat.” Neuroscience (2011); 185: 166–173.

The post Avoided a 12-hour Spine Fusion and is Free from Chronic Pain first appeared on Back in Control.

The post Avoided a 12-hour Spine Fusion and is Free from Chronic Pain appeared first on Back in Control.