A straightforward decision

I rarely make a surgical decision on the first visit, but his situation seemed so straightforward that I decided to make an exception. He also wanted to proceed quickly, as he was frustrated by his limitations. As I walked out the door to grab the pre-operative letter that describes the details of the fusion, he quietly said, “My son just died a few months ago.” I immediately turned around and sat down with him. His son had died from a massive heart attack. I let him know how sorry I was about his loss, and also told him that I was not comfortable with him making such a major decision in light of the situation. He agreed. I gave him the pre-op letter and asked him to return in a couple of weeks. I gave him a copy of my book, Back in Control, which is an excellent resource for dealing with stress, as well as chronic pain. A week later he called and told me that he really wasn’t into reading my book and just wanted to proceed with surgery. I asked him one more time just to glance through the book, as it does help with post-operative pain and rehab; and I signed him up for surgery.

The pre-op appointment

He came in with his wife for his pre-operative appointment to coordinate the final details around the operation. I wanted be sure that I was on the same page regarding the severity of the pain and his understanding of the procedure. He said, “I am feeling better. I have read some  of your book and think that maybe I should work through some of the issues around my son’s death.” We had a long conversation about the effect this degree of trauma can cause. He asked me if it was OK with me for him to delay his surgery for a while.

I saw him a month later and he had no pain in his back or down his leg. He was fully active and had just re-joined the gym. I asked him what seemed to be the most helpful strategy in resolving his pain. He had continued to read the book. However, I am well-aware that reading my book, or any book, is not going to take away pain. It requires some level of engagement. For him, it was awareness. Just understanding the links between anxiety, anger, trauma, and pain helped him make sense of the different emotions he was trying to process. He was also now talking to his friends about his loss, who were offering a lot of support. His whole demeanor had changed and he was now more concerned about how the situation was affecting his wife.

How do I decide who needs surgery?

It is becoming increasingly unclear to me what severity of pathology requires surgery to solve a given problem. His constriction around his 5^th lumbar nerve root was severe and he had a classic history that matched. Had I done the surgery, his leg pain would have resolved; but not his emotional pain. He now is moving forward, as his emotional pain is being addressed. His back and leg pain are gone. He did not have to undergo the trauma and risks of surgery. He will return to being a productive person and provide emotional support for his wife. Although, not the main reason, there was essentially no cost involved.

“I know when a patient is at risk for a poor outcome”

I have witnessed many stories that are similar to George’s; and I am more diligent in making sure that there not major life stresses occurring while making a final decision regarding surgery. There doesn’t need to be one specific event. More commonly people hit their breaking point from cumulative stress, and they don’t see a way out. Physicians almost uniformly feel that they can detect emotional distress in their patients. As I have been doing spine surgery for so many years, I feel like I am really able to detect patients with anxiety and depression in my clinic. However, research shows that physicians are correct in this regards only 25-43% of the time. It does not matter whether the doctor is a junior resident or senior staff physician. George’s story again reminded me that I cannot figure any of this out either. There is too much going on in the middle of a busy clinic – especially on an initial visit. (1)

Physical versus mental pain

The areas of the brain that interpret physical and emotional distress are located in close proximity to each other. (2) It also seems that there are abnormalities of a given person’s body that are not quite severe enough to cause pain. But when the pain threshold is lowered, in the presence of adversity, these specific areas can become symptomatic. As one of my workout buddies points out, “It is the weak area that lights up.” Prior pain circuits can also be activated.

There are hundreds of research papers documenting the link between anxiety and depression with pain, and poor outcomes with treatment. For many reasons, these factors are not being routinely addressed. The culture of medicine is geared towards performing procedures, and not on talking to you about other options or providing the necessary resources. It is critical that you have done everything possible to calm down your nervous system before you undergo a surgical procedure. In this medical environment, you will have to take on that responsibility.

1. Daubs, M, et al. Clinical impression versus standardized questionnaire: The spinal surgeon’s abilityto assess psychological distress. JBJS (2010); 92; 2878-2883.
2. Hashmi, JA et al. “Shape shifting pain: chronification of back pain shifts brain representation from nociceptive to emotional circuits.” Brain(2013); 136: 2751 – 2768.

The post “My Son Just Died” first appeared on Back in Control.

The post “My Son Just Died” appeared first on Back in Control.

Anxiety is the manifestation of flight or fight physiology (how the body functions). The sensation evolved to be incredibly unpleasant, as life forms that ignored these signals didn’t survive. Humans additionally possess language to label these sensations, “anxiety.” We will do anything to avoid it. Suppressing it has even more severe consequences with an increased chance of opioid craving² and the hippocampus of the brain (memory center) shrinks.³ So, the only choice left is to mask it, which actually works – while you are masking. Opioids work well to diminish mental pain, as well as physical, and have been used for melancholy since ancient times.⁴

My perspective

Almost forty percent of my surgical practice was devoted to treating patients with infected spines from IV drug abuse. The problem arose from bacteria entering the blood from contaminated needles. The bacteria lodged in the disc space, which has a limited blood supply. Since there was no way out, the bacteria are trapped. This environment is ideal for growth and an abscess forms. Adjacent vertebrae are destroyed and break. Surgery entailed draining the infection and stabilizing the broken spine with screws, rods, and a fusion. These operations were complex, expensive, and risky. Occasionally, a patient would become paralyzed from the infection clotting off the blood supply to the spinal cord.

A minimum of six weeks in the hospital were required after surgery for IV antibiotics. I knew them well, and I learned some lessons from them.

• He or she would often shake in bed from crippling anxiety, which worsened their pain.
• Instead of increasing pain medications, anti-anxiety drugs were much more effective in lowering pain.
• No one chooses to be an addict – no one. Addiction begins with a need to relieve mental or physical pain and then the drug itself has addictive qualities.
• The destruction wreaked on every aspect of people’s lives is devastating.
• Once he or she calmed down, conversations were much easier.

What’s currently being done?

We are currently approaching the epidemic from almost every possible wrong angle. Why is this happening?

1. Not addressing the root cause

The biggest and most obvious problem is that modern medicine isn’t providing viable solutions to chronic mental and physical pain. We are focused on structural problems being the source of pain, and if we can’t find the “cause,” we just treat symptoms. Not addressing the root cause of a sustained flight or fight state, is a disaster. The reality is that everything is wrong in that every cell in your body is bathed in stress chemistry, on high alert, and your body breaks down.

2. Inadequate training

Physicians are remarkably well-intentioned, work too hard, and enjoy seeing their patients improve. But our training is woefully inadequate and not connected to ongoing scientific advances. Recent neuroscience research has provided answers to chronic pain but the knowledge hasn’t penetrated into mainstream medicine. The current definition is that chronic pain is, “……an imbedded memory that becomes connected with more and more life experiences and the memory can’t be erased.”⁴  It’s a complex neurological problem and we are treating it as a structural issue. It can’t and doesn’t work.

Your doctor doesn’t have the correct tools to solve your chronic illnesses. Both patients and providers are frustrated. It affects the doctor/ patient interactions. About 20% of physicians are comfortable treating chronic pain, and only 1% enjoy it. Many patients in pain feel labeled and discriminated against by many physicians. They are correct. The labels include, “drug seeker”, “malingerer”, “have secondary gains”, “difficult”, “addict”,and the list is endless. Once you are labeled, the person who placed the label has lost awareness of who you are. They can longer hear important details to help you heal. When a patient pushes to be heard, the situation may become unpleasant.

Even worse, many of the “mainstream” interventions have been demonstrated in numerous research papers to be ineffective and often cause harm.⁵ Many proven effective treatments are not readily available because they are not covered by insurance plans.⁶  Why do you think we have such an epidemic of chronic if we were treating it correctly? A significant percent of a medical system’s revenue is driven by these expensive and risky interventions.

3. Known data is ignored

Modern medicine is pretending to treat your chronic pain and is arrogant in dismissing deep research that reveals answers. A 2014 paper documented that only 10% of orthopedic and neuro spine surgeons are assessing and addressing the well-known risk factors for a poor surgical outcome prior to recommending surgery.⁷  You trust your doctor to implement a best practices approach and you’re repeatedly disappointed. With increasing frustration, your stress physiology remains elevated, and your pain worsens. Repeatedly dashing hopes also induces depression.⁸

4. No one is listening

A safe trusting healing relationship with your doctor is at the core of care. Other treatments have limited benefit without it. Physiology shifts from threat to safety, which induces healing. With short visits and huge demands from the system (the business of medicine), your physician doesn’t have enough time to know you.^9,10 Family, social, interpersonal, and work dynamics predictably overwhelm almost any treatment plan. Conversely, addressing these situational dynamics is a powerful way to enhance healing.

Chronic mental and physical pain is complex and layered on the uniqueness of each person. How can you solve any complex problem without knowing details? Major life-altering decisions are commonly made on an initial visit. Few people would build a house or even purchase a car with extensive research. The consequences of an ill-informed choices about your body can be devastating.

5. It’s the mental pain

Another problem is that mental and physical pain is processed in similar brain regions, and mental pain is even less tolerated than physical pain.¹¹ About fifteen years ago, I was perplexed by the severity of symptoms reported by many patients with essentially normal spines. I began to ask questions about their lives and discovered that most of them were dealing with unusual amounts of stress. I began asking patients, “If I could get rid of your pain or your anxiety, which one would you choose to address?” Most of them quickly answered, “ I can’t deal with the anxiety.”

A fallout of the the government’s focus of restricting access to pain medications is that patients are more stressed, which is inflammatory and further increases pain. Physicians fear prescribing even low-dose pain meds.

I recently saw two different successful businessmen for ongoing leg pain after each having two low back operations and their pain was much worse. I couldn’t see much wrong on the original MRI scans done prior to their first operations and the most recent scans didn’t reveal a cause for their ongoing pain. Finally, I remembered to ask them about their anxiety compared to the pain. Neither of them appeared to be particularly anxious. Both of them immediately said it was the anxiety that was the much bigger problem and they could deal with the leg pain.

Most my patients who have infected spines from IV drugs are overwhelmed beyond words with anxiety. They have been dealing with it for so long that they make no pretense of it being otherwise. It often began to be problematic in their early teen years and magnified by family and school dynamics. Opioids help mental pain. Even when on their usual doses of medications to prevent withdrawal symptoms, they are frequently physically quivering in bed from anxiety. Most physicians, historically including me, don’t ask many questions about anxiety and frustration.

6. Simplistic thinking

Successfully eliminating polio and smallpox epidemics, took a widespread public health effort at many levels, costing billions of dollars. But it was accomplished with an extensive cooperation between the government, private sector and medicine. The opioid epidemic is a far bigger problem cutting across all age groups and levels of society. Limiting access to opioids as the main focus isn’t going to make the smallest dent in the problem and, as already mentioned, is going to make it worse. Anyone can and will turn to illicit sources for medications. When you’re in unrelenting pain, you’ll do whatever it takes to survive. Getting drugs from marginal suppliers or from the streets is becoming a common occurrence amongst people who never remotely would have considered it. What else are you going to do, in light of fact that medicine is not providing alternatives to solve your pain? Many people have their lives consumed by the pursuit of drugs and pain relief. Patients have laughed at us when we ask about where they are obtaining their opiates. From their perspective it’s fairly easy and it feels like it is becoming somewhat of the norm.

Finding relief any way that he can

One typical case was that of middle-aged carpenter with low back pain, who had been able to work for years by taking a stable low dose of narcotics. He needed to keep working, so when the local pain center shut down, he felt he had no other choice but to use IV heroin. I met him in the hospital where not only was his spine infected, but it had spread deeply into his pelvis. He was extremely ill. He required three operations to drain almost a gallon of pus and stabilize his spine.

The viable solution

In defense of the current efforts, the opioid epidemic has caught the attention of everyone. However, they are working from a flawed paradigm regarding the driving force behind chronic mental and physical pain like they did when working on eradicating a specific viral infection with vaccines. Yet the answer is right in front of us.

The core answer is for the medical profession to embrace and implement what we learned in medical school. Sustained stress causes chronic illness and disease because of the body’s physiology, and not from structural causes.

These reactions are automatic, emanate from the powerful unconscious brain, and aren’t controllable with rational interventions. So, what is the solution? Lower your threat physiology. The treatment model is called, “Dynamic Healing” and threat physiology is regulated through three different portals. Your stresses (input) are processed in a manner to have less impact on your nervous system. Secondly is calming your nervous system. Finally, there are strategies to directly regulate your physiology from flight or fight to safety.

The reason there is a viable solution to the opioid epidemic is because most of the strategies used each portal are self-directed. They should still be in the context of good medical care. The details are beyond the scope of this discussion, but the bottom line is that as you attain the skills to lessen your exposure to stress/flight or fight physiology and increase your time in safety (rest and digest), your body knows how to refuel, regenerate, and heal.

References

1. Beyer, Don, Chairman. JEC (Joint Economic Commission Dems), 2021. https://www.jec.senate.gov/public/_cache/files/67bced7f-4232-40ea-9263-f033d280c567/jec-cost-of-opioids-issue-brief.pdf
2. Garland EL, et al. Thought suppression as a mediator of the association between depressed mood and prescription opioid craving among chronic pain patients. J Behav Med (2016); 39:128–138. 10.1007/s10865-015-9675-9
3. Hulbert JC, et al. Inducing amnesia through systemic suppression. Nature Communications (2016); 7:11003 | DOI: 10.1038/ncomms11003
4. A.R. Mansour, M.A. Farmer, M.N. Balikia and A. Vania Apkarian. Chronic pain: The role of learning and brain plasticity. Restorative Neurology and Neuroscience (2014): 32:129-139. DOI 10.3233/RNN-139003.
5. Franklin GM, et al. “Outcome of lumbar fusion in Washington State Workers’ Compensation.” Spine (1994); 19:1897–903.
6. Heyward J, et al. Coverage of Nonpharmacologic Treatments for LowBack Pain Among US Public and Private Insurers.JAMA Network Open. 2018;1(6):e183044. doi:10.1001/jamanetworkopen.2018.3044
7. Young AK, et al. Assessment of Presurgical Psychological Screening in Patients Undergoing Spine Surgery. J Spinal Disorder Tech (2014); 27: 76-79.
8. Love at Goon Park: Harry Harlow and the Science of Affection. Deborah Blum. Perseus Books, Philadelphia, PA, 2002.
9. Presented by Daniel Alford, MD. Lecture: Challenges in Physician Education, Kaiser Pain Symposium, October 20, 2018.
10. Alford DP, German JS, Samet JH, Cheng DM, Lloyd-Travaglini CA, Saitz R. Primary care patients with drug use report chronic pain and self-medicate with alcohol and other drugs. J Gen Intern Med. 2016;31(5):486-491.
11. Lane RD, at al. Biased competition favoring physical over emotional Pain: A possible explanation for the link Between early adversity and chronic pain. Psychosomatic Medicine (2018); 80:880-890. DOI: 10.1097/PSY.0000000000000640

The post Science has the Answer to the Opioid Epidemic – Is anyone listening? first appeared on Back in Control.

The post Science has the Answer to the Opioid Epidemic – Is anyone listening? appeared first on Back in Control.

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.

The post Your Hand Stuck Over the Stove first appeared on Back in Control.

The post Your Hand Stuck Over the Stove appeared first on Back in Control.

Spine surgery is out of control. I am not against surgery and I was a complex spinal surgeon for 32 years. From the beginning of my career, I felt that too much surgery was being performed. But for my first eight years of practice, I was a part of this aggressive approach. When a research paper came out in 1993 showing the return-to-work rate was only 22% after a low back fusion for pain, I immediately stopped performing that operation. (1)

But he rate of spine surgery has continued to rise in spite of evidence that much of it is ineffective. It rose rapidly in the mid-1990’s with the introduction of new techniques that did improve the fusion rate. However, outcomes haven’t improved, and disability keeps rising. Why?

“Let’s try spine surgery”

Spine surgery works wonderfully well when there is a distinct identifiable anatomical abnormality, and the symptoms are in the expected region of the body. However, it works poorly if surgery is done for “pain” and the source of it is unclear. There is a widespread belief among patients and many physicians that if everything else has been tried and failed, then surgery is the next logical step. Nothing could be further from the truth.

Defining the correct anatomical problem to surgically treat would seem to be the first logical step. However, this step is often not done well. One of the most glaring examples of blindly proceeding with surgery in spite of the evidence stacked against it, is performing a fusion for low back pain. There was one paper in 2001 that hinted it might be effective, but it was sponsored by a spinal instrumentation company, and the non-operative care was not defined. (2) One well-known paper compared lumbar fusions for pain to a solid rehab protocol and the non-operative care resulted in better outcomes. The final comment in the paper was that “this type of care wasn’t widely available.” (3)

• It is well-documented that disc degeneration, bone spurs, arthritis, bulging discs, etc. are rarely the cause of back pain. So, when a fusion is performed for LBP, we really don’t know from where it might be arising. (4)
• The success rate of performing a fusion for LBP is less than 30%. (5) Most people expect a much better outcome and the resultant disappointment is also problematic.
• If any procedure is performed in a person with untreated chronic pain in any part of the body, he or she may experience chronic pain at the new surgical site up to 40-60% of the time. Five to ten percent of the time it is permanent. (6)

Trip to the dentist

Consider going to the dentist with a painful cavity that may require a root canal, crown or extraction. There is a defined problem, and the pain will predictably disappear once the problem is solved. But what about the situation where you might be having severe mouth or jaw pain, and there isn’t a tooth that seems to be the source. Would you expect your dentist to randomly try working on different teeth to see how it might work? After all, these are minor interventions compared to undergoing spine surgery. What if the problem is gum disease, a sinus infection, TMJ, or even a tumor in your oral cavity? Making an accurate diagnosis of the problem is always the first step in solving it.

The treatment grid

My intention is to educate you and anyone on your health care team about all of the issues that factor into deciding whether to undergo spine surgery. There are two sets of variables: 1) the type of anatomy – can you see it on a diagnostic test? 2) The status of your nervous system and resultant body chemistry. Are you calm? Or are you stressed and hyper-vigilant? If your nervous system is on “high alert” for any reason, the outcomes of surgery are predictably poor, especially if you can’t identify the anatomical problem. The combinations result in four possible scenarios. The book is based around this treatment grid:

• IA—Structural lesion, calm nervous system
• IB—Structural lesion, stressed
• IIA—Non-structural lesion, calm
• IIB—Non-structural lesion, stressed

The Treatment Grid

You will be able to place yourself in the correct quadrant with the help of your providers. Each one has a distinct treatment approach, which will allow you to make better treatment choices. The most basic decision is that if there isn’t a clearly identifiable source of pain, then surgery isn’t an option, regardless of how much pain you are experiencing. Low-odds surgery in the presence of untreated chronic pain has a high chance of making you worse – much worse. Especially if the surgery doesn’t go well.

Mike

Mike was in his mid-40’s and had just moved to Seattle about six months earlier. He was undergoing some physical testing to qualify for a government job. During the process, he tripped and twisted his back. His back pain was severe with a lot of muscle spasms. About four months after the fall, a surgeon elected to perform a fusion at his lowest level of his spine (Lumbar 5-Sacral 1). He had a small bony defect called a spondylolisthesis that had been there his whole life and was unlikely to be the source of his acute back pain. There was no reason to consider surgery.

During the operation, one of the screws used to stabilize his spine was misplaced and impaled the 5^th lumbar nerve root. It was removed a couple of days later, but the damage had been done. When he saw me for another opinion about a year later, he was still experiencing severe pain down the side of his right leg. He had no leg pain before the surgery. He was on high-dose narcotics without relief. He had already figured out that the surgery was unnecessary and was really angry about it. His life as he had known it was gone – permanently. There was nothing that I could do, I heard a couple of years later that he had undergone yet more surgery without any relief.

This book will enable you to understand the difference between a spine problem that is amenable to surgery versus one that is not. It covers the whole spine from your neck to your pelvis. You will also be able to assess the state of your nervous system and resultant body chemistry. If you are stressed, there are simple, consistently effective measures that can calm your nervous system. The goal of the comprehensive treatment process is to help you become pain free with or without surgery.

Whatever you decide to do or what resources you might use, don’t jump into spine surgery until you understand the whole picture. It may be the most major decision of your life.

1. Franklin GM, et al. “Outcomes of lumbar fusion in Washington state workers’ compensation.” Spine (2994); 19: 1897–1903; discussion 1904.
2. Fritzell P, et al. “Swedish Lumbar Spine Study Group. Lumbar fusion versus non-surgical treatment for LBP.” Spine (2001); 26: 2521-2532.
3. Brox J, et al. Randomized Clinical Trial of Lumbar Instrumented Fusion Cognitive Intervention and Exercises in Patients with Chronic Low Back Pain and Disc Degeneration. Spine2003; 17: 1913-1921.
4. Boden SD, et al. “Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation.” J Bone Joint Surg (1990); 72:403– 8.
5. Carragee EJ, et al. “A Gold Standard Evaluation of the ‘Discogenic Pain’ Diag­nosis as Determined by Provocative Discography.” Spine (2006) 31:2115-2123.
6. Ballantyne J, et al. Chronic pain after surgery or injury. IASP (2011); 19: 1-5.

Video: Get it Right the First Time

The post Do You Really Need Spine Surgery? first appeared on Back in Control.

The post Do You Really Need Spine Surgery? appeared first on Back in Control.

• Connect mainstream medicine with existing science – most symptoms, illness and disease  are created by the body’s physiology (how it functions), and not structures.
• Establish the necessity of a trusting dynamic relationship with your clinician. Feeling heard and safe is not a luxury. They are healing modalities in that they shift physiology from threat to safety. Also, if we don’t know you and understand the details of your situation, how can we make accurate decisions.

Most chronic mental and physical disease is caused by the body being in a sustained state of flight or fight (threat physiology). The fallout of treating most diseases from a structural paradigm isn’t effective and causes harm. It is particularly damaging in spine surgery, and the rates of spine surgery for chronic low back pain continue to skyrocket. It eventually became clear that we were performing low back fusions for anxiety (sensation created by threat physiology) with a success rate of less than 30%.¹

Understanding chronic symptoms, illness, and disease

My efforts evolved out of my own 15-year struggle with chronic mental and physical pain. Most of my approaches failed and then some began to help. As I pursued treatments that worked and abandoned the ones that didn’t, I inadvertantly escaped out of this Abyss in 2003. All 17 of my symptoms resolved and continued to improve. However, I still had no idea why I become ill and why I healed. I was shocked, as many of my fellow clinicians, that the answers have been in literature of over 60 years.

In 1962, two researchers clearly documented that stress causes illness, disease, and early death.² I was aware of this data, but I did not connect the dots. I treated my patients from the paradigm that it was my responsibility was to find a structural cause of pain, and I felt badly if I could not find a reason to perform surgery. I aggressively performed fusions for low back pain for the first 8 years of my practice. When a paper out of Washington State³ showed a success rate of less than 25% for low back fusions for pain, I stopped doing them, but did not know what to do.

The healing journey

My current approach represents what I learned from my struggles, witnessing what helped hundreds of my patients heal, and now understanding the science behind these concepts. The DOC Journey course and app and my other efforts are simply a framework that presents documented science in amanner and sequence that is accessible by patients and clinicians. My vision is to connect medicine with known science of chronic stress causing illness, with the fundamental idea being that the doctor patient relationship is at the core of healing. If a patient can’t feel safe with their health care provider, the rest of the treatments are of limited value.

Many people heal with just these self-directed concepts, but outcomes are always better and more consistent with added resources. This framework is intended to allows patients to take charge their care, the clinician can leverage his or her efforts, and provides a long-term template for ongoing learning and healing. It evolved out of my busy practice with increased efficiency, effectiveness, and enjoyment. It is inspiring and energizing to witness patients emerge from hopelessness to thriving.

An important aspect of these concepts is the clinician learning and implementing these approaches in their personal and professional life. A dynamic working partnership can  then be created when both parties understand these healing principles. These resources are an adjunct and/or foundation for other clinical practices, and not an alternative.

Anxiety is a physiological state

It took me many years to realize that anxiety is not primarily a psychological issue. It is the intentionally unpleasant feeling generated by your body when in flight or fight. Avoiding this powerful sensation is the driving force behind human behavior, and much of it is dysfunctional. We are not taught how to regulate our body’s danger response. Our conscious brain is no match and our efforts to control it create a lot of misery for us and those around us.

It is actually a gift that keeps us alive. This survival warning signal is necessary, and the key is developing a “working relationship” with it. It is what you have and not who you are.

This is an article I wrote for Psychology Today regarding the mental health crises.

Obsessive thought patterns and OCD

Crippling anxiety is what almost took me out. It initially manifested with panic attacks and progressed to severe OCD (Obsessive Compulsive Disorder) for over 15 years. The hallmark of OCD is repetitive intrusive thoughts that for me became quite intense. I had “internal OCD” which consists of a disturbing thought following by a compensatory counterthought. There were no external behaviors. So, I had no idea of what was going on, and there seemed to be no endpoint.

OCD is relatively common,⁴ and variations include nail biting, hoarding, body image disorder, skin picking, hair pulling, and eating disorders. Additionally, many if not most people are bothered by disruptive thought patterns or ruminations, which detract from quality of life. One could also consider addictive behaviors in light of efforts to escape these repetitive unpleasant thoughts. Much of the mental health world views OCD and ruminating thoughts as unsolvable and the approach is to manage them. The missing link is that threat physiology is not being adequately addressed. Half the brain consists of glial cells, which have cytokine receptors and are part of the immune response.  A fired-up brain fires off a lot of thoughts.

My hypothesis is that RUTs (repetitive unpleasant thoughts) are a major driver of chronic mental and physical disease by stimulating sustained threat physiology. Humans are trapped by unpleasant thoughts with the main variables being frequency and intensity. They are a universal function of human consciousness. They may be a significant factor in driving teens to commit suicide, “deaths of despair.” However, I am seeing RUTs create misery in every age group, and as young as 6 years old. RUTs were the main source of my misery followed closely by social isolation.

I no longer suffer from OCD, and I escaped from this Abyss over 20 years ago. I don’t even have the disruptive thoughts I had before I became ill. It has taken many years to figure out how and why I escaped from these obsessive thought patterns. High level achievers are particularly prone to them. This is a link to the section I created on my website that presents my concepts of a solution.

This RUTS section is a rough outline of my upcoming book. Solutions are discussed first and the background of the problem later. There is a large body of research of the mental mechanics of the brain, physiology, consciousness, and effects of stress. I learned a sequence of healing while helping many other people out of this hole and it continues to evolve.

Action needed soon

The burden of chronic disease continues to rise in the US and lifespans are dropping compared to other developing countries. We spend almost four times as much per capita as any other nation.⁵ The business of medicine has essentially kidnapped all of us – clinicians and patients. How can thoughtful decisions be made without patients feeling heard and clinicians not understanding all of the dimensions of their lives generatingthreat physiology (anxiety)?

Performing risky and expensive interventions that are not data-based are causing a lot of harm. “First do no harm.” Individually and as a society, do we embrace this core manifesto or is this just rhetoric? I feel there is some urgency for change as the fabric of our society is coming apart.

Clinicians allied with patients are the only possibility of taking back our medical care. It will require ongoing collaboration from all parties. Whether my resources or another similar set are utilized, we have to treat people in a manner that honors the body’s physiology and capacity to heal. We have the data. Let’s implement what we already know!

References

1. Carragee EJ, et al. “A Gold Standard Evaluation of the ‘Discogenic Pain’ Diag­nosis as Determined by Provocative Discography.” Spine (2006) 31:2115-2123.
2. Holmes TH, Rahe RH. The Social Readjustment Rating Scale.J Psychosom Res (1967); 11:213–8. doi:1016/0022-3999(67)90010-4
3. Franklin GM, et al. “Outcome of lumbar fusion in Washington State Workers’ Compensation.” Spine (1994); 19:1897–903.
4. Carmi, L., Brakoulias, V., Arush, O.B.et al. A prospective clinical cohort-based study of the prevalence of OCD, obsessive compulsive and related disorders, and tics in families of patients with OCD. BMC Psychiatry22, 190
5. Bezruchka S. Increasing Mortality and Declining Health Status in the USA: Where is Public Health?Harvard Health Policy Review [internet]. 2018.

The post David Hanscom’s Mission and Resources first appeared on Back in Control.

The post David Hanscom’s Mission and Resources appeared first on Back in Control.

• There are many different physical and mental symptoms that are possible when you are in sustained flight or fight physiology.
• At my lowest point, I was experiencing 17 of them. No one could tell me what was happening despite seeing many physicians. I suffered for over 15 years.
• The mental pain was the worst part of my ordeal.
• One reason this process has been effective for so many people was that I learned many important details from my own harsh experience.
• My symptoms resolved and I am grateful I can pass along the healing principles.

I was driving across a bridge late one night, when my heart began to suddenly pound at a furious pace. I couldn’t breathe. I was sweaty, light-headed, and I thought I was dying from a heart attack. I was only 37 years old. This was the first of many panic attacks I would have over the next two years. In one minute, I went from being a fearless spine surgeon to experiencing relentless, progressive anxiety. I wouldn’t emerge from this slow spiral into hell for 13 years. What happened and why so suddenly?

The beginning

My first migraine happened on the 4^th of July. I was five and excited because the local fireworks were being set off in the town commons, directly across the street from our house. But as the sun set, my head began to throb and by 10 o’clock I felt like I was being hit with a sledgehammer. The fireworks less than 100 yards away weren’t helpful.

This was the first of 17 symptoms of a stressed nervous system I developed over the next 50 years. My suffering included tinnitus, burning feet, prolonged tendonitis, insomnia, anxiety, Obsessive Compulsive Disorder (OCD), major depression, migratory skin rashes, crushing chest pain, sweats, PTSD, back and neck pain, heart palpitations, light-headedness, and tension headaches. At my lowest point, I was experiencing all of them simultaneously.

The “perfect” family

My father was a family doctor in a small, New England town. He was highly respected and appreciated. My mother was active in many local activities. I was the oldest of four children, with two brothers and a sister. People would often comment on our  “beautiful family.” We were – from the outside.

Inside our house, my mother was in an intense rage most of the time. She was physically and verbally abusive to me and my three younger siblings. My father wasn’t around much, and he didn’t comprehend the full extent of the situation.Since this was all, we knew, we thought this was what life was supposed to be like.

Interestingly, one of the few things that would cut her anger short was one of my migraines. She would instantly become a loving and nurturing mother, placing cold compresses on my forehead, and keeping everyone quiet.

My new identity

When I entered high school, I felt a deep shift. I was increasingly aware that my family life was not ideal, and I decided that I had had enough. I “shut the door” on my past

Although I still lived at home, I mentally separated from the chaos. I embarked on a quest to create a new identity. I became an excellent student, trumpet player, hard worker, leader, and athlete. During my junior year in college, I took 18 to 21 hours of credit every quarter, worked construction 10-20 hours a week, played sports, had an active social life, ran for student body president, and pulled off a 4.0 GPA. I was having the time of my life. I wasn’t sleeping much.

I continued to graduate from medical school with honors and was accepted in a competitive orthopedic residency in Hawaii. With a great wife, a home in Hawaii, and a promising career, I thought I had it made. I was unaware that I was keeping busy to outrun my past and I had also become a master at suppressing unpleasant emotions.

I completed two years of internal medicine residency before I entered surgical training in Hawaii. Most orthopedic residents undergo a couple of years of general surgery residency before specializing and are comfortable in the operating room. I had never made a skin incision or even knew how to tie a knot. However, handling stress was such a core part my existence, I did not feel it. I was wrapped up in my identity of being “cool under pressure.”

I noticed that my feet burned while I was jogging, which I thought was due to the warm, Hawaiian pavement. My migraines were more frequent, and I had a reoccurrence of warts over both of my hands. One afternoon, while in a weekly orthopedic conference, I noticed some vivid, intrusive thoughts entering my mind. I didn’t think too much about it, but I felt a bit unsettled. Still, I was on top of the world, enjoying my family, learning, and living in a paradise.

Stress

The wheels started to come off when during my post-residency spine fellowship at one of the top programs in the world. It was not as physically demanding as the rest of my residency, but the expectations were extremely high. My migraines were occurring every other week, my ears started to ring, while my feet continued to burn. I pushed through it all.

My “iron man identity” continued to evolve. It seemed that I could handle an unlimited amount of stress. It was my badge of honor. The obstacles I encountered in private practice dwarfed any prior challenges in my training. I recall sitting at my desk one night after working yet another 14-hour day. A patient had developed a serious postoperative wound infection. Another one had gotten into a fight with a security guard. I discovered I wasn’t getting a paycheck that month because of the high office overhead. My mindset was, “ Bring it on.”

A few weeks later, I crashed with the panic attack.

It was only the beginning

Little did I know how severe these symptoms would become and how many more would occur. Skin rashes popped up and disappeared all over my body, my scalp itched, my nightmares became more intense, I had deep aching pains in my upper back, and intermittent crushing chest pain.

There were other terrible aspects of my ordeal. I am a social person and since I didn’t feel great, I quit spending as much time with my friends. The loneliness was crushing. No marriage could have survived all these untreated symptoms because I was often not in a great mood. I worked at hiding it from almost everyone.

As my family disintegrated, I descended into a full-blown obsessive-compulsive disorder (OCD). I had the internal version, which is experiencing vivid intrusive thoughts, that I would then try to counter with “good” thoughts. I was in an endless, unwinnable battle and my thoughts progressed to disturbing impulses. Along with my many other symptoms, I was in bad shape. I then made the mistake of reviewing some articles on OCD and discovered that the prognosis was (and still is) poor. The best outcome would be to somehow manage or diminish the symptoms with medications or behavioral therapy. I became totally despondent. There was no escape and I sunk into a major suicidal depression. Still, no one could explain to me what was going on or how to solve it

Penetrating the facade

I now understand that major life changes, especially around family dynamics, create more stress and symptoms. The stresses can be positive or negative. The problem with major family events is that they penetrate the façade, and I had been working on mine for decades. A major shift in my symptoms occurred with the birth of my son. My divorce was disastrous. The burning in my feet increased to the point where they felt like they were in a toaster oven. The ringing in my ears was intolerable, I couldn’t sleep, all my other symptoms worsened, and the unrelenting anxiety was the worst part of my ordeal.

I pursued many self-help books, took medications, saw other physicians, underwent multiple diagnostic tests, and aggressively pursued psychotherapy and counseling. I was both open to anything and desperate.

I would’ve thought that meeting my current wife would have been the answer to my suffering. We had an instant connection and I fell in love – except it felt like I was falling off a cliff. I lost more control. When I mustered up the courage to tell her that I was in love with her, she thought I was going to tell her that I had terminal cancer. My suffering dramatically worsened, and I was beginning to seriously give up. No avenue of treatment was working. I had no hope.Slowly, things changed. I escaped the grip of chronic pain in 2003 and continued to gain a deeper understanding of the problem, as well as the principles behind the solutions.

Recap

One reason that the concepts presented in Back in Control  have been helpful for so many people is that they evolved from my prolonged suffering. Almost everything I tried failed, and when I experienced the faintest glimpse of a way out, I kept building on it, step-by-step. Not only I am I doing well, but I am thriving. It is my  privilege to share these strategies with you and be a witness to your healing journey.

Chronic pain has multiple manifestations. Each person has a different experience and must find their own way out. But contrary to common perception, chronic pain is a solvable problem. I am one of the success stories.

The post My Descent Into The Abyss first appeared on Back in Control.

The post My Descent Into The Abyss appeared first on Back in Control.

Disneyland

While in medical school, I was at Disneyland with several of my friends. I had been there many times and one of my favorite rides was “Pirates of the Caribbean”. I enjoyed the music, art, and the general excitement of it all. The sensation of quickly sliding down to the next level in a boat was also a lot of fun. For some reason, I suddenly looked at the pirate scenes more closely.

“Pirates of the Caribbean”

As we entered the large room with a captured ship, there was a terrified bound woman getting ready to walk the gangplank. Behind her, several pirates were gleefully observing while getting the next victim ready. The scene of the captured town in flames showed a group of young frightened women on a platform being auctioned off to the highest bidder. Three or four women were being chased around the burning buildings attempting to escape their pirate pursuers. Several pirates were lying on the ground drunk, disinterestedly watching the whole scene. Another prisoner was trapped in a burning jail cell trying to persuade a dog to come closer, as the dog had the keys to the cell in his mouth.

We entered the main pirate’s lotto, which had piles of loot scattered everywhere. There lay the drunken captain, lounging in the midst of it. Many personal items were depicted in the middle of the mass of treasures.

“Pirate’s Cove”

Many years ago, I was in New England on a family vacation. We were playing miniature golf at a “Pirate’s Cove”. I looked up and there was a cage that housed prisoners until they starved to death. On each hole there was a continuing story about Captain Blackbeard. Part of the tale involved his marriage to his 12^th wife who was 16 years old. The governor of the state attended the wedding, as it was a major societal event.

Why?

What is it about pirates that we admire and romanticize so much? What characteristics should we embrace? The aspect I find particularly disturbing is that their terror is guised under the cloak of light fun and entertainment. This exposure begins in childhood for essentially all of us.

They rob at will. They not only just kill their victims, they often use perverse methods of torturing them to death. What is admirable about raping and selling women and children? The prisoner potentially being burned alive did not seem much of a concern to them. Why did the governor of a Southern State attend the marriage of a brutal older man to an underage girl? Why did I need to learn about that story while enjoying an evening of miniature golf with my family? Society has frowned on divorce for centuries. What about 12 marriages?

Do we admire what the Nazis did to their prisoners? Are their unspeakable deeds minimized in children’s rides or miniature golf courses?

My relative as a pirate prisoner

In the late 1700’s, I had a distant relative who was captured by pirates. My genealogist brother researched the story. He was one of 30 prisoners that were allowed to live, but they were enslaved. The conditions were so harsh that after three years only three were left alive. Thomas Jefferson finally paid his ransom. He was so brutally treated that he was disabled for the rest of his life. He passed away a few years after his ordeal. Another entire Hanscom family was murdered in a different pirate raid.

Packaging evil deeds in fun – normalizing abuse

It’s my feeling that when horrible deeds are packaged and presented in a way that minimizes the severity of their effect, it has a corrosive effect on who we are as humans. It becomes easier to ignore things around us that are unacceptable. Verbal abuse would be one of those amongst an infinite list.

Might this be confusing for children? They are taught to treat those around them with respect, yet simultaneously are being presented with the idea that being a pirate would be somewhat of the ultimate dream – freedom to do whatever you want to whomever you want without consequences.

I have worked with a medical system in Alaska that provides high quality medical care to a population of Native American Indians. They have recognized that abuse of any kind is detrimental to one’s health and the data is clear that an abusive upbringing is associated with poor mental and physical health. They have committed to eliminating abuse within this generation and have developed a remarkable infrastructure to address the problem. Several of the programs are focused on victims telling their stories. What I had not realized was the severity of the abuse and it is so common that in many villages it is the norm. The population had become de-sensitized to the problem although they weren’t de-sensitized to the suffering. It’s a terrible cycle. Bringing the abuse into awareness through telling their stories has been a major step in defining the problem and solutions are being implemented. Awareness is always the first step in solving a problem in any domain.

Aced out

Awareness of suffering

I have become acutely aware of my own suffering and those around me. It was a rough experience that brought me to this awareness. It is now clear to me how violence mixed with entertainment contributed to my inability to really appreciate the depth of others’ pain. Do you find pirate tales and violent movies entertaining? I did for much of my life.

Chronic pain is misery that is endless. Put yourself in the shoes of those poor pirate prisoners and imagine how they must have felt. Consider the suffering of other people around you who are in chronic pain. There are plenty. In the U.S. alone there are over 100 million people in chronic pain.

Awareness

The first step of reprogramming your nervous system is awareness. There’s nothing noble about pirates or the suffering they inflict. Become aware of how becoming desensitized affects your connection to the pain of those around you. If we are to evolve, issues such as these must be addressed both individually and as a society. Calling out the damage inflicted by packaging bad behavior under the guise of entertainment would be a significant concrete step.

The post Romanticizing Pirates – Normalizing Suffering and Abuse first appeared on Back in Control.

The post Romanticizing Pirates – Normalizing Suffering and Abuse appeared first on Back in Control.

Objectives

• Providing yourself with cues of safety is essential to healing. However, your body instinctively gravitates towards being aware of threats.
• Even when life is good, your brain is constantly scanning your surroundings (including your consciousness) for danger. It is your “personal brain scanner.”
• As disruptive as anxiety is, it is your protector and gift of life. You are not going to get rid of it or transform it into a pleasant sensation.
• Efficiently dealing with it daily allows you to nurture joy and live the life you wish.

Abraham Maslow was a prominent psychiatrist who looked at the human condition in terms of the hierarchy of needs.¹ At the base of it were basic physiological needs such as food, air, clothes, water, heat , sleep, sexual intercourse, light, hygiene, shelter, urination, and excretion. Without these basics being met, it is unlikely we can or will pursue the higher levels of needs with the top being self-actualization.

What he didn’t mention was that “not being in pain – mental or physical” is not only a foundational need but it is a driving force for most human behavior. People will do almost anything not to feel anxious and vulnerable. It is bi-directional in that lack of the above-mentioned resources will clearly create anxiety and meeting those needs will help lower it. I again want to acknowledge the depth of suffering that occurs in this scenario, and it is almost impossible to pursue a healing journey under severe adversity.

Stress = threat

However, if these needs are being met, then stress (threat) is not the problem. It is the reaction to it that creates so much chaos within you. Avoiding stress doesn’t work and becomes its own stressor. Remember the most impactful stresses are the ones you cannot control. So, that is why learning how to lower your threat physiology through the different portals is so critical.

The metaphor of a bathroom is relevant because you cannot get rid of anxiety and survive. It is part of everyday life. It is important to develop a “working relationship” with it and let it do its work. So, it is a matter of processing life every day, dealing with the waste, and visiting this room as many times as you need to. If your stress reactions build up without an outlet, you will eventually become ill.²

As you learn to develop this relationship with these emotions as opposed to fighting them, you’ll become more skilled in processing them, and your reactions will become fewer and less intense. There are three aspects of lowering this neurochemical inflammatory reaction.

• Separate your identity from this response. It is what you possess, not who you are! It is also universal and there is no reason to take anxiety personally.
• You can directly lower these hormones and inflammatory markers with tools such as humming, breath work, nasal breathing, and calming sounds.
• By stimulating neuroplastic changes in your nervous system, your automatic reactions are less disruptive, and the real healing comes from the creation of new circuits that are pleasurable and creative. There are infinite possibilities and the metaphor of building your new home is a foundational framework.

Emotional flexibility

One solution to dealing with anxiety is control. It is what this sensation is intended to do – be so unpleasant so as to compel you to solve threats – and it works. You are alive and reading this lesson. However, since mental and physical threats are processed in a similar manner, and humans can’t escape their consciousness, we are all trapped by our thoughts to a greater or lesser degree.³ Most of us instinctively fight disruptive thoughts and feelings, but this only reinforces them.

The other strategy, which is actually fairly effective is mental and emotional rigidity. If you train your mind to focus and become immersed in any number of belief systems, your mind is occupied, and unpleasant thoughts are largely “pushed aside.” The beliefs can take any number of different forms such as religion, politics, strong opinions about morality and people who are different than you. What is problematic is that humans are programmed by their own lives and infinitely unique. None of us see anything exactly the same way – even solid objects. Rigid thinking works quite well for decreasing anxiety for the person, but not for those around him or her. You have lost awareness of the needs of others and pigeon-holed them into your way of thinking.

One definitive solution for anxiety is giving up the need for control. In other words, you must learn that anxiety protects you, and is the gift of life. It is also why you have to separate your personal identity from this reaction and develop a “working relationship” with it. It is never going to be a pleasant sensation, but as you become more “emotionally flexible” you’ll learn to tolerate, even become comfortable with it. It needs to be processed daily, all day long.

Emotional perfectionism is a problem. You monitor your progress, feel like you have” failed” if you dive back into being anxious or angry, and your self-critical voices start talking to you. You are now a victim of these thoughts (and you really are), and you are not going to outrun them. Even if you can for a while, they are relentless and will wear you down.

Recap

Anxiety is a physiological state. Glance though the lessons in Leg 3 of this course. It is challenging to deeply change your concepts of anxiety. Most of us are raised to feel that this is a psychological issue and if you are overwhelmed by it, you are not tough enough. “If you can’t take the heat, get out of the kitchen.”

Nothing could be further from the truth. Suppressed anxiety is a disaster, causes damage to the memory center of your brain,⁴ and disrupts every aspect of your life. You are so used to doing it (who taught you otherwise), you may have no idea that this is what you are doing. Being “tough” was at the core of my own descent into The Abyss.

The main focus of The DOC Journey is learning ways to methodically become aware of and process anxiety and anger so you can live a life that reflects who you really are. To have a good life, you have to live a good life. However, this also requires learning how to efficiently separate from and deal with your survival reactions. Being anxious or angry isn’t good or bad. It is life.

 Questions and Considerations

1. Emotional pain hurts. Why would we want to feel that pain? We don’t. However, learning to live with it is essential to healing.
2. Anger effectively covers up feeling vulnerable, which we instinctively dislike. No one EVER wants to give it up, and we can’t. It is another factor in becoming emotionally flexible.
3. It is difficult to understand the necessity of anxiety and anger and also be aware of its impact on you and your life. These emotions preclude awareness and the reason why specific skills are required to break through this catch-22.
4. De-personalize these sensations and develop skills to deal with them. You must let go to move forward.

References

1. Miles Vich. Maslow’s leadership legacy. Journal of Humanistic Psychology (2008); 48: 444–445.
2. Smyth J, et al. Stress and disease: A structural and functional analysis. Social and Personality Psychology Compass (2013); 7:217-227. doi:10.1111/spc.12020
3. Eisenberger NI, et al. An experimental study of shared sensitivity to physical pain and social rejection. Pain (2006); 126:132-138. doi:10.1016/j.pain.2006.06.024.
4. Hulbert JC, et al. Inducing amnesia through systemic suppression. Nature Communications (2015); 7:11003. doi: 10:1038/ncomms11003

The post Processing Anxiety/ Frustration – They are not Going Away first appeared on Back in Control.

The post Processing Anxiety/ Frustration – They are not Going Away appeared first on Back in Control.

• Social isolation is both a contributing factor to anxiety and also a result of it.
• When you are suffering, it is challenging to reach out to others in a meaningful way.
• The physiological effects are devastating, with significant mental and physical consequences.
• It even affects the expression of your genome (DNA) in forming aggressive inflammatory cells that destroy your own tissues.
• The loneliness and isolation that many people experience is one of the worst aspects of the whole experience of dealing with chronic illness.
• Conversely, reconnecting with your family, friends, and colleagues is a powerful force for healing.
• The catch-22 is feeling good enough to begin reaching out. It is one of the reasons that there is a sequence to the healing journey. Each person is ready at a different point along the way.

Loneliness and social isolation may some of the worst aspects of suffering from any chronic illness. Over 50% of Americans are socially isolated regardless of where they live or the size of the town or city. It is ironic in that social isolation is such a significant contributing factor to poor health in this modern era. It is also dangerous. It is estimated that the effects on one’s health is equivalent to smoking about 15 cigarettes/ day.¹ Sadly, the age group that is the most affected are those in college and in their 20’s. This stage of your life has the potential to be the best of times.

 Consumed by suffering

When suffering from crippling anxiety and other physical symptoms, you spend a lot of your conscious hours looking on the Internet, seeking medical care, trying different treatments, and discussing your problems with anyone who will listen. Why wouldn’t you? Your life has been consumed and you want it back. Unfortunately, in spite of your best efforts to move forward, from a brain development and physiological perspective, you are moving the wrong direction. Here are some of the effects:

• Unpleasant circuits in your brain are reinforced.
• Pleasant one become less active with disuse.
• You drive people away that you used to have fun with and bond with others who are in a similar condition.
• Eventually, many people are so drained from the endless battle with their suffering, they become isolated, even in the midst of their own family.
• Oxytocin is a hormone that causes social bonding and is also powerfully anti-inflammatory. Lack of connection drops it down and your inflammatory state becomes even higher.

Some data

The effects of social isolation are deep. They go right down to the expression of your DNA directing the production of proteins that are the essence of life. There are about 20-30 genes that effect the production of certain white blood cells called monocytes. White blood cells are at the core of fighting foreign material in your body, including cancer cells, viruses, and bacteria. There is an over-active form of them called, “warrior monocytes” that are too aggressive and also attack your body’s own tissues creating many diseases states and symptoms. Anxiety is one of these inflammatory states. The most powerful factor causing the creation of these cells is social isolation. The second factor was chronic stress (anxiety).²

Dr Dantzer wrote an extensive review paper³ looking at the social influences on inflammation. There are many factors that affect inflammatory markers, and he presented the top four factors that lowered inflammation.

• A sense of control
• Hope/ optimism
• Positive affect/ attitude
• Social connection

Humans evolved by having language and being able to cooperate through social connection. It is the reason we are so tribal, and unfortunately, we haven’t evolved enough as a species to view every person as part of the human tribe. There is an evolutionary basis for excluding groups of people, as we compete for resources. That being said, social connection is a deep need, and it is expressed in your physiological state.

Another paper out of UCLA reported on a study where a volunteer was placed in a special MRI scanner called a functional MRI (fMRI). It highlights area of increased brain activity. The volunteer then played a computer-based video game where he or she was in a game of three-way catch. The computer was programmed at a certain point to exclude the volunteer and the ball was “tossed” between the remaining two players. The volunteer did not know the other two players were just the computer. Guess what? Even though it was just a computer game, and the volunteer could not physically see the other players, the centers of the brain that are active in chronic physical pain lit up. In other words, emotional pain is processed in a similar manner. ⁴

The catch-22 of social isolation

I will only say that becoming socially isolated and feeling lonely was one of the worst aspects of my 15 years of suffering. The only word that slightly described the feeling was, “crushing.” I began to experience deep self-deprecating thoughts that revolved around, “why would anyone want to hang around with me?”, and “I don’t have anything interesting to say.” These thought patterns were endless. This occurred despite me generally being very social person. Just the feeling of being lonely felt like an Abyss and was paralyzing with regards to re-engaging. I really could not see an end to it.

Healing

I noticed very early on that my patients would check off, “re-engaging with family and friends” as part of their healing. Social interactions are tricky in that you be rejected sometimes and hence one of the reasons people have social anxiety. It is greatly magnified when you are already experiencing chronic mental and/or physical pain. So not only do you not have the energy to reach out to others, feeling inadequate may also contribute. Here are some suggestions.

• Be kind to yourself. You are doing the best you can.
• People who you used to be friends with may not have as much in common with you and you may be rejected.
• Others you have bonded with through your pain may also reject you as you heal. You are no longer validating their suffering, and as you heal, they are confronted with their own inability or unwillingness to pursue the same journey.
• So, the first step in returning to a normal life, is to be prepared for these kinds of interactions.

Then just move forward in any way that you can.

• Call old friends or family members. Many of them are in the same condition you are. It is remarkable how common it is to be trapped by anxiety and pain. However, as mentioned many times, conversations around these topics are counterproductive for all parties.
• Re-engage with old skills such as art, music, and hobbies.
• Read interesting books or watch inspiring movies. They are great topics for conversation.
• Join a club. You don’t need to be an expert. There are numerous choices such as birdwatching, Scrabble, ping pong, book, movie, and history clubs, walking with friends, and music.
• Find ways to give back and there are endless options. One of my successful patients was “trapped” in a nursing home and spiraling back down into the Abyss. She decided to become an advocate for other patients who had dementia. Within a few weeks, her whole mood and outlook dramatically improved.

Recap

Loneliness is crushing and both a contributing factor to chronic illness and also a result of it. A significant aspect of healing is reengaging with those around you. What makes this all the more difficult is that while you are suffering, you may not have the interest or energy to reach out to others. Then if you are still in the mode of discussing your troubles, you will push people away who can nurture you, or attract others who are also frustrated with their suffering, and they will pull you deeper into The Abyss. This cycle is deadly.

That is why you must empirically make decisions to keep reaching out and connecting regardless of how you feel. You will feel awkward, especially when you have taken medical conversations and complaining off of the table as topics. The connections can be as simple as a phone call, reaching out to old friends, or joining a book club. The key is doing something – anything to reach out and break out of your patterns.

Humans and language evolved through language and social connection. It is one of the most basic of needs. Actively reaching out and giving back is a powerful move to stimulate your brain to rewire and heal. To have a good life, you must live a good life. It requires practice.

 Questions and considerations

1. You might be sitting here and feeling overwhelmed by the thought of even trying to reach out. That is OK and understandable. You can’t just flip this one around on a dime.
2. Just do something. Anything. You have heard the term, “baby steps” many times.
3. The problem is that when your brain has been barraged with negative thought patterns, you may feel people may not want to be around you. That is a classic common cognitive distortion of, “mind reading.” Maybe they don’t and you also have to be OK with that. Maybe they are in the same situation as you are and don’t have the energy to engage.
4. I can personally vouch for how distorted thinking patterns become from my own experience. For a long time, even after I was much better, I was still quite self-conscious.
5. Humans evolved by interacting with other humans. Somehow, re-engaging with life has to be part of your healing journey.

References

1. Cigna US Loneliness Index 2018. Report published by Cigna Insurance Company.
2. Cole SW, et al. Social Regulation of gene expression in human leukocytes. Genome Biology (2007); 8:R189. doi: 10.1186/gb-2007-8-9-r189

3. Dantzer R, et al. Resilience and immunity. Brain, Behavior, and Immunity (2018); 74:28-42. https://doi.orgl/10/1016/j.bbi.2018.08.010
4. Eisenberger N. “The neural bases of social pain: Evidence for shared representations with physical pain.” Psychosom Med (2012); 74: 126-135.

The post Heal by Connecting with Others first appeared on Back in Control.

The post Heal by Connecting with Others appeared first on Back in Control.

“Don’t turn the ball over!”

Which brings us to the Golden State Warriors, who have become an NBA basketball dynasty. There are many facets to winning a game, involving strategies and skills that are well beyond my comprehension. However, one aspect of winning is minimizing the number of times you turn the ball over. Each time you turn the ball over, you open the door to making a bad pass or having the ball stolen by the opposing team. But it also involves a different energy than free throws, shooting, conditioning, and ball handling. There are many factors causing ball turnover; it always means less control.

The Warriors are legendary for their ability to move the ball around quickly, and you would expect a higher number of turnovers. It was a topic prompting discussion in multiple public forums, and decreasing turnovers must have been a focus of the team. However, something I read in the newspaper one day caught my attention: The Warriors had decided to quit worrying about turnovers and just play.

It was inspiring to watch their performance improve. Not long after, they went on to win the NBA championship.

Their experience is a classic example of “the ironic effect.” Trying not to think of something not only causes you to think about it more, but it also sets off a documented trampoline effect, you’ll think about it a lot more. Focusing on the highest level of performance is much different than “not trying to make mistakes.”

Skiing “not to lose”

My son is a world-class mogul skier and won the Junior Nationals championship in dual moguls two years in a row. He then hit many rough spots, including multiple significant injuries. One of them was a high-speed fall than caused his left shoulder to dislocate. He was moving so fast that he thought he was going to die as he hit the snow and narrowly missed a tree. He lost some of his edge of being infallible. He didn’t quit; he began skiing, “not to lose.” Of course, at that level, you also can’t win. His efforts to improve kept getting sabotaged in spite of an incredible commitment to conditioning and practice. In the midst of a few more injuries, including nine concussions, he really struggled.

He engaged the expertise of an athletic performance coach, David Elaimy, with an emphasis on connecting with one moment at time and visualizing what he wanted to accomplish. He also understood the powerful effects of expressive writing, writing down thoughts then destroying the paper they’re written on. It is the one exercise that breaks up the need for mental control, which is the driving force behind the ironic effect and repetitive thought patterns.¹

As he stood at the starting gate for his last attempt at qualifying for the U.S. ski team, my son carved in the snow  the word, “fail” with his ski pole, then trusted himself to execute what he already knew how to do—ski at the highest level. He went on to ski the best run of his life and qualified for a shot at the Olympic Freestyle team. For other reasons, a skier who finished below him was chosen for the team. But he did it. He broke through and performed to his potential under extreme pressure.

What does this have to do with pain?

There are two separate but tightly linked areas of expertise involved in resolving mental and physical pain.

One is learning how to process stress by developing a “working relationship” with your powerful survival fight-or-flight response. By learning the tools to stop fighting it, you can place your attention on what you want to accomplish.

The other is learning to nurture yourself and actively create the life you want. Few of us have been taught these skills.Your nervous system and body’s physiology will shift from an activated defensive state to that of safety, with profound benefits to your mental and physical health.

Winning is not the same as “not losing”

By trying “not to turn the ball over,” your powerful unconscious brain is trying to help with that effort, but it is also taking attention and energy away from what you desire. Focusing on what you want to accomplish is a more effective way of enjoying your life.

I have no idea whether the Warrior’s coaching staff was aware the ironic effect. I am even not sure whether turnovers dropped much. But the switch likely allowed them to focus more attention on execution.

Successfully dealing with ironic effect has a major influence on people’s quality of life. I have witnessed hundreds of people heal. that way. Deep healing cannot occur while you are in a sustained defensive mode, in fight or flight. Life is meant to be more than just surviving. Becoming a “professional” at living your life allows you spend less time feeling stressed, and decreases your exposure to fight or flight physiology. To win, you must practice winning.

References

1. Wegener DM. The Seed of Our Undoing. Psychological Science Agenda (1999)/ 10-11.
2. Wegener, D.M., et al. Paradoxical effects of thought suppression. Journal of Personality and Social Psychology (1987); 53: 5-13.

The post The Golden State Warriors and the “Ironic Effect” first appeared on Back in Control.

The post The Golden State Warriors and the “Ironic Effect” appeared first on Back in Control.