His letter

I met Dr. Hanscom under the most stressful circumstances imaginable.

When I moved back to the Northwest a little over a year ago, I experienced crippling anxiety, panic and agoraphobia – combined with excruciating lower cervical and upper thoracic pain radiating down not one, but both arms. I was in and out of the ER four times in one month, and over a period of several months, with new and emerging physical symptoms, I had seen over sixteen doctors of different specialties and had nearly every study and workup imaginable, running up some fifty-thousand dollars in medical expenses in the process. I simply did not know what was wrong with me and was completely frustrated with the medical care system to a great degree.

When my back pain became the focus, I came to the local spine center and presented to Dr. Hanscom my symptoms. After filling out an extensive questionnaire, which covered not just physical lifestyle, but emotional and behavioral issues as well, I sat in the exam room waiting. He came into the room after having viewed my MRI and offered not surgery, but something different, as an option. He told me to read a book Feeling Good, use the tools in it and begin to look at how my lifestyle and the way I was thinking were affecting my physical symptoms. In fact, he said, if I quote correctly, “I believe that when you do the exercises in this book and get a handle on your anxiety and depression, these symptoms will clear up.” He also stressed the importance of good quality, full stage sleep, which I was also being deprived of, as a crucial aid to the healing process.

After this experience, while driving home I remember telling a friend down in LA on the phone, “Gee I went to see a doctor and I ended up finding a healer.” In light of everything, it just made sense. In short, I was ready to move on to the advanced user features of my own software and hardware for that matter. I purchased the book, read it and did the exercises, used the tools contained therein, followed up with Dr. Hanscom and after a few months, I began to notice a difference.

Then on a recent trip to Los Angeles for work this year, I noticed I had no back pain at all. Diligence is key and maintenance is the watchword, but I remain asymptomatic to this moment and when I do feel the twinges, the spaciness, or any other telltale symptoms, my first impulse now is to confront the thought behind the physical and emotional feeling. And more often than not, I return to a normal, happy and focused state of mind – only this time with a much easier disposition.

Charlies-story-pain-free-after-17-different-doctors

My Perspective

I met Charley in 2006. I had just re-commited to the DOC project. I realized that my patients either with or without surgery were not doing nearly as well as I had experienced in Sun Valley where the project was born. He was experiencing a lot of neck pain, but was also not sleeping. It was also clear that he was quite anxious and becoming increasinly discouraged by not finding a way out of the Abyss. He clearly was motivated to get better, as he had seen 16 physicians within an 18-month span.

At that time I did not have much clarity about the links between anxiety, anger, and pain. I happened to have a slow clinic day and was able to talk to him for a while. We hit it off and had a great conversation. We began by working on his sleep and I shared the book, Feeling Good with him. I asked him to begin the writing that David Burns, the author, had suggested.

The first six months were not that easy for him and we had frequent phone calls. He all of a sudden, “woke up” and went after everything with a vengeance. There was no book or website at the time presenting the Back in Control concepts. What he taught me was there is no magic formula to any of this. It is a matter of re-connecting with the best part of yourself. Then there is no stopping you.

Charley moved back to Southern California were he is re-engaging in a busy, rich, full life and career. He has been pain free for over 10 years. We recently shot a short video to encapsulate his story and discuss his last ten years. He has not only remained active but has launched in a massive startup company. He will be the first to tell you, as will I, that this is not a straight-line journey but overall incredibly rewarding and you will connect with your capacity to create whatever life you wish.

We have become good friends and regularly stay in touch. I appreciate his willingness to share his journey with you.

The post Charley’s Story: Pain Free After 17 Doctors first appeared on Back in Control.

The post Charley’s Story: Pain Free After 17 Doctors appeared first on Back in Control.

• Surgery works well if there is an identifiable structural problem. This situation was present here in the form of tibial malalignment creating tracking problems with the patella. Re-aligning the joint is helpful. The reason I wrote my book, Do You Really Need Spine Surgery? Take Control with a Surgeon’s Advice was not to dismiss surgery, but only to have it done when the problem is clearly identifiable.
• The diagnosis of spondylolisthesis is mentioned. It is a surgical problem only if there are pinched nerves causing leg pain. Then you almost have to undergo surgery. Back pain is vague and is not a structural problem. Fusing a stable spondylolisthesis for back pain is not indicated. Indeed, the pain was resolved with a regular yoga practice and surgery may never be required.
• This reader took control. That is the one most important step.
• Finally, the mindset of being connected to only what is present is a major part of healing. Very nicely said.

The letter

I have a story to tell, and this surgical screw sums it up very nicely. It represents a turning point in my life. Some of my bones are a bit defective in shape, enough to cause problems after decades of wear and tear. Bear with me, I’ll get to the part that yoga has played in a bit…

This screw held my shin together for several months after a surgery to realign my kneecap by surgically fracturing my tibia and putting it back together at a different angle. That was only one of my multiple orthopedic surgeries on both feet, both knees, and both shoulders.

I went from pre-surgery not being able to carry a laundry basket down a flight of stairs, to post-surgery backpacking the 93-mile Wonderland Trail around Mt. Rainier. Now I average several hundred miles a year of hiking, backpacking, and snow-shoeing, something I could only dream about before.

Spondylolisthesis

Several years ago I also found out I have a spine defect (spondylolisthesis and pars fractures) that will eventually need a lumbar fusion as it progresses. I sometimes can’t feel my right foot and my low back feels less-than wonderful. I had started practicing yoga inconsistently before that diagnosis, but when I realized how incredible yoga has been for managing my low back pain (I don’t even take Advil or Tylenol), I dove into yoga head-first and never looked back.

That led to me to a regular yoga practice, then 200-hour Yoga Teacher Training (YTT) and recently 300-hour YTT. I went from dabbling in yoga because it was kinda “fun” to becoming a yoga teacher with several classes a week. It has changed my life.

I can’t imagine where I would be right now without having gone through what I have gone through. Just like that screw and what it represents. Rehab was not very pleasant, but I came out so much stronger and happier on the other side of it.

Moving forward

Sometimes life throws curve balls at you, some good, some bad. It’s easy to let your mind go into the “Why me?” or “It’s not fair!” mindset. I spent years in that dark place. Decades. It’s not a good place to be, either for yourself or for those who love you.

Mindset – Yoga has taught me to always try to find the positive in things, no matter how bad they might look on the outside. To see the blessings even when things look daunting. To know that it’s OK to take time to take care of myself, because that makes me better able to take care of others. To be completely content with where I am RIGHT NOW regardless of hurdles I’ve been through or what might be coming in the future. I guess what I’m trying to say here is that sometimes you have to go thru a bit of hell to come out oh-so-much-better on the other side. Smile. Get on your yoga mat and smile.

Final thoughts

This story is a wonderful illustration of moving forward, regardless of the obstacles. The rehab is a critical factor but life outlook is equally important. Your brain will develop wherever you place your attention and is physically altered through neuroplasticity. People often thrive at a level they did not know was possible.

The post “Un-screwed”–Yoga Healing Back Pain first appeared on Back in Control.

The post “Un-screwed”–Yoga Healing Back Pain appeared first on Back in Control.

My scoliosis surgery at age 14

This brilliant book (Back in Control) is a must read for anyone who lives with chronic pain, and for anyone whose life is affected by loving someone who has chronic pain.

I have lived with severe, chronic back pain, since a failed back surgery eighteen years ago. When I was 14 years-old I underwent surgery to correct scoliosis. Hardware was place in my thoracic spine (T6 to T12). Within a few short weeks following the surgery, I began experiencing an unusual amount of pain. My spine surgeon, Dr. A told me that the pain that I was experiencing was normal and that it would get better. The pain didn’t get better, in fact it got worse.

You’re a “chronic pain patient”

During the next eight months following my surgery, the pain became so intense that I couldn’t attend high school. Every time I returned to Dr. A to tell him how much pain I was in, he told me that the pain was not a function of the surgery; rather, I was a “chronic pain patient”. Operating under this assumption, I engaged in months of painful physical therapy, chiropractic treatments, and eventually I was referred to a chronic pain specialist, who put me on methadone to control my pain.

The spine surgery was infected

I eventually developed flu-like symptoms (vomiting, headaches, listlessness and high fevers) that didn’t remit. After eight months of dealing with ever worsening back pain, and repeatedly being dismissed by my surgeon, I went to a different spine surgeon for a second opinion. This surgeon was Dr. David Hanscom, and the year was 1995. Within a short time, he determined that it was likely that I had a staph infection in my spine. I was taken in for emergency surgery the next day to clear the infection. Dr. Hanscom was right, and so was I.

Fast forward to 2013… “The pain isn’t going away”

Just one week before my thirty-third birthday, I found myself unable to stand in an upright position – the muscles in my jaw, neck and back were in spasm; and I had a headache so severe that I felt nauseated. No amount of Ibuprofen, analgesic rub, or time laying on an icepack made a difference. I felt trapped and hopeless. Over the years, since my surgeries as an adolescent, I tried every alternative therapy known to man, and yet I still experienced pain on a daily basis. It finally hit me; my pain was not going to go away — it was getting worse. At the age of thirty-three, I felt like an eighty year-old woman. I thought that maybe another surgery would be my ticket out of the chronic pain hell that I had been living in for almost two decades. I had sworn to myself that I would never undergo another spine surgery, but I was at the end of my rope, and desperate for relief.

Stress?

Just before this pain flare-up, I had been dealing with a very difficult client at work. I could not control the trajectory of this issue, or the behaviors of my client; and coincidentally, my back pain was out of control. I had the sense that my back pain and stress with work were loosely connected. I was stressed with work, so it stood to reason that my muscles felt tense. I had no idea just how interconnected my back pain and stress levels actually were.

I have long thought that I had back pain because there was fundamentally something wrong with my spine. I have scoliosis, and had a corrective surgery that failed, and a traumatic experience post-op, with a spinal infection that went ignored, and could have killed me. I also experienced a great deal of anxiety since early childhood, and this anxiety increased in severity, as I got older.

Pain and anxiety are connected

Essentially, I deduced that I had two major issues in my life: back pain from a failed surgery, and anxiety and depression. What I know now is that these two issues are not independent of one another; rather they are one in the same.

It was by divine intervention that I learned about the work Dr. Hanscom is up to now. After visiting Dr. Hanscom’s website, I immediately ordered his book, Back In Control, and read it in two days. Once I finished his book, I signed up for the Hoffman Process, which is something you will learn about in his book. I then made an appointment with Dr. Hanscom, and was able to get in quickly because I was a patient of his eighteen years ago.

Hope

Back in Control blew me away, and it gave me a spark of hope. When I saw Dr. Hanscom in March of 2013, he told me that there was nothing wrong with my spine. Of course, I still had scoliosis, but my spine was solid. I was shocked to learn this! All of these years, I believed full-heartedly that my scoliosis and failed surgery was causing my pain; and for all of these years I was wrong. My pain was a function of pain pathways created by my central nervous system, post-surgery. Essentially, my pain was, practiced pain. This was a concept that was hard for me to grasp! But my faith and trust in the man who saved my life when I was young, helped keep me open to these new concepts.

Pain free!!

As I write this review, I have no back pain. This seems miraculous! The information provided in Back in Control, and my experience participating in the Hoffman Process, has radically changed my life in more ways than I could have ever imagined. I am so grateful!

Instead of my pain being constant, it comes in waves, and once I identify the pattern in my thinking that is the root of my pain, the pain goes away – completely. I used to have back pain 95% of the time, now I have back pain 15% of the time, and the numbers keep improving the longer I stay engaged in this work. Many days, I am pain-free. I don’t wake up with headaches anymore, I don’t grind my teeth at night, and I no longer take anxiety medication to get through my day. I simply don’t need it. I feel more alive than I can ever remember feeling, even pre-surgery. Many of the things that I have struggled with for years seemed to have vanished.

Be open to possibilities

My hope for you is that you read Back In Control, and consider going to the Hoffman Process. No one deserves to live in chronic pain. It tramples your quality of life, and negatively impacts the lives of those around you. Be open to the fact that the source of your pain is probably not what you think it is. We all deserve to be liberated in both mind and body. Living in pain is devastating and dehumanizing.

You are so much more than your physical pain, your psychological challenges, and your patterns.

The post Trapped for 18 Years from Scoliosis Surgery first appeared on Back in Control.

The post Trapped for 18 Years from Scoliosis Surgery appeared first on Back in Control.

Dr. Sarno

He is a well-known physiatrist who described the “tension myositis syndrome.” (TMS) I had been familiar with his observations described in his best-selling 1984 book, Mind Over Back Pain. He felt that the nervous system was created muscle tension and inflammation. He also made the astute observation that anger or rage was a critical factor in the evolution of chronic pain. He was partially correct about the anger, but modern neuroscience research has shown that the symptoms are created from the physiological response to threat and not primarily from muscle tension.

Dr. Schubiner

Howard Schubiner is a pain physician who practices in Detroit, MI, who spent time with Dr. Sarno. He has authored a book, Unlearn Your Pain, which addresses chronic pain as one of the symptoms of the Mind Body Syndrome (MBS), which is another name for the tension myositis syndrome. I have chosen the term, Neurophysiologic Disorder (NPD).

In March of 2011, he was one of the keynote speakers of a seminar I co-chaired, A Course on Compassion-Empathy in the Face of Chronic Pain. I had a vague understanding of what I had been through but was still searching for more answers. As I sat in the lecture I had a deep insight into my experience and it instantly all made sense. He concisely presented the over 30 possible symptoms of stressed nervous system and I realized that I had experienced almost half of them. In chapter five of his book, Unlearn Your Pain, Dr. Schubiner lists 33 symptoms of NPD (He uses the term Mind Body Syndrome).

The Neurophysiological Disorder (NPD) – Make the Right Diagnosis

As your nervous system is connected to and controls every cell in your body, the potential symptoms and combinations are almost endless. Mainstream medicine does not embrace these concepts and that would, historically, include me. I have both watched it and experienced it. Our medical culture has “medicalized” a neurological diagnosis. The first step in being successful in treating any disease is making the correct diagnosis.

My Experience with NPD

Here is the list of my symptoms of NPD. I will tell the stories in detail in later posts.

• Migraine headaches
• Migratory skin rashes
• Severe burning in both of my feet
• Obsessive compulsive disorder
• PTSD
• Anxiety/panic attacks
• Severe depression
• Chronic tendonitis
• Heartburn/acid reflux
• Tinnitus
• Insomnia
• Back/neck pain
• Tension headaches
• Unrelenting itching
• Chest pain
• Palpitations

Every one of these symptoms has vanished or is at a level that causes minimal interference with my quality of life. However, if I quit practicing the principles that I am teaching some of my symptoms will re-occur in about two weeks. These are permanent pathways. Usually my ears will begin to ring, my feet will burn and a skin rash will appear on the back of both of my wrists.  Fail well

Terminology

There have been many attempts at using a term to describe the array of symptoms that occur when your body is full of adrenaline and cortisol. These terms include:

• Tension Myositis Syndrome (TMS)
• Mind Body Syndrome (MBS)
• Stress Illness Syndrome
• Central Sensitization Syndrome
• Neurophysiologic Disorder (NPD)

All of these terms are describing the same process. Any stress, perceived or real is going to put your body into a fight-or-flight mode and you will experience multiple physical symptoms. The key to healing is feeling safe, which creates a wonderful chemical environment where you can both physically and mentally thrive. It is a learned skill that is not difficult.

The post My Battle with NPD first appeared on Back in Control.

The post My Battle with NPD appeared first on Back in Control.

Anger

Nonetheless, there are obstacles to becoming pain free. The absolute biggest block that I encountered daily was anger. I honestly didn’t know how to help a patient get past it. He or she becomes irrational. When you are chronically angry, it is your baseline, and you cannot even recognize that you are angry. I personally had no clue that I had any anger issues until I was 50 years old. In fact, one of the first lines to my wife when I first met her was that I was a “good catch” because  I had dealt with all of my anger issues. I am glad that neither of us had any idea that I had not even opened the door to my frustrations, as we never would have made it.

Noncompliant

The problem with anger is that you cannot listen and accurately assess a given situation. The conversation I have with a patient who is noncompliant goes like this. “Doctor, you mean to tell me that there is nothing wrong with my back? I have been in pain for several years and I know that this pain is not in my head. You must be missing something.”

I reply, “The pain you are experiencing is not imaginary pain, nor is it psychological. We know that if we did a functional MRI of your brain right now, the part of your brain that corresponds to your area of pain would light up brightly. All that matters is what is happening in your brain. We also know that the brain can fire spontaneously without an indentifiable source of the pain. I don’t just believe you have pain–I know you are experiencing pain and are frustrated about being trapped.”

I also explain to them that degenerated discs are normal as you age and that there is no correlation between a degenerated disc and back pain. The surgical success of a fusion for LBP is less than 30% with a significant downside of a failed surgery. They then say, “I don’t want surgery. I just want to be fixed and get my life back.” When I reply that we have had very consistent results following the steps outlined in this book, they explode saying, “I don’t want to read a book or anything like this. Just do something to fix my back.” They will then start ranting and often even yelling that no one will help them. Occasionally they will walk out of the room.

Anger is an absolute block to moving on

This is a frequent scenario. I would estimate that at least 50% of my patients fall somewhere in this part of the spectrum. They are noncompliant actually not by choice. I realize that chronic pain causes anger, but It is this anger that is also a complete block to engagement in effective treatment. Anger is destructive and it is multi-directional. It is particlurlarly self-destructive. You also have a strong sense of “being right” when you are angry and an even stronger sense of everyone else “being wrong.” I honestly do not know what to do to break this mind set.  I have tried everything from being confrontive to being incredibly patient. Nothing has worked. In fact, I have found that the longer I spend trying to convince someone to engage, the angrier they become. Angry people become upset when trying to be convinced to give it up. They just cannot hear me.

Address Your Anger

If you are angry or living in one of the above disguises of anger, be careful. You are trapped. You are truly stuck, and no one can even throw you a lifeline. What you cannot see is the havoc you are wreaking on those around you and onto yourself. I do not know how best to quell the anger rooted in chronic pain. I am open to suggestions.

The post Anger-The Absolute Block first appeared on Back in Control.

The post Anger-The Absolute Block appeared first on Back in Control.

I then spent the last year developing The DOC (Direct your Own Care) Journey. It is a self-directed program that reflects the successful efforts of many patients in breaking free from chronic pain. It has become a more clear process and people are healing more quickly with minimal resources and risk.

“You have degenerative disc disease.”

I regularly saw patients who’d been told that they had “arthritis, bulging discs, herniated discs, bone on bone, ruptured discs or degenerated discs”. They were terrified that they would become increasingly disabled and needed to be especially protective of their spines. Surgeons could be aggressive in pointing out how their lifestyle might become quite limited or they might end up in a wheelchair without surgery.

We know that if you view any body part as “damaged”, you’ll tend to focus on it and the sensations from that area become magnified. Then the next logical step in thinking your spine is “a disaster” is to be worried about becoming paralyzed and again surgeons will often state this. None of this is true. We generally don’t know the exact source of neck/thoracic/back pain (axial pain) most of the time. But we actually do know that the discs between the vertebrae are not the source of chronic pain.

Discs lose water content and become stiffer as we age. Since MRI scans are dependent on the signals created by water, less hydration means less signal and a darker disc on scan. That’s it. That is all it means. It doesn’t mean it’s a source of pain. A more accurate term for this condition would be “normally aging discs” instead of “degenerative disc disease.” It’s not a disease.

You do stiffen up as you age

A less flexible spine doesn’t correlate with a painful spine. There have been multiple studies done in the cervical, thoracic, and lumbar spine demonstrating that there is little correlation between a degenerated, herniated, bulging, or ruptured disc and back pain. (1) For example, if you randomly study 100 people who have NEVER experienced significant low back pain, by age 50, the majority of them have bone spurs, herniated or ruptured discs, disc bulges, or “degenerative disc disease”. By age 65, it approaches 100%.

There was a study done in the 1950’s that showed that after a disc operation, the chance of having low back pain after surgery was less if there was more degeneration of the disc and therefore less motion.

I encountered this scenario daily in clinic. Patients came to me with severe leg pain from a pinched nerve and had no back pain. Yet the x-rays and MRI scan often show that the spine has severe arthritis, degeneration or ruptured discs. I have personally undergone two low back surgeries and my three lower discs are severely degenerated on MRI. Nonetheless, it is my right arthritic knee and hip that slows me down, not low back pain.

Severe degeneration and no LBP

I evaluated an active middle-aged woman with extreme pain down the side of her left leg every time she stood up or walked. She had no pain with sitting or lying down. She was an avid cyclist, runner, and worked out at the gym regularly. She had narrowing around her fifth lumbar nerve root as it exited out of the side of her spine. Every time she stood up, the fifth nerve was tightly pinched. Her spine was one of the worst looking spines I have ever seen in any person of any age. Every disc was completely collapsed and each vertebrae was bone against bone. There was also a moderate amount of curvature (scoliosis). She had absolutely no back pain. She had never had significant back pain. I performed a one level fusion at L5-S1, which relieved the pressure on the nerve. The fusion prevented the opening around her 5th nerve from collapsing when she stood up. Her leg pain is gone and she has been back to full activities for over ten years.

This example is extreme only in the severity of the degeneration of the discs. I see patients routinely who present with severe degeneration of their spines and have only leg or arm symptoms from pinched nerves.

Structural versus non-structural

If you can’t specifically localize the source of pain, it would be considered a non-structural problem. Axia pain almost always considered non-structural since the pain is widespread and there isn’t a reliable method to identify the “pain generator”. Surgery is helpful only for structural problems, when the offending lesion can be identified and the symptoms closely match.

One analogy is that of going to the dentist with a painful cavity. The source of the pain is obvious. By having the tooth repaired or pulled, the problem is solved. But if you present to the dentist with mouth pain and can’t identify the source, you have to be much more careful. Random procedures in your mouth probably won’t solve the pain, since there are so many possibilities. Doing back fusions is about as successful. Most of the discs in the lower back have some degeneration. Even if you thought one of them might be the source of pain, how do you know which one it is? More invasive testing, such as injecting dye into the disc, hasn’t worked out well either.

Stiffer

I recall a Golf Digest article many years ago showing a famous golfer’s swing during his first years on the PGA tour compared to 20 years later. Early in his career he had a beautiful “C” shape of his lower back at the completion of his swing. Twenty years later, his lower back was almost straight throughout all the phases of his swing. None of us are as flexible in our 60’s as we were in our 20’s.

Discs can be the cause of pain in the initial acute phase of an injury. This often occurs in the presence of a relatively normally hydrated disc that has more motion than a degenerated disc. (2) It’s felt that the ring around the perimeter of the disc is partially torn and there’s an irritation of the nerve fibers in the ring that can be quite uncomfortable. Before my first back operation, I would experience severe episodic bouts of low back pain. After the rupture of my L5-S1 disc relieved the internal pressure on the pain fibers in the ring, my back pain disappeared.

Even though discs may cause acute neck/ thoracic/low back pain, they are not the source of chronic axial pain. Chronic pain in any location in the body becomes a neurological issue after six to twelve months. (3)

There are hundreds of thousands of spine fusions being performed annually in the US on degenerated discs for axial pain. The results are predictably poor and people are often worse. (4, 5) Be careful. A spine fusion is a major intervention. You might be making the decision to have surgery performed on a structure that is completely normal for your age. How can that possibly be a good idea? Challenge your surgeon.

References:

1. Jensen MC, et al. Magnetic resonance imaging of the lumbar spine in people without back pain. NEJM (1994); 331:69-73.
2. Weber, Henrik. Lumbar disc herniation: A controlled prospective study with ten years of observation. Spine (1983);8:131-140.
3. Hashmi, JA et al. Shape shifting pain: Chronification of back pain shifts brain representation from nociceptive to emotional circuits. Brain (2013); 136: 2751 – 2768.

4. Perkins, FM and H Kehlet. “Chronic pain as an outcome of surgery: A Review of Predictive Factors.” Anesthesiology (2000); 93: 1123 – 1133.

5. Carragee, EJ et al. A Gold Standard Evaluation of the ‘Discogenic Pain’ Diagnosis as Determined by Provocative Discography. Spine (2006) 31: 2115 – 2123.

Listen to the Back in Control Radio podcast Degenerative Disc Disease Isn’t a Disease

The post Degenerative Disc Disease Isn’t a Disease first appeared on Back in Control.

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