10 years in a wheelchair

Jane, a woman in her early 60s, was exactly such a patient. She’d lived with severe scoliosis all her life. Then, in 2001, she was rear-ended while driving, and the following year, she had a bad fall while grocery shopping. By the time she came to see me, she had severe pain everywhere. She’d been using an electric wheelchair for nearly a decade. She was taking over 200 mg of morphine per day and high doses of anti-anxiety drugs.

When I examined her, she was tilted forward and to the left, barely able to stand. Her spinal curve was severe enough that I recommended surgery but I warned her that the treatment had a high rate of complication.  Because of this, it was unsafe to do the operation until her medications were stabilized, her pain significantly diminished, and she was more mobile. The term we use is “prehab” or rehabilitation before surgery to optimize the outcome.

I gave her my book, Back in Control and referred her to a colleague to coordinate her care. She was not that interested and they mutually agreed to not continue care. Eight months passed and I saw her on my schedule. I was curious because I knew the size of her curve and the severity of her pain. High-dose narcotics makes it all the more difficult because they sensitize the nervous system. I did not have high expectations…

Out of the wheelchair

I was shocked when I walked into the room and there was no wheelchair, walker, or cane. She was standing up to greet me. She was off all of her medications, had no pain, and was working out in the gym three times per week. She was animated, smiling, and engaging. I ended up an hour behind in schedule, as I wanted to find out what had turned her life around.

Jane admitted that she had spent the last 10 years sitting alone in her house stewing over all the wrongs that had been done to her. She only went out when necessary. After understanding the linkage between anger and the pain pathways, she decided to forgive. She forgave her ex-husband, the person driving the car that had hit her, the people involved in her legal battle, and the medical system that had not helped her. This process took several months to work through – but within weeks of doing so, her pain began to abate.  She still had scoliosis but as her pain diminished, she stopped stooping over protectively to guard her back. She now could stand up straight and tall.

Reconnecting through forgiveness

Forgiveness researchers, such as Dr. Fred Luskin, have shown how rumination and anger influence central and autonomic nervous system function and impair functioning of the hypothalamic-pituitary adrenal cortical axis (stress system). While forgiveness is seen as a coping mechanism that helps to relieve the stress of anger, it also has direct and indirect effects on health and nervous and endocrine function.

It has been my position that anxiety-induced anger is the driver of chronic pain. The manifestations of unrelenting anger are profound and one of them is becoming socially isolated. Now you have all the time in the world to think about your pain and all the ways you have been treated badly. You body is full of adrenaline, which decreases the blood supply to the frontal lobe (thinking area) of your brain. Indeed, it is well-documented that patients’ brains shrink in the presence of chronic pain. Between the adrenaline and not using the creative part of your brain, that would make sense. Fortunately, your brain will re-expand with resolution of the pain. (2) Anxiety, anger and adrenaline

Social isolation

Besides moving too fast, our modern societal structure does not encourage us to interact with each other in a meaningful way. I read a US News & World Report article several years ago, which reported that the average number of close friends that person in the US had was 2.2. That means that many people have essentially no close friends.

I am a pretty social person but when I was in the midst of my own burnout I became isolated. It wasn’t that there weren’t people around. I had so many intensely negative thoughts about myself whirling around in my head that I couldn’t believe that anyone would want to hang out with me. The loneliness was crushing. When I arrived back in Seattle in 2003, a close friend invited me over for a barbeque and I was shocked. I have not forgotten that day and it was the beginning of my re-entering life.

People being with people

We have held three five-day Omega workshops and this year we will be putting on a weekend seminar with Dr. Bernie Siegel, author of Love, Medicine, and Miracles. My priority was to create a safe environment where people could be with other people and share experiences. One of the most effective ways to re-connect is play and as people began to relax and laugh their pain would disappear. Of course it, returned when they returned to the real world and their triggers. But most of the participants learned the skills to consistently remain out of pain. The more satisfying aspect of the process though was that as the pain abated many re-engaged with their lives in a much more powerful way. Play

As we presented our material throughout the week, I realized that we did not have to do much. It was the participants being with other people that created healing. It was remarkable. Dr. Louis Cozolino wrote an exhaustive review in his book, The Neuroscience of Human Relationships. (3) He points out that humans evolved by interacting with other humans. Therefore, the consequences of becoming isolated are consistent and often severe. Studies out of Australia have shown that there are damaging mental health effects when workers become disabled and out of the workflow of the day. Sitting around the house without a sense of purpose is not a great way to thrive. (4)

One of the first Omega participants sent me this video link. She experienced profound healing after being in pain for over 35 years and has been a true inspiration. TED talk: Our lonely society makes it hard to come home from war

This Fox segment was filmed with another one of our Omega participants. She has a great story amongst many others. We never anticipated the power of people healing people.  Video: Write your way out of pain

Jane was in a wheelchair for over 10 years and on high dose narcotics with a severe spinal deformity. It was by her working past her anger, getting out of the house and re-connecting with her friends did she heal. No medical treatment can replicate the power of the body to heal itself. Anger disconnects – play connects.

1. Eisenberger N. “The neural bases of social pain: Evidence for shared representations with physical pain.” Psychosom Med (2012); 74: 126-135.
2. Seminowicz DA, et al. “Effective treatment of chronic low back pain in humans reverses abnormal brain anatomy and function.” The Journal of Neurosci­ence (2011); 31: 7540-7550.
3. Cozolino, Louis. The Neuroscience of Human Relationships. Norton and Co. New York, NY, 2014.
4. Waddell, G and Kim Burton. Is Work Good for Your Health and Well-Being? TSO. London, England, 2006.

Listen to the Back in Control Radio podcast Social Isolation and Chronic Pain

The taste of freedom – Omega 2017

Social Isolation and Chronic Pain

The post The Pain of Social Isolation first appeared on Back in Control.

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The DOC Journey is a condensed set of core resources that reflects the experience of hundreds of patients suffering from chronic pain that have successfully taken their lives back. It reflects the evolution of our knowledge of about pain and how to more clearly present the problem, principles behind the solutions, and how to continue to thrive and move forward once you have broken free.

The guided course is one one of the resources that provides a guided pathway through the maze of choices offered to patients. It provides background information, tools, strategies and support that enables you to develop a game plan around your unique set of issues and circumstances. As it’s a largely self-directed process, you can then create partnerships with your medical and non-medical providers to solve your pain.

Back in Control: A Spine Surgeon’s Roadmap Out of Chronic Pain provides the framework for a deeper understanding the nature of chronic pain and breaks it down in its component parts. It is recommended that you use it as your reference book.

Overview of the guided course

This course is organized around principles we learned in our workshops. We witnessed profound shifts in pain and mood during the three or five-day events and we were consistently amazed by the magnitude of the changes. For those who continued to learn and practice the tools, the outcomes were sustained. Your brain can only rewire by consistent repetition. This is the sequence that emerged from our experience.

• Awareness – first step in solving anything
• Hope – has been shown to be a powerful healing force
• Forgiveness – you cannot move forward until you have let go.
• Play – is how we evolved and figured out human relationships. Re-connecting with this energy is precipitates rapid changes. It does take a series of steps to get there.

Why this sequence

This process is evolved from my own 15-year suffering from severe chronic pain. There was no reason it should have happened and I was extremely fortunate to break out of it. It all began with a panic attack in 1990 out of the blue. I was under a lot of stress but nothing more than I was used to. For 30 years I have been searching for the answer of how could my life been so dramatically and permanently altered in 10 minutes?

I broke free from the grip of pain in 2003, but I only knew that some writing exercises that I had inadvertently began to engage in seemed to be a significant factor. I still did not know why it happened and I certainly didn’t know anything about chronic pain. The neuroscience research since 2009 has clearly revealed the answers and the solutions.

I feel the reason that this journey has been so successful for well over 1500 patients is that I painfully traveled every millimeter of it and learned a process from mostly from what didn’t work. If some approach seemed to have promise, I pursued it personally and shared the ideas with my patients. It is still evolving and I am excited in that I am able to present it more clearly and my patients have been able to respond more quickly.

Awareness is the foundation of healing. You will develop an awareness of:

• The nature of chronic pain – as opposed to acute pain, there is nothing useful about being in ongoing pain. Mental pain is a bigger issue than physical pain.
• Your situation. What factors are relevant to your specific situation? What is your diagnosis? Has it been clearly explained to you?
• The principles behind solving chronic pain. Once you understand the problem and the nature of the solutions, you’ll be able to take charge of your own care.

Hope has been shown to exert a favorable effect on the inflammatory response and is a key factor in healing. (1) Loss of it is a common theme with almost every patient experiencing chronic pain. You are suffering miserably, no one can tell you what is wrong with you, you’ve been told that you just have to live with it and do the best you can, and no really believes how much pain you are in. Where is the endpoint? Not only do patients break loose from the grip of chronic pain, they often thrive at a level they never conceived possible. You will hear many of their stories.

Forgiveness is critical and is the dividing line between healing or remaining stuck. Your brain processes mental pain in the same way as a physical threat. Most people in pain hold onto the situation or person who wronged them. (2) It is understandable, but you cannot heal and move forward until you let go. Forgiveness is learned skill and a powerful statement that you are taking your life back!

Play is how mammals learn to socialize. Humans take it to a different level since we have language added to the mix. You learn safety vs. threat, body language, negotiation skills, effect of tone of voice, etc. When you are in a play mode your body’s chemistry is optimized and your sense of contentment and well-being is increased. This is not play intended just to distract you, but rather that in which you are fully engaged in something you love.

The goal

You will learn methods that will stimulate physical changes in brain (neuroplasticity) and can re-direct your nervous system to form more functional circuits. The outcome is to optimize your body’s reaction from one threat to safety. The final signal to your body’s cells is sent through cytokines. These are extremely small communication proteins. The defensive one are inflammatory (Pro-I) and the safety cytokines are anti-inflammatory (Anti-I). You will learn to regulate your body’s chemistry and inflammation to create a favorable healing environment. The effects are often profound with all parties excited and somewhat incredulous at the degree of healing.

Navigating the course

The core journey is arranged in sequence that begins at where you are at suffering from unrelenting pain and lays down a foundational set of concepts and tools in order to move forward. The intention is for you to move at your own pace, as the healing process is different for everyone. Some people experience rapid relief of pain within a few weeks. Most people experience significant shifts in pain and mood within 3-6 months. But never give up. I have had many patients email me years later that they had broken free from the bonds of pain.

Although there is often some improvement early in the Journey, the tipping point for deep healing always occurs around processing anger, which is inevitable when you are trapped in misery. Anger is protective and we are not programmed to be vulnerable. It threatens survival. That is why the DOC Journey is arranged in this order. You must first be ready to let go before you can accomplish it.

The guided course

There are seven legs to this guided journey with “rest stops” along the way. The reason for the stops is to embed and practice your tools. Calming your nervous system and optimizing your body’s chemistry is a learned skill set. Each person will find his or her own best set of methods.

Leg 1 – Preparing for your journey

Leg 2 – Starting your trip

Leg 3 – Anxiety is the Pain

Leg 4 – Awareness

Leg 5 – Anger processing – the Tipping Point

Leg 6 – Moving Towards Your Vision

Leg 7 – Expanding the Center of Your Circle of Life

The DOC Journey

Although this course is a core aspect of The DOC Journey, other resources are available that will provide additional support and depth of knowledge about how to proceed. The group coaching is especially helpful. Many of your questions will be also be answered with the video tutorials, which are connected to the appropriate lesson and also accessible in the Toolbox.

The best part of The DOC Journey is that the effects continue indefinitely. You have “changed your filter” and you’ll continue to process your environment with this new perspective. Since your brain keeps physically changing, it takes an active effort to turn back. Once you own your life, it is yours.

The post The Guided Course of “The DOC Journey” first appeared on Back in Control.

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After my fourth L3-L4 surgery the neurosurgeon sat me down and said “…you are not going to get better but rather worse as you grow older. You have a life sentence of pain.” I’ve had 6 spinal surgeries and 20 additional surgeries. I know chronic pain intimately. After 25 years of debilitating chronic back pain with daily migraines my anxiety level was extreme. My C-reactive test was exceptionally high. I could barely endure another day of pain. It seemed hopeless. I gave up and attempted suicide 3 years ago.

Letting go of anger

Since that time I discovered that Dr. Hanscom’s program works. I faced my anger and resentment and rid myself of all of my negative thoughts towards others and towards my losses brought on by the pain. I forgave everyone who had ever hurt or slighted me. I consciously resolved to face new anger  issues as they came up. I’m now quick to forgive and forget. I carried a lot of anger from my childhood and through my painful journey as an adult. I finally discovered that holding on to anger is toxic to my health. I discovered that I could not get better until I rid myself of anger and resentment.

Getting centered

This program works for me if I will just follow the steps in the book. I’ve lost track of the number of times I’ve read Back in Control. I have found that daily meditation is my best avenue for continued healing and peace of mind. Meditation helps me stay centered, stay in the moment and greatly reduces my stress level. I’m a living example of why you must never give up hope. If I can cleanse myself and open new pathways to a life without chronic pain you can too.

The post Life Sentence first appeared on Back in Control.

The post Life Sentence 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.

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