My first year in training

I will never forget my first holiday season as an internal medicine resident in Spokane, WA. I learned that the holidays are a nightmare for the medicine service, especially the GI service. Diabetics don’t take their insulin and their sugars go out of control. Cardiac patients don’t take their meds and are admitted for chest pain and abnormal rhythms. The GI service is the worst in that patients with liver disease drink more and develop major bleeding in their gut. People are depressed and the stress of the holidays puts them over the edge.

He died?

We had a resident’s clinic once a week. One of my favorite patients was an 80 year-old gentleman, who was as nice of a person as you could meet. He had some moderate lung disease but otherwise was fairly healthy. He was admitted to the hospital on Christmas Eve with respiratory failure. It didn’t make sense to any of us, as his lung disease wasn’t that severe. We had a whole team working intensely to solve the puzzle. It didn’t matter. He died two days later. During the course of the hospitalization I found out that his son who lived in Seattle had not invited him over for Christmas and he had become despondent. I have since learned that the will to die is as strong as the will to live.

My descent into loneliness

I could not figure  this increase in illness and depression over the holidays for many years – until I descended into my own anxiety-driven depression and chronic pain. There were many unpleasant (terrible) aspects of being in the abyss, but maybe the worst one was feeling alone. I am an extremely social person. As I became progressively more anxious and reactive I began to feel isolated. In retrospect I realize that a lot of this was occurring in my own head. My friends were not avoiding me. I was not interacting with them. While I was trying to survive the terror of raw anxiety I was not able to reach out to others. I became more withdrawn and felt uncomfortable even talking to people. Discovering I had NPD

Obsessive thought patterns

What began to happen is that I developed what I now recognize as an obsessive thought pattern (classic symptom of the Neurophysiologic Disorder) that everyone else had a better life than I did. It did not matter what the evidence was to the contrary. I could not shake that thought. The holiday season made it much worse. First, it reminded me of times that were much better and I felt even more sorry for myself. Secondly, people really seemed like they were having a better time than I was. (jealous/angry). Finally it seemed like the merriment around me was almost mocking my plight. For over 10 years I would become dark around the holidays.

I became socially isolated. I imagined that people just didn’t want to be around me and the story in my head became strong and convincing. Fortunately, I had a few people that I connected with that could see through the storm of my thoughts. It was that human connection that kept me going. But the feeling of loneliness was one of the worst aspects of my descent into chronic pain.

Social exclusion and the ACC

A study published in 2003 (1) looked at the brains of volunteers who were hooked up to a functional MRI scanner (fMRI) which highlights metabolic activity of the brain in response to different stimuli. The volunteers were visually involved in a computer game of “three way catch”. They were not told that the other two “players” were just the computer. At a certain point they were suddenly excluded from the game while the other two “players” threw the ball back and forth another 45 times. The volunteer would consistently feel excluded and experience emotional distress. Interestingly, a part of the frontal lobe, the ACC, would light up. This part of the brain is “the neural alarm system.” It lights up when something in the environment is not right or threatening. Not surprisingly pain is a basic signal that also lights up this area. This study documented that emotional pain lights up the same area.

So chronic pain creates yet another vicious loop. Pain lights up the ACC (anterior cingulate cortex). While in pain you feel much less inclined to be social, which then reinforces the stimulation of the ACC. You now have added emotional pain to the physical pain.

Where does chronic pain begin?

People need people. People need to connect first with themselves and then with others. There are many societal factors, in addition to chronic pain, that create social isolation. It is unclear whether the social isolation that stimulates this “neuro warning center” could be the starting point of chronic pain.

Omega

My wife, Dr. Fred Luskin, and I put on a five-day seminar at the Omega Institute last summer. There were 11 participants who experienced a significant shift in their mood and pain during the week. As they went back to their home environment some had their pain return and many remained relatively pain free. The essence of the week was that we were able to relax and connect with one another. My impression was that the environment allowed us to open up and share. The capacity of people to heal each other was powerful. (The workshop was July 19-24, 2015.) “The Cup Song??”

The holiday season during my burnout was the equivalent of being excluded from the computer game. I’m sure that if I was placed into a fMRI during that period my ACC would have lit up like a small nuclear reactor. The sense of social exclusion was crushing. My Battle With NPD

I was very fortunate to not only escape from the abyss, but thrive. I wish the same for you in 2016.

1. Eisenberger, Naomi, et al. “Does Rejection Hurt? An fMRI Study of Social Exclusion”. Science, 2003, pp. 290 – 292.

The post Happy Holidays – Not first appeared on Back in Control.

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Where is your attention?

Do you want more play in your life? Are you sure? Many people become so used to pursuing a cure or fix for their pain, that it becomes such a habitual behavioral pattern that you may not be aware of how attached you are to it.

There are two parts to this story. The first one is that you can’t fix yourself, because your focus is still on the problem. The harder you try, the worse it will become. It’s a consistent experience. Your body chemistry will remain out of balance, and there are many physical symptoms that stem from the effects on the various body organs. The second, and most critical aspect of healing, is learning the methods to auto-regulate your body’s chemistry, which also has profound effects on your organ systems resulting in a marked decrease in physical symptoms and improves your over sense of well-being.

Play

One of the most effective ways of achieving this state of being is to nurture a sense of play in almost every aspect of your life. It is a choice you can make daily with or without your pain. If you are waiting for the pain to disappear first, you’ll be waiting a long time. The pain is center stage and where your nervous system will experience an increase in the complexity and strength of these unpleasant circuits. (1)

We discovered the play concept many years ago during our annual Omega Institute workshop, “Relief from Chronic Pain.” We held the first one in 2013. It was before I had any concept of how the body chemistry had such a profound effect on creating mental and physical symptoms. I did have a basic understanding of neuroplasticity, and also knew that social isolation creates similar symptoms to those of people suffering from chronic pain. The seminar is based on awareness, hope, forgiveness and play. The intention was to create a structured, enjoyable shared experience.

Re-connecting with play, people and life

My wife, Babs, is a professional tap dancer. Rhythm is second nature to her. We didn’t attempt to dance, but worked on some basic rhythm in the form of “The Cup Song” and a few other simple steps. Most of us were rather inept at learning these skills (there were some notable exceptions) but we began to laugh. It was clear that this wasn’t a high-stakes game and we just had some fun. Many participants had a shift in mood, and some experienced a significant decrease in their pain. Even more had improvement months later because I think their nervous system had reconnected with having fun. Fun gets buried in the morass of pain. They were able to practice the tools unique to them to get back to that spot.

The healing process is paradoxical. Before you can move forward you have to let go. You can’t truly play if you are angry and the more legitimate your anger, the harder it is to process it. So, a significant part of the weekend is focused on forgiveness.

Both play and forgiveness are processes that have different roles and impact on a given day. Even if you can’t forgive for a while, make an empirical choice to play. We do know that actively engaging in fun will change your mood – whether you want to or not. This poem was recently sent to me and reflects some core healing concepts.

When I Dance

“When I dance

I cannot judge,

I cannot hate,

I cannot separate

myself from life.

I can only be joyful

and whole.

That is why

I dance.”

~ Hans Bos

That is why

When I judge

Hate

Separate myself from life

I cannot dance.

Reply from my friend

We would love to meet you this year at our 2019 workshop at the Omega Institute in Rhinebeck, NY being held from Friday evening, June 7^thuntil Sunday noon, June 9^th.

So whatever form it takes – just dance!!

The post When I Dance – Omega 2019 first appeared on Back in Control.

The post When I Dance – Omega 2019 appeared first on Back in Control.

Searching for an answer

A few years ago I had a great deal of stress that landed in my neck and I couldn’t find any relief anywhere for more than 18 months. I saw many professionals – spine surgeons (no structural issue); chiropractor (looked like chronic whiplash symptoms), occupational therapist (recommended diet changes, flats, exercises, saunas, massages) and physical therapist (heat treatments, TENS treatment, exercises, massage) and nothing was working. In fact, when I went to the chiropractor he snapped my neck without asking or explaining prior to doing it and I felt an electric like shock feeling go through my back. For the next 10-12 months, I now had not only neck pain but a deep ache going down both arms. My sleep was disrupted, I was tearful, struggling with focus at work and I didn’t want to do anything.

Omega workshop

I shared my struggle with Dr. Fred Luskin, who shared Dr. Hanscom’s book, Back in Control, with me. I started to implement some of his suggestions with the first being focusing on improving my sleep. I attended the Omega training shortly after and learned more about the impact of stress and the mind-body connection. I saw others improving before my eyes and yet I found myself being miserable. I could hardly sit through the classes and was edgy and irritable but determined to learn.

It took another few months but by addressing the stress, improving my sleep, and taking glucosamine I have been pain-free for a number of years. What is even better than that is that when I feel the neck muscles tightening from either stress or behaviors (too much computer work), I can focus on getting good sleep, anti-inflammatory diet, add the glucosamine back in and now avoid major relapses. In fact, once I recovered I have never reached the same level of pain again.

Moving on

I have been so impressed with Dr. Hanscom’s work and insights into the mind-body connection that I have been focusing my PhD studies in Mind Body medicine on chronic pain and stress management. I now share the tools that I have learned and the Back In Control book with every client I work with who struggles with chronic pain.

I will be forever grateful to Dr. Luskin who led me to Dr. Hanscom and Dr. Hanscom for putting his understanding out to the world. As I have heard him say many times, “If you calm the system down surgery may no longer be necessary. If surgery is necessary, calming the system down before the surgery has much better outcomes.” Prehab

Thank you Dr. Hanscom for looking out for the greater good and not the bottom dollar. Hospitals and pharmaceuticals would prefer pain management but the DOC (Direct your Own Care) can significantly reduce pain and in some cases even cure without all the negative side effects.

How many more neck surgeries?

Omega 2018 workshop

The post Chronic Neck Pain Gone – DOC Prevents Relapse first appeared on Back in Control.

The post Chronic Neck Pain Gone – DOC Prevents Relapse appeared first on Back in Control.

As in the past, joining me will be my wife, Babs Yohai, who is a professional dancer; and my daughter Jasmine Yohi-Rifkin, a dancer and choreographer with an MA in psychology. Both will present effective somatic, movement, and expressive arts tools that participants can use after the workshop.

This year, also joining me will be special guest Bernie Siegel, MD, best-selling author, retired pediatric and general surgeon, and founder of Exceptional Cancer Patients (ECaP—a form of group therapy for cancer patients). Bernie has written prolifically about healing and many other topics that address life’s challenges. You may know two of his most prominent books, The Art of Healing and Love, Medicine and Miracles. Over the last couple of years Bernie has inspired me with his wisdom and accomplishments. He will join us live via Skype on Saturday afternoon.

While Bernie and I use different approaches, we both share the conviction that the key to healing is connecting with our own capacity to heal ourselves. I use neuroscience to support the principles in my book, Back in Control; but the science also supports Bernie’s concepts. It will be exciting and insightful to have Bernie talk about his approach and how our two bodies of work intersect.

Over the years that I’ve been offering this workshop, its format has evolved by applying four tools that address chronic pain: awareness, hope, forgiveness, and play.

Awareness

In order to solve a problem, it helps to understand it. For example, it is useful to know that stress created from a physical or emotional source elicits an automatic survival response, which includes the release of stress hormones such as adrenaline and cortisol. Anxiety is the feeling elicited from these chemicals. The first step in solving your pain is to recognize this link. This and other neurophysiological aspects of pain are discussed in chapter one of Back in Control; and we recommend that participants read it before attending, to get the most out of the workshop.

Dr. Siegel advises us to be aware of the role pain plays in our lives, and what it can teach us to help us heal. I strongly encourage you to read The Art of Healing. Bernie has many great stories, and I’m excited to hear what he will be teaching us at the workshop.

Hope

Many people in pain lose hope and find themselves in a downward spiral of despair. I was in that abyss for over fifteen years and became an “epiphany addict,” on a desperate quest to find “the” answer. As a physician, I had access to every known solution, but not one of them brought relief. 2002 found me utterly hopeless and attempting suicide.

Like most of the medical profession, I was looking at chronic pain as something to be managed, and found little success in treating it. Once I finally discovered the mind-body connection, which has been supported in neurophysiological research, I learned that a combination of treatments was the answer. Now I have not only my own, but scores of success stories to share at the workshop. With the correct treatment process, solving pain is not only possible—it’s probable. Chronic pain is curable.

Forgiveness

Most patients find it extremely difficult to forgive the person or situation that caused their pain. The more legitimate one’s anger, the more difficult it is to let it go. Typically, people are most angry with themselves. But as long as you hold on to anger, you hold on to chronic pain, no matter whom you are angry with. As travelers of the same neurological pathways, anger and pain sensations are tightly linked.

You must be willing to deeply forgive not only others, but yourself—down to your deepest wrongs. You may improve by using other tools in the DOC process; but you will not become pain-free until you completely forgive. Many people in pain are addicted to the power of anger and pain, and refuse to give it up. They not only choose to continue to suffer but also make the lives of those close to them miserable. If you are one of those people, this workshop is not for you.

Play

The one goal I had when I began holding Omega workshops was that people just be with each other and share some experiences. Almost all my patients had become socially isolated, which gave them more time to obsess about their pain. I thought, after they learned and practiced some effective tools, they would go home, put them to use, and then start to experience an improvement. But one of the biggest surprises was how quickly chronic pain disappeared during the workshop. After suffering for years, many participants became pain-free during those few days.

In the workshops we create a structured environment where participants feel safe to share. As participants relaxed, a sense of play crept into the group and their pain began to abate. When this first happened it was totally unexpected! But it might have had something to do with our prohibition against complaining or discussing their pain or medical treatments during the workshop.

When participants returned home and re-encountered familiar triggers, pain typically re-appeared. But with new tools to process these emotional agitators, eventually the participants did well. One of my mentors, the coach for the University of Washington women’s golf team who, by using many of these concepts, advanced them to the national championships in 2016, taught me, “Adversity is a chance to practice your tools.”

Success Story: Deb

Deb was a social worker in her mid-forties when she attended our first Omega workshop in 2013. She had experienced severe, unrelenting neck pain for over four years, and tried all the traditional treatments without success. She was studying chronic pain for her PhD dissertation, thinking that it would help her solve her own pain. Deb did not fully participate in the workshop, missing a couple of key sharing sessions and staying off-campus with her boyfriend. When her condition did not improve, I assumed that was just the way it was going to be. But about ten months later she became completely pain free. Why? Deb attributes her remarkable recovery to stopping physical therapy, adopting an anti-inflammatory diet, getting better quality sleep, practicing expressive writing, and focusing on forgiveness. Not only is she free of pain; she has brought the DOC tools into her community and set up a non-profit housing project. She is a delightful, energetic, contributing member of her community.

Awareness prepares you for change.

Hope is the energy needed to begin the climb out the Abyss.

Forgiveness eradicates anger and its poisons.

Play connects you with others and transcends pain.

Step into your new life.

The post Omega 2017: Awareness, Hope, Forgiveness and Play first appeared on Back in Control.

The post Omega 2017: Awareness, Hope, Forgiveness and Play appeared first on Back in Control.

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

The destructive power of anger

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

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

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

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

Placebo

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

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

The warts on my hands

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

The drug of choice

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

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

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

Treatments without risk

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

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

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

Heal yourself

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

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

The post Harnessing the Body’s Healing Power first appeared on Back in Control.

The post Harnessing the Body’s Healing Power appeared first on Back in Control.

Awareness

You cannot successfully address any problem without understanding its root cause. But many people in pain stubbornly insist that, “The problem is that I am in pain,” and leave the solution to their health professionals. Unfortunately, the neuroscience research has not worked its way into mainstream care and they don’t understand the problem either. A recent paper that reviewed hundreds of studies stated that “chronic pain is a maladaptive neuropathological disease state.” (1,2,3) You cannot successfully solve a neurological problem with interventions aimed at structural issues. It is just not possible. This approach can’t and doesn’t work. That is why over 1 in 3 American adults are suffering from some level of chronic pain.

The body processes both emotional pain and physical pain by responding with stress hormones? Both kinds of pain are successfully treatable using similar strategies? Given a choice most of my patients would like to eliminate their emotional over their physical pain. Paradoxically, as the emotional pain drops, so does the physical pain. It doesn’t work the other way around.

My friend, Fred Luskin, author of Forgive for Good, pointed out that the human body is designed for survival, not necessarily for quality of life. All stress–real or imagined–is perceived as a threat and triggers your body to secrete adrenaline and cortisol. If you are under constant stress you may not even notice it, but your body will continue to secrete these chemicals that keep you in a continual “fight or flight” mode. You may be so used to being in this state, that it seems normal. The first step in healing is to become aware of your state of mind, life outlook and the effect they have on your body’s chemical balance. You have to understand your current state of being before you can change direction.

Hope

Hope is a critical component for thriving and living a meaningful life.

The observation and experience of core group of physicians and some other health care professionals is that of chronic pain is solvable. However, most physicians view it as a diagnosis to be managed. They simply haven’t been trained in utilizing an effective approach. They are almost as frustrated as their patients because they went into medicine to help people. Most of my patients have been to many providers and undergone multiple treatments without success. Additionally, since no one has provided them a plan should the treatment fail, there does not seem to be any way out.  They feel trapped. The indescribable anger and frustration really crank up their stress chemical output, which increases the pain. How many times can you experience that kind of disappointment and still keep moving forward?

Dr. Viktor Frankl, author of Man’s Search for Meaning, was an Austrian psychiatrist who survived the WWII concentration camps. In his book, Dr. Frankl described how the worst part of the ordeal was not the indescribable physical suffering, but not knowing when if and when it was going to end.

Every week I see huge smiles on the faces of patients who are now pain free after years, sometimes decades, of pain. They cannot express their feeling in words, and I feel privileged that I have been able to provide a framework for them to pull themselves out of the hole. It began with awareness and hope.

Forgiveness

You will not heal while you hold on to anger, no matter how justified your anger might be. In fact, the more legitimate your anger, the harder it is to let it go. How can you move forward while hanging on tightly to the past? There are many resources out there to help you process your anger, and Stage 2 of this website is a solid starting point. The method does not matter as long as it enables you to truly let go. Remember, that to stimulate your brain to develop new pain-free pathways you have to move forward with or without your pain. I highly recommend Dr. Luskin’s book, Forgive for Good. When it entered the DOC program, I began to see many more patients free themselves from their pain. I consider acknowledging and processing anger the “Continental Divide” of chronic pain.

Several studies have shown that the vast majority of people in chronic pain still blame the person or situation that caused their injury. Interestingly, the person they blame the most is themselves. (4) When patients tell me they are not angry I often will ask them how critical they are of themselves. The most important person to let off of the hook is you. Knowing how anger obstructs healing and creates more pain, why do you insist on holding on to it? Is it really worth it?

Pain free after suffering for decades

Iris became pain free after decades of severe chronic pain. She had been on high-dose narcotics and using a walker. Now she is off her meds and walking unassisted.  She wrote me, “The book you have written has saved my life. It is so much more than a book on back pain; it is back in control of my sanity, my depression, my self-worth, and my caring. I had no idea that anger was behind my anxiety and depression.” I have never met her but was able to talk to her a few months later. The key to her healing was awareness and letting go.

Play

Anger and play could not be farther apart. Anger disconnects us from others, from ourselves and from life; while sharing play is the essence of life.

Play is an essential aspect of child development. It is how we learn to constructively interact with others. Play areas of the brain are powerful and permanent circuits present in every human being; but they can get buried in the hubbub of daily life and the distraction of chronic pain. They’re present even in someone who did not develop an overabundance of them in childhood. But although play exists in all of us, they must be nurtured by making conscious choices to play. You do not need to continue to live your life in anger.

About ten years ago, I made a conscious decision to re-inhabit my play pathways when I chose to enjoy my day regardless of the circumstances. I am not always successful; but I committed to re-engaging with these circuits as quickly as possible when I wandered off course. Eventually, the labels “work” and “play” have merged into one. Play for me is curiosity, gratitude, awareness, letting go and simply deciding to enjoy and appreciate what I am doing at the moment.

Three of the principle methods for eliminating chronic pain are: 1) “de-adrenalizing” the nervous system, which slows the speed of nerve conduction and decreases the level of pain; 2) building new circuits that circumvent the embedded pain ones; and 3) shifting to new and more functional areas of my brain.  Play does all of this.

Omega Workshop

I didn’t realize how powerful play pathways were until a five-day workshop I facilitated at the Omega Institute in Rhinebeck, New York. Fred Luskin worked with us during the forgiveness portion, and my wife and daughter helped us play together. Feeling safe and relaxed, we began to laugh. Many attendees went pain free within five days and have remained that way. Even I did not expect such a powerful outcome. The Cup Song

My book presents a robust framework to help you organize your thinking about pain. Using awareness, hope, forgiveness and play will allow you to discover your own way out. Give it a go. Those of us physicians who use some version of this approach feel strongly that the majority of our patients will significantly improve or free themselves from the grip of pain.

1. Davis KD and M Moayedi. “Central mechanisms of pain revealed through functional and structural MRI.” Journal of Neuroimmune Pharmacology (2013); 8: 518–534.

2. Baliki MN and A Vania Apkarian. “Nociception, pain, negative moods, and behavior selection.” Neuron (2015); 87: 474-491.

3. Tracey I and MC Bushnell. “How neuroimaging studies have challenged us to rethink: Is chronic pain a disease?” The Journal of Pain (2009); 10, 1113–1120.

4. Eccleston C, et al. “Patients’ and professionals’ understandings of the causes of chronic pain: blame, responsibility and identity protection.” Social Science & Medicine (1997); 45: 699–709.

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The post Awareness, Hope, Forgiveness and Play first appeared on Back in Control.

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Dr. Fred Luskin, author of Forgive for Good, my wife Babs Yohai, a professional tap dancer, and I will hold a five-day workshop at the Omega Institute in Rhinebeck, NY. The course is structured around education, hope, forgiveness, and play. It is based on the concepts presented in Back in Control: A Spine Surgeon’s Roadmap Out of Chronic Pain and Dr. Luskin’s work out of Stanford on forgiveness. Babs role is a critical piece in that she engages the group in somatic experiences, which connects thoughts to physical sensations. The activities stimulate the shifting of neurological pathways with many changes occurring during the week.

Pain pathways are permanent

Most readers of this website already know that pain pathways are permanent and tightly intertwined with anxiety and anger circuits. It has also been shown that mental and physical pain are processed in a similar part of the brain. We consider and treat them in the same manner. As you cannot rid yourself of any of these patterns it is necessary to create alternative pathways. This can be done in several ways:

• Awareness, detachment, and reprogramming
  • Begins with connecting negative thoughts with physical sensations and then substituting appropriate alternatives
• Calming down the nervous system
• Play

Play pathways are also permanent. People in pain lose their sense of humor. Reconnecting with those enjoyable pathways is a powerful way of shifting out of pain circuits.

My wife

My wife is a professional tap dancer and accomplished in Balinese mask dancing. She has expertise in rhythm and movement. In 2013 I asked her to be one of the faculty, as these types of practices can quickly reconnect and create new neurological connections. She was somewhat apprehensive about her role but agreed to give it a try. She ended up having a major impact. She began with having us “scan” our bodies for tension and letting it go. Next she had us moving around the room with and without masks. Participants began to relax and interact with each other.

The Cup Song

Then she pulled out The Cup Song, which I had never heard of. It turns out that is it viral on the Internet and has been around since the 1930’s. It was popularized by the movie, Pitch Perfect, starring Anna Kendrick.

The Cup Song

We all sat around the table and struggled at various levels to learn this rhythm with cups. We all began to laugh and the energy of the room changed. We kept trying and laughed more.

The shift

There are many factors that went into the success of the workshop but within a day of “learning” this rhythm, the participants began to experience a significant decrease in their anxiety. By the end of the week five of eleven went to pain free with the rest experiencing various degrees of relief of both pain and anxiety. We are staying in touch and almost everyone is continuing to move forward.

My vision for the week was to present enough of the structured care concepts so that people could implement them at home. I was hoping that most would engage and experience a shift in pain and mood over three to six months. There was not any part of me that envisioned the entire group experiencing a major shift.

Connection

I will be writing about the Omega week in a fairly detailed manner and will learn more as the group gives each other feedback. There were clearly other factors such as videos of patient’s successes, structured conversations, buddies, education, and active meditation techniques. However the concept of “playful” is what transpired as the most powerful force.

I have repeatedly pointed out that the concepts of the DOCC project are not a formula. What heals people is connection – to each other and to him or herself. The best part of who you are is when you are at play. Ready to Blossom

The Cup Song or the gym?

One of the participants had been experiencing quite severe back and leg pain for about five years. He initial improvement was punctuated by the anticipated ups and downs over the months following the 2013 Omega experience. Here is one of his emails:

“Ah, the victim role, that is me seemingly all the time. All of David Burn’s (author of Feeling Good) cognitive distortions are helpful to recognize in myself, but victimhood is the reminder most useful for me. I fall into it so easily!

I had a bad evening with the lower back several days ago. Instead of my usual hour+ strengthening and stretching routine, I practiced The Cup Song for 45 minutes and most of the tension in my back went away. I’m starting to synch the lyrics with the percussion! I’ll need to go back to Omega for The Natural Singer In You to work on my tone and pitch!”

Enjoy your day today

Play is not often mentioned in the context of chronic pain. Could The Cup Song be a key to healing from chronic mental and physical pain?

The post Rewire Your Brain – Omega 2015 first appeared on Back in Control.

The post Rewire Your Brain – Omega 2015 appeared first on Back in Control.

The essence of curing chronic pain is connecting to your own body’s capacity to heal. When you are trapped by any circumstance, especially chronic pain, first your anxiety escalates and then you become angry. Your body is full of stress chemicals and you’ll experience many physical symptoms. Once or twice a year we hold a retreat for people that have been suffering from chronic mental or physical pain.The intention of the workshop is for you to experience a weekend of sharing enjoyable experiences in a structured safe environment and relax. Relaxing is challenging in the context of suffering.

The faculty includes my wife, Babs Yohai, who is a professional tap dancer and movement artist, and my daughter Jasmine Yohai, who is an expressive arts therapist. The weekend begins Friday evening and ends Sunday at noon. We spend Sunday afternoon relaxing by the lake with many of the participants. The core concepts of the workshop are:

• Awareness – It is important to understand the nature of chronic pain and your relationship to it.
• Hope – We enjoy sharing many success stories – and some will be returning.
• Forgiveness – Processing anger is the tipping point of  becoming pain free.
• Play – Relaxation and play are the essence of what Babs and Jaz bring to the weekend.

Jasmine

Jaz has an unusual background in that she graduated as a dance major, has a Masters in psychology, spent extra time learning expressive arts therapy and is currently working for a non-profit organization in Oakland, CA housing homeless people. She is relaxed, although she’ll tell you that she often doesn’t feel as relaxed as she appears.  She exudes concern and compassion and loves to be of service in whatever capacity she can. Her role is putting us through different shared exercises that are calming, and she is excellent.

Babs

When I first asked Babs to be a part of the workshop in 2013, I was becoming aware of the power of play in addressing the power of pain. Chronic pain is a result of memorized neurological circuits in your brain. The more you try to fight and fix them, the stronger they will become because you’re paying too much neurological attention to them. One approach is to create alternative circuits by stimulating new connections in your brain – neuroplasticity. Learn another language Another is to shift back on to your play circuits, which is a more rapid and powerful strategy. Although, that may seem like a forgotten word to you after so much suffering, it is one of the basic foundations of the development of human consciousness. Play exists deeply in all of us even if we can’t consciously connect to it.

In addition to tap dance, Babs is accomplished in Tango, Salsa and Balinese mask dancing. She has a lot of depth in rhythm and movement. I asked her to be one of the faculty, as these types of practices can quickly reconnect and create new neurological circuits. She was apprehensive about her role but agreed to give it a try.

I wasn’t asking her to teach us to dance. I was interested in re-connecting the mind with the body through music and movement. She began with a simple song combined with stepping and clapping. Then she introduced The Cup Song. She and Jaz led us in learning a new language of rhythm, causing a shift from pain to play circuits. We began to relax and laugh.

The Cup Song

A shift in pain

My original concept of the workshop was that I had five days to give an intensive course in teaching the DOC concepts, and then people would learn to implement them at home more quickly than when learning in the office setting. What happened was completely unexpected in that many people experienced a shift their mood and the pain would drop – sometimes dramatically during the workshop. I think it happened for a couple of reasons.

First, it is common, almost the rule, that people in pain become socially isolated, which is a terrible way to live. In fact, research shows that the pain of social rejection shares similar brain circuits to that of physical pain.  One of my goals was to create a structured environment where the participants could be with others in a safe place and share enjoyable experiences. What I eventually realized was that my main function was to create and maintain the structure, and that people heal each other. By connecting to others, you are able to find your way back to you.

Secondly, “neurons that fire together, wire together” is a common phrase among neuroscientists. Anger, anxiety and pain circuits are tightly intertwined, and stress usually fires up the pain circuits. Shifting to the play area of the brain unlinks them and pain drops.

Third, anxiety is an indicator of elevated levels of adrenaline, cortisol and histamines. You are on high alert and one of the results is that these hormones increase the speed of nerve conduction and you’ll feel more pain. The weekend gives you a chance to feel again what it is like when your system is full of chemicals that are elevated when you are at play.

Omega 2019 

The workshop is now three instead of five days and we were surprised to see that it was equally as effective. It feels like the participants are more focused and dive in quickly. Much of the work is done in small  groups of four or five.

It was at Omega that we learned about the deadly effects of people discussing their pain with their family, friends and colleagues. One basic ground rule is to never discuss your pain or medical care with anyone or complain. Your brain will develop wherever you place its attention. Research even shows that belonging to a pain support group or keeping a pain diary is counter-productive. You might as well place your hand right into a large hornet’s nest. You are reinforcing the pain circuits, not moving away from them. I didn’t realize how much time people in pain spent discussing it or endlessly searching for a solution. It is completely understandable.

Although, many mindfulness-based pain programs have impressive results, it is unusual to experience such a shift within a couple of days. What has happened is that the group has tasted freedom from pain. They now have the knowledge and tools to get back to that spot. With practice, a high percent of participants can break free of chronic pain and re-create their life.

The Cup Song or the gym?

Here is an email from one of the participants who has made steady progress over the year after Omega. He had been experiencing quite severe back and leg pain for about five years:

Ah, the victim role, that is me seemingly all the time. All of David Burn’s (author of “Feeling Good”) cognitive distortions are helpful to recognize in myself, but victimhood is the reminder most useful for me. I fall into it so easily!

I had a bad evening with the lower back several days ago. Instead of my usual hour+ strengthening and stretching routine, I practiced The Cup Song for 45 minutes, and most of the tension in my back went away. I’m starting to synch the lyrics with the percussion! I’ll need to go back to Omega for The Natural Singer In You to work on my tone and pitch!

At no point during my career would I have ever anticipated play being a major healing modality.

Enjoy your day today

The post “The Cup Song” first appeared on Back in Control.

The post “The Cup Song” appeared first on Back in Control.