• Honor your suffering. You are trapped by physical and mental sensations without an apparent way out.
• You feel extremely isolated but many people in this hole (The Abyss) are also suffering badly. You are not alone.
• Your rightful frustration (rage) fires up your symptoms even more.
• Systematically learning and using tools to calm your body, will allow you to heal.

The Depth of Your Suffering – Darkness

All of us seek safety – physically and mentally. When we don’t feel safe, our bodies switch to a flight or fight mode, and we feel stressed. Another descriptive word is “anxious”, which is simply the feeling generated when you sense danger. We yearn for safety and detest anxiety, and when we can’t resolve the problem causing us to feel uneasy, we feel trapped. The word for this more intense bodily response is anger. It is our last-ditch effort to regain control and feel safe. When we still can’t escape a real or perceived threat, our bodies break down with the outcome being chronic mental and physical diseases.

Anxiety and anger are not psychological constructs; they are your body’s warning signals, and they evolved to be intentionally unpleasant. They are the pain and are manifested in many ways. Even with physical symptoms, the cause is unclear. There are reasons. Chronic stress translates into threat physiology (how your body functions), which causes symptoms, illness, and disease. Unless you know how to effectively process stress, you are trapped.

Feeling trapped causes deep suffering, creates many problems. BTW, everyone suffers. There are degrees, and not having basic needs met such as safety, food, shelter, and companionship creates havoc with every aspect of your health and life. I do not want to dishonor this level of suffering. For example, the incidence of significant anxiety issues is 100% if your income level is less than 19,000/ year.¹ This is 1994 data that translates in approximately $38,000 in 2024.

We are also trapped by being a species with language, abstract thinking, and awareness of the finite nature of life. We can’t escape death. In addition to our physical challenges to staying alive, we cannot escape our thoughts. We have no protection from mental pain and suppressing unpleasant thoughts inflames the brain even more. These translate into RUTs, (repetitive unpleasant thoughts). They are universal varying in severity and frequency. The range is:

• Occasional unwanted thoughts
• Repetitive thoughts
• RUTs
• Repetitive disruptive thoughts
• Invasive thoughts

 “The Abyss”

One afternoon, I was listening to a patient attempting to describe the depth of her suffering and it hit me how deep and hopeless this hole is for most people. I realized that words were inadequate to encapsulate the degree of misery. Since no one seemed to have any answers, there was no apparent way out. The description that seemed to fit for this dark, bottomless pit was “The Abyss”.

A recent research paper documented that the effect of chronic pain on one’s life is similar te the impact of terminal cancer.² You hadn’t anticipated the possibility of your life being consumed by pain. The paper showed that chronic pain was worse in that with cancer, you at least know the diagnosis and there is an endpoint, one way or the other. This statement might sound harsh in that suffering from terminal cancer is horrible, but ongoing pain (mental and physical) without knowing if there is an endpoint is even worse.

A stark example of how uncertainty can eat away at you is illustrated in Dr. Viktor Frankl’s book, Man’s Search for Meaning.³ He was an Austrian psychiatrist who was imprisoned in a concentration camp during WWII. He lost several close family members and experienced unspeakable horrors. As he describes his personal experience, it is difficult to imagine anyone enduring even a fraction of what he witnessed and endured. Yet, he points out that the worst part of it all was not knowing when it was going to end. 

Life in The Abyss

In addition to other life stresses, patients are trapped by unpleasant mental and physical symptoms, illnesses,and diseases. You are also trapped by the medical system, which is not consistently showing you a way out. Over time, you become discouraged (despondent). My equation for it is:

The Abyss = Anxiety/Anger x Time

Why isn’t pain part of this equation? It is because anxiety is the pain. When you are stuck in a whirlpool of relentless anxiety and frustration, life goes dark.

How deep is this hole? Here is a short list of the suffering I have encountered both personally and witnessed in my patients.

Losses include:

• Independence
  • Financial
  • At the mercy of the disability system
• Capacity to enjoy good music, friends, fine food, and hobbies without the experience being marred by pain
• Peaceful family life
• Feeling good – there are over 30 symptoms created by a chronically activated nervous system. There are also many other mental and physical disease states. Your body breaks down.
• Integrity – people don’t believe you and often the harder you try to convince your friends, family, peers, employers, and health care providers, the less you are believed.
  • Being labeled – malingerer, drug-seeker, lazy, not motivated, and difficult
• Unlimited physical activity
• Peace of mind – RUTs are relentless and may be the worst part of the ordeal.
• Hope – this may be the worst aspect of it all. Repeatedly having your hopes dashed induces a depression.

No Way Out

Consider the depth of “The Abyss.” Your soul is being pounded into the ground by a pile driver of anxiety/anger as you remain trapped in your body, riddled by mental and physical pain. Your life is being systematically destroyed, but in some cruel cosmic joke, you’re alive to bear witness – without hope. This dark place in your mind is unusually deep – bottomless. And no one is listening………

Recap

Allow yourself to comprehend the depth of your suffering and degree of damage your pain has inflicted on your life. Awareness is the first step in successfully reversing this downward spiral. Right now, you are at the bottom, except there is no bottom……

Chronic illnesses are complex and random treatments can’t and don’t work. It is necessary to break your unique situation into its component parts and systematically deal with them. There is a way out of this incredibly dark place, but you cannot go from the depths of suffering to better health with willpower and belief. As you methodically acquire knowledge and skills to deal with each aspect of your situation, you’ll be able calm and re-route your body to break free and heal.

Questions and considerations

1. First, give yourself a break. You are suffering badly. Many treatments have failed, and you may even be worse. No one seems to be able to show you a way out or even offer hope. There is no reason to have positive feelings about any of this. Allow yourself to feel the depth of your suffering and frustration. Express it a piece of paper and immediately tear it up. A few people have difficulty processing the feelings released with this exercise, and if you feel uncomfortable, immediately stop.
2. Consider what is important to you in life, but you can’t access or experience them. Write down two or three things you would like to experience. Not being in pain is not one of the choices. You’ll see why as the course unfolds and it is also a given. None of us want to be in pain.
3. List three to five of your most intolerable symptoms. For many people, the relentless onslaught of unpleasant thoughts is the worst aspect of it all.
4. Give yourself credit for staying on your feet long enough to keep trying. A willingness to learn and practice is the number one factor predicting success.

 References:

1. Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of dsm-iii-r psychiatric disorders in the united states: Results from the national comorbidity survey. Arch Gen Psychiatry. 1994; 51(1): 8-9.
2. O’Connor AB. Neuropathic pain: quality-of-life impact, costs, and cost effectiveness of therapy. Pharmacoeconomics (2009); 27: 95- 112.
3. Frankl, Viktor. Man’s Search for Meaning. Beacon Press, Boston, MA, 1959,1962,1984, 2006.

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Your Hand Over the Heat

If you were to put your hand close to a hot burner on a stove, what would happen to your level of anxiety?

• It would quickly escalate.
• You would withdraw your hand.
• You would protect yourself.
• Anxiety would be alleviated.

What would happen to your anxiety if you were forced to leave your hand over the burner?

• It would go through the roof.
• You would feel trapped and extremely angry.

I don’t believe you’re OK.

Anxiety is a Programming Problem

The changes to the central nervous system during chronic pain represent a programming problem rather than a psychological problem.

• Anxiety gains strength with time and repetition.
• Anger is a powerful force that covers up the feeling of anxiety
• Anger spins anxiety-inducing neurological circuits more quickly.
• We deal with anxiety by exerting some form of control.
• If you are successful in controlling the situation or yourself, then your anxiety is alleviated.
• Without control, you become frustrated or angry. Anger = loss control

With chronic pain, you have, metaphorically, lost your ability to “withdraw your hand from the red hot burner.” How can you rate yourself as a zero on anxiety and irritability? If you had no other stress in your life, chronic pain alone would be enough to destroy the quality of your life.

There are several other stress factors to consider with chronic pain.

• People in chronic pain don’t see an end to their suffering. They lose hope in returning to a pain-free life.
• Chronic pain patients are truly victims of pain. So it’s more difficult to let go and not have anger run your life.
• When chronic pain patients suppress anxiety and anger, these negative feelings become much stronger. (2)  White Bears and ANTS.

Being Pain-Free is a Basic Need

We all deserve to live free of constant pain. Being pain-free is a basic need. It has been shown that the impact of chronic pain on a person’s quality of life is equivalent to having terminal cancer. (1) We cannot accomplish higher goals and flourish as human beings without first securing the comfort of being in our bodies. I discuss this in “Maslow’s Miss”  and in the video: “Your Hand Over the Stove.”

“The Link Between Pain and Anxiety”. Inspire, January 21st, 2013

1. Fredheim OM et al. “Chronic non-malignant pain patients report as poor health-related quality of life as palliative cancer patients.” Acta Anaesthesiologica Scandinavica (2008); 52: 143 – 148.
2. Wegener, DM et al. “Paradoxical effects of thought suppression. Journal of Personality and Social Psychology (1987); 53: 5 – 13.

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Anger

There is a a “genealogy” of anger that is important to recognise.

• Circumstance
• Blame
• Victim
• Frustration/ anger

Anger is the set of sensations generated by an intense fight or flight response and it is damaging to your body when it is sustained. There is a set of tools that I call, “anger processing” that calm down this response and it is a set of skills you must use many times a day. Life keeps coming at us. Unfortunately, the more legitimate your anger, the more difficult it is to process – but it still damages your body. Being trapped in mental or physical pain is one of those situations.

Carol

Carol is a woman who contacted me about ten years ago. She had read Back in Control and began to use the strategies outlined on my website to calm her nervous system. She had been severely disabled with pain throughout her body. Within a few months she began to improve and was markedly better by the time she connected with me.

I have since learned that all chronic disease, mental and physical, is caused by chronic stress, which means your body’s chemistry is in sustained activated threat physiology. She had already developed a significant set of medical problems by the time I had met her with many physical setbacks. She kept moving forward and her efforts were inspiring.

Then she had to be put into a nursing home on the other side of the country, and she was truly miserable. I did not have any suggestions and was also a bit discouraged by her situation. Then a few months ago, I received this letter.

Her letter

Dear David,

Just a note to let you know your DOC Journey has pulled me through yet another trip back to The Abyss. Since moving here last June, I have felt I have been in a “third world country,” also known as an Assisted Living Facility. It’s bad enough being 83 and sick, but it’s even worse when the facility you live in is way below par in every way, Staff, food, medical needs, activities, cleanliness, and caring. Add that to that the frustration over my loss of hearing. Closed Captions are now a part of my TV world and I find myself wanting them everywhere. I cannot afford the doctor who recommended hearing aids right now because I am working on yet another expensive “fix it” project, my teeth. What else can go wrong? The depression/anxiety and pain were also taking over my life again.

However, rather than just sit here and play the victim, I thought; what can I do to make this better? I remembered a conversation you and I had after I read his book, Back in Control and about helping others. That is what I felt he did for me. He took his knowledge and experience and has helped me and others understand how we can apply it to our own situation with his book, the weekly newsletters, various posts, and podcasts, the Q&A sessions and other educational material. He shared what he knew and paid it forward! How could I make this work in my own situation?

I remembered the experience I had of working with my mother back in 1977. She had Alzheimer’s. I knew nothing about that, Medicare, Medicaid, and elderly living. I moved in with her, turned her 3^rd bedroom into an office and worked on getting her proper care and eventually, into a lovely Skilled Nursing Facility. It was an exasperating experience as I was suffering from a recent divorce, depression/anxiety, chronic pain, and Fibromyalgia. But, as I look back on it now, I realize it was very also very educational. Several years later, when I was the Executive Secretary for both the Director and the Administrator of a 27-story health care facility in San Francisco, it occurred to me that I could use that expertise and knowledge as well, and act as an advocate for residents who could not be an advocate for themselves.

Subsequently, living here for a while, I realized that most of the residents have some level of dementia, and no one is paying much attention to them. Unfortunately, their families have just dumped them off for someone else to look after. I knew how good it made me feel when I talked with you because you validated me as a real person, not just a number. For such a long time I felt that no one understood what I was talking about. His understanding and willingness to share gave me so much hope and began to restore me as a human being. I learned that this is what people want most, to be recognized, cared for, and loved.

As bad as this place is (and it’s bad), I felt that perhaps God had placed me here for a reason. Before moving here, I lived in a fabulous Assisted Living facility in Washington, so it gave me something to compare this to. Maybe I could make a difference. I found out where to complain, the State Health Care Facility Complaint Board, and contacted them. I also contacted the Ombudsman for this district. I wrote to and talked with both parties, plus Administration heads and some of the board members of the place where I live and pointed out nearly 20 complaints. The more I have worked with these residents and staff, instead of thinking about my problems, the better I’ve felt. And, I am pleased to say that because I was willing to stand up and pay it forward, the facility is making some real changes that have made a major difference in most of the resident’s wellbeing.

–Carol

Trapped – or not

People often use the term, “stress management” to deal with adversity. What is overlooked in this phrase is that at the situations that are the most stressful are the ones you can’t control. So, the approach needs to be flipped. You must learn to calm yourself first, which requires learning the skills and practice (there are plenty of opportunities). Positive thinking doesn’t work. You have to address each scenario head on. If you can change it, do it. If you can’t, then use your tools.

Paradoxically, as you are not burning up energy on situations you have no control over, you’ll have more to actually solve more of your problems. If you are dependent on your circumstances for your peace of mind, you are at the mercy of them.

She was truly trapped, and actually still is. Many, if not most of us are in similar situations, whether it is finances, difficult work environment, lack of opportunity, racism, or family dynamics. She chose to relate to her circumstances differently, which allowed her body to reconnect to its capacity to heal. You will be surprised to see how many more of your problems are solvable when you can calm down first. She continues to be an inspiration for me.

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• Unpleasant thoughts are impossible to avoid and can significantly impact your quality of life.
• They are a “neurological trick” created by your unconscious brain. They are not subject to rational interventions.
• The root cause of the problem is the human need for mental control. It sets off two different reactions.
  • One is that suppressing unpleasant thoughts causes them to become more frequent and stronger.
  • The other one is that when you try to think about something, you’ll think about it less.
• The final outcome is obsessive thought patterns that fire up your nervous system, which causes you to be in a sustained flight or fight response. This state compromises your mental and physical health.
• The DOC Journey teaches you recognize the nature of these thoughts, and you can move past them into the life that you want.

The inability to escape from unpleasant thoughts has a major impact on many people’s quality of life. Much energy is spent in attempting to control or suppress them. It turns out that they arise from the unconscious brain as a reflex, and they are much more powerful than your conscious brain. Rational interventions cannot and do not work.

The problem arises because these disruptive thoughts become stronger with time and repetition, are memorized, and evolve into obsessive patterns. A historical research term for them is, “URT’s” (Unpleasant Repetitive Thoughts). (1) My description is “RUTs” (Repetitive Unpleasant Thoughts). I refer to this phenomenon as “Phantom Brain Pain.”

Then there even a bigger issue in that they are processed in a similar manner as physical threats and stimulate your body into a flight or fight response (threat physiology). It is important to have this survival response, but it is deadly when it is prolonged. Your body is in high gear and your inflammatory cells are attacking your own body’s tissues. However, thought suppression is only part of this story.

The Ironic Effect

A significant obstacle to health and well-being is the “ironic effect.” We all know that when you suppress thoughts and emotions that they become more powerful and disruptive. (2) But a lesser known, and even more deadly problem is that when you try to think of something, you’ll think about it less. (3) Your conscious intention is overwhelmed by your unconscious brain focusing on ways you may not achieve this goal. Since the unconscious brain is so powerful, it is a huge mismatch.

The problem is that the more well-intentioned you are, the more likely this universal process will kick in. If your intention is to be out of pain, inadvertently, you’ll think about the pain more and reinforce it. The research shows that if you seek happiness, you’ll end up sad. If you try to be sad, you’ll end up buoyantly happy. If you try not to stereotype people, you’ll end up being more prejudiced. It is a major human existence problem in that many people who want to contribute to the world’s well-being, end up being crippled by overwhelming unpleasant thoughts and crippling anxiety. People with few scruples are not as bothered by this ironic effect and perhaps why many people in power run over people that are more conscientious.

The “seed” of this ironic process is the need for mental control – any control. (3)  The effect varies considerably from individual to individual, but it is consistently present. As bad as it sounds, and it is problematic, the solution is incredibly simple. Just write down your thoughts on a piece of paper and destroy it. The act is that of giving up mental control and it is without risk. It is the reason The DOC Journey has you begin this exercise before you get into the substance of the course. Every human being should do this daily like brushing your teeth. Look at it as cleaning out the lint trap of your dryer. Even a few minutes a day interrupts this reactive process. It is also the reason why expressing writing is the one “mandatory” step without an alternative.

Moving past these obsessive thought patterns

Understanding the powerful irrational nature of these inner critical voices will change your life in several ways. First, they are a neurological mechanism intended to protect you. You cannot take them personally. This realization allows you to learn to separate your identity from this reflex and access who you are and want to be. Your “demons” are actually suppressed thoughts and who you are NOT. Again, the more of a well-intentioned person you are, the more intense the thoughts. It really isn’t fair.

The other mechanism of trying to think noble and positive thoughts creates the opposite effect in that you think about them less. It creates disruptive thought patterns such as, “not good enough”, “just work harder,” “I’m a loser,” and “why does this always happen to me?” It is also problematic in that they push you to become “successful”, but you may not be able to feel it. A common scenario is the “imposter syndrome.” It seems many highly successful people feel like frauds even though there is abundant evidence to the contrary.

Where is your attention?

Whatever the reason, the end result is the same. You spend a significant amount of your life energy trying to squelch these voices and they won’t respond because they can’t. In fact, they will become stronger in that you are paying attention to them and stimulating neuroplastic changes in brain. It is similar to spinning a basketball ball on the tip of your finger. It will keep spinning as you put more energy into it. Also consider these thoughts as “dust devils” that are mini-tornadoes that occur in the prairie. They spin extremely fast, they cannot be stopped, or even penetrated.

So, the second way your life will be impacted is that once you understand the problem and realize you are wasting your energy trying to assuage this noise, you can move past them. The energy is now available to turn towards the future and construct the life you desire. Going back to the basketball comparison, as you stop paying attention to these circuits, they will slow down and may stop spinning almost completely. You cannot “fix” these thought patterns. The key is to first separate from them (expressive writing), and then create circuits in your brain that are much more enjoyable. You can also shift onto the part of your brain that already knows how to play. All of this can happen quickly with practice. The energy now available to go this direction will amaze you. You’ll quit trying to solve the unsolvable.

Begin with your disbelief

Your success with this course is not about generating belief in David Hanscom, The DOC Journey, or any other set of resources. That would be a form of thought suppression. Positive thinking generates the same thought pattens through the ironic effect. Your journey must begin and continue by connecting with what is happening at the moment. As you begin this course, that would be acknowledging your disbelief and downright cynicism. You have tried almost everything presented in this course at least once. Why should this experience be any different? Like trying to be happy ends up being sad, wanting to be free of pain causes you to be in more pain. If you can’t seem to get past positive thinking, keep trying. We all want to believe and experience happiness but living in chronic pain is tough.

The DOC Journey presents deeply researched tools that will allow you to calm and down re-route your nervous system as well as ways to regulate your body’s chemical state. It begins where you are and sequentially teaches you tools to accomplish this one step at a time. The way out of pain is truly paradoxical and why The DOC Journey is presented in a planned sequence. It also reflects the journey taken by many successful patients.

Recap:

Unpleasant repetitive thoughts are the “curse of consciousness.” They are unique to being human in that we possess language and can create abstract thoughts and concepts. They become our version of reality and identity. (4) We may spend a lot of time trying to fix or escape from them, but it isn’t possible. They are relentless and irrational.

Understanding the neurological mechanism of how they occur allows you to recognize them for what they are, connect to your own value system, and move past them into a much more enjoyable life experience.

References

1. Makovac E, et al. Can’t get it off my brain: Meta-analysis of neuroimaging studies on perseverative cognition. Psychiatry Research: Neuroimaging (2020); 295:111020. doi.org/10.1016/j/psychresns.2019.111020
2. Wegener DM, et al. “Paradoxical effects of thought suppression.” Journal of Personality and Social Psychology (1987); 53: 5-13.
3. Wegener DM. The Seed of Our Undoing. Psychological Science Agenda (1999)/ 10-11.
4. Feldman-Barrett. How Emotions are Made. Mariner Books; Main Market Ed. 2018.

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Good Times

It’s always a wonderful weekend and incredibly relaxing in that everything is right there. Good food, fireplace, hot tub, warm pool and a lot of bantering (that would be the mild term). We do revert back to middle school behavior (at best). My wife keeps asking me the question if guys ever grow up. I think the answer is obvious. It’s a great break for all of us.

We ski in smaller groups and we usually meet at a restaurant in the middle of the mountain called “Watsons” at 11:30, just before the lunch crowd arrives. I don’t ski quite as well as I used to and decided to come in a little early and relax. I purposely worked on enjoying the fantastic view of the valley and could not have been in a better state of mind. It was also one of the few times when I was well ahead of the curve with regards to saving enough seating for 18 people. The restaurant was almost empty.

I was sitting at the end of two tables that seated 12 and had placed my gear on a table for six just across the aisle. Four of my group appeared at 11:20 and sat down at the large table. My plan was working well, and I was having a great time. We were talking about the morning, which included skiing on fantastic snow. Suddenly I turned around and there were four boys between nine and eleven, who had pushed aside my gear on the other table and were sitting down.

Trouble

I pointed out to them that I had another six people arriving shortly and this table was saved. “Where are they? We’re here! You can’t save tables.” They were clearly veteran Alta skiers, but I had never heard of that rule at any ski resort in over my 50 years of skiing. I also didn’t see any signs that I couldn’t save a table. I was caught off guard and firmly restated my case. At that point four more of my “ buddies” sat down at the large table. There were also two older women immediately behind the boys and they started hissing, “Just give them the table.” As I continued my protest, one of the boys looked at me said, “We’ll give you five minutes.” I was getting more confused and flustered. I don’t remember that I would have talked to an adult in this manner when I was 10 years old. Usually skiers just walk on by, since saving a table for your group is the norm (so I thought).

Thrown under the bus

Then I asked my friend, Bill, to come over and sit down at the embattled table with me, since the larger table was continuing to fill up with members of my group. Instead of coming over and helping me out, he said, “Come on, why don’t you let them have it?” while looking directly at them. I was now well into looking like a “grouchy old man” and the women continued to hiss at me. I caved in, but I wasn’t happy. My tranquil meditative state had been severely compromised, and I was being thrown under the bus. My “friend” fist-bumped them and they said, “Thanks!”

Three minutes later, another seven people showed up and had no place to sit. This wasn’t going well, and my group thought all of this was hilarious. I wasn’t happy with them, the kids, the women or me. I really was upset, and it was just over a table. My friends know how much stress I deal with every week and were surprised how triggered I was over such a non-issue. Of course, the more frustrated I became, the harder they laughed – even though I was holding the space for them. I haven’t been that angry in a while. What the heck happened?

Gulliver

The image that jumped into my head was that of Gulliver being tied to the ground after being captured by Lilliputians. Gulliver’s Travels was written in 1726 by Jonathan Swift, and was a disguised commentary on world affairs, as well as on human nature. The book is divided into four sections. The first is about being captured by the Lilliputians, who were one twelfth his size. He was tied to the ground by hordes of them while he was sleeping. They wanted to seal the deal by blinding him. He had to navigate some tricky situations to eventually escape.

I was trapped by people a fraction of my size and age. My “adult” friends finished me off. The similarities to being pulled into the Abyss of chronic pain weren’t subtle. It’s always a combination of factors that pull you into the hole. They add up quickly and escape becomes essentially impossible. When I was pulled into the Abyss in 1990, I didn’t see it coming and it took me 13 years to come out of my tailspin. And it was by pure luck that I did. It took me years to figure out what had happened to me, and longer to learn how to share the concepts with my patients. A few of the variables that can trap you are:

• The source of pain is usually not able to be identified, so no one really believes you’re in pain.
• Although modern neuroscience research has revealed the answers to solving your chronic pain, mainstream medicine continues to ignore the data. Essentially every treatment in spine care that is covered by insurance has been shown to be ineffective. Proven effective treatments are usually not covered. We are pretending to practice medicine.
• Repeatedly having your hopes dashed is a reliable way of inducing a major depression, as demonstrated in animal studies.
• You are labeled and judged.

This list is only a hint of the multiple ways  you are trapped by mental or physical pain. You can’t see them coming and the adversities keep pummeling you from multiple directions. The worst aspect of it is that since there doesn’t appear to be any viable solutions offered to you, where is the endpoint? You eventually lose hope and retreat into an angry survival mode.

I felt trapped and any one of the variables alone would not have stopped me from holding onto my treasured table. I didn’t anticipate all the angles of the situation that took me down. A major one was my own sense of not looking good to the other parties or to me. I was a “grouchy old man.” I am still not sure, as I am writing this piece a couple of weeks later, that I’ve completely let it go…………

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Physical consequences

A paper was sent to me this week by a friend and colleague of mine that documents some of the consequences. It is a British study pulled out of a group of over a half a million people. (1) They compared the mortality rate of those with chronic widespread pain with those without any chronic pain. The increased mortality rate was stunning. Overall the chances of dying early were over double. The causes of were death for higher for: 1) cancer – 173% 2) cardiovascular – 320% 3) respiratory – 566% 4) other diseases – 400%.

What led to this increased mortality? It was not the pain. It was related to factors associated with being in chronic pain that were preventable.

• Smoking
• Obesity
• Lack of exercise
• Poor diet

Their conclusion was that addressing these lifestyle factors could reduce mortality by around 35%. I agree with this approach but why not solve the chronic pain? The motivation to live life more fully will return once you are no longer being crushed.

Trapped

Not only are you crushed by the pain but also by the emotions associated with it. You are trapped. When you are trapped by anything such as finances, an unpleasant job, an abusive relationship at home, work or school you will get upset. Being trapped by pain is even more of a problem. Then there is the additional problem of the medical profession not offering you a way out and people don’t really believe you’re in pain. Dr. Sarno was one who used the word, “rage” to describe the situation. My term is “The Abyss.” It is so dark in this hole without hope that words do not come close describing the isolation and despair that consume you. Although addressing these “modifiable lifestyle factors” will help, it is difficult to sustain when you are legitimately frustrated and often trying just to make it to the next day.

Solve the pain. Escape from “The Abyss” and then no one can stop you from thriving. I have watched hundreds of people heal and it is inspiring to watch how quickly they move on. Given a chance, humans are driven to pursue health and happiness. They don’t have to be motivated.

A phrase I commonly hear is, “Who would have thought it was the anger?” You have often heard me cite the phrase, “Neurons that fire together, wire together.” Chronic pain is linked to anger pathways and anger increases pain. Anxiety, anger and adrenaline You are not going to heal, including caring for yourself, until you address your anger – no matter how legitimate it might be. Essentially, you have the choice to let go of your suffering and move on.

Jane

I spent years talking to a patient about anger and she wasn’t buying it. She had already undergone four surgeries and wanted me to do another. Her spine wasn’t perfect and I was tempted. I also knew how much chaos was occurring in her life. I finally said, “No. Feel free to see another surgeon.” I had used all my lines on her and I gave up. About a year later I received an incredible email that she had been free of pain for a while and was re-married with a beautiful new family. She often sends me photos. Happy doesn’t begin to describe the look on her face. It has been one of the most rewarding and unexpected turnarounds I have witnessed. She will be sharing her story on “The Stories of Hope” section. She finally admitted that anger was the problem and she couldn’t see it.

Suffering from chronic pain throws your whole body out of kilter? You have nothing to lose by just engaging in risk-free, age-old proven treatments and seeing what happens.

This paper gives additional meaning to a phrase I frequently hear, “I just want my life back.” Take it back. You might be losing it faster than you think.

Addendum

I just received an email from a reader who pointed out that many people, if not most people in chronic pain do make a strong effort to address the factors that are mentioned above. I do agree with her comments. However, people who work hard at staying healthy, yet still suffer from chronic pain, are often frustrated because their best efforts are still not able to solve the problem. Unfortunately, this legitimate frustruation still creates chronically elevated levels of stress chemicals. That plays itself out in multiple physical symptoms, including a compromised immune system. I would encourage those of you who feel and are trapped in this maze to keep persisting. I am continually blown away by people’s stories who find their way out through what I have historically considered unsolvable situations.

1. Macfarlane GJ, et al. Persons with chronic widespread pain experience excess mortality; longitudinal results from UK Biobank and meta-analysis. Ann Rheum Dis (2017); 0: 1-8.

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I was introduced to this concept in the 1980’s by Dr. Bernie Siegel’s book, Love, Medicine and Miracles. He reviews some of literature that links stress with disease and also relates many stories of patients with terminal cancer who beat the disease. He formed a non-profit group, ECaP (Exceptional Cancer Patients). These miracles happened in the presence of widespread disease without any hope of survival. Although this has been witnessed for decades, he asked the question, “Why?” It is not just a lucky occurrence. Remarkable healing stories – Dr. Bernie Siegel

The destructive power of anger

The same principles hold true for the healing that occurs in the DOC process. It is not a series of steps that you undertake and you are free of pain. It is a framework that organizes your thinking and clears the air so you can figure out your own next steps. Somewhere in the midst of quieting down, my patients unconsciously connect with the core of who they are and allow themselves to heal.

Being trapped causes frustration and anger. Anger disconnects you in almost every direction and adversely alters your body’s chemistry so all of your cells (organs) are bathed in stress chemicals. Some things that trap us are:

• Our thoughts
• Anxiety
• Unpleasant work environment
• Abusive home situation
• Uncomfortable/ painful physical sensations
• Too little money
• Not being able to meet basic daily obligations – always behind
• Random medical treatments

Most of these problems are not solvable, so as your legitimate frustrations continue, so will the chemical assault on your body. You cannot connect with your body’s capacity to heal in this adverse physiological environment. You can   train yourself to alter this primitive survival response.

Placebo

Placebo is a term that has been incorrectly presented to both doctors and patients. It is felt that if a patient responds to a placebo, then there clearly must not be a problem. Really? It has been shown and continues to be demonstrated that almost every medical treatment has a significant placebo component – even in the presence of the active ingredient of the drug. Also, the more invasive the treatment the more powerful the placebo effect. In other words, an injection is stronger than a pill, and a surgical procedure has even a greater placebo effect.

The percent of people that respond to a given treatment with a placebo effect ranges from 20 to 50% and it is consistent. I am not aware of any study that shows that the placebo effect is absent. Harnessing and  this placebo effect is what you desire. It is specific, powerful and does not have side effects or risks. There is nothing more impressive than having your immune system rally and wipe out a given cancer. All that doctors can do is to kill cells with drugs and radiation and hopefully the cancer cells are destroyed first. Occasionally surgery can completely remove it, but never in these terminal cases. The newer generation of treatments is focused more on targeting only the cancer cells.

The warts on my hands

I had a remarkable experience with my body’s healing powers in my 20’s. You can read about it in detail but after suffering with five to ten warts on both of my hands for over 10 years this disappeared forever within a week after a dermatologist told me to rub fresh Aloe Vera leaves over them. Then he told me that he thought it was a long-shot but it would work, “Because I think it is just a placebo.” I was extremely upset and angry and I can still feel what happened inside me that day. I remember feeling that “I am done with this” and I felt a deep shift occur in the middle of my body. I rubbed the Aloe Vera on my warts for a couple of times and then threw the stems out. Two weeks later I had new hands. I cannot adequately encapsulate this experience in words. It has been shown that even when patients know they are receiving a placebo it is still often effective. (2)

The drug of choice

Placebo is the drug of choice for any disease state, including chronic pain. You must get out of your own way and allow your body heal. Connecting to your own healing capacity does not carry risks or cause harm.

Unfortunately, many medical procedures do have significant risks and cause damage, even when there are no complications. I had to directly or indirectly deal with almost all of them including, stroke, blindness, paralysis and death. Addressing bad outcomes was one of  the most difficult aspects of being a surgeon. This is especially true when you wonder if you could have possibly avoided the procedure, or did my patient really understand the implications of his or her decision? There are conflicting reports but it appears that there are over 150,000 deaths annually from medical errors, which would make it the third leading cause of death behind heart disease and cancer.

One mechanism of action of placebo is that it engages the same brain mechanisms that release the body’s endorphins (natural pain killers) and ‎cannabinoids (active ingredient in marijuana). Interestingly, researchers can block the pain-killing placebo effect with a drug that blocks narcotics called naloxone.

Treatments without risk

A 2012 study recently came to my attention where lidocaine patches for LBP were compared with just the patches. It is extremely interesting in that 50% of the patients responded in both groups. Does the paper show that patients really did not have pain? “No!” It demonstrates that the healing response is stimulated by the patch. Does that mean we should be prescribing patches without the lidocaine? “No!” The risk of Lidocaine on the patch is essentially zero and adds minimal cost. A 50% response rate is excellent. (1)

It doesn’t even matter if the patients know that the “drug” is a placebo. Another “open label” placebo medication study showed a large reduction in chronic low back pain compared to the usual treatment. The mechanism of action of this effect is unclear and it does not require deception to be effective. Somehow the act of taking the pill stimulates the body’s capacity to heal. (2)

When patients heal at some point during the DOC process there is no way of knowing what aspect of it was effective and it doesn’t matter. You have connected with your body’s ability to heal and without a downside.

Heal yourself

Understand that each and every person has the capacity to access his or her own body’s ability to heal. We have observed that the vast majority of patients who engage will not only improve but thrive. Unfortunately, the anger that fires up so many symptoms is also the obstacle that blocks engagement. The major factor that portends a good outcome is willingness to be open to new ideas and then pursue them. Or, as one successful patient pointed out, “It requires a suspension of disbelief.”

1. Hashmi, JA, et al. Lidocaine patch (5%) is not more potent then placebo in treating chronic back pain when tested in a randomized double blind placebo controlled brain imaging study. Molecular Pain (2012); 8:29-30.
2. Carvalho C, et al. Open-label placebo treatment in chronic low back pain: a randomized controlled trial. Pain (2016); vol 0: 1-7.

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I also remember that there was usually a lag between the end of school and the beginning of my summer job. I was fine for a couple of days but then I would quickly get cabin fever. I could not stand laying around the house and not being productive. I enjoyed getting outside and being with my co-workers.

Abusing my back

Unfortunately, I had little regard for my body with regards to lifting properly. I was continually reminded to use my legs and not my back and arms. I did not have great upper body strength so, of course, I used my back. I had no concept of the consequences and had a perverse sense of pride about how much I could lift and for how long.

The perils of parenting

In March of 1985 I was holding my sleeping one-year old son and placed him over the top of the side rail of the crib. It would have made much more sense to lay him down, lower the side rail and then place him in the crib with a relatively straight spine. I was still bulletproof and why would I change my lifting habits now? Just as I was fully leaned over the top of the rail I felt a snap in my back and a searing pain in my left big toe. That was the beginning of a six-week descent into abject misery of constant severe pain. I had thought (incorrectly) that if pain was very localized, that it would be more tolerable. I could not and did not sleep more than two to four hours a night for over six weeks. I still do not know how that is possible and I never had even one full night’s sleep.

My suffering worsened in that I could not eat,  lost 25 pounds, developed kidney failure from taking too many aspirin, experienced ringing in my ears, and I became increasingly irrational. (at least that is what I am told)

I was only able to work half time as the second partner in a private orthopedic practice. I had only debt after just finishing my residency. I was about to begin my spine fellowship training in Minneapolis in 4 months. I finally elected to do the one thing I swore I would never do and that was to have spine surgery. The simple decompression surgery at L5-S1 went well and my great toe pain was gone. I quickly returned to work and was excited about getting on with my training I was ecstatic – until my wounds began to drain about 10 days later. I developed a deep wound infection from being malnourished after losing so much weight. A second operation and six weeks of antibiotics finally resolved it. My spine surgery – and infection

“You’re fired”

I had been through a lot and fortunately I had a remarkably benevolent partner who continued to pay my salary, although I was only about a third functional. I was dealing with it pretty well until my future fellowship directors found out about my infection and promptly informed me that I had been replaced. They did not think I could do the job and I was also not offered a later position.

Somehow that was it. It was the one part of the situation I could not handle – losing my job. I was devastated. That night I sat alone in my car and completely broke down. I cannot verbalize the depth of despair and helplessness that I experienced. I could not care for my family or even myself. I clearly saw how vulnerable you were not being able to fend for yourself in a capitalistic society. I felt like a medieval warrior going to battle without any weapons or armor. It was one of the most painful and enlightening moments of my life.

The “benefits” of being disabled

Physicians are often given the impression that people are generally looking to get off of work. The answer to disability is to tighten the rules and get tougher. They feel that many injured workers just don’t want to work. They also do not realize the implications of taking people off of work. Once a person loses their job the whole nature of the claim changes. It becomes more difficult to get hired by anyone since you now have a track record of missing work. Here are some of of the other “benefits” of being off of work:

• Your income is at least 25% less and is fixed.
• A claims examiner is in charge of your life instead of you.
• You cannot get through to them to get an update on your progress or status and he or she is in charge of your entire life.
• Your disability check can be taken away from you without notice.
• No one believes you are in pain. My battle with NPD
• Life becomes one of surviving rather than thriving.
• Worker’s comp will not cover stress management treatments or provide resources to help you.
• How do you get out of this situation?
• Your providers are not filling out the paperwork and not getting back to your employer.
• There are endless contradictions regarding your care and diagnosis and you often are given bad news.
• Even without the conflicting medical advice, anxiety and frustration usually continue to rise.
• Pain invades every part of your life including many conversations. It is not that interesting after a while.
• What happened to your dreams?
• Research has shown that being off of work is detrimental to your mental and physical health.
• Many people lose their assets, including their home

I remember a moment about five years into my practice when I realized that my Worker’s Comp patients were not doing well because of lack of motivation. It was because  were justifiably angry. The Worker’s Comp system that they expected to help them and allay their anxiety was mostly harassing them. I didn’t blame them for being upset.

Disabled

Life is not better being disabled. Maybe you have been that way for so long that you can no longer understand or appreciate the alternatives. You are so used to being trapped that anger seems normal. Many people don’t even think they are angry. That included me. No one, and I mean no one, is going to help you out of this hole. It is deep and will keep getting deeper. Many Italians choose suicide – People need to work

The only patients I see succeed are those who have made a decision to live a different life and they are not going to live this way anymore. I have watched hundreds of patients become pain free. It is just much more difficult if it involves Worker’s Comp. How do you want to live your life? I had the smallest taste of what it is like to not be able to work and take care of myself. Not only did I not like it, it was the worst part of my ordeal.

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There are three parts to solving your pain:

• The first is to understand chronic pain. It is a neurological problem that is different than acute pain.
• Second, all the variables relevant to your situation must be addressed simultaneously.
• Finally, every successful patient has taken control of his or her own care.

Introduction to Chronic Pain

 Pain impulses begin with stimulation of pain receptors and are sent to the brain through peripheral nerves and the spinal cord. In the brain a substance called myelin is laid down with repetition that etches in these pain circuits. Myelin can roughly be compared to the insulation around an electric wire that improves the speed of conduction. The process is similar to an athlete, artist or musician learning a skill. However the frequency of chronic pain impulses is more like a machine gun. Pain circuits become deeply embedded in the nervous system within six to twelve months. Similar to knowing how to ride a bicycle they are permanent.

Pain signals danger, which creates anxiety. Your body secretes adrenaline, cortisol and other stress chemicals, which protects you by increasing your heart rate and increasing the blood flow to your muscles. It also shuts down the blood supply to the frontal lobe of your brain (your thinking center) and amplifies the sensation of pain. Every millisecond of your life has evolved around avoiding anxiety. It is the only reason the human organism has survived. Your bodily responses to the environment are not centered on having a great time. Anxiety, Anger, and Adrenaline

Trapped by Pain

When you continue to be trapped by pain (or any life circumstance) you will become frustrated and angry. Anger results from loss of control. Any time you cannot fulfill a basic need such as air, food, or water you will become anxious then angry. Not being in pain is a basic need. Maslow’s miss Anger stimulates the body’s physiological response to meet that need. Therefore anger is anxiety with a chemical kick. Now the adrenaline levels really are elevated, which does improve your chances of solving a given problem. But it destroys the quality of your life, especially your close relationships. A terrible vicious cycle ensues – more pain, more adrenaline, more pain, and so on. Where and how does it stop? For most people it does not and it consumes them and everything around them. It is the worst part of the human experience. Your Hand Stuck Over the Stove

Anxiety is a neurophysiological response to a threat. It’s a mental reflex that sets off an automatic protective response. So similar to pain circuits anxiety pathways are also permanently etched in and become stronger with repetition. That is why every human experiences increasing anxiety with age. If they don’t, then their body will adversely respond with other physical responses. There are over 30 different symptoms that may occur. There are no exceptions. It is just a matter of degree, type of manifestations and coping skills.

As chronic pain always creates anxiety and frustration they are neurologically linked. Neuroscientists have a saying, “Neurons that fire together, wire together.”

It sounds like a dismal situation and it is if you approach the problem with traditional methods. Trying to deal with irrational pathways with rational means cannot work. The unconscious brain is a more than a million time stronger than the conscious brain. The more attention that is paid to what I call “The Terrifying Triad” of pain, anxiety, and anger the stronger they will become. If you try to ignore them then it becomes even worse. The more you try not to think about something you will think about it more. So what is the solution? White bears

Neuroplasticity

It has been recently discovered that the brain has a tremendous capacity to change at any age. The descriptive term is “neuroplasticity.” We do know that in chronic pain peoples’ brains physically shrink. Fortunately it re-expands with resolution of the pain. It is possible by using simple tools to both shift off these pathways onto non-painful circuits and to stimulate the formation of new pathways. Although there are many ways of accomplishing this I am presenting the starting point, which has been the foundation for essentially every patient I have seen successfully become pain free.

Stimulating Brain Change – Awareness, Separation, Reprogramming

 There are three steps to shifting and creating alternate brain pathways.

• You must first become aware of your automatic response to a given stress. It will always be a rapid protective response.
  • Stress by definition is always a threat – otherwise it wouldn’t be stress.
• Then you must create a space, or separate, in order for you to substitute a more appropriate or functional reaction.
• Reprogramming is the final step.

Awareness and Detachment – Expressive Writing

Humans have a problem in that unpleasant thoughts create the same response as a physical threat but you can’t escape from them. They key is to simple separate from them. I have discovered the easiest and most effective way of developing an awareness of my response to stress is to simply write down my negative or positive thoughts and destroy them. It has been shown in over 300 research papers that this is an effective way of changing the body’s response to stress. Stress isn’t the main problem. It’s your response to it.

There are two reasons to tear up, shred, or burn your writing. It’s not to get rid of the thoughts. They’re permanently embedded. The first is so you can write with complete freedom. Any thoughts, positive or negative will do. Write and Don’t Stop The more important reason it to not spend any time or energy analyzing them. Your attention will be focused in that direction and you’ll be reinforcing them. You might as well place your hand into a hornet’s nest.

In my opinion the writing accomplishes several things.

• It creates an awareness that these random thoughts are in your nervous system and that they are just thoughts.
• As the paper is a physical distance from you it allows you to separate from these thoughts. It is easier to see that they are just thoughts and have nothing to do with your reality.
• This space is connected with vision and feel, which connects with the unconscious.
• As you are connecting a thought with a physical sensation, you are creating new pathways.

Expressive writing creates awareness and separation with one exercise. It is simple and concrete – and doable. It was the first treatment that was helpful for me after trying to solve my chronic pain for over 15 years. I was lucky to have discovered it, as I was nearing the end of what I could tolerate. Video: Write Your Way Out of Chronic Pain

Warning: Please note that many people may experience an early decrease in mood and sense of well-being. Pain may also initially increase. This is not a bad prognosis for a long-term beneficial effect. It is recommended that you limit the writing to about 20 minutes per time until you are feeling better. If you feel too uncomfortable stop the writing immediately and contact your physician or mental health professional. The Dangers of Positive Thinking

Reprogramming

Reprogramming can be accomplished in thousands of ways such as music, hobbies, talking to friends, acupuncture, etc. However there is one core method that I feel is basic to the reprogramming process. I call it “active meditation”. It is more often referred to as mindfulness. It is simply placing your attention on sensations. Any one will do – taste, feel, sound, pressure, etc. There are three steps and it just takes five to ten seconds per time. (1)

• The first step is to relax
• Let yourself stabilize
• Finally, place your attention on any sensation. Taste your food. Feel the breeze. Listen to sounds.

I feel the active meditation accomplishes several things. As you relax your body will begin to secrete less adrenaline. By placing your attention on a given sensation your nervous system is no longer on the pain pathways. You have shifted off of them and are now truly in the present moment. As you continue to do this throughout the day it becomes more and more automatic. Eventually as you use the pain pathways less they will become weaker and the other pathways will become stronger.

One metaphor that comes to mind is that of diverting a large river into another channel. There is very little water that will initially flow through the new riverbed but with continued excavation there will be more and more flow. Eventually just the force of the water will create a new river. The old riverbed is still there. (It is permanent) but is much less developed. As you use your pain pathways less and the new pathways more, at some tipping point you will go to pain free.

Begin the writing/ active meditation NOW

The DOC project addresses the other factors that affect your pain experience. But the expressive writing/ active meditation is the core starting point. I ask all of my patients to begin that evening. I suggest that they write once or twice a day for at least 10 to 15 minutes. The active meditation should be done as many times as you happen to think about it. I am guessing that I do it 20 – 30 times a day. It eventually becomes an unconscious habit.

As nothing really changes until the writing/ active meditation begins I ask my patients to begin these exercises before they do much reading. I can instantly tell on the second visit whether they have started the expressive writing. People notice changes in their mood quickly although the pain may not have resolved. The research does show that most people will experience an initial dip in their mood and sometimes increased pain for a few days or weeks. Then I know they are actually writing.

Expressive writing/ active meditation alone is not the solution to your pain any more than reading my book. But these exercises are incredibly powerful especially considering how simple they are. BTW, what is the downside? How high are the stakes? Do you really want to continue to live like this? Was this your high school dream? You have once chance at this life. Take it!!

1) Learned from a workshop put on by Alan Wallace, PhD

The post Introductory DOC Concepts first appeared on Back in Control.

The post Introductory DOC Concepts appeared first on Back in Control.

Trapped

When the real or perceived threat persists we feel trapped. This, of course, causes the secretion of even more hormones and the feeling of being angry. Anger and anxiety are similar entities. Many reactions occur in your body, which include:

• Shift of blood supply to skeletal muscles, which enables you to flee danger.
• Decreased blood flow to your brain – especially to the frontal cortex where most thinking occurs.
• Increased blood pressure
• Faster heart rate
• Sweating
• Rapid breathing

Adrenaline also effects every cell in your body with each organ systems manifesting its own unique response. There are four categories:

• Smooth muscles – control the digestion, bladder emptying, and diameter of blood vessels and lung airways.
• Skeletal muscle – muscles used for motor function including heart muscle
• Central nervous system – is intended to protect you and one starting point is to amplify danger signals from the environment such a pain
• Conversion reaction – a given organ system will just shut down.

Adrenaline/ Cortisol

There are over 30 symptoms that can occur with this sustained “adrenaline bath” from the different organ system reactions. They include:

Smooth muscle

• Migraine headaches
• Irritable bowel
• Spastic bladder
• Sweating
• Pounding sensation of your heart

Skeletal muscle

• Back pain
• Neck pain
• Rapid heart rate
• Fibromyalgia
• Chest pain
• Tendonitis

Central nervous system

• Burning sensations throughout the body
  • Can feel like peripheral neuropathy
• Itching
• Skin rashes
• Insomnia
• Extreme anxiety/ depression
• Obsessive thought patterns
• Tinnitus or ringing in the ears
• Eating disorders
• Obsessive compulsive disorder (OCD)
• PTSD

Conversion reactions – whole systems shut down

• Paralysis
• Blindness
• Weakness

Your body – a cell culture medium

Dr. Bruce Lipton is a world-renowned cell biologist formerly from Stanford. He has authored several remarkable books including, The Biology of Belief and The Honeymoon Effect. My wife and I had the pleasure of meeting him and his wife. He succinctly pointed out that when he places human cells in a culture medium that contains adrenaline and cortisol that the cells shrivel. When placed in a culture dish that contains oxytocin and growth hormone they flourish. The difference isn’t subtle. Oxytocin is the hormone secreted at birth and is felt to be significant in a mother bonding with her infant. It is also nicknamed “the love drug.”

He also points out the human body is essentially one big culture medium contained by skin. BTW, there are about 50 trillion cells in the body. Therefore, as adrenaline is in contact with every cell the effects are profound. The way you think does affect your body chemistry. What chemical environment do you want your cells to be exposed to on a daily basis? You do have a choice.

Anxiety, anger, and adrenaline OR awareness, forgiveness, and acceptance.

Anger – The “Continental Divide” of Chronic Pain

Listen to the Back in Control Radio podcast Anxiety, Anger and Adrenaline

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