Your Hand Over the Heat

If you were to put your hand close to a hot burner on a stove, what would happen to your level of anxiety?

• It would quickly escalate.
• You would withdraw your hand.
• You would protect yourself.
• Anxiety would be alleviated.

What would happen to your anxiety if you were forced to leave your hand over the burner?

• It would go through the roof.
• You would feel trapped and extremely angry.

I don’t believe you’re OK.

Anxiety is a Programming Problem

The changes to the central nervous system during chronic pain represent a programming problem rather than a psychological problem.

• Anxiety gains strength with time and repetition.
• Anger is a powerful force that covers up the feeling of anxiety
• Anger spins anxiety-inducing neurological circuits more quickly.
• We deal with anxiety by exerting some form of control.
• If you are successful in controlling the situation or yourself, then your anxiety is alleviated.
• Without control, you become frustrated or angry. Anger = loss control

With chronic pain, you have, metaphorically, lost your ability to “withdraw your hand from the red hot burner.” How can you rate yourself as a zero on anxiety and irritability? If you had no other stress in your life, chronic pain alone would be enough to destroy the quality of your life.

There are several other stress factors to consider with chronic pain.

• People in chronic pain don’t see an end to their suffering. They lose hope in returning to a pain-free life.
• Chronic pain patients are truly victims of pain. So it’s more difficult to let go and not have anger run your life.
• When chronic pain patients suppress anxiety and anger, these negative feelings become much stronger. (2)  White Bears and ANTS.

Being Pain-Free is a Basic Need

We all deserve to live free of constant pain. Being pain-free is a basic need. It has been shown that the impact of chronic pain on a person’s quality of life is equivalent to having terminal cancer. (1) We cannot accomplish higher goals and flourish as human beings without first securing the comfort of being in our bodies. I discuss this in “Maslow’s Miss”  and in the video: “Your Hand Over the Stove.”

“The Link Between Pain and Anxiety”. Inspire, January 21st, 2013

1. Fredheim OM et al. “Chronic non-malignant pain patients report as poor health-related quality of life as palliative cancer patients.” Acta Anaesthesiologica Scandinavica (2008); 52: 143 – 148.
2. Wegener, DM et al. “Paradoxical effects of thought suppression. Journal of Personality and Social Psychology (1987); 53: 5 – 13.

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

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

She was a healthy physically active rancher. Her low back pain started in the summer of 2005 after a lifting injury. The pain had become constant and was located throughout most of her back. She was still functioning at a fairly high level, in spite of the pain.

Her prior care

Jean’s care so far had consisted of six visits to physical therapy, and two sets of cortisone injections in her back, none of which had been helpful. She had not been prescribed a ongoing organized treatment plan. On her second visit to a spine surgeon, it was recommended that she undergo a eight-level fusion of her lower back from her 10^ththoracic vertebra to the pelvis. It is a six to eight-hour operation that carries significant risks.

Jean’s x-rays showed that she had a mild curvature of her lower back. Other imaging tests did not reveal any identifiable, structural source of pain. From my perspective as a scoliosis surgeon, I felt her spine was essentially normal for her age.

Instead, I felt that her pain was probably from the muscles and ligaments around the spine. The medical term that we use is myofascial. When an operation geared towards the bones, such a fusion, is done in the presence of mostly soft tissue pain, it rarely works. In addition to the risks, the entire lower back becomes a solid piece of metal and bone. This surgery should only be done if there are no other options. The procedure comes with long-term lifestyle limitations and she was still so active.

At this point, I was perplexed as to why surgery had been recommended when she had done so little rehabilitation. I also didn’t understand why she was continuing to experience such severe ongoing back pain without any obvious cause.

What was missing?

I consulted her spine intake questionnaire to look for clues.

It revealed that she’d had some marital difficulties and had just reconciled with her husband six months earlier. That immediately caught my attention because marital troubles usually indicate significant stress. She then said her job had become much more difficult. Although she worked for the same employer, they had forced her to switch duties without adequate training. She was worried about not only her performance, but also her ability to keep her job – another major problem.

I turned the page. A month before her pain began, her twenty-six-year old son had drowned. I knew that outside stressors played a role in chronic pain, but this factor had never been so powerfully demonstrated. Her case really brought home for me how crucial it was to take a full view of the patient’s life and circumstances, instead of just looking at surgical solutions.

As I sat there stunned, I realized that I needed to do something different. In fact, the whole medical profession needed to do something different. How could a surgeon have recommended a fusion without taking the time to get to know Jean and to hear her circumstances? I have always wondered if she went through with the surgery, but I never heard from her again.

From that moment, some form of structured rehabilitation became my focus with every patient, without exception. I have not taken my eyes off of that vision since that day.

The post My Call to Action first appeared on Back in Control.

The post My Call to Action appeared first on Back in Control.

Crystal could not walk for more than half of a block without having to sit down. As she had been this way for several years, she was becoming increasingly weaker. She was very unhappy at the prospect of losing her independence, in addition to experiencing a lot of discomfort. Understandably, her anxiety was through the roof.

The Surgery

I performed a three-level laminectomy on her at L2-3, L3-4, and L4-5. This procedure removes the narrowing around the nerves, and about 70% of the time, patients are able to walk without pain. It takes a while for the strength and endurance to return. Unfortunately, most patients don’t engage in the rehab enough to experience the full benefit of their surgery. As she was so frail, my optimism for Crystal was tempered. I knew her leg pain would improve, but probably not her strength.  She also just did not seem like the person who would engage in a full rehab program.  I never give up though, so I talked to her about the DOC project and told her about my website.

Post-Op

The surgery went well and Crystal’s legs felt better. During our first phone appointment, she began to ask a lot of questions about the website and had begun the writing exercises.  She was slightly encouraged, and I was pleasantly surprised. The talk evolved into a somewhat extended conversation about the central nervous system and conditioning. It is difficult to make the effort to exercise when a person has a lot of anxiety.  To see a full recovery, I ask all of my patients to workout with weights three to five hours per week.  She was interested in getting completely involved in the process.

One month after the surgery, she was sleeping better, and felt her anxiety dissipating. She would go out for small walks every now and then. I encouraged her to join a gym. I really did not expect her to go.

Her Outcome

When I talked to her a few months ago, she was a different person. Her voice was energized. She had joined a gym and was working out four or five times a week. She felt a dramatic increase in her strength and endurance. Her anxiety was down by 80-90%.  She was going out with her friends and socializing. She was ecstatic.

I asked her to write a follow up letter about her experience, which is about a year from her surgery.

Crystal’s Letter

Dear Dr. Hanscom,

How nice it is to feel better!

It’s great to be able to do some of the things again that I used to do. I am doing everything that I have been asked to do. I am working out in the gym every week. I am also working through all of the stages of the web site. All of the books have been interesting and helpful.

My friends tell me how good I look. They say that they no longer see the look of pain in my face.

I feel like I have my life back.

Sincerely,

Crystal

Move Forward

I have kept in touch with Crystal and we talk every three months. Seven years later, she is still working out in the gym, and her strength and endurance have continued to improve. She is active in the community with a nice circle of friends. This in sharp contrast to when I first met her and she was lying around her house, at the mercy of her pain.

The tools on this website are self-directed. My observation is that there is no question of “if” you’ll better, but only a question of “when.” The decisive factor is a patient’s willingness to engage. It is stories like Crystal’s that keep me moving forward with this project.

“Better Not Look Down”

The post A New Life at 72 first appeared on Back in Control.

The post A New Life at 72 appeared first on Back in Control.

Self esteem involves endless judgment of comparing yourself to others around you. I discuss the negative impact that this concept has on us.

For more, see The Myth of Self Esteem.

The post Video: The Myth of Self Esteem first appeared on Back in Control.

The post Video: The Myth of Self Esteem appeared first on Back in Control.

I talk about how anxiety and stress can lead to certain obsessive tendencies. Some of the tools from the DOCC project are laid out, specifically those that can help break down the circuits that fuel anxious and stressful thoughts and behaviors.

For more, see Your Demons are Robots.

BF

The post Video: Anxiety and It’s Demons first appeared on Back in Control.

The post Video: Anxiety and It’s Demons appeared first on Back in Control.

I talk about how the suppression of negative thoughts associated with chronic pain can really fire up the nervous system.  Dr. Daniel Wegner from Harvard published an elegant paper in 1987 demonstratng the impossibity of trying to suppress thoughts. I’ve talked about it before in White Bears and ANTS.

BF

The post Video 16/19: “White Bears” first appeared on Back in Control.

The post Video 16/19: “White Bears” appeared first on Back in Control.

I discuss how anger is the turbocharger that keeps anxiety both covered up and fired up. Until you turn off anger you won’t be able to get a handle on your anxiety or your pain.

The post Video 15/19: Anger Fueled Anxiety-“The Highway to Hell” first appeared on Back in Control.

The post Video 15/19: Anger Fueled Anxiety-“The Highway to Hell” appeared first on Back in Control.

BF

The post Video 14/19: Chronic Pain: Pain Free is Not Only Possible, it’s Probable. first appeared on Back in Control.

The post Video 14/19: Chronic Pain: Pain Free is Not Only Possible, it’s Probable. appeared first on Back in Control.

Normally aging discs

As you age, the discs between your vertebrae lose water content and become stiffer. That is a normal part aging.  You lose flexibility. Over age 50 most people have degeneration of at least one disc. There is no evidence that supports the idea that a degenerated disc causes pain. (1)

At age 32, I underwent a disc excision for a ruptured disc followed by a second operation two weeks later for a deep wound infection. My three lowest discs are completely degenerated and collapsed. Other than an occasional muscle strain from my terrible golf swing, I do not experience back pain. I saw patients weekly with “terrible looking spines” and sciatica from pinched nerves. However, most of them had no back pain. The upshot is that most spine fusions for LBP are performed on normal spines for a given person’s age.  The results are poor. There is less than a 30% chance of long-term success. (2)

If there is an identifiable structural problem with a matching pattern of pain, the success rate of surgery is much higher. These are the only situations that I will perform surgery. An example would be a bone spur pinching the 5^th lumbar nerve root while there is pain down the side of the patient’s leg. In this case, there is a strong correlation between the structural description and the pain. This pattern of pain usually disappears after surgically removing the spur.

Mouth pain vs. a cavity

I frequently compare spine surgery with dentistry. Generally a dentist can specifically identify the structural problem causing your pain.  It might be a cavity that has gone down to the root.  The chance that your dentist can solve this problem with a filling, root canal, crown, etc. is essentially 100%.

What if you went to your dentist with “mouth pain,” but the source of the pain could not be identified?  This is also a common occurrence. The pain may emanate from the sinuses, be caused by TMJ, or can even be a “neurophysiological” symptom. What would be the chance of success if your dentist started doing procedures without seeing which tooth was the source of the pain? It would be almost zero.

Fusions for back pain

Currently there are hundreds of thousands of spine fusions being performed annually for “back pain.” Often, they are based on injections into the discs called discograms that have been shown to be unreliable. Or they are based on MRI’s showing “degenerative changes.” We know bone spurs, arthritis, and degenerated discs do not correlate well with back pain. Yet major structural bony interventions are being performed with the surgical world not being able to accurately diagnose the source of the pain. Many surgeons feel somewhat compelled to perform the surgery because it is the “last resort.”

Fusions not only are ineffective in relieving back pain, but the downside risk of complications and breakdown of the spine often creates serious problems. There is even a medical term called “Failed Back Syndrome”. What is not well-known is the extent of the destruction caused on these patients’ lives. I discuss this outcome in the appendix of my books, Back in Control and in Do You Really Need Spine Surgery? Take Control with a Spine Surgeon’s Advice. Many of these situations were catastrophic.

Surgery is not the “definitive” answer for lower back pain. It is usually the wrong answer!!!

1. Boden, SD et al. “Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects: A prospective investigation.” Journal of Bone and Joint Surgery(1990); 72: 403 – 8.
2. Carragee, EJ et al. “A Gold Standard Evaluation of the ‘Discogenic Pain’ Diag­nosis as Determined by Provocative Discography.”Spine(2006) 31: 2115 – 2123.

The post Back Pain vs. Mouth Pain first appeared on Back in Control.

The post Back Pain vs. Mouth Pain appeared first on Back in Control.

Our brain has neurological circuits that can become memorized. In this video I discuss phantom pain, which is more the rule than the exception with amputations. This factor is a significant problem with any chronic pain situation.

The post Video: Memorizing the Circuits: Phantom Pain first appeared on Back in Control.

The post Video: Memorizing the Circuits: Phantom Pain appeared first on Back in Control.