Spine surgery is out of control. I am not against surgery and I was a complex spinal surgeon for 32 years. From the beginning of my career, I felt that too much surgery was being performed. But for my first eight years of practice, I was a part of this aggressive approach. When a research paper came out in 1993 showing the return-to-work rate was only 22% after a low back fusion for pain, I immediately stopped performing that operation. (1)

But he rate of spine surgery has continued to rise in spite of evidence that much of it is ineffective. It rose rapidly in the mid-1990’s with the introduction of new techniques that did improve the fusion rate. However, outcomes haven’t improved, and disability keeps rising. Why?

“Let’s try spine surgery”

Spine surgery works wonderfully well when there is a distinct identifiable anatomical abnormality, and the symptoms are in the expected region of the body. However, it works poorly if surgery is done for “pain” and the source of it is unclear. There is a widespread belief among patients and many physicians that if everything else has been tried and failed, then surgery is the next logical step. Nothing could be further from the truth.

Defining the correct anatomical problem to surgically treat would seem to be the first logical step. However, this step is often not done well. One of the most glaring examples of blindly proceeding with surgery in spite of the evidence stacked against it, is performing a fusion for low back pain. There was one paper in 2001 that hinted it might be effective, but it was sponsored by a spinal instrumentation company, and the non-operative care was not defined. (2) One well-known paper compared lumbar fusions for pain to a solid rehab protocol and the non-operative care resulted in better outcomes. The final comment in the paper was that “this type of care wasn’t widely available.” (3)

• It is well-documented that disc degeneration, bone spurs, arthritis, bulging discs, etc. are rarely the cause of back pain. So, when a fusion is performed for LBP, we really don’t know from where it might be arising. (4)
• The success rate of performing a fusion for LBP is less than 30%. (5) Most people expect a much better outcome and the resultant disappointment is also problematic.
• If any procedure is performed in a person with untreated chronic pain in any part of the body, he or she may experience chronic pain at the new surgical site up to 40-60% of the time. Five to ten percent of the time it is permanent. (6)

Trip to the dentist

Consider going to the dentist with a painful cavity that may require a root canal, crown or extraction. There is a defined problem, and the pain will predictably disappear once the problem is solved. But what about the situation where you might be having severe mouth or jaw pain, and there isn’t a tooth that seems to be the source. Would you expect your dentist to randomly try working on different teeth to see how it might work? After all, these are minor interventions compared to undergoing spine surgery. What if the problem is gum disease, a sinus infection, TMJ, or even a tumor in your oral cavity? Making an accurate diagnosis of the problem is always the first step in solving it.

The treatment grid

My intention is to educate you and anyone on your health care team about all of the issues that factor into deciding whether to undergo spine surgery. There are two sets of variables: 1) the type of anatomy – can you see it on a diagnostic test? 2) The status of your nervous system and resultant body chemistry. Are you calm? Or are you stressed and hyper-vigilant? If your nervous system is on “high alert” for any reason, the outcomes of surgery are predictably poor, especially if you can’t identify the anatomical problem. The combinations result in four possible scenarios. The book is based around this treatment grid:

• IA—Structural lesion, calm nervous system
• IB—Structural lesion, stressed
• IIA—Non-structural lesion, calm
• IIB—Non-structural lesion, stressed

The Treatment Grid

You will be able to place yourself in the correct quadrant with the help of your providers. Each one has a distinct treatment approach, which will allow you to make better treatment choices. The most basic decision is that if there isn’t a clearly identifiable source of pain, then surgery isn’t an option, regardless of how much pain you are experiencing. Low-odds surgery in the presence of untreated chronic pain has a high chance of making you worse – much worse. Especially if the surgery doesn’t go well.

Mike

Mike was in his mid-40’s and had just moved to Seattle about six months earlier. He was undergoing some physical testing to qualify for a government job. During the process, he tripped and twisted his back. His back pain was severe with a lot of muscle spasms. About four months after the fall, a surgeon elected to perform a fusion at his lowest level of his spine (Lumbar 5-Sacral 1). He had a small bony defect called a spondylolisthesis that had been there his whole life and was unlikely to be the source of his acute back pain. There was no reason to consider surgery.

During the operation, one of the screws used to stabilize his spine was misplaced and impaled the 5^th lumbar nerve root. It was removed a couple of days later, but the damage had been done. When he saw me for another opinion about a year later, he was still experiencing severe pain down the side of his right leg. He had no leg pain before the surgery. He was on high-dose narcotics without relief. He had already figured out that the surgery was unnecessary and was really angry about it. His life as he had known it was gone – permanently. There was nothing that I could do, I heard a couple of years later that he had undergone yet more surgery without any relief.

This book will enable you to understand the difference between a spine problem that is amenable to surgery versus one that is not. It covers the whole spine from your neck to your pelvis. You will also be able to assess the state of your nervous system and resultant body chemistry. If you are stressed, there are simple, consistently effective measures that can calm your nervous system. The goal of the comprehensive treatment process is to help you become pain free with or without surgery.

Whatever you decide to do or what resources you might use, don’t jump into spine surgery until you understand the whole picture. It may be the most major decision of your life.

1. Franklin GM, et al. “Outcomes of lumbar fusion in Washington state workers’ compensation.” Spine (2994); 19: 1897–1903; discussion 1904.
2. Fritzell P, et al. “Swedish Lumbar Spine Study Group. Lumbar fusion versus non-surgical treatment for LBP.” Spine (2001); 26: 2521-2532.
3. Brox J, et al. Randomized Clinical Trial of Lumbar Instrumented Fusion Cognitive Intervention and Exercises in Patients with Chronic Low Back Pain and Disc Degeneration. Spine2003; 17: 1913-1921.
4. Boden SD, et al. “Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation.” J Bone Joint Surg (1990); 72:403– 8.
5. Carragee EJ, et al. “A Gold Standard Evaluation of the ‘Discogenic Pain’ Diag­nosis as Determined by Provocative Discography.” Spine (2006) 31:2115-2123.
6. Ballantyne J, et al. Chronic pain after surgery or injury. IASP (2011); 19: 1-5.

Video: Get it Right the First Time

The post Do You Really Need Spine Surgery? first appeared on Back in Control.

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• Connect mainstream medicine with existing science – most symptoms, illness and disease  are created by the body’s physiology (how it functions), and not structures.
• Establish the necessity of a trusting dynamic relationship with your clinician. Feeling heard and safe is not a luxury. They are healing modalities in that they shift physiology from threat to safety. Also, if we don’t know you and understand the details of your situation, how can we make accurate decisions.

Most chronic mental and physical disease is caused by the body being in a sustained state of flight or fight (threat physiology). The fallout of treating most diseases from a structural paradigm isn’t effective and causes harm. It is particularly damaging in spine surgery, and the rates of spine surgery for chronic low back pain continue to skyrocket. It eventually became clear that we were performing low back fusions for anxiety (sensation created by threat physiology) with a success rate of less than 30%.¹

Understanding chronic symptoms, illness, and disease

My efforts evolved out of my own 15-year struggle with chronic mental and physical pain. Most of my approaches failed and then some began to help. As I pursued treatments that worked and abandoned the ones that didn’t, I inadvertantly escaped out of this Abyss in 2003. All 17 of my symptoms resolved and continued to improve. However, I still had no idea why I become ill and why I healed. I was shocked, as many of my fellow clinicians, that the answers have been in literature of over 60 years.

In 1962, two researchers clearly documented that stress causes illness, disease, and early death.² I was aware of this data, but I did not connect the dots. I treated my patients from the paradigm that it was my responsibility was to find a structural cause of pain, and I felt badly if I could not find a reason to perform surgery. I aggressively performed fusions for low back pain for the first 8 years of my practice. When a paper out of Washington State³ showed a success rate of less than 25% for low back fusions for pain, I stopped doing them, but did not know what to do.

The healing journey

My current approach represents what I learned from my struggles, witnessing what helped hundreds of my patients heal, and now understanding the science behind these concepts. The DOC Journey course and app and my other efforts are simply a framework that presents documented science in amanner and sequence that is accessible by patients and clinicians. My vision is to connect medicine with known science of chronic stress causing illness, with the fundamental idea being that the doctor patient relationship is at the core of healing. If a patient can’t feel safe with their health care provider, the rest of the treatments are of limited value.

Many people heal with just these self-directed concepts, but outcomes are always better and more consistent with added resources. This framework is intended to allows patients to take charge their care, the clinician can leverage his or her efforts, and provides a long-term template for ongoing learning and healing. It evolved out of my busy practice with increased efficiency, effectiveness, and enjoyment. It is inspiring and energizing to witness patients emerge from hopelessness to thriving.

An important aspect of these concepts is the clinician learning and implementing these approaches in their personal and professional life. A dynamic working partnership can  then be created when both parties understand these healing principles. These resources are an adjunct and/or foundation for other clinical practices, and not an alternative.

Anxiety is a physiological state

It took me many years to realize that anxiety is not primarily a psychological issue. It is the intentionally unpleasant feeling generated by your body when in flight or fight. Avoiding this powerful sensation is the driving force behind human behavior, and much of it is dysfunctional. We are not taught how to regulate our body’s danger response. Our conscious brain is no match and our efforts to control it create a lot of misery for us and those around us.

It is actually a gift that keeps us alive. This survival warning signal is necessary, and the key is developing a “working relationship” with it. It is what you have and not who you are.

This is an article I wrote for Psychology Today regarding the mental health crises.

Obsessive thought patterns and OCD

Crippling anxiety is what almost took me out. It initially manifested with panic attacks and progressed to severe OCD (Obsessive Compulsive Disorder) for over 15 years. The hallmark of OCD is repetitive intrusive thoughts that for me became quite intense. I had “internal OCD” which consists of a disturbing thought following by a compensatory counterthought. There were no external behaviors. So, I had no idea of what was going on, and there seemed to be no endpoint.

OCD is relatively common,⁴ and variations include nail biting, hoarding, body image disorder, skin picking, hair pulling, and eating disorders. Additionally, many if not most people are bothered by disruptive thought patterns or ruminations, which detract from quality of life. One could also consider addictive behaviors in light of efforts to escape these repetitive unpleasant thoughts. Much of the mental health world views OCD and ruminating thoughts as unsolvable and the approach is to manage them. The missing link is that threat physiology is not being adequately addressed. Half the brain consists of glial cells, which have cytokine receptors and are part of the immune response.  A fired-up brain fires off a lot of thoughts.

My hypothesis is that RUTs (repetitive unpleasant thoughts) are a major driver of chronic mental and physical disease by stimulating sustained threat physiology. Humans are trapped by unpleasant thoughts with the main variables being frequency and intensity. They are a universal function of human consciousness. They may be a significant factor in driving teens to commit suicide, “deaths of despair.” However, I am seeing RUTs create misery in every age group, and as young as 6 years old. RUTs were the main source of my misery followed closely by social isolation.

I no longer suffer from OCD, and I escaped from this Abyss over 20 years ago. I don’t even have the disruptive thoughts I had before I became ill. It has taken many years to figure out how and why I escaped from these obsessive thought patterns. High level achievers are particularly prone to them. This is a link to the section I created on my website that presents my concepts of a solution.

This RUTS section is a rough outline of my upcoming book. Solutions are discussed first and the background of the problem later. There is a large body of research of the mental mechanics of the brain, physiology, consciousness, and effects of stress. I learned a sequence of healing while helping many other people out of this hole and it continues to evolve.

Action needed soon

The burden of chronic disease continues to rise in the US and lifespans are dropping compared to other developing countries. We spend almost four times as much per capita as any other nation.⁵ The business of medicine has essentially kidnapped all of us – clinicians and patients. How can thoughtful decisions be made without patients feeling heard and clinicians not understanding all of the dimensions of their lives generatingthreat physiology (anxiety)?

Performing risky and expensive interventions that are not data-based are causing a lot of harm. “First do no harm.” Individually and as a society, do we embrace this core manifesto or is this just rhetoric? I feel there is some urgency for change as the fabric of our society is coming apart.

Clinicians allied with patients are the only possibility of taking back our medical care. It will require ongoing collaboration from all parties. Whether my resources or another similar set are utilized, we have to treat people in a manner that honors the body’s physiology and capacity to heal. We have the data. Let’s implement what we already know!

References

1. Carragee EJ, et al. “A Gold Standard Evaluation of the ‘Discogenic Pain’ Diag­nosis as Determined by Provocative Discography.” Spine (2006) 31:2115-2123.
2. Holmes TH, Rahe RH. The Social Readjustment Rating Scale.J Psychosom Res (1967); 11:213–8. doi:1016/0022-3999(67)90010-4
3. Franklin GM, et al. “Outcome of lumbar fusion in Washington State Workers’ Compensation.” Spine (1994); 19:1897–903.
4. Carmi, L., Brakoulias, V., Arush, O.B.et al. A prospective clinical cohort-based study of the prevalence of OCD, obsessive compulsive and related disorders, and tics in families of patients with OCD. BMC Psychiatry22, 190
5. Bezruchka S. Increasing Mortality and Declining Health Status in the USA: Where is Public Health?Harvard Health Policy Review [internet]. 2018.

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• Processing anger is more doable if it is broken down into its components.
• Anger is a powerful, necessary, and hard wired survival reflex. You cannot tame it with the conscious brain.
• It is an acquired skill that requires ongoing “adult education” in order to refine it.
• Framing the approaches in terms of an “anger academy” will help you rethink the complexity of anger and enable you to deal with its parts in a focused manner.
• Developing a “working relationship with anger” is your degree.
• It an expertise that you will be using daily indefinitely.

Anxiety is the sensation you feel when you sense real or perceived danger and anger represents a more intense reaction when you can’t solve the threat. They are hard-wired responses that are present in every living creature and sustain life. The only way to lower them is to decrease your levels of the stress hormones, inflammatory markers, and metabolism (rate of fuel consumption). You cannot reason with or control the flight or fight response. It is as effective as talking to the hard drive of your computer – can’t work. Consciousness elicits the same threat physiology, but you can’t escape it. Consider how much of your life’s energy is consumed by battling these unpleasant emotions.

There are two distinct aspects of deep healing.

• Learning tools to neutralize and lower these survival reactions
• Placing your energies and attention on creating the life you want.

Healing occurs as you move into wellness and away from the pain circuits. What doesn’t work is using “fun” and other activities to counteract these emotions. The bottom line is that you want to minimize your time in threat physiology and learn to create mental and physical safety. Regardless of the site of intervention, processing anger is focused on lowering the levels of the hormones and inflammation caused by your threat response.

You can directly lower these hormones, increase the resiliency of your nervous system, and learn to change the nature of your input. All three areas are important and require different tools. We are going to use the metaphor of a boarding academy to conceptualize the various strategies.

Welcome to “Anger Academy”

Visualize a walking onto a beautiful campus and seeing the main building bordered by two departmental ones. There is an entry gate with a security guard, and you must be carefully screened before you are allowed be on the grounds. The three buildings represent:

• Output – the student center/ food/ spa/ lounge – Main building
• Your nervous system – engineering and design center – on your right
• Input – educational/ training center – on your left

The curriculum – Enrollment

It is most desirable on a given day or moment to have your “output” or your body’s neurochemical state in a range that is neutral or relaxed. The more time you can spend in this state the better. But, anger is inevitable, and it is important to use it only when necessary and be careful not to cause damage–especially to those who are close to you. The final physiological response is affected by 1) the reactivity of your nervous system and 2) the content of your input. It is a dynamic process that varies from minute to minute.

The state of your nervous system is influenced by your prior programming, current circumstances, and how you are caring for your body. For example, lack of sleep and exercise along with a highly inflammatory diet will elevate your levels of inflammation and compromise your coping skills.

Daily stresses are often overwhelming. If you come from a challenging and chaotic childhood, it is hard to feel safe because maybe you really never knew what that was like. Consider the hypervigilance of a feral cat compared to a pampered domestic one. It is difficult to truly tame a cat who had to fend for itself from birth. It takes less stress to set off the threat response and this is also hardwired in for each individual.

Output is clearly affected by your “input.” There are two categories of input.

• What are you choosing to put into your nervous system?
• What are you holding onto from the past?

The first step is becoming aware of the nature and effects of your ongoing input. Once you have some clarity, there are multiple strategies to alter it. It is a deeply personal process.

Security gate

The security area represents the current state of your body’s chemistry, and it can vary from a profile of being content and safe to upset and inflamed. Of course, the reason you are coming to this institution is that you are trapped in pain and the levels of frustration often reach a level of rage. The sensations are intense and powerful. Your whole body, including your brain, is full of inflammatory markers. Your brain’s blood supply is diverted from your neocortex (thinking centers) to the lower centers that are meant more for basic survival. In this state it is not possible to think clearly or absorb new information. So, before you can enter the university to master anger processing skills, you must first normalize this inflammatory state. Your “output” is hypervigilant, which is the outcome of being trapped for any reason.

The “security guard” will take your temperature, vital signs, and see if you are calm enough to engage in the learning the skills to process anger. This is not a small step, in that anger is the greatest block to healing. There are many facets to it; it is powerful, and most people don’t want to give it up because it keeps you safe – whether the sense of safety is real or perceived.

If you are fired up, you can leave and return another day, or you can hang out in the spa just outside of the campus intended for your use to calm down. It has a pool, hot tub, massage, sauna, gym, and soft music. It is a beautiful modern building and could not be a more relaxing place to be. You can stay as long as you would like and return anytime.

If you choose to turn around and return to your prior situation without taking some action to calm down, it is unlikely that you will be able to meet the criteria to enter the campus. Regardless, whether you calm down on your own or with some help from your time in the spa, it is the first step in being able to engage in learning the strategies to understand and deal with anger. Your brain has to come back “online.”

On the grounds

Once you are through security, you have a choice of which building you want to enter but continuing to calm yourself is probably the best option. Each one has multiple resources to help you acquire anger processing expertise.

The center main building (output) is a deluxe version of  the spa area just outside of the campus. It’s large with nice facilities and concierge services. There is no limit as to how well you are treated. You can hang out with your friends, eat great food, and kick back in the jacuzzi. There are resources to teach you to self-soothe and nurture yourself. You may want to spend more time there to re-energize before you start to work on the other aspects of anger.

The engineering and design building on the right is where you will be rebuilding and strengthening your nervous system. Every action you take today is based all of your life experiences up to this very second. It consists of your prior life programming, the state of your general health, and how skilled you already may be in using tools to calm and improve it. In essence, it is the sum total of your coping skills and resilience. Both can be refined and strengthened with a thoughtful approach.

The training/ education building on your left is where you will learn strategies to process the input from your life – all of it. What is being entered into your nervous system affects the composition of output?

CHOICES OF INPUT

Examples of what you might currently be uploading are conversations that are critical of others – either directly to them or in the form of gossip, discussing your pain and medical care, complaining, sharing a generally negative world view, watching violent TV, etc. These types of activities keep your nervous system fired up with many direct effects on your body and peace of mind.

What are you holding onto from your past that continues to agitate you? Why would you do that? The past has little if anything to do with your day. You have given your quality of life over to someone or some entity that you despise. Forgiveness is an advanced set of techniques that dramatically alters the input into your nervous system.

Your degree

An “working relationship with anger” diploma will allow you to efficiently neutralize your flight or flight response. It is one of the more practical degrees you can attain. Acquiring these skills is one of the most powerful and definitive moves you can make to take back control of your life. But remember, the first step is getting past security.

Recap

Anxiety is the sensation generated by your neurochemical response to a threat and intended to motivate you to take action to solve it. If the stress persists, your reaction will become stronger, you’ll secrete more stress chemicals, and feel anger. Anger is your body’s last ditch effort to regain control.

It is a powerful and hard wired impersonal reaction. It is also complex and involves every cell and organ system in your body. You cannot survive without it, and it is impossible to thrive if this physiological state is sustained.

Developing a “working relationship” with it involves understanding the different aspects of it and learning to minimize your time in a threat state through different portals. Do you want your life to continue to be an ongoing replay of your past or are you ready to create the life you want – from reactive to creative?

 Questions and Considerations

1. When trapped by chronic mental or physical pain, your brain and body are literally on fire. Your inflammatory markers are sky high, and you cannot think clearly. Have you considered how you feel in this state and compared it to when you are calm? Even without pain, what is the quality of your life when you are enraged?
2. Your brain is “offline” while you are angry, and it really is temporary insanity. It is humbling to consider how many “issues” disappear after you have calmed down.
3. Every living creature, including homo sapiens, has a version of this reaction. It is universal and intended to be unpleasant. So, why you take it personally? It is protective, and what you have, but not who you are.
4. Forgiveness alone is the historic approach in addressing deal anger. However, it is a big leap to forgive in light of many circumstances. Anger is a complex full body response to an uncontrollable threat and breaking it down into its components is a basic starting point to master dealing with it.

The post Anger Academy first appeared on Back in Control.

The post Anger Academy appeared first on Back in Control.

The root cause of disease

Two aspects of this sequence determine the expression of symptoms. One is the magnitude and duration of your stresses (input), and the other is the reactivity of your nervous system. There are three possible outcomes (output) – safe, neutral, or threat. Living creatures are in the neutral zone most of the time and gravitate to safety whenever possible to rest and regenerate.

The perception of danger (threat) causes the nervous system to send signals to prepare for battle and wage it if necessary. The common term is, “fight or flight,” and your body’s response (activated) is intended to feel unpleasant enough (anxiety) to compel you to take action to resolve the situation. The goal is to remain in this agitated state for as short a time as possible. But what if you cannot solve the problem and you’re chronically fired up? Your body stimulates even more of a response to regain control, and you are hyperactivated (angry).  Unpleasant sensory input progressively impacts your body at three levels.

• Response
• Symptoms
• Illness/ Diseases

When the threat is short-lived your response will be appropriate to the situation and quickly disappears when it has passed or resolved. Almost every internal and external action of your body is automatically directing you in a manner, so you don’t feel many unpleasant sensations. It is called the nociceptive system. If you do sense danger, you are programmed to resolve it immediately. Examples are looking away from the sun, spitting out rancid food, pulling your bare foot back from hot pavement, frequently shifting in your chair to avoid skin breakdown, and avoiding predators.

When threats are prolonged, you will experience symptoms such as back pain, tension headaches, anxiety, poor appetite, nausea, urge to urinate, sexual dysfunction, burning sensations, skin rashes, dizziness, ringing in your ears, and insomnia. There are over 30 different physical and mental symptoms that can occur.²

When threats are sustained, you have a significant chance of becoming seriously ill or developing a disease. It is well-documented that chronic stress kills people and unfortunately the symptoms of an illness or disease also add to the threat load. This is particularly true in chronic pain.³

Dynamic Healing Overview

The nature of your body’s physiology under threat

Environmental cues of threat set off a defensive response. Immediately, before you are even aware, your immune system girds for the possibility of injury by initiating inflammation (to protect cells against invaders (bacteria, viruses, cancer cells), elevates metabolism to provide fuel for defense, increases the speed of nerve conduction–which increases your alertness but also your pain sensitivity, and elevates the levels stress hormones (cortisol, adrenaline, noradrenaline, histamines). Much of this defensive state is modulated by small signaling proteins called inflammatory cytokines.

So how do you think you feel when you are in this physiological state? Your heart is racing, you are sweaty, tired, anxious, overwhelmed, nervous, stomach feels tight, blood pressure is elevated, pain is worse, and your breathing is rapid. The bottom line is that you don’t feel great when your body is in this heightened neurochemical state. Are these symptoms imaginary? Not a chance. None of them.

Defining threat

Examples of physical threats include viruses, bacteria, being attacked by a predator – human or animal, hunger, lack of shelter, poverty, lack of opportunity, being bullied at work or school, racism, authoritarianism, trapped in a difficult living or family situation, and physical maladies.

Mental threats are processed in a similar manner as physical ones with the same physiological response.⁴ They are more problematic in that humans have consciousness, many of our thoughts and emotions are unpleasant, and unlike visible threats like tigers or a severe storm, we cannot escape our thoughts. Repressed thoughts and emotions are even more impactable on your body’s neurochemical state. Many of our unpleasant thoughts are based on cognitive distortions or “stories” about our lives. Unfortunately, whether the threat is real or perceived it has the same deleterious effect.⁵

Systematically addressing the root cause – circumstances versus coping capacity

First, it is always important to undergo a medical workup to make sure there is not a structural issue such as vascular disease, pinched nerve, tumor, or an infection.

Second, regardless of the findings of the workup, maintaining your body’s metabolic, immune, and nervous system balance is important. If you require a procedure, your odds of a good outcome will be maximized.

Third, all three aspects of chronic illness must be addressed. Here are some examples of interventions for each one.

Input (what are you uploading into it and what are you holding onto?)

• Forgiveness
• Cognitive Behavioral Therapy
• Expressive writing
• Never discussing your pain or medical care

State of the nervous system (calm or hypervigilant)

• Exercise
• Sleep
• ACT (Acceptance Commitment Therapy)
• Processing prior trauma

Output (physiological profile – safe, neutral, threat)

• Breath work
• Mindfulness/ meditation
• Humming
• Vagal stimulation
• Certain pitches of music

Finally, you must take charge of your own body and health. Chronic diseases are complex, and you are unique. You are the only one who can figure out a solution. The first step is understanding the nature of chronic disease. The solutions lie In implementing strategies that address the root cause of disease and lower inflammation,⁶ which destroys tissues throughout your body. It is more doable than you think. Not taking charge may have severe consequences.

Modern medicine is continuing down the wrong road

Modern medicine is mainly addressing symptoms. This approach works well when there is an identifiable structural problem that can be fixed. But the vast majority chronic illnesses/ diseases result from being in a prolonged fight of flight state and structural approaches cannot and do not work. The burden of chronic disease continues to rise without an end in sight.¹ Why do we continue to travel down the same road?

The tragedy is that It is an eminently solvable problem at a fraction of the risk and cost. There is  deep data revealing the common neurophysiological nature of chronic mental and physical diseases. Most of modern medicine is ignoring it.⁷ A significant percent of interventions have no supporting data. Integrative medicine and similar approaches are much better at systematically addressing the dynamic interaction between a person and his or her circumstances. Treating symptoms is necessary but won’t definitively heal you. The more accurate term for current “mainstream medicine” is “disintegrative medicine.”

Dynamic Healing Medicine

Dynamic healing medicine requires listening and knowing you. Feeling safe positively affects your neurochemical profile.⁶  It is important to understand both your circumstances (input) and your coping skills (nervous system resilience) to develop a healing relationship with your provider.

My book, Back in Control: A Surgeon’s Roadmap Out of Chronic Pain,⁷ provides a foundation and framework to understand and implement your own solution to chronic illness.

The DOC Journey course and app are frameworks that reflect updated neuroscience research. They include a guided course, videos tutorials, webinars, and access to supportive group sessions. We have been delighted that we have been able to provide clearer explanations for chronic mental and physical pain and allow patients to more quickly find their way out of The Abyss.

Join us in bringing Dynamic Healing into mainstream awareness.

References:

1. O’Neill Hayes, Tara, and Serena Gillian. Chronic disease in the United State: A worsening health and economic crisis. Americaactionforium.org; September 10^th, 2020.
2. Schubiner H and M Betzold. Unlearn Your Pain, 3^rdMind Body Publishing, Pleasant Ridge, MI, 2016.
3. Smyth J, et al. Stress and disease: A structural and functional analysis. Social and Personality Psychology Compass (2013);7/4:217-227. 10.1111/spc3.12020
4. Eisenberger NI, et al. An experimental study of shared sensitivity to physical pain and social rejection. Pain (2006);126:132-138.
5. Burns, David. Feeling Good. Harper Collins, New York, NY, 1980.
6. Porges, Stephen. The Pocket Guide to the Polyvagal Theory: The Transformative Power of Feeling Safe. Norton and Co, New York, NY, 2017.
7. Hanscom, David. Back in Control: A Surgeon’s Roadmap Out of Chronic Pain. Vertus Press, Seattle, WA. 2016.

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The post Dynamic Healing first appeared on Back in Control.

The post Dynamic Healing appeared first on Back in Control.

Roadmap to a solution

What are the clues? Over 90% of people who have died of COVID-19 have some other chronic medical condition(s) (1). The common perception is that in this scenario, the body simply gets overwhelmed. The pre-existing situation is unsolvable and the outcome is inevitable. This idea could not be farther from the truth.

All these chronic conditions are associated with elevated inflammatory markers from the body responding to threats. A major aspect of this response is the immune system. Mental threats are more problematic than physical threats in that you cannot escape disturbing thoughts and emotions and repressing them is even worse. Therefore, every human being is exposed to some level of elevated stress hormones and inflammation. Many people have learned to process threat in way that causes little damage. However, many, if not most of us, have not been taught these skills and therefore are  exposed to elevated levels of inflammatory cells. It is the essence of chronic disease.

The following chronic diseases are all connected to sustained inflammatory and metabolic destruction of tissues: cardiovascular disease, peripheral vascular disease, Parkinson’s disease, autoimmune disorders, obesity, adult-onset diabetes, anxiety, depression, obsessive compulsive disorder, and bipolar disorder. It is all the same process with different clinical manifestations and many people suffer from multiple different ones.

Plan A–Lowering Inflammation Lengthens Life

This document, Plan A, presents 12 categories of interventions that will lower your levels of inflammation. If most severe cases of COVID are connected with chronic medical conditions, then address them. By starting with lower levels of inflammation, there is a better chance of staying below the critical threshold where the inflammatory process spins out of control, there is diffuse damage to many different organs, and your lungs fill up with fluid. There are now multiple professionals advocating a similar approach. One group looked at it from using preventative medications, but it can be achieved with these other means.

Getting and being happy is a learned skill and it is well-documented that those who learn it live longer with a better quality of life. Dealing with COVID-19 requires the same approach as dealing with chronic disease–lower threat and inflammation and create safety. Obviously, it all occurs at a much faster rate with COVID.

Join us in this grass roots movement

Please circulate Plan A to as many of your friends, family, and colleagues as possible and also encourage them to pass it along to their circles. This plan was assembled by a group of physicians and scientists who feel strongly that this approach will have an impact in lowering the severity of this deadly disease. It also represents a template for the future of healthcare moving from an illness to a wellness model. It boils down to means of creating safety instead of being at the mercy of threats. Most chronic mental and physical disease is preventable and some if it even reversible. This booklet represents a major effort to change both the trajectory of COVID–19 pandemic and also the manner in which we approach health care and chronic disease.

There is another aspect of all of this to consider. Inherent in this approach is each person taking full responsibility for his or her role in their health. It is easy to look at others or society for solutions when they truly exist only in each one of us. It is possible with a collective effort of taking personal responsibility for every aspect of our lives, we can change the course of this relentless pandemic, the nature of health care, and create societal changes that will enhance the quality of our lives and those of future generations. We each have to take action, as the burden of chronic disease is crushing us. (2)

Seeing such clear relationship between chronic stress and disease, both in my clinics and in the literature is what finally persuaded me to quit my practice. The DOC Journey is the most recent evolution of the healing process. It has been inspiring and energizing to continue to see people without hope consistently connect to their own capacity to heal.

Plan A – Lowering Inflammation, Lengthening Life

References:

1.   Williamson EL, et al. OpenSafely: factors associated with COVID-19 death in 17 million patients. Nature (2020); https://doi.org/10.1038/s41586-020-2521-4.
2. O’Neill Hayes, Tara and Serena Gillian. Chronic disease in the United States: A worsening health and economic crisis. Americanactionforum.org; September 10th, 2020.

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The nature of illness

All physical and mental symptoms are the result of you gathering data from your surroundings from different sensors, your brain interpreting the sum total as safe, neutral, or threatening, and then you automatically responding in a manner to ensure survival. You may or may not be aware of the reactions. They can be dictated by signals from chemicals, small proteins (cytokines) produced from your cells, signalers from the nervous system (neurotransmitters), or signalers from our glands running through our blood (hormones).

The term, “mind body” is not a useful term in that it implies that there is a separation between them. There is actually just you; one system that responds as a unit. Your nervous system, including your brain, is simply one of the many ways your cells communicate to coordinate your functions. The mind and the body are inaccurate constructs and distractions to understanding illness and disease compared to wellness and health.

Safety

With cues of safety from your environment, including your mind, your response will be signalers such as safety cytokines (anti inflammation and pr- anabolism), GABA (calm), acetylcholine (restoration), serotonin (contentment), dopamine (rewards), oxytocin (connection and bonding), growth hormone and growth factors (regeneration). The immune response will be strong yet inflammation low when stimulated by safety cytokines. Clinically the result is feeling less inflamed, less painful, relaxed, composed, present with a slower heart rate, blood pressure and breathing. The more time that can be spent in this regenerative state the better for health and wellness.

Your body’s goal is to survive. Defeating or dissipating threats and discord and maintaining safety and harmony to keep your range of behaviors and chemistry in a stable restorative and regenerative zone is key to thriving. The nociceptive (pain) and the emotion systems, both with and without awareness, guide you to take actions to avoid harm. When you experience an uncomfortable or unpleasant feelings from any source, it is simply signaling danger and then you can take appropriate steps to find safety.

Threat

Environmental cues of threat or internally generated ones are met with a defensive response including stimulation of your immune system with elevations of inflammation, elevated metabolism to provide fuel for defense, and increases in multiple stress signalers including the threat cytokines (IL1, IL6, IL17, TNF), inflammatory chemicals, (histamine, prostaglandins), mobilizing neurotransmitters (glutamate, dopamine, noradrenaline), and stress hormones (adrenaline, cortisol, aldosterone, vasopressin and endorphins).

Clinically, you are on “high alert” and there are numerous bodily responses to threat. The basic ones include an increased heart rate, rapid breathing, increased speed of nerve conduction (increases pain), elevated blood pressure, sweating, muscle tension, and a sense of danger that we call anxiety. There also numerous symptoms created by this physiological state. They include tension and migraine headaches, neck and low back pain, skin rashes, stomach cramps, depression, bipolar, burning sensations in various parts of your body, and there over 30 different responses. Although the chemical environment encompasses your whole body, each organ and organ system will manifest its unique response.

Symptoms, illness, and disease

 When the threat is transient or resolvable, there will be different physiology that will quickly abate the symptoms. When the threat is more prolonged, people will develop illnesses and diseases that, also, are reversible with appropriate treatment including the removal of threats and restoration of safety. When threat is sustained people can develop serious illness and diseases that may cause permanent tissue damage and create physical, mental and social havoc.

 What causes disease? There are two aspects consider.

• Your nervous system/ body
  • Your inherent coping skills
  • Your current state of reactivity influenced by diet, exercise, sleep, meds, etc.
• Your environment or perception of it
  • The magnitude and duration of threat – the inability to find safety

So, it is the interaction of the surrounding stressors with the human organism that determines the manifestation of physical and mental symptoms; illness and disease versus wellness and health.

The current state of “mainstream” medicine

Modern medicine has nullified these aspects of care in that we are not given the time nor are we encouraged to talk to our patients. From the beginning, we are not providing cues of safety. Then, we don’t know our patients and their coping capacity and really don’t know much about their environment. We are given only the time to treat symptoms. We are ignoring the root cause of the problem–total threat load. It is similar to putting out a major fire with a garden hose. It can’t and doesn’t work. Indeed, there is an ongoing and growing epidemic of chronic disease – both mental and physical, social and spiritual.

Solving our medical care crisis

Our medical care crisis could be solved with one simple move – significantly increase the reimbursement for talking to patients. This would allow a sense of safety, allow providers to assess both the patient and his or her surroundings, and direct them to resources to reduce the threats in their lives, improve safety,  coping and connection skills and provide tools to more effectively process their stresses.

The other half of the equation is to quit paying as much for procedures and also not reimburse for interventions that have been proven to be ineffective or damaging.

Addressing  root causes

A basic concept in extinguishing a fire is to deprive it of its fuel. Forest fires are the classic example. Fire breaks eliminate fuel and are only ineffective if the fire is so powerful as to jump over them. Fire retardants cover wood in a manner that it cannot be consumed. If water is used, it may be delivered in a mist, which helps lower the oxygen available. Water also removes heat. A carbon dioxide fire extinguisher displaces oxygen and suffocates it. The bottom line is that to fight a fire you have to address one of the root causes of it – oxygen, heat, or fuel.

Treating only symptoms is not only ineffective, the “fire” will continue to burn causing ongoing tissue damage. Successfully minimizing the impact of chronic illness requires minimizing the multitude of threats and maximizing access and opportunities for safety. coping and connection while also improving skills to better process toxic environmental inputs.

Summary

Every mental and physical symptom is created by the interaction between your surroundings and your body. Your body contains trillions of sensors that collect data that is sent to and processed by your central nervous system. Unpleasant sensations compel you to take action signaled by your brain and local tissues to resolve threat. Pleasant input causes you to take actions that are restful and regenerative.

The two factors creating symptoms and disease are you (and you coping capacity) and your surroundings (stressors). When you stresses overwhelm your coping capacity, you’ll experience symptoms, maybe become ill, or develop a serious disease. The solution lies in 1) increasing your coping capacity and 2) teaching you skills to more effectively process stress so it has less of an impact on your body, health, and sense of well-being. As you learn to regulate your body’s neurochemistry, you’ll have control, a sense of safety, and thrive. The DOC (Direct your Own Care) Journey presents a well-traveled sequence of lessons that will allow you to master these skills.

References

1. O’Neill Hayes, Tara and Serena Gillian. Chronic disease in the United States: A worsening health and economic crisis. Americanactionforum.org; September 10th, 2020.

Plan A–Thrive and Survive COVID-19, 2nd edition; Loving Life Lengthens It

The post Essence of Illness first appeared on Back in Control.

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• A guided course of seven legs and rest stops
• Video tutuorials
• Webinars
• Weekly group Q&A sessions
• Weekly blogs and podcasts
• Access to having questions answered
• An app based on our workshops – awareness, hope, forgiveness, and play

This post is the introduction to the final rest stop of the guided journey. We are excited in that it represents a much clearer sequence of concepts and there is more clarity as to what are next steps. One of the most powerful aspects of The DOC Journey is the sequencing. You are dealing with deep patterns in the unconscious brain and it takes awareness and repetition to access and redirect them. But the core of it all is much clearer and has been easier to present and explain to people. With engagement, the outcomes have been consistent with the main variable being how much time it takes.

Introduction to rest stop seven

Your Journey has not ended but it has just begun. You began from a place that was dark and you are working your way into the light or maybe you are already there. People often get frustrated because they don’t feel they are healing quickly enough or wonder why others seem to be doing so much better than they are. There is no time frame or rush. Everyone is different and each of us has experienced more than our share of suffering. There are no exceptions. It is important to keep learning and using your tools that allow your brain/body to heal. The key words are patience and persistence.

Remember the deep paradox of this journey. You are letting go to move forward in contrast to our strong inclination to keep fixing ourselves and those close to us.

Thrive

Many people feel better after a few months. They are no longer in a crisis, their pain has improved, and they stop. They usually continue to stick with some basic strategies and do fine. But my observation is that they are missing a huge opportunity to thrive. Once you break free of The Abyss, your potential to move forward is unlimited. The more you nurture this opportunity to grow, the farther you’ll be away from your pain circuits. The concepts of play, giving back, and the spiritual journey are not tools to combat anxiety and pain. That turns into obsessive behavior and little is accomplished. They are more about expanding your life and horizon into the life you always wanted. There are several aspects to creating this capacity to navigate and fully experience every aspect of your circle of life.

• The foundation is awareness combined with the circle of life, which includes “the ring of fire.” Being aware of which part of the circle you are in is a powerful approach. You now have a choice of using your tools to change direction or stay where you are.
• The goal of using the ring of fire model is not to attempt to be in one particular part of it. It is a common perception to feel that most of your life should be spent in the center. That is not life or realistic. Being aware of when you are in the center is the key and knowing when you need to enter it to “re-fuel.” It is the foundation for passing through the ring of fire and engaging in your life activities in the blue ring.
• There are several important concepts to consider.
  • You should nurture and expand the center. The more time you can realistically spend there, the better. It is where your body regenerates.
  • As you learn to develop a “working relationship” with the ring of fire, it will paradoxically be less daunting and easier to navigate.
  • The blue periphery is life and there never was a limit to it. We create our own limitations.

 Your new home

This final rest stop is a framework for settling into your new life and continue to practice the tools that will help you indefinitely. We will conceptualize this stop as where you are building your new home.

• The green center is your lot and it is round. It provides the foundation for your house and you can landscape it to your heart’s content. This is done by using tools that engender self-compassion and you are expanding the center.
• It is important to protect your home and the red ring will do that for you. Anxiety and anger necessary danger signals. You will also be personally arming yourself to defend yourself and your safe haven.
• Each room of your house represents an aspect of your life that you will furnish and decorate.

The phases of the construction include:

• Dreaming of what you want and defining it
• Drawing up final plans
• The rooms
  • Entry – Awareness
  • Family room – Social connections
  • Kitchen – Diet/ Nutrition
  • Bathroom – Processing anxiety/ frustration
  • Master bedroom – Sleep/ Nurturing your closest relationships
  • Other bedrooms – Your family/ guests
  • Den/ office – headquarters
  • Garage – Transportation to the outside world/ your reserves
  • Landscaping – Nurturing and growing the center
  • Protection
    • Alarm system
    • Dog
    • Self-defense
  • Basement–workout room/ exercise

The essence of life is avoiding threat and seeking safety. It is necessary to actively seek both in that you need safety to create the reserves you need to deal with life’s challenges. Otherwise, you’ll be overwhelmed a good percent of the time, with a limited capacity to enjoy your life or even worse, continue to suffer.

You have only just begun

We all equate home with safety, but all too often it is not, especially when chronic pain is in the middle of it. Family members are also our most powerful triggers and it is bidirectional. Creating a “safe house” or haven takes a focused effort but none of the steps are difficult with the right tools. You have heard the saying, “A carpenter is only as good as his/ her tools. You now have the opportunity to create whatever life you want and even though this is the end of this course, you have just begun your journey.

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Conceptualizing pain

What is pain? We toss the word around a lot without really understanding what it actually means. A loud noise is uncomfortable. Bitter tastes are unpleasant. Ringing in your ears is more than annoying. What about when someone, “hurts your feelings?”

The way every living species of creatures evolved and survives is by processing multiple types of sensory input and interpreting the sum total of it as safe or dangerous. Then its behavior is directed towards safety and rewards while also avoiding threat. These automatic actions in response to this input keeps us in a neutral zone most of the time so we remain functional and comfortable.

Nociceptive pain

The name for this function of the nervous system is called, “the nociceptive system.” When the limits of safety are exceeded for a given part of the body, your receptors will signal danger and cause you to engage in corrective action. The intensity of the signal will depend on the input from a specific part of the body. For example, a bright spotlight shined in your eye would not be tolerated for very long. Your brain knows your eyes would be damaged quickly and the danger signal is sent out for you to close your eyes or move away from the light. But what if the same light was focused on the bottom of your foot? No problem because there is no threat from light alone to that part of your body. Pain is simply a warning signal that there is potential damage to a specific body part.

So, acute pain is necessary and protective. It is a gift and people who are born without a pain system don’t survive more than 10-15 years. They can’t sense danger. Tissues are destroyed and they die of infection. (1)

A nightmare

But there is nothing useful about chronic pain. A delicately balanced signaling system is out of kilter and it can no longer accurately interpret the environment. You are trapped by incredibly unpleasant sensations without any hope of escape. It may be one of the worst experiences of the human condition.

Based on the last 10 years of neuroscience research, new definitions of chronic pain are being created. Here is one proposed by the IASP.

IASP definitions of chronic pain

For the first time since 1979, the International Association for the Study of Pain (IASP) revised its definition of pain. This was made necessary by the research showing clearly that pain could arise from sources other than physical tissue damage. Although the revision is a relatively small one, it has big implications for appreciating the complexity of pain and expanding our ability to assess and manage pain with multi-disciplinary approaches.

Old 1979 definition of chronic pain

“An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.”

Revised 2020 Definition

“An unpleasant sensory and emotional experience associated with or resembling that associated with actual or potential tissue damage.”

This definition is expanded by 6 key points

1. Pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors
2. Pain and nociception are different phenomena. Pain cannot be inferred solely from activity in sensory neurons.
3. Through their life experiences, individuals learn the concept of pain.
4. A person’s report of an experience as pain should be respected.
5. Although pain usually serves an adaptive role, it may have adverse effects on function and social and psychological well-being.
6. Verbal description is only one of several behaviors to express pain; inability to communicate does not negate the possibility that a human or a nonhuman animal experiences pain.

By adding the words resembling that associated with allows for an expanded understanding and appreciation of pain beyond that which was previously limited to actual tissue damage.

Dropping the phrase “describe” the pain, allows for acceptance of pain from those who may not have the ability to describe their pain whether infants, cognitively impaired individuals, those with communicative disorders, or any other reason that a description of pain may not be possible including nonhuman animals.

Commentary on the six key points

1. It logically has to be personal since each person is genetically different and we are programmed with regards to safety vs threat by our past. If you come from a less than nurturing background, more things in the present will seem dangerous because when you were younger they were dangerous. You will spend a higher percent of your time in a “high alert” and the sustained exposure to stress hormones and inflammation will create physical symptoms and serious diseases.
2. Acute pain is the danger signal that indicates that you have exceeded the safety limit of a given structure of your body. The nociceptive system keeps your behaviors in a range to protect you. Chronic pain happens when the signals have become disconnected from the environment and keep firing even in the presence of safety.
3. Pain being a learned experience is well established in the medical literature. One classic study involved looking at childhood trauma. A scoring system was developed called the ACE score (adverse childhood experiences) looking at 10 factors such as various kinds of abuse, parent(s) in prison, addicted to drugs, or having a mental health diagnosis. There is a marked increase in chronic diseases including chronic pain. (2)
4. Patients in chronic pain are often labeled. They include, “drug addict”, low pain threshold”, “faker”, “drug seeker”, “unmotivated”, and the list is endless. Often the labels are even more disparaging. No one likes being labeled. Once a person has been labeled, you can no longer “see them”. Since physical symptoms are created by the patient’s interaction with his or her environment, it is critical to know them and also their life circumstances. How can you solve any problem without deeply understanding it?
5. There is no usefulness in chronic pain. It is a disaster and it always interferes with function, social interactions, and psychological well-being – ALWAYS.
6. Chronic pain is so disruptive to every aspect of your life that words do not come close to describing the depth of suffering. It has been shown that the impact of chronic pain is greater than that of having terminal cancer. (3) The term that best reflects this condition is, “The Abyss.” It is a really dark place without a way out.

Unfortunately, mainstream medicine has not incorporated the last 20 years of neuroscience research into their treatment approach. It continues to recommend random simplistic treatments for a complex problem. It can’t and doesn’t work.

The new IASP definition is a start and opens the door for a better treatment paradigm. Chronic pain is solvable with an understanding of it and the principles behind the solutions. The starting point is for YOU to better understand it and then solve it with using the medical system as a resource. Once you take charge, it is game on.

1. Yancey, P and Paul Brand. Pain: The Gift Nobody Wants. DIANE Publishing Company (1999).
2. Anda RF, et al. “The enduring effects of abuse and related adverse experiences in childhood. A convergence of evidence from neurobiology and epidemiology.” European Archives of Psychiatry and Clinical Neuroscience (2006); 256: 174–186.
3. Fredheim OM, Kaasa S, Fayers P, Saltnes T, Jordhøy M, Bortchgrevink PC. Chronic non-malignant pain patients report as poor health-related quality of life as palliative cancer patients. Acta Anaesthesiol Scand. 2008;52(1):143-148. 

The post Clarifying the New IASP Definition of Chronic Pain first appeared on Back in Control.

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It’s the sensation created by elevated levels of stress chemicals.

• Adrenaline – increases sensitivity and alertness
• Cortisol – mobilizes energy stores/ inflammation
• Histamines – immune system/ inflammation
• Endorphins – modulates the stress response

Anxiety is an automatic survival response. The unconscious brain is estimated to process 11 millions bits of input per second whereas the conscious brain deals with 40 per second. It is a huge mismatch. That is why it’s not subject to rational psychological interventions alone.

Decreasing your body’s level of stress hormones causes anxiety to drop.

There are two ways of accomplishing this:

• Relaxation strategies
  • Mindfulness, meditation, “active meditation”, forgiveness, play, medical hypnosis, biofeedback and many more.
• Stimulating the brain to change (neuroplasticity), so there is less reactivity to stress.
  • Learning to “be with your pain”.
  • Not discussing it with anyone.
  • Expressive writing
  • Moving forward with your life with or without your pain.
  • “An enjoyable life”

There are two more critical concepts:

Since anxiety is a unpleasant deeply seated core survival reaction, you’ll do almost anything to avoid it. Essentially, anxiety is the pain. The basic intent of it is to cause you to act in a manner to diminish a threat (control) and move on.  When you can’t escape a mental (thoughts) or physical threat, your body will secret more stress hormones to increase your chances of survival. The sensation generated is anger. Anger is anxiety with a chemical kick. It’s even less subject to rational interventions.

Not only are there strategies to decrease the stress hormones, there are powerful ways, to stimulate increased levels of relaxation (play) chemicals, such as:

• Oxytocin – bonding, the “love” drug
• Dopamine – reward
• Serotonin – mood elevator
• GABA hormones (the body’s equivalent of Valium).

This dramatically different chemical environment generates a deep sense of well-being.

Your capacity to enjoy your life depends on your skills in minimizing your levels of stress hormones and stimulating your “play” chemicals. Modern neuroscience has documented why “Laughter is the best medicine”.

Explanation of anxiety: Converstion with David Elaimy

Wake the fun up

Listen to the Back in Control Radio podcast Anxiety Basics.

The post Anxiety Basics first appeared on Back in Control.

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To master a new language requires a focused commitment for an extended period of time. Say you wanted to become fluent in French. It would take years of reading books, attending classes, listening to audio tapes and probably immersing yourself in the culture for a period of time. Eventually, a new part of your brain would develop that enables you to speak French. This is possible because of the brain’s capacity to change by increasing the number of neurons and connections between them, laying down an insulating material call myelin, and changes occurring in the glial cells, which are the supporting cells of the central nervous system. This process is called, “neuroplasticity” and your brain changes every second. (1)

“Not speaking English”

You can’t learn French by “not speaking English” or trying to improve it. Of course not. What a ridiculous idea!  But what about trying to solve chronic pain by focusing on “not being in pain”? Where’s your attention? What is being reinforced? Your brain will develop wherever you place your attention. By constantly (and understandably) seeking a cure or discussing your pain with those around you, you’re reinforcing the pain circuits. As they become more deeply embedded in your nervous system, you’ll use the creative part of your brain less and the research shows that the brain physically shrinks in the presence of unrelenting pain. Fortunately, it re-expands when you have healed. (2)

“What you resist will persist”

One of the core neuroscience-based concepts of solving chronic pain revolves around the current definition that it “…….is an embedded memory that becomes connected to more and more life experiences, and the memory can’t be erased.” (3) Once you’ve developed chronic pain, the pathways are permanent. The more you fight them, the stronger they’ll become. Discussing or pursuing a cure can be compared to putting your hand right into a hornet’s nest. So, what do you do?

What is counter-productive are practices that keep your pain in the forefront. (trying to learn French while focused on the problems with your English)

• Endless quest for a cure – I spent years being an “epiphany addict”.
• Frequently discussing your pain or medical care. That wouldn’t count as quality time with those close to you.
• Complaining
• Gossiping
• Not being willing to learn new ideas or being open to change

“An enjoyable life”

What you can do is to learn a new language, which is “an enjoyable life”. Since anxiety and anger are basic survival responses, that’s where your brain is programmed to go as the default mode. These automatic responses become stronger with age and repetition. To train your brain differently requires a deliberate long-term focused effort.

The first step in any new endeavor is to create a vision of where you want to go? What do you want your life to look like? Do you want to live in this state of affairs indefinitely? You can’t accomplish anything of significance until you know what it looks like and internalize it.

What you’re doing by creating and pursuing what you want is developing a new nervous system within your existing one. It’s like putting a virtual computer on your desktop. As you continue to work on learning the language of “an enjoyable life”, you’ll be paying less attention to the pain circuits and they will atrophy from disuse. At some tipping point your pain and anxiety will diminish dramatically – but not by trying to make it drop. It’s similar to re-directing a river into a different channel. It will be slow at first but as the flow of water is diverted, the force of the water will help create the new channel.

Learning the language

It’s highly doable and the idea is to utilize tools that stimulate your brain to change. The strategies include:

• Reconnecting with the best part of who you are
• Re-learning how to play
• Somatic work – connecting thoughts with physical sensations
  • Expressive writing
• Active meditation – placing your attention on a different sensation
• Re-engaging with familiar art, hobbies, music, dance, sports, etc.
• Spending quality time with family and friends (53% of Americans are socially isolated)
• Forgiveness – you can’t move forward while you’re hanging on to the past
• Giving back – there are an endless number of possibilities
• Listening – it’s more interesting than re-hashing current your own views on life
• Creating your vision in detail of how you want your life to look
• Getting organized so as to be able to execute your vision

This Simon Sinek video, The Infinite Game, is brilliant as he outlines true leadership in by pursuing a vision instead of comparing your efforts with the competition. It only detracts from your quest. At a personal level, as you spend time monitoring your own progress versus pursuing the life you want, you will less effective.

Creating a family vision

We have had a wonderful experience over the last couple of years, as we have realized the power of re-directing the brain as a family. One of the early assignments we give our families is to spend an hour remembering when life was the most fun. Why are you together? What attracted you to each other in the first place? What experiences were remarkably enjoyable? Remember these events in as much detail as possible? Connecting to the part of your brain that knows how to play is one of the first steps of developing this new part of your nervous system. You might notice that as you talk about these wonderful events, that you’re more relaxed, and your mood will shift.

What is a little disturbing, is that chronic pain often takes such a toll on the family that couples have a hard time dropping their guard enough to get into this mind set. There is a lot of anger and frustration connected to endless suffering. It’s more than understandable and persistence pays. After you have reminisced about the good times, the next step is to begin discussing how to bring that energy back into your relationship and family.

Moving forward

This exercise is combined with the “prescription” that you will never discuss your pain with anyone but your health care providers – ever. Discussing your pain is the most effective way to keep your attention on it, and it’s almost impossible to move forward. On the second visit, patients are usually excited about the shift in their relationships and the family is visibly relieved to not being subjected to endless conversations about pain and creativity quickly returns. Family dynamics may be the strongest factor keeping people in pain, but also is a powerful force pulling people out of it.

We all know how to survive, by definition, since we’re still alive. We become more adept with age, but we often lose the skill of thriving. Creating this alternate nervous system demands a deliberate effort. It’s the essence of solving your pain.

Listen to the Back in Control Radio podcast Learn Another Language – “An Enjoyable Life”

1. Feldman Barrett, Lisa. How Emotions are Made. Houghton Mifflin Harcourt Publishing Company, NY, NY, 2017.
2. Seminowicz DA, et al. “Effective treatment of chronic low back pain in humans reverses abnormal brain anatomy and function.” The Journal of Neurosci­ence (2011); 31: 7540-7550.
3. Baliki MN and A Vania Apkarian. “Nociception, pain, negative moods, and behavior selection.” Neuron (2015); 87: 474-491.

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