• Most of us have become so used to solving problems and just making ends meet that we have lost sight of what we really want out of life.
• It is impossible to move forward without some idea of where you want to go.
• View you and your life as a “business” and what do you want to achieve in your life, regardless of the pain.
• By executing any part of your plan, you are moving away from your pain and into a more enjoyable life.

It is the norm for most of us to run our lives by continually fixing problems. We not only get worn down, but we don’t have the pleasure of achieving our dreams. A friend of mine uses the term “surviving and fixing” to describe this approach to living life. He challenges himself and his audiences to develop a “vision of excellence” regarding their own lives. Create the vision of where you want to be and then break it down into doable steps.

Your business plan

Here is a suggested template that to develop a “business plan” for your life. Visualize yourself as a small business trying to accomplish specific goals. Instead of having a nagging sense of not doing what you really want, clearly define the variables. You could also use a more complex small business template and be more specific.

Self-Inventory Template

Overview of self today:

Core Values

• Self
• Family
• Friends
• Career
• Finances
• What brings me joy?
• Giving back

Character – be honest with yourself on both accounts. None of us are perfect, and I have long said that if all of us have “flaws”, why do any of us have flaws?

• Strengths
• Flaws

Skills

• Highest (expert)
• Strong (Competent and can contribute)
• Moderate  (competent)
• Light (participant)

Dreams

• Minimal or no skill but strong interest

Where do I want to be in five years?

• Overview
• Specific areas
  • Self
  • Family
  • Friends
  • Career
  • Finances
  • Hobbies/ travel/ enjoyable activities
  • Giving back

Action Plan

• Each area
  • Specific steps
  • Time frames

My concept of an action plan has changed over this last year. I historically have put time frames around my projects. To a large degree, it has been helpful and also a step to consider. However, one of my mentors who is an incredibly successful businessman counseled me to write down my projects/ vision, then ask myself if I am thinking big enough? Then he said to take time out of the equation because it only creates more anxiety. It is concept that I am still trying to figure out, as I have been so process oriented.

I would venture to say that in the context of being in chronic pain, that removing time from the process is a good idea. He is right about the anxiety factor. It is inflammatory, drains your energy, and you are less apt to achieve your vision.

What about the pain?

The key to this template is to create it without regards to the status of your pain. What do want to do with your life, with or without the pain?

Then create a focused plan regarding your chronic pain. You clearly have been seeking treatment for a while, sometimes for decades. Now that you understand the specific aspects of pain, break out the ones that are relevant to your life, and create an action plan for each and all of them. The more organized you can become, the more effective you will be in solving it. Without a plan, you will remain a victim of a disorganized health care system. Don’t let that continue to be your reality.

One of the cardinal rules of healing is to minimize your time talking about your pain and medical care. This is still a core concept. However, creating an action plan around your pain and medical care is the opposite energy. Instead of being at the mercy of the circumstances, you are taking control, which also happens to be anti-inflammatory.

Recap

You have heard me present the idea of moving forward with or without your pain many times. It is challenging to implement this because you have been so used to being trapped by the pain and your circumstances. You may be thinking that I don’t really understand the depth of your suffering, and I don’t. I am not you and only know that the extent of my suffering was severe and that there is only one choice. You must move away from your pain circuits and forward into the life you want in order to get there. We clearly know that first trying to “fix “your pain means that your pain is running your life and it is being reinforced. Besides, since mental pain is the bigger issue for most people, there is not an end point. Life keeps coming at all of us. You are learning strategies to process stress more efficiently so you can move on. But you have to move on.

Questions and considerations

1. This step of taking the time and effort to create a plan for your life is a bigger step than you might think. The essence of healing is creating a shift in your brain from your pain circuits onto more enjoyable ones. That doesn’t just happen.
2. Have you ever considered your life in terms of running a business?
3. Even if you are completely incapacitated with pain at this moment, please spend a few minutes a day with this process. Any movement forward will help.
4. Your life has been at the mercy of others for a while. What would it feel like to regain control?

The post Create Your “Personal Business Plan” first appeared on Back in Control.

The post Create Your “Personal Business Plan” appeared first on Back in Control.

• It is easy to become focused on problems to the point where you forget what you really want out of life.
• Most of us complain about problems – our own, other’s, society’s,, and the those of the world.
• But what do you want? What is the vision of your life? How do you want to achieve it? What is your time frame?
• Or are you so used to complaining, that you have lost sight of all of this?
• Unfortunately, this mind set fires up your immune system, sensitizes your nervous system, and physically increases your mental and physical pain.

One of the most important aspects of healing is our life outlook. Realistic and positive goal-setting is a core aspect of stimulating constructive neuroplasticity. Your brain will develop wherever you place your attention. It is up to you to decide what you want your life to look like, what you want in it, and then pursue those dreams. Otherwise, you are still focused on the problem, not the solution.

I asked each patient exactly why they were seeing me and what they wanted. Of course, the answer was usually, “I want to get rid of my pain.” It is an understandable request, but it doesn’t work. One of the paradoxes of healing is that you can’t fix yourself. The solution lies in moving away from neurological pain circuits and into the life you desire.

It is critical to connect with your personal life vision, regardless of the level of your pain and suffering. How else will you be able to move forward?

“It’s always something”

There are always significant obstacles to achieving what you would like. When you are young, it is lack of knowledge and resources. Then you are deeply enmeshed in your education and training. You may have started a new family. Finances frequently require “giving up your dreams” in order to just make ends meet. Life keeps coming at us and our hopes become ever more buried. The added burden of physical and mental pain further compounds the suffering.

If you think about the big picture, we all have a lot of dreams, but we seldom execute to attain even a fraction of them. What happened?

It is not true that people stop pursuing dreams because they grow old.                                        

They grow old because they stop pursuing their dreams.

Gabriel Garcia Marquez

I agree with this quote except I have a different take on it. People grow old because their dreams are crushed by anxiety.

A vision?

We are so programmed to survive that we don’t understand the importance of creating a vision and then following through on it. And where would most of us have learned this skill? It would have been helpful to have been taught this early in our educational experience. Since we are not able to effectively process our stresses, we are trapped, anxious, and angry. It might even seem normal – except that we eventually may get crushed by it all. Positive thinking won’t break you out of this powerful cycle.

It is important to first free yourself from anxiety by developing a “working relationship” with it. It is necessary for survival and a gift. It is learned set of skills. Then you can move forward, and your creativity can emerge. But this is still not enough. What is your vision? What brings you joy? What do you really want out of your life?

Assume that your life is a “business” and that there are certain short and long-term goals you would like to achieve.  As with any business start-up, the chances of success are low without a written plan – the more detailed the better.  Outside input and discussions with involved parties adds important dimensions. Creating a personal business plan is a step that will help you achieve your goals.

Some starting questions

Where am I now?

Where do I want to go?

How am I going to get there?

Dare yourself to dream again and be realistic about what is possible. Then do it.

Where am I now?

Don’t pull any punches with this one. If you are engaged with this course, chances are that your quality of life has been crushed. Get every aspect of your misery out on paper, then organize it into categories, and don’t tear this up. Then redo it and get more focused. You have to understand the magnitude of the problem as well as the specifics before you can solve it. Also remember that the healing journey is rooted in connecting to you and your body’s capacity to heal. What is inside of you, being trapped in pain, is a lot of negativity. You must connect with it and stay connected with it. Hope comes from learning to tools to navigate out of this mess and not from positive thinking. Embracing your skepticism is the starting point.

People often respond with the idea that they can’t move forward because they are in pain. That is true, and why the early part of the healing journey is focused on ways to break loose to move forward with or without the pain. You cannot “fix” your pain. The solution lies in moving away from it and into more functional and pleasurable neurological circuits.

Break your misery into its components. There is the mental and physical pain. What are activities that you can no longer do? How is the medical system not meeting your needs? What is the effect of your pain on your relationships and work? How much are you enjoying sitting around the house and being at the mercy of disability system? Is this the way you want to live the rest of your life?

Where do I want to go?

This step is more difficult than the first one. You may be so consumed by your pain, that all possibilities seem to be gone. But go big! This is just an exercise that you’ll eventually bring to life. It isn’t possible to jump from chronic pain to the life that you want. But on the other hand, there is no chance of attaining the life you desire without having an idea what that looks like.

Take pain out of the picture. Getting rid of your pain cannot be one of the goals. Life is unpredictable. Pain comes at you in many unpredictable ways. You’ll develop skills to process adversity more effectively, but it will always be a part of your life. If you choose to remain upset by life’s challenges, your body will remain inflamed, and you’ll continue to suffer. Look at obstacles as opportunities to practice your skills and move forward. This is not positive thinking; it is a positive vision.

Be specific and apply your vision to all aspects of your life.

How am I going to get there?

No vision will be accomplished without a plan. Again, look at the various parts of your life and what would you like to achieve in each arena regardless of the pain? Every plan needs to be executed and there are always obstacles. Part of the “how” is surmounting them.

You now have to pull mental and physical pain back into the picture as one of the obstacles. It is there, your life is being adversely affected, and what steps are you going to take to break free from it? Each person is unique and will find their own way. Even though you must move forward in spite of your pain, maximizing your treatment is a necessary part of your plan.

This is the place where you look at pain and decide on your relationship to it? If you choose to remain a victim of it (and you are), you are stuck. If it just another obstacle to be dealt with, you are on a strong healing path.

Recap

As you stimulate your brain to change (neuroplasticity), you can direct your brain to create and move into enjoyable circuits. Similar to learning a new language, this just doesn’t happen by continually trying to fix your problems. You have to practice living a more enjoyable life in order to have a more enjoyable life.

We all know how to complain. Who doesn’t? Unfortunately, the biggest obstacle to healing is that many people do not want to give up the power of pain, in spite of their misery. It took me many years to see this, and it is sad.

What do you actually want? Do you want to hold on or move forward? You can’t do both. Once you attain clarity and create a plan, you have a high chance of achieving it and thriving. A suggested template to create your personal business plan is part of this leg of The DOC Journey.

Questions and considerations

1. Have you considered that you have been suffering for so long that it seems normal to you? This is especially true if you were raised in an abusive home situation.
2. Surviving and fixing is our default mode. It is instinctual and powerful. Why would we even consider other options?
3. Anxiety and anger are powerful and dealing with these emotions dictates much of our behavior. It is why you must simultaneously learn tools to process and neutralize them in order to move into your vision.
4. We all know what we don’t like and have no trouble sharing our complaints. But what do you want?

The post Connect with the Life You Want first appeared on Back in Control.

The post Connect with the Life You Want appeared first on Back in Control.

• Understanding the nature of chronic disease and the principles behind the solutions, allows you to fully engage in your care.
• Characteristics that keep us alive are what also create disease states.
• Chronic pain is a neurological diagnosis that has profound effects on your body’s physiological state. Existing in flight or fight breaks down your body.
• Survival depends on the protection of anxiety and anger. Letting go of trying to fight or change them releases energy to live your life.
• The essence of chronic illness is living in sustained threat and the solution lies in finding safety.

Here is a review of some characteristics of staying alive, which are the same ones that cause illness and disease.

Your health is dependent on the amount of time your body is in a physiological state of threat compared to feeling safe. Life is dependent on feeling safe in order to regenerate and also dealing with threats in order to survive. But, when you are exposed to sustained threat physiology, your body will break down.¹

Physical and mental symptoms are the result of each organ system in your body uniquely responding to your body’s chemical makeup.² In addition to the multiple physical symptoms, the sensations created by the flight or fight inflammatory state are called anxiety and anger. They are the result of threats, not the cause. They are also powerful, uncontrolable, amoral, destructive, and necessary to maintain life.

The starting point

Picture a complex circuit board that has trillions of etched-in circuits that represent your lifetime of programming. These circuits are not alterable for several reasons. First, they are memorized, similar to riding a bicycle.³ Second, any time you spend trying to analyze and figure them out is counterproductive. The more attention you pay to these patterns of activity, the more they are reinforced. Finally, as the powerful unconscious brain is estimated to process 20 million bits of information per second⁴ (compared to your conscious brain only processing 40 bits per second), rational interventions alone, such as talk therapy, cannot hope to make a dent in these circuits. It is like trying to move a high mountain peak with a shovel. It is not going to happen and much of your life’s energy is consumed in the process of trying.

It sounds discouraging. You have these permanently embedded pain circuits in your brain and the harder to try to fix them, the more they are reinforced. They are also necessary and much more powerful than your conscious brain. So, what do you do?

Solving the unsolvable

Understanding that you cannot solve or improve these unpleasant circuits is the first and necessary principle behind the solution. You must put down your shovel and move on. Instead of trying to “fix yourself,” new strategies are needed to create fresh circuits in your brain. Most of these approaches utilize methods that connect with the unconscious part of your brain with repetition. It’s similar to diverting a river into a different channel. You begin with small steps to create these new channels, but eventually the water’s flow will aid the process.

So why would we ever take anxiety or anger personally? They are inherent for survival but have little, if anything, to do with who we are. By letting go of trying to solve an unchangeable situation, you’ll experience a huge energy surge that allows you to move forward.

The second principle is that since it is impossible to fix your pain circuits, you must develop or shift onto a new set of circuits that aren’t painful. There are many ways of stimulating these changes, and the process is called, “neuroplasticity.” It is similar to installing a new virtual computer on your desktop. With repetition, it is remarkable how quickly these changes happen. Since your brain will develop wherever you place your attention, you must move towards your vision instead of continually trying to fix yourself. As you embrace wellness, you’ll crowd out pain.

Third, you cannot move forward until you have let go of the past. This is difficult because when you are trapped by a chronic disease, you are legitimately angry. However, you are also stuck. There are ways to effectively process anger and there are tremendous benefits to learning these tools.

Fourth, The DOC Journey is simply a framework that organizes your thinking and presents tools in a way that you can apply them in a focused manner. The steps in healing are:

• Awareness – you have to understand a problem before you can solve it.
• Treating all aspects of pain simultaneously – it is similar to fighting a forest fire. Every treatment can contribute to a good outcome, but nothing will work in isolation.
• You take control of your care. Since chronic pain is complex and you are a unique individual, each person’s situation is incredibly complicated. You are the only person that can possibly solve it with guidance. If you are not in charge, nothing can happen.

Fifth, a core concept of The Journey is awareness. It includes awareness of:

• Your emotions
  • Suppressed emotions are especially problematic
• The impact of your actions on others and theirs on you
• The nature of chronic pain
• The principles behind the solutions to chronic disease
• Your specific diagnosis
• Your vision of what you want your life to look like

Finally, since your sense of well-being and health is dependent on the composition of your body’s physiological state, all of your efforts are intended to stimulate it directly or indirectly into a safety state. There are three areas of focus:

• Input – how you process your stresses
• The state of your nervous system – calm or hypervigilant
• Output – it is desirable to remain in balance or safety and minimize the amount of time you are in a threat state.

The desired safety state allows you to feel content and secure, have a slower metabolic rate (rate you burn fuel), less inflammation, and lower levels of stress hormones. Optimizing your body’s physiological state from threat to safety has a profound effect on your health and quality of life.

Recap

The solutions to solving and preventing chronic disease lie in understanding the principles behind them. Embedding these of concepts allows you to continually practice them. This is in contrast to randomly learning techniques to fix yourself. The process gives you control of regulating your body’s physiology from one of threat state to safety.

Questions and considerations

1. Consider that it is your whole body that responds to your immediate set of circumstances in order to optimize your chances of survival. Your nervous system is the processing center for sensory input and an integral part of the reaction. There is absolutely no separation of the mind and body and why even the use of the term, “Mind Body” is inaccurate.
2. Why would you take your powerful survival reaction personally? It is intended to feel so unpleasant so as to force you to act. It is what you possess and not who you are.
3. You’ll be taken on a journey that will allow you to depersonalize this flight or flight reaction. It is just a part of your daily life.
4. Take some time to review the above principles of solving chronic disease. They will eventually enter every aspect of your life and become automatic. As you spend a lesser amount of time in a threat state, you will be able to move forward into a new life and thrive.
5. You can’t fix chronic disease. You must let go and move into wellness.

References:

1. Torrance N, et al. Severe chronic pain is associated with increased 10-year mortality: a cohort record linkage study. Eur J Pain (2010);14:380-386.
2. Schubiner H and M Betzold. Unlearn Your Pain, 3^rdMind Body Publishing, Pleasant Ridge, MI, 2016.
3. Hashmi, JA et al. Shape shifting pain: Chronification of back pain shifts brain representation from nociceptive to emotional circuits. Brain (2013); 136: 2751 – 2768.

4. Trincker, Dietrich. 1965 lecture at the University of Kiel. German physiologist

The post Common Links to Chronic Disease – RUTs are Relentless first appeared on Back in Control.

The post Common Links to Chronic Disease – RUTs are Relentless appeared first on Back in Control.

Mark was in his early 40’s, successful, married with two young girls, and intense. He is a great guy and had a good time with the group. He experienced a nice improvement in his pain. But I tell every person, “Your pain will recur when you go back to your environment with its triggers–especially the family ones, which are the strongest. That is what happened, but he was able to use his tools and do pretty well. He wasn’t satisfied and returned for two more workshops in 2018 and 2019. Each time he had been doing better but wanted more and had hit a wall. Unfortunately, or fortunately, I am a surgeon and not a counselor. I had a blunt (very blunt) conversation to let go, quit trying to fix his pain, stop seeking more wisdom, and just get on with his life. I told him to quit reading books, including mine, and focus on nurturing himself and his family; that is best done through play. He wasn’t that happy with me because he thought I was going to give him more strategies (I had run out….). I did not hear from him for over six months and was a little worried, so I wrote him. Here is part of his email.

Mark’s letter

In general, I have lost a bit of an interest in all the pain-related stuff. I guess I have read too many books in the past and now everything feels a bit old and repetitive. But most importantly, I came to the realization that I will never fully figure it out. So, as a result I haven’t read or listened to anything pain-related since last summer and I have shifted my attention to other things (He actually listened to me).

Both of my girls (10 and 12) play field hockey. And my youngest one made the first team this year, which is kind of a big deal here where I live. Next to Soccer it’s our number one national sport.

Anyway, in order to support my daughter in her endeavor, I changed from being just a spectator to being her coach and practice partner. In other words, I started playing myself and learning a new and technically difficult sport. So, I have been playing 3-4 times a week since July with my daughter. We go out and play ball for about 1-1.5 hours. On the days that we don’t go out we play and practice our skills in the kitchen. There is always a stick and a ball nearby. Long story short, I live and breathe hockey and I absolutely love it. 

Neuroplasticity in action and from action

Instead of doing what I normally did, which has been the same for the past 10-15 years or so, I started changing myself with new goals and ambitions, new thoughts and emotions, and lots of physical exercise. Instead of being occupied with the familiar and usual things, everything changed. My interests went from intellectual (pain related) to something completely new. One day I realized that without intention I was actually creating a new identity by changing my brain and thus reprogramming my nervous system. 

Even though it’s said that hockey is really strenuous on your physique and in particular your lower back, I haven’t had the least bit of pain. On the contrary, it rather goes away. Even my anxiety at certain times of day, has mostly vanished. I feel like by accident I have found a natural way to un-condition myself from certain pain and anxieties that were built into my daily routine and how I react towards life in general. It’s been wonderful to witness… afterwards. I say afterwards because I wasn’t preoccupied with my (old) condition. I didn’t care about the old me because I was too busy becoming someone else. Do you know what I mean?

I do still have pain, sometimes even a lot of pain.. but that is from all the physical exercise. At 46 years of age I may be pushing it a little.. and I am finding out that I am not getting any younger ! But it’s all good. Mark

Moving forward

We have now reconnected and are in touch regularly. He has even come a long way since this email at the beginning of the year. He told my wife, who provides the rhythm and movement part of the workshop that he had thought the play was a waste time. He told her that he now felt it was the most important part.

Here are some observations he recently shared with me that I feel are the essence of healing. I have a question and answer session every Tuesday and Thursday at noon Pacific Time. This email was in response to one of the Zoom calls.

Read this section several times – he just described the essence healing

When I was listening to Vincent (another Omega graduate) and later also Babs (my tap dancing wife), I couldn’t help but wonder how useful these explanations are to the other listeners. Without a proper context, I am just a guy that started playing with a hockey ball, Vincent (an accomplished artist) plays with masks, and Babs creates art. So, how does that relate to someone else’s personal situation. What are they supposed to do with this type of information? People, including myself in the past want answers to questions so they can solve their own issues. 

I kept thinking how I never really understood that point of letting to and enjoying life. On an intellectual level perhaps but I never was able to practice it in real life. For me it was by sheer luck that I finally made a real shift. I was literally tired of solving a problem that couldn’t be solved by my intellect. I was so tired of it that I stopped listening to all my favorite audiobooks every night including yourself (I didn’t take it personally). And I decided to just have fun and do something else with my life. I happened to choose a brilliant combination of physical activity, play and family.

As I told you in one of my previous emails, I literally changed my identity. I believe for me awareness and a change of my identity was key for my breakthrough.

It wasn’t until afterwards that I realized how my pain and anxiety were closely tied to my identity that I build up over many years. My neurology created the same predictable body chemistry every day. How I dealt with people and situations in life, my thinking patterns, emotions never really changed as they were part of my identity. And as pain is a reflection of your ‘body budget’, the way I unconsciously regulate my ‘chemistry’ was always pretty much the same. To me, this was the metaphorical mountain I tried to conquer with a pick axe.

Even though I know that healing occurs differently with different people, I wonder how most of us can achieve a lasting change  unless we change some of our habits and the way we live, without giving up some of who we are. Who we are now, is the identity that experiences anxiety and chronic pain.

Only by letting go of that part of you and replacing it with someone or something new that is fun, playful and loving you can let go of your pain. Simply because part of you that identified with pain no longer is in control. However, that is the difficult part, it starts with awareness and then following through with starting a ‘new life’.

Mark persisted and made it. Some people have almost immediate responses and he had a great start. But it is hard to comprehend what is possible. By continuing to move forwards, he is now living it. Nice work!!

The post Freed by Persistence and Play first appeared on Back in Control.

The post Freed by Persistence and Play appeared first on Back in Control.

My vision is to bring the DOC (Direct your Own Care) principles into mainstream consciousness. It has become clear that the DOC project is one that is best implemented by primary care physicians. Back in Control is a wellness book, not a “solving chronic pain” one. Most of you know that you can’t solve chronic pain because your attention is still on your misery. You have to move toward your vision of how you want to live your life with or without your pain. Paradoxically, as you become healthier, your pain will abate or resolve. We have witnessed this phenomenon hundreds of times. I also practice these concepts daily.

My focus will be in several areas:

• Building a business structure that scales the DOC process to reach a much wider audience.
• Teaching medical providers in any realm how to treat chronic pain. Only about 20% of physicians are comfortable treating chronic pain and less than 1% enjoy it. We aren’t trained correctly in spite of recent neuroscience research providing many answers.
• Educating the public to take responsibility for their own care. This requires learning about chronic pain.
• I am writing three more books:
  • Do You Really Need Spine Surgery?
  • Chronic Pain and Your Family
  • Optimizing Performance In and Out of the OR Applying Athletic Performance Principles
• We are scaling the workshops that we have held at the Omega Institute. It turns out that the group setting is a powerful resource we have seen to move people out of pain.
• I am starting a movement around physician wellness. The burnout rate among physicians is between 50-60% and steadily rising. It has a tremendous impact on patient care. The DOC process is just a framework of care that allows productive discussions to occur and the patient is able to create their own solutions. However, the doctor/ patient relationship is a critical piece of it. It is hard to reach out to patients when you are trying to personally survive. Physicians have 2-4 times the suicide rate of the general population depending on gender and specialty.
• Finally, my biggest focus is on changing the fee structure for medical care. Many recommended interventions in spine care and other specialties have been documented to be ineffective while most effective treatments are generally not covered by insurance. The most necessary part of care is for your physician to listen and you to be heard. It is the one aspect of care that that has been taken from all of us. Creating a fee schedule that allows providers to take the time to get to know you will change the nature of medical care.

Grassroots effort

I am asking for your help. It’s clear that change is going to have to occur from the ground up. The business of medicine has firmly embedded a production approach to your care. It is not going to change. Here is a quote sent to me by one of my mentors.

A new scientific truth does not triumph by convincing its opponents and making them see the light; but rather because its opponents eventually die, and a new generation grows up that is familiar with it.

–Max Planck

How can you contribute?

People often ask me how they can pass on what they have learned. Here are some suggestions that would be of great help to my efforts.

• Continue on your own healing journey. The concepts presented in the DOC process are ones that need to be practiced for a lifetime. Patients often feel well enough that they stop at Stage 2. Stages 3 and 4 are the creative parts of it and where it all really happens. Don’t stop.
• Your personal transformation will have a strong healing effect on those you are close to. There is a direct mirror neurons effect.
• Encouraging friends and family to sign up for the weekly email updates on backincontrol.com.
• Share links on social media.
• Write a quick review of Back in Control on the Amazon or Barnes and Noble websites.
• Let your providers know about the DOC concepts and that they can contact me. My intent with the combination of the book and website is to enable the patient to take control of his or her own care and form a partnership with your physician and other medical professionals. Not only are your visits productive, but are more enjoyable. There isn’t a day in clinic that I don’t emerge more energized and inspired.
• Share your personal success on the “Stories of Hope” section of this website. Hope is a powerful force in healing pain.

Thanks to all of you for your interest and support. It’s what keeps me moving forward. For me, it is truly a new horizon and adventure and I am looking forward to seeing how it evolves.

The post Moving Forward – A New Horizon first appeared on Back in Control.

The post Moving Forward – A New Horizon appeared first on Back in Control.

Florence, Italy, 2013

On vacation

We all intellectually know that life is short and somehow we spend a lot of energy avoiding that thought. I was reminded of the frailty of life this week while vacationing in Florence, Italy.

Many of the cobblestone streets are narrow and the sidewalks even narrower. It is also quite crowded. There is a constant negotiating for sidewalk space with other people going with or against you. At the same time I am trying to relax by enjoying the sights. There is some risk to this combination of forces.

The bus

I was standing just behind my wife looking into a shop window. There were people milling both in front and back of me. We were on one of the more narrow streets when suddenly I felt something touch my hair that felt like a light breeze. Then I heard a horn. I looked up and a local bus had passed me traveling around 25 mph. The mirror of the bus was about five feet off of the ground. With the road being so narrow a portion of the mirror was overhanging the sidewalk about a foot when it passed me. It was traveling so fast that it was 20 feet past me before the driver was able to hit the horn and I could look up. I was within a quarter of an inch of my head being slammed to the ground. The good news is that it would have been quick.

I was relating the story to our incredibly gracious Florentine host who wasn’t surprised. “I had a friend of mine was killed in London about 30 years ago after his head was struck by a passing bus mirror.” Then I was talking to another one of our American friends who has lived in Florence since 1979. She told me that it happens frequently, and she has been wary of the possibility since had moved here. Then my son remembered that he had a classmate who was killed at age 18 in London after being hit by a passing bus mirror. None of these stories were reassuring.

On life #6

This incident was my fifth significant close encounter with dying with this one being particularly intense. Being comfortable with death is a skill I am not inclined to learn, although the philosophers point out it’s a necessary part of truly living. The response it fosters in me is gratitude. I have long realized that life is one day (moment) at time and that I am incredibly fortunate in many realms. The first one being that a “bad day” is much better than not having a day at all. I also live in a free country with food on my table and a shelter over my head. We have comforts and opportunities that have never existed in the human experience.

Another benefit, that I never expected was the gift of suffering. I never understood how extreme the experience of being crippled by anxiety and other physical symptoms could be and each patient in pain takes me back to some part of my journey in the Abyss. I came out of it one millimeter at a time. I am incredibly grateful to be able to share my insights with others. Watching them thrive has been rewarding, inspiring and humbling. The capacity of a given person to heal is almost infinite and I am one example.

The Denial of Death

Ernest Becker wrote a famous book, The Denial of Death. His premise that he elaborates on in multiple ways is that the fear of death drives most of human behavior. I agree that avoiding anxiety is the main driving force in that the human body’s primary role is survival and then procreation. Homo sapiens that didn’t pay attention to the environmental cues simply didn’t survive. The current human race represents “survival of the most anxious” and it’s effective. Worrying about death is unique to humans because we have consciousness and it’s the ultimate fear. However, it is just one of an infinite number of other things to be anxious about. But spending your time worrying, including about the inevitable, then it’s much harder to enjoy the gift of life you have been given today. Deeply accepting death is a major step in truly living. Learning to live with anxiety is another one.

Constantly thinking about how to solve your chronic mental and physical pain is, I think, almost a worse situation than worrying about dying. You are living a life that is steeped with misery, being bounced around, not believed, labeled and there doesn’t seem to be any hope of escape. I will never forget reading Viktor Frank’s book, Man’s Search for Meaning, in which he describes his experience in a WWII concentration camp from a psychiatrist’s perspective. He was able to somehow accept his fate while in the camps. What caught my attention was that he felt that the worst part of the ordeal, in spite of extreme physical suffering, was wondering if and when it would end. The effect of chronic pain has been documented to have a similar impact on a person’s life as terminal cancer. (1)

The paradox

The solution to chronic pain is a paradox. It is important to understand the neuroplastic properties of the brain. Your brain changes structure every millisecond by forming new connections, supporting cells, neurons, etc. It will develop in whatever direction you choose. If you spend your time looking for a solution for your pain or constantly discussing it, you are only reinforcing it. If you choose to move forward with or without your pain, paradoxically you can leave it behind. Remaining anxious about things beyond your control will suck your life energy right out of you. Dealing with your inevitable end is an opportunity to accept, process it and move forward.

A brush with death also reminds me that the goal of The DOC Journey is to enjoy the day that you’re are in. There is a tendency to look at this process as a stepwise formula with the goal being the end of pain and suffering. That’s the opposite of what actually happens. The “goal ” is to get happy first regardless of your circumstances, including the pain. You’ll then have the energy and passion to move through your mental and physical pain and create the life you desire. The ring of fire

Enjoy your day today

1. Fredheim OM, Kaasa S, Fayers P, Saltnes T, Jordhøy M, Bortchgrevink PC. Chronic non-malignant pain patients report as poor health-related quality of life as palliative cancer patients. Acta Anaesthesiol Scand. 2008;52(1):143-148. 

The post “Dying” Before Living first appeared on Back in Control.

The post “Dying” Before Living appeared first on Back in Control.

Then someone told Sarah she was losing her mental capacities. I explained that several studies had revealed that brains shrink in the presence of chronic pain, but re-expand when the pain abates. (1) I encouraged her not only to continue using the DOC tools, but also to re-connect with prior interests. Over the next six months, her depression lifted and she became more energized and interactive. She also regained much, if not all, of her alertness and reasoning abilities. Instead of focusing on dementia, she had re-set her sights on moving forward.

At one point Sarah brought in some dolls that she had created over the years as a therapeutic tool in her recovery. I asked her to write a letter telling the fascinating story of her dolls, so that I could share it with you.

Sarah’s Letter

To my mentor, Dr. Hanscom:

Some time ago you took pictures of my “emotional dolls.” I had shut down physically and emotionally, lost in pain and fear. I had forgotten all the biofeedback training that had helped me years before, and could not escape my desperation. I had no purpose, no reason to live. It was then my physical therapist referred me to you. Your program set me on the right track.

We all have our hurts, some more tragic than others. By telling my story I can be proud of turning suffering into achievement.

The Big Doll

When I was in my late 20’s I began to have severe headaches on the left side of my head. My family doctor diagnosed migraines, taught me about food triggers and exercise, and prescribed Imitrex. But the pain became so bad that when I wasn’t hoping that God would take me, I considered getting a lobotomy or going anywhere in the world that could rid me of this.

When the number of debilitating migraines reached 4 – 5 per week—sometimes landing me in the hospital for days at a time—my family doctor sent me to the Diamond Headache Clinic in Chicago. Dr. Seymour Diamond used a multidisciplinary approach that included biofeedback therapy, cranio-sacral work, and yoga. Through nutritional counseling I learned more about food triggers. Whenever I sensed a migraine coming on, I retreated to a dark room.

But no matter how much I tried, I could not ignore the terrifying, head-eating monster behind the left side of my head, ready to stick its fangs into my left eye. While I was visualizing the monster, I remembered a visit to the Milwaukee County Museum. At a Far East exhibit was a frightening, human-sized doll with huge teeth, a dangling tongue, bulging eyes, hanging breasts, and skulls in its hands. That was my monster, I thought. That is what my migraine looks like.

Then I had an idea. What if I sculpted a doll that looked like the hideous monster that sits behind my left ear? I began to create a doll out of cloth. When I was done, I hung it in my sewing room where I could see it every day. Now this doll, not I, contained all the migraine pain I ever experienced. It could not hurt me—it was only a doll. If I got a mild migraine, which I did about once or twice a year, I remembered it was not my migraine, but the doll’s. I was free and immensely grateful to Dr. Diamond for giving me tools to live a pain-free life.

The Bike Accident

When I was in my 30’s, The Boeing Company hired my husband as an engineer and me as a draftsperson. Life was remarkable with no pain. I stopped using Dr. Diamond’s biofeedback techniques but embraced a rigorous physical fitness regimen. I became a serious triathlete. Every day I biked to work, ran during my lunch hour, biked to a gym and lifted weights or went swimming for an hour or two in the lake across the street from my house.

By my 49th year, I had a good job with a promising future and won most of the races I entered. I was elated to have been accepted to the Ironman Kona Hawaii Triathlon Championships, a 140.6-mile race. I had all summer to train, and I trained hard.

One day I rode my bike to Bellevue, Washington, to join some other bikers on a 100-mile training ride. When I got to the meeting place, a hotel parking lot, my wheel caught a hole in the driveway. I cantilevered over my handlebars, hitting my head on the concrete, and passed out. When I woke up, emergency personnel were all around me, cutting my brand new $65 biking sweater off me. Badly injured, I was put in an ambulance and taken to the hospital, where I had a neck surgical fusion and a wrist reconstruction. The pain never went away. Eventually I had two-level fusion through the front of my neck.

The Small Doll

I lost all that identified me—my job and the ability to run, swim, and bike. I found it difficult to do most tasks. All my friends were athletes, so we no longer had anything in common. After a while I stopped seeing them. The only people I saw were doctors and physical therapists.

I saw no sense to life, no purpose, and felt nothing but the prospect of one surgery after another. My suffering had no limit; If one day was bad, then I knew the next would be worse. I had fallen into a dark pit, an uncharted underworld of loneliness and despair. It was time to sew another doll. I visualized a two-sided face with features on both sides. On one side was the person I wanted others to judge me by.

The opposite side showed who I thought I really was. On this side I jabbed a pair of scissors in my heart and put a mirror in my hand that reflected the word “Fear.” I pierced “my body” all over with copious amounts of needles and other sewing notions, to represent the pain that I had endured for the last 20 years.

Today I am doing well. Dr. Hanscom, thank you for all the training. On the few days I start to slide back into the darkness, I can find my way back to loving myself. Life is potentially meaningful under any conditions. What matters is the capacity to turn life’s negative aspects into something positive and constructive; to make “the best” of any situation. Just focus on all the beauty that surrounds us.

Dolls, as objects of our creative imagination, will, if we invite them, take us to play again in the house of our childhood past and perhaps bestow upon us a future we hadn’t imagined.

—Cassandra Light, The Way of the Doll: The Art and Craft of Personal Transformation

Self-healing

Sarah’s story illustrates several aspects of successfully treating chronic pain, which include: 1) de-adrenalizing your nervous system 2) creating new neurological circuits 3) shifting back on to enjoyable ones.

One of the more important exercises I recommend in my book is to consider one of happiest times of your life and spending an hour recalling as many details as you can. Then experience the feelings. Your brain will begin to wake up as you reconnect. Her dolls pulled her back into a better place. Making the dolls is also an enjoyable activity that shifts your brain onto more relaxing circuits and your adrenaline levels will decrease. Play

It’s Anxiety, Not Dementia

Why is mental function compromised in the presence of chronic pain? First of all, the stress hormone, adrenaline, decreases the blood supply to your brain’s frontal lobe. Second, obsessive thoughts cause the brain to get stuck on a few repetitive circuits, making them more embedded, blocking your creativity, and causing portions of your brain to be under-used. The most tragic part of this sequence is that, with this diminished brain function, you are less willing and less able to learn new ways to heal. In other words, the pain blocks its own treatment.

I, too, experienced a cognitive decline during the worst part of my burnout; but eventually I regained all my faculties plus an added creative bonus–an interest in writing poetry. I predict that research will eventually show much of dementia to be anxiety-induced. It is not necessary—or recommended—to “combat” your illness or try to “fix” yourself. Instead, you can employ the DOC tools and watch the miraculous process of self-healing. Solving the unsolvable

Not only is Sarah doing well, she emanates joy. She is mentally sharp and moving forward quickly with her life. It has been a remarkable experience for me to witness this transformation.

1. Seminowicz DA, et al. “Effective treatment of chronic low back pain in humans reverses abnormal brain anatomy and function.” The Journal of Neuroscience (2011); 31: 7540-7550.

The post Out of the Valley, with Dolls first appeared on Back in Control.

The post Out of the Valley, with Dolls appeared first on Back in Control.

If you are angry, in a reactive mode, it’s difficult to develop a plan. A metaphor showing the impact of anger is how they handle elephants in India. When the elephants are very small, they train them to stay in one place by tying one foot to a stake with a chain.  When the elephant has grown into a huge adult, it will still be held in place by the same type of small stake. They have been programmed to think of the stake as something that cannot be broken. Anger is similar in that it anchors you down and you cannot move forward. Becoming aware of the nature of this bond allows you to break it and you can move on.

Stuck

I have yet to see a patient become pain free until they have let go of their legitimate anger. It is the most challenging and rewarding aspect of this whole process. This phase is difficult for me because I have seen so many people succeed that it is discouraging to watch many that are just not willing to let go. The difference in the quality of life for the patients who can process their anger versus those who cannot or won’t is dramatic beyond words.

The Anger Switch

What makes this process even harder for me to watch is that letting go isn’t nearly as difficult as you might think and the impact on a patient’s life happens quickly. The anger switch is either on or off and there is not much middle ground. Within weeks of crossing this divide there is usually a significant improvement in pain and decrease in anxiety. The difficulty is in initially making the decision to give up the anger. It is powerful and addicting.  Anger: “The Continental Divide” of Chronic Pain

Norma was a middle-aged woman who had undergone four major spine surgeries and still had ongoing pain. I had performed the last two surgeries, each of which gave her about six months of relief. When the pain returned, the new studies were fine and there was nothing I could do to surgically help her. By this time, she knew my lines well, but was not buying the pain pathways idea and that ongoing anger could keep all of her pain fired up. I finally gave up and encouraged her to get another opinion. About a year later I received a jubilant email from her that she was free of pain. Her comment was, “Who would have thought it was the anger?” Once she crossed that line, her pain resolved within a few weeks. She has remarried and is still thriving in the middle of a lot of ongoing personal adversity. She’s moving forward and creating her own life.

I have to let go

I have learned that there’s absolutely nothing that I can do to help them move on. In fact, the more I try to convince someone who is angry to give up their anger, the angrier they will become. This is the point of the process, that I have to let go and hope they will eventually engage. Patience is not the first virtue of a surgeon, but I have learned to wait this phase out. It is surprising and encouraging that many people, months and sometimes years later, suddenly understand and will experience major improvements in their quality of life.

Let go of your anger. You have absolutely nothing to lose and everything to gain.

Video: “Taking Back Your Spirit” – Carolyn Myss

The post The Elephant’s Noose first appeared on Back in Control.

The post The Elephant’s Noose appeared first on Back in Control.

All of us are limited in our ability to do exactly what we would like. Many things limit us including:

• Basic human needs
  • Eating, sleeping, drinking, breathing, etc.
• Money
• Time
• Physical attributes
  • Appearance
  • Intelligence
  • Artistic and athletic talent
• Opportunity

It is how you relate to your limitations, which determines whether you put yourself into the victim role. You need to break loose from this role.

Rising above it

There seem to be some people who can stay out of that role even under extreme circumstances. At least it appears that way to me on the surface. One example I think about at least once a week is the story of Nelson Mandela. It is incomprehensible to me that he could be unjustly imprisoned for twenty-seven years and not only forgive his captors, but go on to be a gracious statesman. He placed many of his former captors into positions of power.

Another dramatic example is that of Viktor Frankl. He was an Austrian Jewish psychiatrist who survived the World War II concentration camps. He lost most of his immediate family. There was a time where he was slated to undergo human medical experimentation. Instead of going into the victim role, he asked himself the question, “What is life asking of me right now?” He found meaning in suffering in the midst of the worst of circumstances. He went on to be a prolific writer and professor after the war. He was able to thrive by letting go.

Adrenaline

Not only does remaining angry destroy the quality of your life, it alters yours body’s chemistry so you are constantly full of adrenaline. Animal studies have shown that the conduction of nerves almost doubles under stress, so you actually feel the pain more. (1) Then more pain – more stress. It’s a deadly cycle. The essence of the whole DOC project is calming down the nervous system and optimizing the body’s chemistry. The neurophysiology of chronic pain

I was raised in a chaotic abusive household and my migraines began when I was five-years old. I had crippling headaches every two to three weeks throughout my entire life. What I did not realize that my body was always full of stress hormones and I thought that was the norm. What else did I know? It was perplexing to me that my headaches often were on the weekend when I was more relaxed. What I now know is that adrenaline decreases the blood supply to the brain and when I relaxed the blood vessels would expand. I could feel the pounding of this increased blood flow and it was brutal. I have not had a severe migraine in many years.

In the context of the DOC project, it’s my patients’ willingness to admit and confront their victim role that allows them to move forward—or not. I can do a lot of excellent work with them in dealing with anxiety, but when it really comes down to letting go of being a victim, they often become completely stuck. It is at this point that I have to let go. There is not much else that can be done until this hurdle is dealt with. I always leave the door open for them to re-engage, and many of them do. Truly acknowledging and letting your anger go is the “Continental Divide” of care. It not only affects your perception of pain but also the quality of your entire life.

1. Chen, X et al. “Stress enhances muscle nociceptor activity in the rat.” Neuroscience (2011); 185: 166 – 173.

For more, see:

• Anger affecting Nerve Pain
• Out of the Abyss with Forgiveness

The post Anger and the Continental Divide first appeared on Back in Control.

The post Anger and the Continental Divide appeared first on Back in Control.