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.

I am somewhat beside myself regarding several aspects of her story.

• Mainstream medicine is overlooking the basic physiology that we all learned in high school. When you feel threatened, your body goes into flight or fight and you experience physical symptoms. When this state is sustained, your body will break down, and you’ll develop serious illnesses. (1)
• The medical profession took away her hope. It has been documented in the neuroimmunology literature that hope/optimism directly lowers inflammatory markers. Taking it away does the opposite.(2)
• You may consider her story unusual or a “miracle.’ What is a miracle is life and the body’s capacity to heal. What if broken bones couldn’t mend as strong as they were before? What about cuts and deep wounds? What if your body couldn’t fight off infection? What kills patients in cancer treatment is often infection because strong drugs that kill cancer cells often compromise the immune system.
• Every day, I take a moment to consider how my heart can beat 60-80 times a minute with the only rest being between beats. It doesn’t make any rational sense.
• But what I find especially upsetting is the story of her early family life, of which variations occur on over 35% of American families.(3) How can this continue to be? We know better and it all keeps happening. The effects of an abusive childhood have been documented to last the rest of your life.

Here is her story of hope and what keeps me moving forward.

I am an unwanted child who was abused by her family. I do not remember ever being healthy. At 13, I started getting migraines.

5 years ago, at age 52, I broke my ankle and had horrible pain after surgery. Even though the most prominent pain doctor in our country diagnosed me with CRPS (chronic regional pain syndrome), physical therapists and the physiatrist didn’t believe it. I tried my luck at another great centre for PT, but it was the same. After each session I could not live for days because the pain was so bad even though I was on opiates.

I reluctantly decided I would re-learn to walk by myself. I had to go excruciatingly slowly, but in a few months I was able to walk with almost no pain. I got off opiates without a problem. Getting in touch with anger that I repressed all my life was extremely beneficial. Even though both my surgeon and the pain doctor were mad at me for giving up on PT, they each wrote that the PT was “a bit too harsh” after they saw me walk again.

Everything was going quite well until I got herpes zoster. When I recovered I was very keen to go walking. I pushed myself to walk for the next few years, but each step I took was painful. In the midst of it, I convinced the surgeon to remove the hardware, which did not help. In the last few months I finally gave up on walking longer distances even though I love to walk.

I have been writing JournalSpeak/expressive writing for 2+ years. It has been a great way to get the anger and other repressed feelings out. In the first 4 months, I got rid of my lifelong insomnia, and my chronic depression was way less. I was able to slowly lower the dose of antidepressants. I am able get rid of my migraines with writing the anger out, and I also need to validate my feelings. While writing down my feelingsI discovered I was scapegoated and gaslit by my family. I see others and myself in a completely new way, and do not feel so helpless anymore.

I was incredibly lucky to discover Dr. Hanscom on the Trauma Superconference. No matter how much anger I got out in writing, I could not get any relief from ankle/hip/back pain. I was eager to try his advice: no listening to the news, no criticising, no talking about pain, and using another virtual desktop on my computer without pain being discussed. He also gave me “permission” to focus on happier things like planning for things I would love to do and am able to do instead of trying to make sense of the past.

I realize that I have pushed myself too hard all my life. I can walk the same distance, but if I push myself, every single step is painful. If I say to myself, “I am going out and will walk as much as I can,” I can walk the same 1.5 km with little to no pain at all. If the pain returns, my nervous system is calm enough now that I can believe myself when I say, “I am safe. My ankles/hip/back are OK” – and the pain goes away!

The fact that the pain doctor said in an interview only a couple of years ago that nothing much can be done for chronic pain, incredibly saddens me. Two of Dr. Sarno’s books(4) were translated to our language years ago. A psychologist that works with people with chronic pain has a 3+ years waiting  list for her groups. She recently said in a lecture for rheumatoid patients that they need to talk about their pain. Even though one patient insisted that people ignore or do not believe her, the psychologist insisted they continue to talk about pain. I know firsthand this does not work. A couple of years ago I joined an online support group for chronic pain, and just reading about pain made my pain so much worse that I had to leave.

I am so incredibly grateful to Dr. Hanscom for saving my life. All the advice and information he shares, allows us to help ourselves even if we live on another continent.

This is not about me

I would like to emphasize that the healing journey is based on deeply-documented interventions. The DOC (Direct Your Own Care) Journey is simply a framework that presents them in organized and accessible manner. There are a growing number of practitioners that understand the human need to feel heard, validated, and safe. Each of them has their own style of educating their patients, implementing effective treatments, and helping patients access their own capacity to heal. Some of the main principles are that chronic disease is complicated, multiple aspects of it must be simultaneously addressed, and the patient must take responsibility for his or her own care.

One interesting aspect to her story is that belonging to a pain support group carries a poor prognosis in that most them are focused on discussing the pain, medical care, and how badly they have been treated.(5) Although they may be correct, these discussions place your brain on the problems and not moving into the two-part solution – letting go and moving forward.

Some other effective interventions include:

• PRT – Pain Reprocessing Therapy(6)
• EAET – Emotional Awareness and Expression Training(7)
• ISTDP – Intermediate Short-Term Dynamic Psychotherapy(8)
• ACT – Acceptance and Commitment Therapy(9)
• Mindfulness-base Stress reduction(10)

She found way out on her OWN 

Again, each of these must be framed in an overall treatment approach. As much (most) of it is self-directed, not a lot of resources are required. When needed, they can be plugged into the bigger picture. I liken it to doing a jigsaw puzzle that is not that difficult. They key is persistence.

Note, that although the framework provided by Back in Control helped her move forward in a powerful way, she had already done a lot of work. I have never seen or corresponded with her. She truly pulled herself out of the hole and entered into a new life! For many who heal, this is the way it often happens.

References

1. Holmes TH, Rahe RH. The Social Readjustment Rating Scale.J Psychosom Res (1967); 11:213–8. doi:1016/0022-3999(67)90010-4
2. Dantzer R, et al. Resilience and Immunity. Brain Behav Immun (2018);74:28-42. Doi.10.1016.j.bbi2018.08.010
3. Felitti VJ, Anda Rf, Nordenberg D, et al. The relationship of adult health status to childhood abuse and household dysfunction. American Journal of Preventive Medicine (1998); 14:245-258.
4. Sarno J. The Mind Body Prescription. Warner Books, New York, NY, 1998.
5. Friedberg F, et al. Do Support groups help people with chronic fatigue syndrome and fibromyalgia? A comparison of active and inactive members. J Rheumatol ((2005); 32:2416-20.
6. Asher YK, et al. Effect of pain reprocessing therapy vs. placebo and usual care for patients with chronic back pain. JAMA Psychiatry (2021).doi:10.1001/jamapsychiatry.2021.2669
7. LumleyMA, Cohen JL, Stout RL, Neely LC, Sander LM, Burger AJ. An emotional exposure-based treatment of traumatic stress for people with chronic pain: preliminary results for fibromyalgia syndrome. Psychotherapy (Chic) 2008;45:165–72.
8. Abbass Allan, et al. Intensive short-term dynamic psychotherapy to reduce rates of emergency department return visits for patients with medically unexplained symptoms: preliminary evidence from a pre-post intervention study. CJEM (2009); 11:529-34.
9. McCracken LM and Vowles KE. Acceptance and commitment therapy and mindfulness for chronic pain: Model, process, and progress. Am Psychol (2014); 69:178–87.14. Hann KEJ,
10. Cherkin DC, et al. Effect of mindfulness-based stress reduction vs. cognitive behavioural therapy or usual care on back pain and functional limitations in adults with chronic low back pain. JAMA (2016); 315:1240-1249. doi:10.1001/jama.2016.2323

The post “My Way Out” (of “The Abyss”) – One Patient’s Story first appeared on Back in Control.

The post “My Way Out” (of “The Abyss”) – One Patient’s Story appeared first on Back in Control.

I want to share an email I received from a colleague regarding the effect of the DOC (Direct your Own Care) process in his practice. He is a retired orthopedic surgeon who is currently practicing addiction medicine. He and I had been in touch and I was helping him bring the Back in Control concepts to his patients. It has always been my intention that my book, this website, and now The DOC Journey be used as an adjunct to medical and non-medical providers who treat any aspect of chronic mental and physical pain, since it is a largely self-directed program.

“Do it Yourself”

His Letter

Greetings David,

“First, let me say how grateful I am to be able to provide a copy of Back in Control to each and every one of my addiction, chronic pain, and or PTSD patients on their first visit.

Due to the drug-induced disruption of communication between frontal cortex and emotional brain, I’ve come to realize that many are functionally teenagers, which has modified my presentation of your book. I now present this as a gift, appealing to either the emotional teenager or to the rational adult, depending on the severity of drug effect (which improves with Suboxone). I’ve now started them out at Chapter 9 with writing exercises, which I often have them do while I’m writing on their chart.

They are usually quite amazed at how easy and calming free writing is. I have them visualizing the disruptive thoughts flowing from their brain, down their arm and hand, onto the paper to be destroyed, along with discussion of the unlearning process. They then become interested enough to go to the beginning of the book and learn the theory. This presentation varies from one individual to another.

Now that I’m further along the learning curve, I am seeing some really amazing results, much of which I attribute to your book. I almost never have to use antidepressants, am having good results weaning off benzos (Valium-type meds), the bipolar mood disturbance screen often reverts to normal.

ACE issues (Adverse Childhood Experiences) are common, especially when chronic pain is involved, including some patients who do not meet the criteria for addiction. This is broached by asking if there are nightmares. The pain drawings and word descriptors are a big tipoff. The response to Prazosin (PTSD and sleep medication), usually just 1 mg at night is amazing. For most of my patients, it is the only sleep med needed.”

Many thanks for your generosity and please be assured that the book has been extremely beneficial to a lot of folks who need all the help they can get.

Gene

Finding Your Own Solution

Chronic pain is solvable by engaging in three phases:

• Understanding the nature of chronic pain
• Addressing every aspect of it simultaneously – similar to fighting a forest fire
• The patient takes control of his or her own care.

Back in Control provides a framework that breaks down chronic pain into its component parts. The patient is able to figure out his or her own solution. There are so many factors that affect pain and with each individual’s life being unique, the only possibility of solving pain would have to come from the patient.

I frequently saw patients in clinic who had broken free from the grip of chronic pain. Each story and journey out of pain is unique. The one common tool is the expressive free writing, which is combined with the active meditation. The writing accomplishes the awareness and separation phases of the neuroplasticity process and the active meditation then re-directs attention to a different sensation. The writing is immediately destroyed so you can write with freedom and also to NOT analyze the thoughts. Otherwise your attention is still on the thoughts and you are reinforcing them.

My approach for the first month consists of five suggestions outlined in Stage 1 of the DOC Process. It the “homework” phase of learning how to take back your life.

• Learn about the complex nature of chronic pain
• Begin the expressive writing
• Combine it with the active meditation
• Focus on getting a good night’s sleep
• Not discussing your pain with anyone – EVER!!
  • No complaining or gossiping
  • Don’t give unasked-for advice or be critical

My intention is to slow down every aspect of your life, especially the frenzied of search for a solution. I understand the desperate need to escape the pain. When I was in the midst of my ordeal, I became an “epiphany addict”. I was on a relentless quest to find the answer to my suffering and my efforts intensified over 15 years. Towards the end, almost every minute was spent on trying to escape my pain. Somehow, I was able to wake up enough to realize that this course of action wasn’t working and I realized that there was not one solution. Until you can calm down a bit, you will continue to have elevated stress chemicals in your body, which directly sensitizes the nervous system and increases the pain. They also slow the blood supply to the frontal lobes of your brain, so you aren’t able to think as clearly.

Expressive Writing

I don’t know why the expressive writing is so powerful. The effects are rapid and consistent. It was the one tool that began my path to healing and maybe it broke up my racing neurological circuits. I have used Gene’s approach for a while and ask my patients to begin the expressive writing combined with the active meditation before they begin reading the book.  Nothing of substance occurs until the writing begins. There are over 1000 research papers documenting its effectiveness. The question is not if it works but why and how it does. You can’t re-direct your nervous system until you separate from the past.

I saw a patient who had escaped chronic pain after suffering for over 40 years. Her journey began with the expressive writing about a year earlier and she was diligent in addressing all of her issues, especially anger. Her entire appearance and demeanor was transformed. She was animated and excited about possibilities. It was an incredibly rewarding and energizing experience to share her excitement. I felt privileged to have been able to share my journey that had also freed me from my pain.

I also think that the expressing writing is symbolic of being proactive and taking charge, which is the essence of healing.

The post Taking Charge of Your Care first appeared on Back in Control.

The post Taking Charge of Your Care appeared first on Back in Control.