I received this message from a person I have never met or communicated with. She had engaged in learning the tools to heal.

The key to healing mental and physical pain happen from learning two separate sets of skills. The first is separating identity from your necessary survival circuits, developing a “working relationship with them. The second is shifting your brain onto more enjoyable and functional circuits. You cannot experience play and joy will simultaneously fighting pain.

You also cannot heal your body, including your brain. It already knows how to heal, and the healing stories are nothing short of miraculous. But life itself is a miracle. Our conscious brain gets in the way and blocks healing. You only must believe your body can heal, let go, and allow it to occur. Her email is typical of what happens, and the healing is deep and transformative.

Not fixing yourself

One of the most difficult challenges is letting go of trying to fix yourself to rid yourself of the mental and physical pain. Why wouldn’t you? You are trapped in miserable place without an apparent way out. It is bad enough enduring the pain, but when you get angry about it, you have now doubled down, and your brain is really on fire. Dr. John Sarno, a famous physiatrist and author used the term “rage”.¹

Good Studio/AdobeStock

However, trying to solve the pain places your attention on it and reinforces it. But when you try not to think about your pain or distract yourself, the thought suppression inflames your brain even more. Either way, you are trapped. Specifically considering self-esteem, which is an endless set of judgments, trying not to be judgmental is impossible. Positive thinking is another form of suppression. Even reading self-help books is another way of staying focused on the problem. Even with my books, there is a tipping point where I recommend people stop reading them and focus on practicing and implementing the tools they have learned.

“Phantom Brain Pain”

There is the additional problem of thinking that something is being missed, and these thoughts become independent sets of circuits. They really are not responsive to reason, and the ongoing pursuit of reassurance only reinforces them. Along with all RUTs (repetitive unpleasant thoughts), I call this phenomenon, “phantom brain pain.” In my mind, the same issues are in play as phantom limb pain, where the suffering is intense, and you cannot even touch the absent limb to calm yourself. How can this happen. The known “source” of pain is completely gone, and the patient still feels the limb and the pain. So, where does this pain exist?

The key to healing lies in separating from your racing necessary survival circuits, developing a “working relationship with them, and dynamically shifting your brain into more enjoyable and functional circuits – and letting go. You cannot experience play and joy while simultaneously fighting pain.

“I give up”

I vividly recall feeling like I was in the midst of a major battle with unpleasant thoughts. The mental pain was a much bigger problem than my physical symptoms. I was never bothered during surgery with them in that I was so focused on what I was doing. For a long time, I was also fine in clinic while I was connecting with my patients. Towards the end of my ordeal, even being at work did not help, and I was pummelled every two or three minutes with ever-increasing intense, intrusive, and vivid thoughts. Meanwhile, I was trying everything possible to deal with them, including working with a psychiatrist. Nothing helped and in fact, it all seemed make things worse. It was around this period where I came close to committing suicide.

One evening, I had read yet another self-help book and I had a flash of a vision that I was standing in front of a repeating circus mirror. I can still see it. It was about six feet high, and it was in a tent. I was looking at endless images of myself. At that time, I was doing what felt like hand-to-hand combat with my thoughts. I would have a disturbing thought, and then counter it with a “good” thought. I was wearing down quickly. I could see that there was no rational solution to these RUTs. I said to myself, “I can’t do this anymore and I quit.” I felt my identity was stripped down to nothing and felt there was little left of what I thought was me.

I honestly gave up and was not sure what I was going to do next. Instead of feeling despondent, I felt a strange sense of freedom, and it turned out that “giving up” the fight was the right answer. It was after that moment, things began to change for the better. I had much to learn, but at least I had inadvertently created some “space” in my brain to allow healing to begin.

Hope

This is a link to a collection of patients’ success stories that I call, “Stories of Hope.” Essentially everyone who is trapped in the Abyss of chronic pain is in a very dark place. Knowing you are not alone is important.

ipopba.AdobeStock

It is impossible to let go of “fixing” without the tools to accomplish it and also learning how to feel safe. You can’t force it and as per her email, you just have to keep moving forward, and it will happen when you are ready. I also wish for you that it happens sooner than later, but persistence is the key. You will learn to regulate your stress physiology and become much better at nurturing joy and creativity. Your behaviors become automatic, your skills will increase and improve, and you can let go and live your life.

References

1. Sarno, John. Mind Over Back Pain. Warner Books, New York, NY.

The post How healing happens first appeared on Back in Control.

The post How healing happens appeared first on Back in Control.

• We are trained that if we can solve enough of our problems, we’ll have an “enjoyable life.”
• Life’s challenges never stop, and we may slowly sink into darkness, “The Abyss.”
• We become desperate trying to escape; especially from our RUT’s (Repetitive Unpleasant Thoughts)
• The most effective way to dispel darkness is turning on light.

We are born as blank impressionable slates full of openness, curiosity, playfulness, and eagerness to learn. There are innumerable sources of learning, and we trust those who we perceive as having wisdom to teach us way to live an enjoyable and productive life.  Words and concepts are important but imitating actions are more powerful ways of learning. The possibilities are limitless.

But what often happens? In a protected and nurturing environment, the light may remain bright for many years and sometimes indefinitely. But for many of us, the light becomes progressively dimmer and at some point, we tip into the Abyss of chronic mental and physical pain. The light is extinguished, and it is a dark place without the slightest hope of escape. This is not what any of us planned when our spirits were shining.

A famous quote

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

They grow old because they stop pursuing dreams.

                         Gabriel Garcia Marquez¹

I modified this famous quote based on my personal experiences and observations of anxiety:

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

They grow old because their dreams are crushed by anxiety.

                         Gabriel Garcia Marquez

                          (Modified by Dr. David Hanscom)

Darkness

How quickly does darkness descend when you never felt safe and nurtured? Maybe you never felt the light that exists within you. Even if you had a great start, what about the onslaught of life?

• Unmeetable expectations
• Bullying – peers, coworkers, siblings
• FOMO
• Social media
• Poor diet/ no exercise
• Never-ending to-do list
• Lack of resources – housing, food, education, finances
• Job issues
• Difficult parenting
• Unrelenting Repetitive Unpleasant Thoughts (RUT’s)

The darkness settles in to the point where we can’t see a way out and eventually, we might forget what the light even felt or looked like. Additionally, there is the relentless wind, that also wears you down. Life keeps coming at us, especially the RUT’s.

So, what do most of us do? We are used to problem solving and we either keep working at fixing our lives (getting rid of the darkness) or many of us give up. Nothing seems to be working. Where do we go next and how can we get out of a place that seems to have no definition or limits? It really is an Abyss.

You cannot “fix” darkness”. It is simply absence of light. You also can’t control most of your thoughts (RUT’s) and stresses (the wind).

Darkness disappears with light. A small match is lit, and you must protect the flame from the wind. You may have to keep lighting it many times. Eventually, you are able to protect the flame and allow it to grow. Even when the light is dim, it still penetrates the darkness. As you continue to add fuel, the flame becomes a fire, then a large bonfire that can hardly be contained. The wind will eventually fan the flames and make them stronger.

“The fog rolled in.”

Many years ago, I was discussing chronic pain with a patient who was also a physical therapist. She related that she had an idyllic upbring with her parents and two siblings enjoying each other. Family outings including scenic drives, trips to Coney Island, music, and playing board games. There was a lot of fun and laughter. Then when she was 12, her father lost his job and her life permanently changed. The fun was replaced with verbal abuse, drinking, rages, and hardly even coming home. She described it as “the fog came in,” and life became dark. It never changed. I only saw her a couple of times recall how sad she was. I did not know much about chronic pain at that time and was perplexed how life could change so quickly. I did not understand the physiological nature of anger and that the thinking brain does not work is well. I don’t know what eventually happened to her.

Healing happens by moving forward towards your vision

It isn’t logical for us to spend so much time and energy fixing the dark and not paying attention to the light. But it is the only way that healing occurs. You are the only one who can light the match over and over again, protect the flame, and create a fire that can’t be put out. Knowing the tools to process darkness are necessary and are a separate skill set from connecting and nurturing your light. That is why there is a sequence of healing: 1) connection, 2) confidence, and 3) creativity.

Recap

Why do we feel that focusing and fixing our troubles is going to give us the life that we want? Not only can you escape from The Abyss with light, what about walking outside and soaking in the warmth of the sun?

Your dreams and play are always within you. Connect with and nurture them and allow your body to heal.

Questions and considerations

1. Our biological imperatives are to first survive and then pass our DNA to the next generation. Our unconscious brain evolved to look for trouble and resolve it in order to physically survive.
2. Humans are more complex in that we possess language and must deal with emotional pain, which is processed in a similar manner as physical pain.
3. Instinctively, we are programmed towards problem solving.
4. Although we also develop through play, it often gets buried in the ongoing chaos of life. We also have the human problem of our inability to escape from our unpleasant thoughts.
5. How much of your life is consumed w ith fixing problems versus nurturing joy? Have you created any “space” for joy?
6. If you wish to live a different life, you must create some “space” to nurture creativity and joy. Light will dispel darkness whereas all the fixing in the world will not pull you out of it.

 References

1. Gabriel García Márquez. Cien años de soledad (One Hundred Years of Solitude. 1967. Editorial Sudamericanos, S.A., Buenos Aires.

The post  Quit Fighting Darkness and Turn on the Light first appeared on Back in Control.

The post  Quit Fighting Darkness and Turn on the Light appeared first on Back in Control.

• Connecting with your sense of play is one of the most powerful ways of shifting your physiology from threat to safety.
• Play circuits are also simply more pleasant.
• Everyone has some level of play in their life, although for some, it is quite limited.
• The interactions created while at play is one of the basic ways humans learn to cooperate with each other, including reading body language, interpreting tone of voice, and negotiating boundaries.
• When suffering from chronic anxiety and other symptoms, play circuits are used less and don’t evolve.
• Nurturing a sense of play and joy is a learned skill that requires thoughtful repetitions. These are not usually taught to us throughout our life experience,
• The benefits of reconnecting with play are healing and have a significant impact on your health and quality of life.

This is the real secret of life –

to be completely engaged with what you are doing

in the here and now.

And instead of calling it work,

realize it is play.

~Alan W. Watts

Play is a physiological state that reflects a sense of safety. You cannot play or feel playful if you are in a survival mode. The essence of escaping from the grip of crippling anxiety is feeling safe. In this state your body is full of relaxing chemicals such as oxytocin (love/bonding drug), serotonin (antidepressant), GABA hormones (anti-anxiety), dopamine (rewards), and small anti-inflammatory proteins called cytokines. Your metabolic rate (fuel consumption) also drops, which allows your energy reserves to be replenished. This scenario not only creates a deep sense of well-being, but it is also healing.

The data regarding the devastating effects of chronic stress on your mental and physical health is extensive and deep. Prolonged exposure to the body’s neurochemical survival response predictably causes illness and disease and shortens life.^1,2,3

Research also shows that cultivating optimism, having a sense of purpose, and feeling hopeful has the opposite effect. When people learned how to skillfully process their stress and nurture joy, they experienced an improvement in anxiety and many other symptoms.⁴ One paper had participants visualizing their best self for five minutes a day over a course of two weeks. They all noted significant improvements in anxiety.⁵

 Play

In our workshops, we discovered that shared play is a powerful force and most of the participants had a significant improvement in their anxiety and pain during the three or five – day events. It happened after people began to relax, share, let go, and laugh together. We initially didn’t understand reasons why people could shift so quickly after being so miserable for years. I now understand that anxiety reflects a sustained inflammatory state that also causes many other symptoms. Feeling connected to others in a relaxing environment stimulates the release of oxytocin. Oxytocin is a hormone that is critical for social bonding and is also powerfully anti-inflammatory. The participants felt safe in this setting and several people commented that they felt like they were in an “adult summer camp.”

Of course, when they returned home to their triggers, their anxiety and pain would reappear. But now they not only possessed new knowledge and tools, but they had reconnected to feeling playful, and relaxed. Many had not felt that way for years. Now they had a memory that they could return to and over time, and they became skilled at it. Years later, many have continued to thrive.

The basis of The DOC Journey is learning how to re-program your brain away from embedded anxiety circuits by stimulating neuroplastic changes in the brain. This requires repetition and eventually it becomes automatic. However, you can make this change happen even faster by shifting onto pre-existing play circuits.

All mammals have play as a part of their development. It is a multi-dimensional experience that processes many environmental cues and reactions are learned that are appropriate to the situation. Play is a core step in how we developed language and consciousness. Even if they feel deeply buried or almost non-existent, your play circuits are there, waiting to be accessed.⁶ Any skill that is not practiced will fade, but those neural circuits can be re-awakened.

As you use the playful part of your brain more and spend less time feeling anxious, your brain’s structure and neurological activity physically changes and grows . Conversely, when you experience chronic stress, your brain physically shrinks. Fortunately, as you heal and create more connections, it re-expands.⁷

I used to play trumpet in high school

An example of how this works is to consider a skill you had in middle or high school. Without practice, it has faded, but the memory is still there. I played trumpet in high school and a little bit in college as well. I could play reasonably well through medical school, but it all disappeared in the midst of the rigors of residencies and fellowships. I recently picked it back up, and although I have no lip strength or dexterity, I still remember the basic techniques and hope to re-connect with them quickly. It is doable, whereas if I were to try to learn a completely new instrument, it would take much longer.

My wife started playing the guitar again after a 30-year hiatus, and within a few weeks, was able to finger-pick like the old days. One day, it just all came back to her, and she  quickly progressed beyond where she left off.

The same is true for you – your play circuits are still there, waiting to be re-vitalized.

A deliberate decision

Many years ago, I was pondering my own journey out of The Abyss and considering some additional approaches. It hit me that the words “work” and “play” are somewhat arbitrary. I realized that my vacations were spent largely with trying to recover from the rigors of work. I didn’t have the energy to fully engage in enjoying my time off.

Much of the problem had to do with how I viewed work and my strong reactions in dealing with the challenges of being a spine surgeon. I decided that I would work on removing those labels from my life.

If I loved my work, and spent most of my waking hours doing it, why call it work? I decided to just embrace the whole experience. My entire team relaxed, and I enjoyed my patients, fellows, and colleagues a lot more. We had fun to the point where sometimes we would have to work on toning it down while we were in clinic.

At the same time, one of my mentors told me, “Challenges are an opportunity to practice your stress-coping skills and are part of any endeavor.” I began to embrace challenges head on and my reactions to stress dropped dramatically. By seeing problems as opportunities, I was both more effective and engaged with the difficult aspects of my job. This simple paradigm shift created a world of difference.

Play is a mindset

A word of caution – I am not referring to play as a way to distract yourself from your suffering. You can’t outrun your mind. Rather, it is mindset of curiosity, deep gratitude, listening, anticipation, awareness, and improving your skills to calm your nervous system. Nothing initially has to change in your life. My work environment was unchanged. It was my attitude that changed. I chose different words every day to reflect a sense of play. The result was a sense of contentment and peace.

Remember, nurturing joy is a learned skill along with processing  stress. You will eventually become an expert. At some tipping point, you’ll simply refuse to let people or situations ruin your day. You’ll also progress to being a source of peace and vitality. That is a long way from being trapped by anxiety and pain,

Recap – Moving forward

Play is one of the most effective ways to give your nervous system cues of safety. However, in the presence of relentless anxiety and pain, this probably seems impossible, and it is without effective tools and an approach that works well for you. You must simultaneously learn to de-energize anxiety and anger while nurturing safety.

Play to distract yourself from unpleasant feelings doesn’t work and is actually counterproductive. You cannot outrun your mind and your inflammatory markers go straight up. Conversely, living life with connection and purpose causes them to plummet.⁸

Choose play –  every day and watch your life transform.

Questions and considerations

1. Have you noticed that much of your vacation is spent trying to recuperate from work? By viewing work as play, you may have more energy to enjoy your time off.
2. You have heard the phrase, “don’t sweat the small stuff.” This is another way of letting go and simply enjoying your day.
3. There are many ways to connect with play. They include deep gratitude, a sense of curiosity, cultivating a sense of humor, and consistently choosing joy as opposed to complaining or feeling like a victim. When where you taught to nurture these traits?
4. As you continue to make these choices, your brain will begin to move in this direction automatically. Consider how much your brain is being programmed with negative self-talk and external messaging.
5. Notice how your mood affects those close to you. A good mood is contagious because it directly stimulates a similar area of the other person’s brain through “mirror neurons.” Conversely, a negative mindset is also having a ripple effect.

References

1. Tennant F. The physiologic effects of pain on the endocrine system. Pain Ther. 2013;2(2):75-86.
2. Torrance N, Elliott AM, Lee AJ, Smith BH. Severe chronic pain is associated with increased 10-year mortality: a cohort record linkage study. Eur J Pain. 2010;14(4):380-386.
3. Rahe R, et al. “Social stress and illness onset.” J Psychosomatic Research (1964); 8: 35.
4. Hausmann, LRM, et al. Reduction of bodily pain in response to an online positive activities intervention. Jrn of Pain (2014); 15: 560-567.
5. Meevissen,YMC, et al. Become more optimistic by imagining a best possible self: Effects of a two-week intervention. Jrn of Behavior Therapy and Experimental Psychiatry (2011); 42: 371-378.
6. Brown, Stuart, and Christopher Vaughan. Play: How it Shapes the Brain, Opens the Imagination, and Invigorates the Soul. Penguin Group, New York, NY, 2009.
7. Seminowicz, David A., 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.
8. Cole SW, et al. Social Regulation of gene expression in human leukocytes. Genome Biology (200); 8:R189. doi: 10.1186/gb-2007-8-9-r189

The post Healing through Play – It is Safety Physiology first appeared on Back in Control.

The post Healing through Play – It is Safety Physiology appeared first on Back in Control.

• Your brain is incredibly neuroplastic and can change quickly in whatever direction you choose.
• We automatically know how to feel pain. What about feeling pleasure? It gets buried in the stresses of life.
• Play and social connection are inherent in all of us and using feel and visualization to connect with it will create a rapid shift.
• Enjoying life in so many dimensions is a unique human trait, and we can thrive if it is nurtured.

When you are experiencing relentless pain, life becomes heavy. You are just trying to keep your head above water from dealing with stress. Your life devolves into surviving in addition to carrying a pain burden. You may have forgotten what it’s like to live your life with deep joy and excitement. We have suggested that creating a positive vision for your life and pursuing it  shifts your brain onto more pleasant circuits. Another dimension of process is connecting to feelings of freedom and pleasure from your past. It may initially take some effort to find them, but they are there. I would suggest an ongoing process that I have personally found helpful.

Connecting

Find a quiet time and place where you can just think and possibly go into a meditative state. Think back to an event in your life when you felt carefree and joyous. It could any number of situations at any point in time. Visually take yourself back there, remembering as many details as you can. Possibilities include:

• Dreams/ goals
• The weather/ temperature
• The conversations
• Attitudes
• Friends/ who you were with
• The activities
• Specific feelings and emotions
• What music, movies, sports, and art did you enjoy during this period?
• Are there songs and artists that you were particularly connected to?

Face and connect with your current reality

Spend as much time as you can with this exercise and repeat it often. Once you have really internalized some of these joyous experiences then sit down and fully experience your present life – pain and all. What happened to your sense of play and excitement?

• Compare it visually and emotionally to one of the times mentioned above.
• Note the gap.
• Make a commitment to get joy back and hold onto it. It requires repetition to change your brain.
• When you fall back into The Abyss (it happens frequently), again note the difference compared to your great moments.
• Don’t worry about making a “plan.” This is an exercise of feeling and waking up parts of your nervous system that have been dormant.

Pain or pleasure?

Believe it or not, you have a choice. You remember that one of the cardinal rules of healing is not sharing your mental or physical pain with others, especially with your family. It is completely understandable why you would want to, but where is your brain developing? I just talked to a gentleman who stated that over 90% of his waking hours are spent in either complaining about his pain and medical care or searching for a solution. Almost everyone in chronic pain does this, including me – for 15 years. I definitely had forgotten what feeling good felt like.

This exercise represents the opposite experience. As you connect with the best part of your brain, your body chemistry is dramatically altered into a safety profile where your body can rest, regenerate, and heal. We also know that optimism and a positive attitude directly lower inflammation in your body, and therefore the pain.¹This is not a light psychological game. It is a powerful way to alter your body’s chemistry.

A movie?

Watching a movie connected with a past pleasurable experience is also effective in waking up your brain. It is slightly different than just watching a funny movie to distract yourself. One movie that caught me off guard many years ago was “Happy Gilmore.” I had just flown in from Seattle to Sun Valley and I was exhausted. I was laying on the floor next to my son, who was about 15 at the time. Somehow, it seemed like one of the most entertaining movies I had ever seen. I don’t recall ever laughing so hard for so long. It connected me to a moment in time that I won’t forget. I have watched it at least 20 more times over the years, and it still lightens my mood. For each person, it will be a unique movie, song, or event.

Interestingly, for those of you who have seen it, there is a section where Adam Sandler goes to his “happy place” when he is stressed. The movie is simply silly, but this part happens to be right on with regards to using visualization to pull yourself out of a hole.

Visualization

It is well-known that performers do repeated visualizations before individual events, whether it is in music, sports, performing arts, or even surgery. Circuits are being burned into your brain that allow you to perform without overthinking. How else could an ice skater, concert pianist, or mogul skier perform such feats so quickly. In a book that I have recommended to my patients for years, The Talent Code,² the author points out that some teams have their tennis players swing a racket without a ball for three months. Why not apply these same tools to making pleasure your default mode?

Stories from the Mountains: Connecting to the Intelligence of the Heart 

Recap

The goal of this exercise to wake up dormant parts of your brain. Play and pleasure become buried by pain and survival. It is different than creating a vision or a business plan. You are reconnecting to the powerful emotional part of your brain. You can nurture it and watch it “wake up.” Feeling these sensations and experiencing these memories is key. Remember, reconnect, and “wake the fun up.”

Questions and considerations

1. Consider how the quality of your life has been taken away by being in chronic pain. No one warned you about this possibility when you were in high school.
2. Take a moment to remember a time when you were excited about the future and what you might experience and accomplish.
3. This exercise is a process to refuel feelings of enjoyment that have been buried, but not gone. Remember, pain circuits are permanent, but so are pleasurable ones.
4. As you nurture the more enjoyable aspects of your brain, you’ll use the pain areas less and they will atrophy. By trying to “fix” your pain, you’ll reinforce them.
5. Healing occurs as you become proficient at processing stress/ pain, but you also have to move into the part of your brain that involves play.
6. Anxiety is a threat physiological state of flight or fight, and play is a safety physiological state of rest and regenerate. Where would you like to spend your time?

References

1. Dantzer R, et al. Resilience and immunity. Brain, Behavior, and Immunity (2018); 74:28-42. doi.org/10.1016.j.bbi.2018.08.010
2. Coyle Dan. The Talent Code. Random House, New York, NY, 2009.

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

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

However, you cannot go from pain to play without tools and strategies. It is too big of a leap. The impact of chronic pain on your quality of life has been documented to be equivalent to suffering from terminal cancer – except that it is even worse.¹ We acknowledge the severity of your suffering, and it is why I use the term, “The Abyss” to describe how dark this place is.

Two aspects of healing

The DOC Journey app considers the healing process in two ways that are interconnected.

• Efficiently processing stress – the protective reactions of anxiety and anger. They are gifts that allowed us to evolve and how we survive. You must develop a “working relationship” with them. They are what you inherently possess, but not who you are. This is a necessary skill set in that you can’t move forward without letting go.
• Moving into your life’s vision of what you desire. This is where the deep healing occurs. The strategies you’ll learn will stimulate your brain to physically change (neuroplasticity). As you move away from the pain circuits and more pleasurable ones are nurtured, you will thrive.

Play for the sake of play

You cannot use play and pleasure to distract yourself from being in pain. Anxiety, anger, and pain are too powerful. It is why the healing journey consists of separate facets –  neutralizing the survival circuits and moving into safety. It is a dynamic process with no beginning or end. It’s life.

Visualize your life as a bathtub. The water flowing in through the faucet represents the enjoyable, rejuvenating parts of life. Then picture an unusually large drain that represents anxiety and anger. When you’re agitated and anxious, the drain is wide open, and it won’t matter how much water you run into the tub, it will never fill up. It’s impossible to build up your energy reserves enough to heal.

The DOC Journey app will teach you ways to dynamically plug the drain. You will use them multiple times a day indefinitely, and they quickly become automatic. However, this step alone doesn’t create healing or give you a good life.

To have an enjoyable life, you must live an enjoyable life.

Now imagine running the bath water with the drain closed. You’ve learned how to effectively process your stresses, so you can relax in the tub and enjoy yourself. You can create whatever life you desire. These learned skills are a bit challenging when you are used to spending so much of your life’s energy escaping from pain.

Similar to learning a new language, your brain will develop in whatever direction you place your attention (neuroplasticity). You cannot learn French by fixing your English. The default language for humans is survival and pain. Trying to fix yourself focuses your attention on the problem and reinforces these pain circuits. Learning French requires repetition and practice. In order to experience and enjoyable life, you must live and nurture it. This is where deep healing occurs.

The physiology of threat and safety

Physiology is the term used to describe the operations of your body. It is largely unconscious, automatic, incredibly complex, and powerful.

ANXIETY/ PAIN

Anxiety is a physiological state. It is the sensation you experience when you sense real or perceived danger. Your body is being directed to mobilize resources to enhance your chances of survival. It is intended to be deeply unpleasant so as to mobilize you to take action to optimize your actions and function (physiology) to live another day.

It is well documented in the medical literature that chronic stress kills. Why? It is because when you are exposed to threats in any form, your body goes into a defensive survival state of “flight or fight” where you are consuming energy. When this is sustained, your body utilizes energy from your own tissues, including tendons, ligaments, fat cells, internal organs, brain cells by breaking them down. This response also includes the powerful immune system, which is intended to ward off cancer cells, viruses, bacteria, and any foreign invaders. However, when it remains fired up, your inflammatory cells will also attack and destroy your own tissues. The end results are mental and physical symptoms, illnesses, and diseases.

Humans have and additional trait in that we possess language and consciousness. Although there are many benefits, there is a severe downside that I call, “The Curse of Consciousness.” Thoughts are sensory input that also create this threat physiological state. Since we cannot escape them, every person is subjected to some level of ongoing stress physiology.

SAFETY/ PLAY

Play is also a physiological state and the home run for healing. It is necessary for your body to be in a safe state in order to rest and regenerate to build up your reserves for inevitable daily threats. When you are in a “rest and digest” state, you are repairing tissues and storing fuel.

The essence of chronic mental and physical disease is sustained exposure to threats. The foundation of sustaining life is minimizing your exposure to fight or flight chemistry and maximizing your time in safety.

The DOC Journey app

The DOC Journey app will help you create experiences to relax and relearn to play. The optimum chemical composition for your health is when you are laughing and connected to the present moment. The sequence of the app is based on the following:

• Awareness – necessary for solving any challenge
• Hope – an anti-inflammatory powerful healing force
• Letting go/ processing anger – you can’t move forward while holding onto the past.
• Moving forward/ Play – a profound shift in your body’s chemistry

The app is educational and also has a toolbox you can easily access anytime. The best part of this journey though, is that you’ll learn to “Wake the fun up” – and thrive.

Recap

Visualize trying to cross a large scenic mountain lake while rowing a boat with a big hole in the bottom of it. The boat is slowly sinking, and you can’t easily both bail and navigate. Most of your efforts are focused on trying to stay afloat, and you don’t much energy left to take in the beautiful view and experience peace.

The hole again represents the drain created by ongoing anxiety and frustration. Trying to outrun your automatic survival reactions can’t and doesn’t work. Processing stress and creating your vision are two separate but intertwined aspects of healing. Once you can efficiently plug the hole, you’ll have the energy to live and enjoy your life journey.

Prepare yourself to navigate your life. Do it now because it won’t just happen. You have only one shot at this human experience.

References

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); 52:143-148.

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My wife, Babs, and stepdaughter, Jasmine, and I have done these workshops together since 2013. Each year, we are energized and inspired by the shifts in mood, outlook, and physical symptoms that occur within a just few days. We have been perplexed for years why this is such a consistent outcome and the last few years of neuroscience research has now explained what happens. It revolves around experiencing threat versus safety.

Fight or flight/ rest and digest

Any mental or physical threat, real or perceived, fires up your body’s flight or fight response through the sympathetic nervous system. The reaction includes stress hormones, inflammation, and elevated metabolism (fuel consumption); and you are on alert, anxious, and agitated. If the perception of danger is prolonged, then your body will respond with many different symptoms and often illness. Chronic stress (threat) keeps you in this heighted state and has been documented in many studies to be deadly. (1)

The essence of the solution lies in finding safety, which creates a “rest and digest” state that allows you to regenerate, drop inflammation, and slow down your metabolism; you feel relaxed with less pain. There are many ways to induce this state of safety. The workshop creates an atmosphere that allows this to happen. Dr. Robert Dantzer and several other researchers wrote an extensive review looking at the interaction of social factors influencing inflammation (pain) and how the inflammatory condition impacts your behaviors. (2) The main ones with most impact are:

• Social connection
• Positive affect (emotional state)
• Sense of control
• Optimism/ Hope

These workshops address all these issues and each of them is calming and directly anti-inflammatory communicated through the Vagus nerve (10^th cranial nerve). Dr. Stephen Porges, through his research and writing on the Polyvagal theory, has nicely laid out the afferent input into the midbrain and its efferent output allows safe human interaction. (3)

Social Connection

There are few times and places where you can feel safe with others. Life is competitive and it’s challenging to get a break. School has many layers of stress. Bullying is rampant. Close friends often turn on each other. Social media has intruded on privacy and quiet time. Research has shown that only about a third of families are relatively free of chaos. Other stressful arenas include sports, music, the arts, employment, and social status. Where’s there a place to rest?

We quickly realized that we didn’t have to do much after we set up the weekend. Participants in a safe and structured setting healed each other. It was also a remarkable experience for us being in the presence of those who are so supportive of each other. Oxytocin is a bonding hormone that is secreted in safe and social situations and is anti-inflammatory.

Positive affect/ play

The  weekend is also focused on re-connecting people with each other by sharing enjoyable experiences. Many of the activities are held in small groups of four or five. Participants can feel safe and it’s remarkable how quickly healing occurs. Much of the weekend is spent in play, which is a great venue to feel safe.

Babs and Jasmine are important contributors by leading you in rhythm, song, relaxation exercises, and sharing.

 Sense of control (The “ring of fire”)

There are many tools that allow you to regulate your own body’s neurochemistry and responses to threats. Just this sense of control is anti-inflammatory. Additionally, understanding the nature of chronic mental and physical pain will enable you to personalize solutions.

Awareness of your current state of being is the first step and we use a tool called, “The Ring of Fire.” Being aware of which color you are in at the moment, allows you to choose your direction. The green center is where you rest and regenerate. Blue is “life.” The red ring of anxiety and frustration is an inherent part of life that must be navigated skillfully. The goal is to be able to exist in any part of the “circle of life” on your own terms.

Hope/ optimism

People in chronic pain lose hope. The loss of hope contributes to the actual pain by increasing inflammation by speeding up nerve conduction. We will be sharing many stories of hope with the group. Regaining hope is powerful.

Comments from prior classes

“I’m still high from the weekend. And off all pain meds (even Advil) after 10 years on opioids…………..    Interesting how the class responded to my hooping (hula hoop). I can see Babs and Jaz doing a session, maybe a half-hour?  What do you think? Neuroplasticity, endorphins, fun!  Whether people catch on right away or not, laughter will be a result.  It could take practice, just like learning the cup song.  And for any resistant males, emphasize that it will improve their sex lives!”

“The program has been enormously helpful, and I can only conclude that it’s helping me to live in a more authentic way, which I feel makes my unconscious happy! I think when you have an abusive parent you have to suppress your feelings so much that suppression, avoidance and denial become your coping mechanisms. But as you know, it’s no way to live your life.

It’s possible I may still need surgery eventually, but if so, I feel that thanks to following the program, I’d be able to do it in a conscious and aware manner. Before, I felt very strongly that It would be a mistake.”

“………….  My family and co-workers are amazed at my progress. I am especially committed to no longer talking about my pain and to writing on a regular basis. I am getting (have gotten) my life back!”

Several commented, “I feel like I just spent a weekend away at camp.”

Reconnection to you

We have always been aware that when returning home, the pain will recur. But tasting freedom from pain is powerful. Every cell in your body is created to survive and thrive. If you allow yourself to be open to possibilities, it is a matter of time before you find your way to healing. Many participants have leveraged these workshops to a more enjoyable life.

References:

1. Rosengren A, Orth-Gomer K, Wedel H, Wilhelmsen L. 1993 Stressful life events, social support, and mortality in men born in 1933. Br. Med. J (1993); 307:1102–1105.
2. Dantzer R, et al. Resilience and immunity. Brain Behav Immun (2018); 74:28-42. doi:10.1016/j.bbi.2018.08.010
3. Porges, Steven. The Polyvagal Theory. Norton and Co., New York, NY, 2011.

Ffvb

through the Vagus nerve (10^th cranial nerve).

The post Experiencing Safety: Solving Chronic Pain: An Immersive Weekend Retreat first appeared on Back in Control.

The post Experiencing Safety: Solving Chronic Pain: An Immersive Weekend Retreat appeared first on Back in Control.

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

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

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

Overview of the guided course

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

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

Why this sequence

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

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

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

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

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

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

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

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

The goal

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

Navigating the course

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

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

The guided course

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

Leg 1 – Preparing for your journey

Leg 2 – Starting your trip

Leg 3 – Anxiety is the Pain

Leg 4 – Awareness

Leg 5 – Anger processing – the Tipping Point

Leg 6 – Moving Towards Your Vision

Leg 7 – Expanding the Center of Your Circle of Life

The DOC Journey

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

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

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

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One of the most difficult concepts to operationalize in healing from chronic pain is that you cannot fix it. Your attention is on the problem, not the solution. Since your brain is constantly changing structure, you’re reinforcing the pain circuits. Solving chronic pain requires that you move towards your vision and actively pursue it. Paradoxically, your pain will be left behind and you can create whatever life you would like.

Somehow, we have big dreams when we are young without resources to attain them, and then when we are older and may have the means to pursue these visions, we don’t. We get stuck in life and all of its trauma. People often dream of retirement and then don’t what to do with themselves. He has an unusual and inspiring approach.

Maurice L. Monette holds a doctorate in Adult Education from Columbia University. He directed and taught in graduate programs for adult learners at Loyola and John F. Kennedy universities. Monette is now an artist and writer and lives in Oakland, California.

Play 20*

Maurice L. Monette

At 68, I asked myself, “Why not play 20?”

The idea to “play 20” hit me when I was trying to learn something new and felt particularly frustrated. I reflected on the fact that many 20-year-olds become able to identify themselves as professionals of some sort by the time they reach 25.  Julia is suddenly an engineer. David has become a nurse. So, with all my experience at 68, why can’t I make myself the artist or writer I’ve actually dreamed of being? Why can’t I begin to identify myself as an artist or writer and become a respectable one within five years?

Why? Because I’m too old. I can’t learn new tricks. I am a senior. My mind isn’t what it used to be. I have pain. I’m not feeling well enough. I shouldn’t need to learn more. I already have it all together. Besides, why risk looking like a fool? I just can’t do it!

A Writer

Those objections aside, the inspiration to “play 20” moved me to try creative writing. I joined a writing group led by a writing coach and I began writing stories. After composing about 100 one or two-page stories in a year’s time, I realized I had the makings of a personal memoir. A year later, I published 80 of those stories as a book. Within two years I had become the creative writer I had dreamed of being. People I didn’t know would meet me on the street and say “you’re the writer, aren’t you?” At first, I hesitated, being accustomed to identifying myself as the leadership coach and university professor that I had been for most of my life. But yes! I write every day – that makes me a writer!

A Painter

Painting interested me too. A local artist taught me the basics of painting with acrylics. That made me aware that to paint well I needed to learn the basics of drawing. I taught myself with drawing lessons on the Internet. Within a year, people were admiring (and even buying) my art. I had become an artist!

For me, to “play 20” is about courageously taking on new learning despite the usual deprecating self-talk that paralyzes me as an older adult. “Play 20” is about taking on the beginner’s mind and practicing the behavior of an ambitious 20-year-old learner:

• Pursue new interests and curiosities
• Recognize my ignorance and naivety and accept it as an opportunity to learn
• Connect with teachers and other learners
• Utilize the internet for classes and other resources
• Recognize the need for feedback and seek it non-defensively
• Maintain a can-do attitude.

Inspired

Practicing these behaviors as an elder was not easy for me, but being an elder had many advantages. For instance, I was drawing not because I had to, but because I was inspired to create beautiful art.  I completed lessons on the Internet without having to pass a test or worry about a grade. I didn’t even have to be ashamed, because I easily accepted that I had never drawn and knew nothing about drawing. I simply had to accept my ignorance and open myself to an exciting venture. I didn’t have to prove myself like I did when I was 20. Except once when a prospective art instructor asked to see my drawing samples. At that moment, I did have to demonstrate my talent to him. But not to worry. I was a volunteer learner and I knew I could find another instructor if need be. My only concern was to find the right instructor for the particular next steps I needed to take. I wasn’t studying for a degree or under pressure to get my next job. I just wanted to become an artist with skill.

Tempering ego and assuming the beginner’s mind continue to benefit me in many ways.  Perhaps the Spanish word that is sometimes used for “retirement” says it all: jubilación, “jubilation” in English.  I am jubilado not only because I am retired but also because I can take joy in new learning that brings me new skills, insight, beauty, growth, new relationships, and new identities.

So, why should becoming a writer or artist (or whatever I want to become) be any more impossible now than at 20? Why not “Play 20”?

* Adapted text excerpted from Play 20: A Collection of Essays and Drawings by Maurice L. Monette posted on his memoir blog, justplay20.com. Each of the 20 essays in the Play 20 collection describes a joy or challenge of his own Play 20 journey, provides samples of his art, and includes lessons he learned about learning as an older adult. With Play 20, Monette offers to one of the most vulnerable populations impacted by COVID-19, the home-bound, and seniors in our community, a way to look ahead, to learn, to recreate, and to Play 20.

The post “Play 20” – Create Your Life at Any Age first appeared on Back in Control.

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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.

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I plateaued for about six months but now had some hope. I had always perceived myself as “cool under pressure” and felt that most things weren’t worth getting upset about. I could not have more wrong. What I was highly skilled at was suppressing anger. It exploded and I did not process it well.

I first had to admit that I had a lot of anger, but since “I was right”, I didn’t perceive it was a problem. So, I wasn’t progressing much and my life continued to disintegrate. Over about six months, I was finally able to learn some basic anger concepts and skills and began to rebuild my existence. What I did not expect is that my all of my physical symptoms began to improve and six months later, they had all but disappeared. I was shocked and still did not understand the role of sustained anger and elevated stress hormones/ cytokines causing inflammation.

From reactive to creative

Many people get to this spot of a dramatic turnaround and stop the journey, which is fine. They are excited, as am I, and they usually continue to do well. However, I also think that they have missed the best part. Instead of having to fight your way out of The Abyss, you have the opportunity to further connect to who you are, move forward from your center in a powerful way, and experience life at a level you never knew was possible. That is what this phase, Expanding Your Horizon is about.

The healing journey is based on connecting to your own capacity to heal, learning tools to optimize your body’s chemistry, feeling safe, and then creating the life that you want. As you move towards your idea of what you want your life to look like, you’ll be shifting off the pain circuits and nurturing ones that bring you pleasure and satisfaction. As you move into regaining your life perspective, connecting with your passions, play, and giving back, you’ll be spending much less time reinforcing your pain circuits and thrive.

Here are the areas to address that will enable you to experience the best part of your journey:

• Sleep – still the cornerstone
• Effectively processing stress – Life never stops coming at us
• Physical conditioning – is simply one of the best ways to feel better
• Medication management – a thoughtful approach will simplify this aspect of your care.
• Life outlook – is one of the most critical aspects of your journey. You have to know where you want to go to get there. How you do it is also important.
• A deeper understanding of chronic pain – will allow you to be innovative in dealing with it and allow you to have more control of your care.
• Family dynamics – turned out to be maybe the most powerful force in holding people back, but when addressed with a structured approach was remarkably helpful in healing – for the patient and the whole family.

Moving forward

Addressing sleep was the first step in the evolution of the DOC process. Twenty years ago, only a small percent of physicians dealt with sleep issues. I took an aggressive approach and would begin with “sleep hygiene” measures. But if a patient wasn’t responding within a couple of weeks, I would use combinations of sleep medications. Most people would respond within six to eight weeks. A significant percent of patients experienced a dramatic improvement in their pain. It wasn’t until years later, that I read a major paper showing that lack of sleep could induce chronic pain. (2) Unfortunately, it is still common to have major risky interventions done or recommended before sleep is addressed.

Processing stress became inherent in my practice as I worked with patients dealing with the problems created by being in chronic pain. I had experienced a lot of benefit with the book, Feeling Good, as I mentioned above and I had my patients use it. I quickly noticed that the only ones who responded were those who did the recommended writing. Other stress management approaches emerged over time. I eventually learned that stress is not the problem, as much as your reaction to it.

Addressing Physical Factors is basic to musculoskeletal care.

• Physical therapy must be tailored to a patient’s specific needs.
• Aerobic conditioning has long been documented to improve pain.
• Weight training not only increases strength but also stimulates the release of hormones that enhance your sense of well-being. It also seems to have a neurological component in that you are on the offensive, taking charge instead of being at the mercy of your pain.
• Nutrition is critical. For example, an anti-inflammatory diet can quickly lower your pain. Intermittent fasting consistently lowers inflammation.
• Bone health – osteoporosis (low bone density) creates havoc with the quality of your life and is both preventable and treatable.

Medication management is critical. You need symptomatic relief to give you “the space” to learn and implement the tools to heal. They will become much less important as your pain resolves and no one really wants to be dependent on medications. They are expensive and a hassle.

My approach was the reverse of what is usually done. I would keep patients on the same medications, including narcotics. Medication discussions were always face-to-face. Although, the goal was to wean down, the patient always had the last say regarding how quickly this would occur. Anxiety is the pain and going to war over medications is counter-productive. With the patient in charge, he or she had control (an antidote to anxiety) and I rarely had a problem with patients coming off of their meds. In fact, as the pain dropped, the side effects increased and they were anxious to stop taking them. The only criteria I required was that they had to be actively engaged in the other aspects of the structured care approach.

Life outlook is one the most important aspects of healing. Goal setting is a core aspect of stimulating neuroplasticity. Your brain will develop wherever you place your attention. It is similar to learning a new language. You have to decide what you want your life to look like, what you want in it, and then pursue it. Otherwise you are still focused on the problem and not the solution. A corollary aspect of this is forgiveness. You can’t move forward until you can let go.

Awareness of the nature of chronic pain is important because it is so complex and each individual is unique. The traditional approach is to manage it, not solve it. Random simplistic treatments are used to treat symptoms and not address the core problem of a fired up nervous system and sustained exposure to elevated stress chemicals. The DOC process is a framework that allows you break down pain as it relates to you into its components. It allows you to address all of them simultaneously. It is this multi-pronged approach that is what is so effective in successfully treating chronic pain.

The final component regarding family dynamics came about over the last few years of my practice in Seattle. We had known that chronic pain takes a terrible toll on the family. It became clear that a patient could engage in many aspects of the DOC process but the family dynamics would sabotage everything. Conversely, by addressing the family interactions around pain, patients would often experience powerful healing. We began to set up rules around pain in the household. The basic one was that the patient could not discuss their pain with anyone – ever – especially with their family. The corollary was no complaining, giving unasked-for advice, or criticizing. Basically – be nice.

From reactive to creative

Don’t stop now when you are really just beginning. It is a triumph to be out of The Abyss, but there is much more to life than just surviving. Most people have been fighting the pain for so long that they have forgotten what it is like to relax and enjoy it.

If you take the word, reactive and move the “c” to the front, you have the word creative. If you can “c” first, you have some space to look at your options and create your reality.

1. Burns D. Feeling Good. Avon Books, New York, 1999.
2. Agmon M and G Armon. “Increased insomnia symptoms predict the onset of back pain among employed adults.” PLOS One (2014); 8: e103591. pp 1-7.

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