Feeling safe

The DOC Journey is based on our three and five-day workshops that we have held since 2013. From the beginning we were amazed how many people would break free of their pain within time frame of the workshop. We always warned them that they would dive back into The Abyss when they returned home to their “triggers.” But somehow they had reconnected to the part of their nervous system that was safe and relaxed. Once they tasted that deep sense of peace and connection, they had a sense of what was possible. They would learn their own ways to return to that state. Many moved on to a life they had never before experienced.

I had not expected such a response and did not understand what had happened. But every workshop was a similar experience. I finally concluded that I wasn’t doing that much, but the shift was because people were learning and sharing enjoyable experiences in a structured and safe environment. Several participants described it as being in an adult summer camp.

Research shows us that loneliness causes many physical symptoms including chronic pain and, of course, being in pain is isolating. (1) Social connection is a deep basic human need and the foundation of how we developed language and human consciousness. It is tragic that over 50% of Americans are lonely and socially isolated. (2) Social isolation is crushing to your soul.

Characteristics of success

There is never an exact answer to a given person’s specific situation, since each one of us is so unique. However, there are some patterns that have emerged in patients who have done well.

• Back in Control: A Surgeon’s Roadmap Out of Chronic Pain provides a foundation and framework for moving forward.
• The sequence of learning is critical in that you have to understand the nature and parts of a problem before you can solve it.
• You can’t move forward until you have broken the links to the past.
• It is critical to implement the strategies that work the best for you into your day-to-day life. They are not difficult, but just passive learning doesn’t work.
• Re-engaging with friends, family, and your community is a powerful aspect of healing.

All these variables are important. Chronic pain is a complex problem and simplistic isolated treatments can’t and don’t work.

Our online Q&A

What I again did not anticipate was how effectively a community could be created online. It almost seems have had more impact than our in-person workshops. Here is one participant’s email.

The Q&A sessions I attend 2x per week are such an important part of my support system as I’ve started navigating The DOC Journey. I’ve suffered with chronic pain for over three years, and after two spine surgeries that provided no relief of my symptoms, I felt very alone and confused. I found this special community during a time when I felt little hope, and I know the timing was providential. As I process my journey with others that understand what I’m going through, I am able to give and receive support and encouragement, along with obtaining many tools that are making a significant difference in how I am able to show up in my life. This community is something I will always be grateful for!

Overview of the sessions

The Q&A format is a powerful force in creating change. We know that human connection is essential for health and that being socially isolated has detrimental effects on your health. One of the consequences is chronic pain. There are other manifestations and the effects are estimated to be equivalent to smoking 3/4 of a pack of cigarettes per day. (2)

Rules of Engagement

Much of the effectiveness of The DOC Journey is stimulating the formation of new circuits in your brain that bypass those that are creating pain. Your brain will develop wherever you place your attention and one of the reasons that any patient of mine was never allowed to EVER discuss his or her pain with ANYONE except their medical providers.

• The cardinal rule of participating in this group is never discussing your pain or medical care – even if asked.
• Ask yourself what you can do to be of help to others on the Q&A.
  • Specifically, please be mindful that each person in the small group breakouts of 3-4 has a chance to share.
• Understand the concept of mirror neurons-your mood has a direct mirror neuron effect on others. The term is called “co-regulation.” (3)
  • I have personally found that a little expressive writing, active meditation, or breathing exercises before the session is a big help if I am a bit out of sorts.
• Although your participation with comments and questions is welcomed, please don’t feel obligated. We want you to feel comfortable with the group.
• The sessions are intended to deepen your skills and answer questions. It is not focused on teaching. Reading my book, Back in Control: A Surgeon’s Roadmap Out of Chronic Pain will provide the framework for you to move forward.
• The DOC (Direct your Own Care) Journey provides a sequence that will keep you moving forward and it is based on our workshops. The sequence is:

• • Awareness
  • Hope
  • Forgiveness
  • Play

Meeting Agenda

• 11:50 – noon – Informal discussion/ catching up
• 12:00-12:05 – Relaxation exercise
• 12:05 to 12:15 – Didactic session/Sharing successes and challenges
• 12:15 to 12:30 – Open discussion and questions
• 12:30 – 12:50 – Small group breakout sessions – discussions will be based that day’s topic or what may have been brought up in the sharing session.
• 12:50 to 1:00 – Closing discussion

I will be prompt regarding time and will stop the didactic/ sharing at 12:15 – 12:20 and we will begin the open discussion. Please email me at dnhanscom@gmail.com with questions you’d like addressed or if you would like to share your perspective. You don’t have to be pain free to share. Small victories are the key to all of this. We would like to find out what you have found useful.

Letting go

The DOC Journey is a paradoxical one at almost every step. Repeated conversations are helpful in learning to process your environment in a different manner. Hearing about other approaches is helpful, but the best part is sharing your challenges and success with others.

References:

1. Cacioppo, John and William Patrick. Loneliness: The Need for Social Connection. Norton, New York, NY, 2008.
2. Cigna US Loneliness Index 2018. Report published by Cigna Insurance Company.
3. Porges, Stephen. The Polyvagal Theory. Norton, New York, NY, 2011.

The post People – The Most Powerful Part of The DOC Journey first appeared on Back in Control.

The post People – The Most Powerful Part of The DOC Journey appeared first on Back in Control.

It’s Donna, a former patient. I just wanted to write and tell you some good news regarding my back situation. You were right about forgiveness as well as the emotional aspects of back pain–at least in my case.

After following the physiological recommendations and taking the various classes you suggested, I read your book and began my own journey of forgiveness with the help of my church.

I continued to get stronger and feel better as I progressed through the various stages. However, the nerve pain continued to remain. It would crop up for no apparent reason and take me out. The final step to my healing process was a worship night at my church and prayers of healing. I was able to release all the guilt and shame I had been holding onto unbeknownst to me. I had received prayers, love and unconditional acceptance in return from the prayer team.

With all that said, the bottom line is, I am out of pain!! It has attempted to return but I am able to pray it away and remind myself of the healing that took place and it goes away. There is a huge element of emotional healing involved, as you have stated. I thought you might be interested in hearing another success story.

Thank you again for all of your insight, wisdom and help! It is truly amazing to wake up pain free!

Gratefully Yours, Donna

Meet Donna

Imagine getting a letter like this from a patient you had worked with for a couple of years and then lost touch with after she moved away. Her success story is enough to write about in and of itself; but her case also changed the way I think about chronic pain.

Donna was an extremely pleasant, positive, and physically fit aerobics instructor and single mother of three teenagers. She came to me for a second opinion regarding a proposed spine fusion. It was going to be her sixth spine operation in seven years. She began to experience lower back pain (LBP) around the year 2000, without any obvious inciting event.

Before coming to see me, she had undergone the following procedures:

2002    Two-level lumbar spine fusion from L4 to S1, with marginal results

2003    Spinal hardware removed

• • L5-S1 (lowest level) had not healed
  • Weak area repaired, but it did not help

2007    Neurostimulator placed into spine (two trials placed), which helped for about a year

 When she first came to see me in 2009, Donna was unable to work because of the following condition:

• • Disabling LBP and leg pain
  • L5-S1 fusion still had not healed
  • Arthritic facet joints (joints along the back of the spinal column that link the vertebrae)
  • Lumbar 3-4 disc, just above the two-level lumbar 4 to the sacrum fusion broken down to the extent that the vertebrae were “bone on bone” (However, her spine was stable at this level in that the vertebrae did not move when she leaned forwards and backwards, and there were no pinched nerves.)

Donna’s Journey

Because her condition was stable, and because there is little if any correlation between degenerative disc disease and back pain, I recommended no more surgery for her. As bad as her L3-4 disc looked, I did not feel it was the source of her pain. Besides, if L3-4 was fused, there was a strong chance she would not improve—L2-3 could break down quickly; and over five or ten years she might need a fusion up to her thoracic spine. With a fusion that high, you can no longer twist; and Donna was, after all, an aerobics instructor, and needed that flexibility.

Instead, I suggested that Donna apply the treatment outlined in the DOC process, and I referred her to a non-operative physician to help her along. She took my advice and aggressively pursued every part of the DOC program. She addressed sleep and stress, avoided pain medications, attended wellness classes, and resumed workouts at the gym. She consciously chose to move forward with her life in spite of her pain.

But she did not improve very much. I don’t think I’ve ever seen a patient work so hard at getting better with so little improvement. Because of her spine pathology, I still questioned whether I should offer her more surgery; but by that time she had decided to recover without any more surgical procedures. After a couple of years she moved to another state, and we lost touch.

Then, a couple of years later, around 2011, her letter came. At the time I was surprised at her degree of pain relief. But today I have seen this level of recovery occur consistently in many patients who fully engage the DOC process. In my experience, the most consistent predictor of success has been truly letting go of anger, including that caused by the chronic pain experience. True forgiveness is not just an intellectual exercise. While I have seen many patients improve before they let all the anger go, none become pain-free until they cross that line.  I call it the “Continental Divide” of chronic pain.  Remember, although you have legitimate and understandable reasons for your frustrations, your anger will still hurt you.

Today and what I have learned

Today I am more aware of the mind-body connection than I was when I first saw Donna eight years ago. I now regard emotional pain and physical pain as equivalent, in that they are processed in a similar part of the brain and with the same chemical responses. It appears that anxiety is the pain. As anxiety-produced adrenaline drops, nerve conduction slows down, and you feel less physical pain. Knowing this today, I can understand outcomes for patients like Donna, who became pain-free without additional surgery, even with her significant spine pathology. Her case also taught me:

1. Patience is critical for both physician and patient. I had given up—not on Donna but on the idea that the DOC concepts were going to help her. I learned that I can never predict who will respond or when the tools will kick in.
2. No matter where the pain originates or how severe the pathology might appear, relief is possible, if not probable, without surgery. That is not to say that the DOC process is 100% successful, nor do I feel that I have discovered a magic program. But I feel that the structure it imposes does allow patients to organize their thinking so as to connect with their own capacity to heal.
3. A caring community is powerful. Most patients in chronic pain isolate themselves, giving them more time to think about their pain, allowing the pain pathways to become deeply imbedded. Reconnecting with family, friends and society is a significant factor in moving away from pain pathways.

The final stage of the DOC process is “Expanding Your Consciousness.” The ultimate solution for solving pain is regaining your life perspective, regardless of the form it takes.

Never give up–ever!

The post Healing With Support from her Community first appeared on Back in Control.

The post Healing With Support from her Community appeared first on Back in Control.