• Honor your suffering. You are trapped by physical and mental sensations without an apparent way out.
• You feel extremely isolated but many people in this hole (The Abyss) are also suffering badly. You are not alone.
• Your rightful frustration (rage) fires up your symptoms even more.
• Systematically learning and using tools to calm your body, will allow you to heal.

The Depth of Your Suffering – Darkness

All of us seek safety – physically and mentally. When we don’t feel safe, our bodies switch to a flight or fight mode, and we feel stressed. Another descriptive word is “anxious”, which is simply the feeling generated when you sense danger. We yearn for safety and detest anxiety, and when we can’t resolve the problem causing us to feel uneasy, we feel trapped. The word for this more intense bodily response is anger. It is our last-ditch effort to regain control and feel safe. When we still can’t escape a real or perceived threat, our bodies break down with the outcome being chronic mental and physical diseases.

Anxiety and anger are not psychological constructs; they are your body’s warning signals, and they evolved to be intentionally unpleasant. They are the pain and are manifested in many ways. Even with physical symptoms, the cause is unclear. There are reasons. Chronic stress translates into threat physiology (how your body functions), which causes symptoms, illness, and disease. Unless you know how to effectively process stress, you are trapped.

Feeling trapped causes deep suffering, creates many problems. BTW, everyone suffers. There are degrees, and not having basic needs met such as safety, food, shelter, and companionship creates havoc with every aspect of your health and life. I do not want to dishonor this level of suffering. For example, the incidence of significant anxiety issues is 100% if your income level is less than 19,000/ year.¹ This is 1994 data that translates in approximately $38,000 in 2024.

We are also trapped by being a species with language, abstract thinking, and awareness of the finite nature of life. We can’t escape death. In addition to our physical challenges to staying alive, we cannot escape our thoughts. We have no protection from mental pain and suppressing unpleasant thoughts inflames the brain even more. These translate into RUTs, (repetitive unpleasant thoughts). They are universal varying in severity and frequency. The range is:

• Occasional unwanted thoughts
• Repetitive thoughts
• RUTs
• Repetitive disruptive thoughts
• Invasive thoughts

 “The Abyss”

One afternoon, I was listening to a patient attempting to describe the depth of her suffering and it hit me how deep and hopeless this hole is for most people. I realized that words were inadequate to encapsulate the degree of misery. Since no one seemed to have any answers, there was no apparent way out. The description that seemed to fit for this dark, bottomless pit was “The Abyss”.

A recent research paper documented that the effect of chronic pain on one’s life is similar te the impact of terminal cancer.² You hadn’t anticipated the possibility of your life being consumed by pain. The paper showed that chronic pain was worse in that with cancer, you at least know the diagnosis and there is an endpoint, one way or the other. This statement might sound harsh in that suffering from terminal cancer is horrible, but ongoing pain (mental and physical) without knowing if there is an endpoint is even worse.

A stark example of how uncertainty can eat away at you is illustrated in Dr. Viktor Frankl’s book, Man’s Search for Meaning.³ He was an Austrian psychiatrist who was imprisoned in a concentration camp during WWII. He lost several close family members and experienced unspeakable horrors. As he describes his personal experience, it is difficult to imagine anyone enduring even a fraction of what he witnessed and endured. Yet, he points out that the worst part of it all was not knowing when it was going to end. 

Life in The Abyss

In addition to other life stresses, patients are trapped by unpleasant mental and physical symptoms, illnesses,and diseases. You are also trapped by the medical system, which is not consistently showing you a way out. Over time, you become discouraged (despondent). My equation for it is:

The Abyss = Anxiety/Anger x Time

Why isn’t pain part of this equation? It is because anxiety is the pain. When you are stuck in a whirlpool of relentless anxiety and frustration, life goes dark.

How deep is this hole? Here is a short list of the suffering I have encountered both personally and witnessed in my patients.

Losses include:

• Independence
  • Financial
  • At the mercy of the disability system
• Capacity to enjoy good music, friends, fine food, and hobbies without the experience being marred by pain
• Peaceful family life
• Feeling good – there are over 30 symptoms created by a chronically activated nervous system. There are also many other mental and physical disease states. Your body breaks down.
• Integrity – people don’t believe you and often the harder you try to convince your friends, family, peers, employers, and health care providers, the less you are believed.
  • Being labeled – malingerer, drug-seeker, lazy, not motivated, and difficult
• Unlimited physical activity
• Peace of mind – RUTs are relentless and may be the worst part of the ordeal.
• Hope – this may be the worst aspect of it all. Repeatedly having your hopes dashed induces a depression.

No Way Out

Consider the depth of “The Abyss.” Your soul is being pounded into the ground by a pile driver of anxiety/anger as you remain trapped in your body, riddled by mental and physical pain. Your life is being systematically destroyed, but in some cruel cosmic joke, you’re alive to bear witness – without hope. This dark place in your mind is unusually deep – bottomless. And no one is listening………

Recap

Allow yourself to comprehend the depth of your suffering and degree of damage your pain has inflicted on your life. Awareness is the first step in successfully reversing this downward spiral. Right now, you are at the bottom, except there is no bottom……

Chronic illnesses are complex and random treatments can’t and don’t work. It is necessary to break your unique situation into its component parts and systematically deal with them. There is a way out of this incredibly dark place, but you cannot go from the depths of suffering to better health with willpower and belief. As you methodically acquire knowledge and skills to deal with each aspect of your situation, you’ll be able calm and re-route your body to break free and heal.

Questions and considerations

1. First, give yourself a break. You are suffering badly. Many treatments have failed, and you may even be worse. No one seems to be able to show you a way out or even offer hope. There is no reason to have positive feelings about any of this. Allow yourself to feel the depth of your suffering and frustration. Express it a piece of paper and immediately tear it up. A few people have difficulty processing the feelings released with this exercise, and if you feel uncomfortable, immediately stop.
2. Consider what is important to you in life, but you can’t access or experience them. Write down two or three things you would like to experience. Not being in pain is not one of the choices. You’ll see why as the course unfolds and it is also a given. None of us want to be in pain.
3. List three to five of your most intolerable symptoms. For many people, the relentless onslaught of unpleasant thoughts is the worst aspect of it all.
4. Give yourself credit for staying on your feet long enough to keep trying. A willingness to learn and practice is the number one factor predicting success.

 References:

1. Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of dsm-iii-r psychiatric disorders in the united states: Results from the national comorbidity survey. Arch Gen Psychiatry. 1994; 51(1): 8-9.
2. O’Connor AB. Neuropathic pain: quality-of-life impact, costs, and cost effectiveness of therapy. Pharmacoeconomics (2009); 27: 95- 112.
3. Frankl, Viktor. Man’s Search for Meaning. Beacon Press, Boston, MA, 1959,1962,1984, 2006.

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• Anti-depressants
• Sound generators
• Hearing aids
• Cochlear implants
• Behavioral therapy
• Transcranial magnetic stimulation (2)

Much to my surprise (and shock), my tinnitus of over 25 years resolved as I went through my own healing process. It has been gone for over 20 years.

My Experience

The old saying, “Youth is wasted on the young,” is true—especially in my case. Many of the physical issues of my adulthood resulted from a perceived invincibility during my teenage years, combined with my refusal to heed adult advice. Protecting my ears was one of those cautions that I cavalierly ignored.

The Destruction of My Hearing

I worked as a carpenter and hod carrier from the time I was 14 years old and into medical school. Every summer and most college vacations, you could find me building houses. The summer before medical school began, I built my parents’ home. Although I was involved in many aspects of construction, my most frequent task was framing and pouring concrete slabs, which entailed using a Skilsaw much of the day. I never gave a thought to decibel levels, even when I was using the tools close to my ears.

Fellow workers mentioned ear protection, but I just did not see the need. To further punish my ears, I used a nail gun to shoot nails through two-by-four floor plates into concrete. I would load a 16-penny nail (3.5 inches long) into the gun, position it over the 2 by 4, and pull the trigger. To make matters worse, the sound was magnified when I performed this work in basements. Still, the suggestion of using ear protection didn’t seem important.

The Ringing Begins

When I was about 32, I began to notice a strange sound in my ears, like a bell ringing, all the time. It started during a time when I was recovering from low back surgery that had gotten infected. I wasn’t sleeping well, and my stress levels were extremely high.

At first, I didn’t think much about the ringing—until I realized that it wasn’t going to stop. First, I tried to ignore the ringing, which didn’t work. Every time I heard it, I became increasingly frustrated. My attempts to cope with it began to drive me slightly crazy. The problem grew larger and larger. One day I read about a former TV star who had committed suicide because of his tinnitus. This was not reassuring.

No Answers

I saw several ear-nose-and-throat (ENT) physicians, whose exams revealed that I had suffered some high-frequency hearing loss. When I asked about the ringing, they shrugged their shoulders and said it was nerve damage, and nothing could be done. Loud environments aggravated the condition, so I avoided them. Even eating in restaurants would exacerbate it. Earplugs were somewhat helpful.

The Ringing Stops

The tinnitus ceased along with 16 other chronic symptoms around 2003. I could not understand why I could have been so miserable and then have so many divergent symptoms resolve. I heard a lecture by Dr. Howard Schubiner, author of Unlearn Your Pain, where he listed over 30 symptoms that are caused by your body being under sustained stress.(3) Essentially, all chronic mental and physical symptoms, illnesses, and diseases are caused by sustained flight or fight physiology. The effects occur at the mitochondrial (energy producers in each cell) level, and your DNA directs the production of inflammatory cells. The solution lies in calming your stress response to safety (rest and digest) where your body can refuel and regenerate.

Hearing loss is common as we age and permanent. It includes a diminished capacity to discriminate. For example, I could not hear you well if you talked to me in a noisy restaurant. Today I regret the folly of my youth, knowing that much of my hearing disability was self-inflicted. The exact link between hearing loss and tinnitus is unclear.

Calming Down Your Body’s Chemistry

The process of lowering your stress chemistry is called “Dynamic Healing.” You can regulate your body’s stress physiology by:

1. Processing the input in a manner that is less impactful to your nervous system.
2. Increasing the resiliency of the nervous system.
3. Using tools to directly lower your stress physiology. The speed of nerve conduction slows down, and your inflamed brain calms down.

I don’t know the numbers, but numerous people who have learned and used these concepts have reported that their tinnitus diminished or disappeared. I talked to a radio show host who inadvertently used these principles and noted his tinnitus resolved.

The tinnitus still returns when I am in noisy environments, if I am sleep deprived, or if my stress-coping skills are especially challenged. But if I am careful, the ringing is minimal to non-existent. It has been an incredible relief to escape that endless, irritating sound.

Conclusion

There are various types and causes of tinnitus. Not all of them will respond to these concepts, but there is no way of knowing without learning to calm yourself and see what happens. There is no downside, and you may be pleasantly surprised. no longer have to endure tinnitus.

References

1. National Institute of Health. Tinnitus. Available online: https://www.nidcd.nih.gov/health/tinnitus (accessed on 17 September 2021).
2. Denton, AJ, et al. Implications of transcranial magnetic stimulation as a treatment modality for tinnitus. J. Clin. Med (2021); 10:5422. https://doi.org/10.3390/jcm10225422
3. Schubiner H and M Betzold. Unlearn Your Pain, third edition, Mind Body Publishing, Pleasant Ridge, MI, 2016.

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Anxiety is the manifestation of flight or fight physiology (how the body functions). The sensation evolved to be incredibly unpleasant, as life forms that ignored these signals didn’t survive. Humans additionally possess language to label these sensations, “anxiety.” We will do anything to avoid it. Suppressing it has even more severe consequences with an increased chance of opioid craving² and the hippocampus of the brain (memory center) shrinks.³ So, the only choice left is to mask it, which actually works – while you are masking. Opioids work well to diminish mental pain, as well as physical, and have been used for melancholy since ancient times.⁴

My perspective

Almost forty percent of my surgical practice was devoted to treating patients with infected spines from IV drug abuse. The problem arose from bacteria entering the blood from contaminated needles. The bacteria lodged in the disc space, which has a limited blood supply. Since there was no way out, the bacteria are trapped. This environment is ideal for growth and an abscess forms. Adjacent vertebrae are destroyed and break. Surgery entailed draining the infection and stabilizing the broken spine with screws, rods, and a fusion. These operations were complex, expensive, and risky. Occasionally, a patient would become paralyzed from the infection clotting off the blood supply to the spinal cord.

A minimum of six weeks in the hospital were required after surgery for IV antibiotics. I knew them well, and I learned some lessons from them.

• He or she would often shake in bed from crippling anxiety, which worsened their pain.
• Instead of increasing pain medications, anti-anxiety drugs were much more effective in lowering pain.
• No one chooses to be an addict – no one. Addiction begins with a need to relieve mental or physical pain and then the drug itself has addictive qualities.
• The destruction wreaked on every aspect of people’s lives is devastating.
• Once he or she calmed down, conversations were much easier.

What’s currently being done?

We are currently approaching the epidemic from almost every possible wrong angle. Why is this happening?

1. Not addressing the root cause

The biggest and most obvious problem is that modern medicine isn’t providing viable solutions to chronic mental and physical pain. We are focused on structural problems being the source of pain, and if we can’t find the “cause,” we just treat symptoms. Not addressing the root cause of a sustained flight or fight state, is a disaster. The reality is that everything is wrong in that every cell in your body is bathed in stress chemistry, on high alert, and your body breaks down.

2. Inadequate training

Physicians are remarkably well-intentioned, work too hard, and enjoy seeing their patients improve. But our training is woefully inadequate and not connected to ongoing scientific advances. Recent neuroscience research has provided answers to chronic pain but the knowledge hasn’t penetrated into mainstream medicine. The current definition is that chronic pain is, “……an imbedded memory that becomes connected with more and more life experiences and the memory can’t be erased.”⁴  It’s a complex neurological problem and we are treating it as a structural issue. It can’t and doesn’t work.

Your doctor doesn’t have the correct tools to solve your chronic illnesses. Both patients and providers are frustrated. It affects the doctor/ patient interactions. About 20% of physicians are comfortable treating chronic pain, and only 1% enjoy it. Many patients in pain feel labeled and discriminated against by many physicians. They are correct. The labels include, “drug seeker”, “malingerer”, “have secondary gains”, “difficult”, “addict”,and the list is endless. Once you are labeled, the person who placed the label has lost awareness of who you are. They can longer hear important details to help you heal. When a patient pushes to be heard, the situation may become unpleasant.

Even worse, many of the “mainstream” interventions have been demonstrated in numerous research papers to be ineffective and often cause harm.⁵ Many proven effective treatments are not readily available because they are not covered by insurance plans.⁶  Why do you think we have such an epidemic of chronic if we were treating it correctly? A significant percent of a medical system’s revenue is driven by these expensive and risky interventions.

3. Known data is ignored

Modern medicine is pretending to treat your chronic pain and is arrogant in dismissing deep research that reveals answers. A 2014 paper documented that only 10% of orthopedic and neuro spine surgeons are assessing and addressing the well-known risk factors for a poor surgical outcome prior to recommending surgery.⁷  You trust your doctor to implement a best practices approach and you’re repeatedly disappointed. With increasing frustration, your stress physiology remains elevated, and your pain worsens. Repeatedly dashing hopes also induces depression.⁸

4. No one is listening

A safe trusting healing relationship with your doctor is at the core of care. Other treatments have limited benefit without it. Physiology shifts from threat to safety, which induces healing. With short visits and huge demands from the system (the business of medicine), your physician doesn’t have enough time to know you.^9,10 Family, social, interpersonal, and work dynamics predictably overwhelm almost any treatment plan. Conversely, addressing these situational dynamics is a powerful way to enhance healing.

Chronic mental and physical pain is complex and layered on the uniqueness of each person. How can you solve any complex problem without knowing details? Major life-altering decisions are commonly made on an initial visit. Few people would build a house or even purchase a car with extensive research. The consequences of an ill-informed choices about your body can be devastating.

5. It’s the mental pain

Another problem is that mental and physical pain is processed in similar brain regions, and mental pain is even less tolerated than physical pain.¹¹ About fifteen years ago, I was perplexed by the severity of symptoms reported by many patients with essentially normal spines. I began to ask questions about their lives and discovered that most of them were dealing with unusual amounts of stress. I began asking patients, “If I could get rid of your pain or your anxiety, which one would you choose to address?” Most of them quickly answered, “ I can’t deal with the anxiety.”

A fallout of the the government’s focus of restricting access to pain medications is that patients are more stressed, which is inflammatory and further increases pain. Physicians fear prescribing even low-dose pain meds.

I recently saw two different successful businessmen for ongoing leg pain after each having two low back operations and their pain was much worse. I couldn’t see much wrong on the original MRI scans done prior to their first operations and the most recent scans didn’t reveal a cause for their ongoing pain. Finally, I remembered to ask them about their anxiety compared to the pain. Neither of them appeared to be particularly anxious. Both of them immediately said it was the anxiety that was the much bigger problem and they could deal with the leg pain.

Most my patients who have infected spines from IV drugs are overwhelmed beyond words with anxiety. They have been dealing with it for so long that they make no pretense of it being otherwise. It often began to be problematic in their early teen years and magnified by family and school dynamics. Opioids help mental pain. Even when on their usual doses of medications to prevent withdrawal symptoms, they are frequently physically quivering in bed from anxiety. Most physicians, historically including me, don’t ask many questions about anxiety and frustration.

6. Simplistic thinking

Successfully eliminating polio and smallpox epidemics, took a widespread public health effort at many levels, costing billions of dollars. But it was accomplished with an extensive cooperation between the government, private sector and medicine. The opioid epidemic is a far bigger problem cutting across all age groups and levels of society. Limiting access to opioids as the main focus isn’t going to make the smallest dent in the problem and, as already mentioned, is going to make it worse. Anyone can and will turn to illicit sources for medications. When you’re in unrelenting pain, you’ll do whatever it takes to survive. Getting drugs from marginal suppliers or from the streets is becoming a common occurrence amongst people who never remotely would have considered it. What else are you going to do, in light of fact that medicine is not providing alternatives to solve your pain? Many people have their lives consumed by the pursuit of drugs and pain relief. Patients have laughed at us when we ask about where they are obtaining their opiates. From their perspective it’s fairly easy and it feels like it is becoming somewhat of the norm.

Finding relief any way that he can

One typical case was that of middle-aged carpenter with low back pain, who had been able to work for years by taking a stable low dose of narcotics. He needed to keep working, so when the local pain center shut down, he felt he had no other choice but to use IV heroin. I met him in the hospital where not only was his spine infected, but it had spread deeply into his pelvis. He was extremely ill. He required three operations to drain almost a gallon of pus and stabilize his spine.

The viable solution

In defense of the current efforts, the opioid epidemic has caught the attention of everyone. However, they are working from a flawed paradigm regarding the driving force behind chronic mental and physical pain like they did when working on eradicating a specific viral infection with vaccines. Yet the answer is right in front of us.

The core answer is for the medical profession to embrace and implement what we learned in medical school. Sustained stress causes chronic illness and disease because of the body’s physiology, and not from structural causes.

These reactions are automatic, emanate from the powerful unconscious brain, and aren’t controllable with rational interventions. So, what is the solution? Lower your threat physiology. The treatment model is called, “Dynamic Healing” and threat physiology is regulated through three different portals. Your stresses (input) are processed in a manner to have less impact on your nervous system. Secondly is calming your nervous system. Finally, there are strategies to directly regulate your physiology from flight or fight to safety.

The reason there is a viable solution to the opioid epidemic is because most of the strategies used each portal are self-directed. They should still be in the context of good medical care. The details are beyond the scope of this discussion, but the bottom line is that as you attain the skills to lessen your exposure to stress/flight or fight physiology and increase your time in safety (rest and digest), your body knows how to refuel, regenerate, and heal.

References

1. Beyer, Don, Chairman. JEC (Joint Economic Commission Dems), 2021. https://www.jec.senate.gov/public/_cache/files/67bced7f-4232-40ea-9263-f033d280c567/jec-cost-of-opioids-issue-brief.pdf
2. Garland EL, et al. Thought suppression as a mediator of the association between depressed mood and prescription opioid craving among chronic pain patients. J Behav Med (2016); 39:128–138. 10.1007/s10865-015-9675-9
3. Hulbert JC, et al. Inducing amnesia through systemic suppression. Nature Communications (2016); 7:11003 | DOI: 10.1038/ncomms11003
4. A.R. Mansour, M.A. Farmer, M.N. Balikia and A. Vania Apkarian. Chronic pain: The role of learning and brain plasticity. Restorative Neurology and Neuroscience (2014): 32:129-139. DOI 10.3233/RNN-139003.
5. Franklin GM, et al. “Outcome of lumbar fusion in Washington State Workers’ Compensation.” Spine (1994); 19:1897–903.
6. Heyward J, et al. Coverage of Nonpharmacologic Treatments for LowBack Pain Among US Public and Private Insurers.JAMA Network Open. 2018;1(6):e183044. doi:10.1001/jamanetworkopen.2018.3044
7. Young AK, et al. Assessment of Presurgical Psychological Screening in Patients Undergoing Spine Surgery. J Spinal Disorder Tech (2014); 27: 76-79.
8. Love at Goon Park: Harry Harlow and the Science of Affection. Deborah Blum. Perseus Books, Philadelphia, PA, 2002.
9. Presented by Daniel Alford, MD. Lecture: Challenges in Physician Education, Kaiser Pain Symposium, October 20, 2018.
10. Alford DP, German JS, Samet JH, Cheng DM, Lloyd-Travaglini CA, Saitz R. Primary care patients with drug use report chronic pain and self-medicate with alcohol and other drugs. J Gen Intern Med. 2016;31(5):486-491.
11. Lane RD, at al. Biased competition favoring physical over emotional Pain: A possible explanation for the link Between early adversity and chronic pain. Psychosomatic Medicine (2018); 80:880-890. DOI: 10.1097/PSY.0000000000000640

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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.

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Artificial disc disaster

In 2005, Marsha had an MRI scan done that showed some mild degeneration of the discs in her lower back. These were normal for her age. A surgeon recommended she undergo two artificial discs at L3-4 and L4-5. They did not help her pain; in fact, she got worse. The discs buckled, and a year later they were removed at another hospital on the west coast. During this operation, surgeons went back in through her abdomen to remove these artificial discs. In this operation, the major blood vessels are attached to the discs. It is a very difficult procedure, and during the operation, her major vein, the vena cava, was torn. Her ureter (the tube from the kidneys to the bladder) was also torn. Both were repaired, but she was left with residual swelling of her feet due to the partial disruption of the vena cava. A year later, she had L5-S1 fused for ongoing low back pain. When she saw me, she still had ongoing low back pain, thoracic pain, and neck pain. Two other spine surgeons had recommended that she undergo a two-level fusion in her neck. The MRI of her neck was normal for her age, showing just some mild degeneration.

She desperately wanted to go back to work. Her husband was threatening to leave her. She was on drugs to wean her off narcotics but was having a difficult time. She was extremely motivated to get better, but she was also completely trapped by her pain and lacked a plan to solve her pain problem.

Why Surgery?

None of her surgeries were helpful or necessary. Yet the spine world was offering her only more surgery. I do not know the end of this story. I spent a couple of extra hours with her explaining the DOC protocol in detail. She did not want to engage in any of the concepts and continued to spiral downward, as I learned from a phone call a few weeks later.

It is upsetting to me that she has the three-level fusion in her lower back and residual swelling in her feet. If she had been able to engage in the structured rehab before any surgery, her potential would have allowed her to completely come back to normal. Now, she will have some permanent structural limitations and a high chance of permanently suffering from chronic pain. BTW, if she had chosen to pursue a healing journey, she could still have done well in spite of her multiple surgeries.

Two Years Later

I am writing this about two years after our visit.  I never heard another word from her.  There is a high probability that she went on to another operation.  The mindset that “surgery is the only solution” becomes its own irrational circuit.  I have found out that the longer I try to talk someone like this out of surgery, the less productive it becomes for both of us.  Often, the patient becomes extremely agitated and sometimes will progress rapidly into a rage. You cannot solve irrational anxieties by rational means.

I am a surgeon trying to talk you out of surgery

I am a spine surgeon who was paid extremely well to do surgery. I am not against performing spine surgery but I am strongly against operating on normally aging spines that have been documented to not be a source of pain. So, I’m trying my best to talk you out of surgery that has not only a low chance of helping you but that actually worsen your situation. If that isn’t even the slightest bit persuasive, you need to look very closely at your decision-making process. Right now, trying to break through this barrier is my biggest challenge.

Before you make the final decision to proceed with spine surgery, get to know your surgeon. If he or she doesn’t want to engage in a detailed conversation about it, then you need to look elsewhere. There is no turning back and a failed spine surgery can destroy your life. Also, I wrote a book, Do You Really Need Spine Surgery? that breaks down the decision-making into two factors – the anatomy and the state of your nervous system. The decision will become clear for you. Video: Get it right the first time.

BF

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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.

The post David Hanscom’s Mission and Resources first appeared on Back in Control.

The post David Hanscom’s Mission and Resources appeared first on Back in Control.

• Avoiding danger is what keeps us alive. Humans call this signal anxiety.
• Avoiding this sensation drives much of dysfunctional human behaviour. We know how to stay alive but not necessary thrive.
• Anxiety is a physiological reaction that is about a million times stronger than the conscious brain. It cannot be controlled.
• We can auto-regulate and redirect it. Addressing anxiety at the root physiological cause will solve many mental health problems.

Why is Anxiety Considered a Psychological Diagnosis?

Anxiety is simply a warning signal. Every form of life has a withdrawal/ avoidance response to real or perceived danger. All life forms, from one-celled organisms to humans respond with complex changes to optimize the odds of survival. This unconscious automatic reaction is powerful and has evolved to feel extremely unpleasant in higher life forms. It compels action to lessen the sensations. The species who did not pay attention to these danger signals, simply did not survive.

 Staying alive

When you sense danger, how do you feel – anxious? Although this a basic survival feeling, humans have the capacity to name it. It is the result of stress, threats, and life challenges, not the cause. Avoiding this sensation is the driving force behind much of human behavior, and seeking safety is necessary to store up reserves to fight another day.

What happens in your body that creates this sense of dread? The term is, “threat physiology.”

Threat physiology

Physiology is the term that refers to how your body functions. Your survival reactions are mostly unconscious, and about 40 million bits of information are processed per second. Our conscious brain deals with only about 40 bits per second. Your unconscious brain is a million times stronger than your conscious brain; the responses are hardwired and automatic, and the reason it is not subject to being controlled. However, it can be regulated and reprogrammed.

Examples of physiological actions are heart rate, blood pressure, blinking your eyes, acid-base balance, sweating, breathing, bowel and bladder function, hunger, and the list is almost endless.

These are some of drivers activating threat physiology.

• Stress hormones – adrenaline, noradrenaline, histamines – ready the body for fight and flee
• Cortisol – mobilize fuel (glucose) from tissues throughout your body.
• Glutamate – Neurotransmitters change from calming to excitatory to increase alertness and sensitivity to danger signals.
• Inflammatory cytokines (small molecules that transmit signals between cells) – the many aspects of the immune system kick into action.

Anxiety is a physiological state

This is a small fraction of actually what occurs in fight or flight physiology. Consider how you feel when your body is in this state. Here is a suggested word progression.

• Alert
• Nervous
• Afraid
• Angry
• Paranoid
• Terrorized

They fall under the umbrella of “anxiety” or “fear.” We will do almost anything to avoid this sensation resulting in many bad behaviors. Psychological diagnoses are ALL anxiety driven. The exceptions are in the positive psychology domain.

A paradigm shift

The way we view mental health must change. Here are some suggestions.

• Eliminate the word anxiety from the DSM coding system. It is the driving force and cause of poor mental and physical health.
• Most psychological diagnoses are descriptions of behaviors driven by the sensations created by threat physiology. Descriptions are less pejorative than labels (diagnoses).
• Substitute the word anxiety with the phrase, “activated threat physiology.”
• Anger is “hyperactived threat physiology.”

“Dynamic Healing”

The root cause of our mental health crisis is sustained threat physiology. There are many ways of lowering it and creating “cues of safety.” The model is called “Dynamic Healing” and is at the core of how medicine should be delivered. The portals are:

• The input – you can process your stresses so as to have less impact on your nervous system.
• The nervous system – the resiliency can be increased so it takes more stress to set off the flight or fight response.
• The output – your nervous systems takes in sensory input, summates them, and sends out signals of threat or safety. There are ways to directly dampen the threat response.

None of the approaches are difficult and require few resources. There are many clinicians in all medical fields that understand and are applying these approaches. It is just not happening on a wide enough scale.

There is no question that symptoms and behaviors must also be addressed while people heal. But if the root cause is not dealt with, their suffering will continue. Hence, the nationwide burden and fallout of poor chronic mental health continues to skyrocket.

Let’s do this!!

Our mental health crise reflects a lot of needless suffering as deep science has pointed the way to effective treatments for over 40 years. Most of clinical medicine is not connected to the data or is categorically ignoring it. It is certainly not being widely taught in medical school.

Where will the energy come from to wake us all up? It has to emanate from the public demanding better care because the business of medicine seems to have little interest in true change. It is the responsibility of the medical profession to honor the known data and implement what is already known.

The answers for our mental health crises are right in front of us if we just pay attention. Take your medical care and life back. It is your right.

The post There is an Answer to the Mental Health Crisis first appeared on Back in Control.

The post There is an Answer to the Mental Health Crisis appeared first on Back in Control.

As a surgeon who has spent a lifetime dealing with patients with chronic pain, including me, have come to see that the MUS diagnosis is wholly inaccurate and should be immediately discarded. Every bodily symptom you experience results from an identifiable structural problem or from your body’s physiological response to  your surroundings. Symptoms don’t just happen. The correct diagnosis is MES (Medically Explained Symptoms).

Physiology

Physiology is the term that describes how the body functions. We stay alive because living creatures can maintain an incredibly delicate balance of the body’s acid/ base balance, electrolytes, blood pressure, temperature, heart rate, and the list is long. It is a dynamic process that changes by the second in response to input from your surroundings.

We require safety (rest and relaxation) to regenerate and build up our reserves. When we are under any stress (threat), the body responds with elevated activity in multiple different organ systems to increase the chances of survival. Fuel stores are depleted, and reserves are lowered as energy is shunted to muscles in the event of fast action is required.

Our bodies are intended to be mostly in “neutral” or what is called homeostasis. When you are going about your daily business without noticing how you are feeling, you are in homeostasis. It can be maintained for long periods of time because reserves are being replenished commensurate with your needs.

Any time your body is under any kind of mental or physical threat, your body’s physiology will react in a manner to bring you back into balance. There are three contributors of this scenario 1) your circumstances (input) 2) the state of your nervous system (coping capacity) 3) output (body’s total neurochemical response).

By definition, anytime your senses any level of danger from any source, you are under threat – even if it lasts for just a few seconds. When you are in homeostasis, your body responds so quickly, you won’t notice the changes. However, when the threats begin to overwhelm your nervous system’s coping capacity, you’ll experience unpleasant symptoms.

The threats can be mental or physical and there are almost always multiple physical and mental responses. The physiological manifestations include:

1. Changes in your immune system with increased inflammation.
2. Your body’s metabolism (the rate you burn fuel). You are either storing fuel (anabolic state) or consuming it (catabolic state).
3. Nervous system activity – you are designed to become more sensitized and alert when there is potential danger.

These are broad categories of the effects of threat. But, since there are so many organ systems required to keep you alive, numerous physical and mental symptoms are created. Every symptom that is not from an obvious anatomical problem is a result of this interaction of your body responding to sensory input from your surroundings that is interpreted as potentially dangerous. How else could you stay alive?

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. (2). They are more problematic in that humans have consciousness and 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.

Physiologically explained symptoms

Unpleasant sensory input progressively impacts your body at three levels.

• Response
• Symptoms
• Illness/ Disease

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 directing you in a manner, so you don’t feel unpleasant sensations. 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 an aggressive dog.

When threats are more prolonged, you will begin to suffer 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 symptoms that can occur. (3)

But when threats are sustained, you have a significant chance of becoming seriously ill or developing a disease. It is well-documented that stress kills people and unfortunately the symptoms of a chronic illness also add to the threat load. This is particularly true in chronic pain. (4)

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 bacterial or other invasion), 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.

The consequences

This is a list of some of the symptoms and illnesses that are connected with your body’s physiology being in a prolonged heightened state:

Symptoms

• Irritable Bowel syndrome
• Irritable Bladder syndrome (interstitial nephritis)
• Migratory skin rashes
• Tinnitus
• Burning sensations
• Migraine headaches
• Pelvic, neck, thoracic, and low back pain
• Insomnia
• Tendonitis

Illness

• Anxiety
  • Depression
  • OCD
  • Bipolar
  • Schizophrenia
• PTSD
• Fibromyalgia
• Chronic fatigue

Disease

• Autoimmune diseases
  • Colitis/ Crohn’s disease
  • Ankylosing spondylitis
  • Rheumatoid arthritis
  • Multiple Sclerosis
• Cancer
• Coronary artery disease
• Alzheimer’s disease/ Dementia
• Early death
• Suicide
• Addictions
• Parkinson’s disease
• Obesity
• Liver disease
• Osteoporosis

There is a wide range of “Medically Unexplained Symptoms/ Illnesses/ Diseases” that are created by your body’s  survival response. Dr. Stephen Porges has eloquently explained how the autonomic nervous system through the vagus nerve, modulates these various physiological states. (5)

Why is MUS such a deadly diagnosis?

The worst aspect of the diagnosis of MUS is that it creates despair; it takes away hope. Research has shown that hope, optimism, and a sense of purpose are anti-inflammatory and allow your body to regenerate. (6)  So, the diagnosis itself is inflammatory and adds to threat. Do not accept it at any level. The correct diagnosis is MES.

Any major reason MUS is so damaging is that many physicians assume it is untreatable, there is nothing more that can be done, and refer you to a psychologist for any number of reasons that most of you are familiar with. “It is in your head.” You don’t have much of a pain tolerance.” “You are just looking for drugs.” You have “secondary gain issues and don’t really want to work.” The labels keep piling on and none of them are helpful to your healing and they are just wrong. But MUS has a certain finality to it, and it is crushing. It is tragic because physicians have not been taught the link between mental/ physical threats to the physiological changes that cause physical symptoms. I feel the ultimate tragedy is that with the correct understanding, MES is one of the most treatable diagnoses with minimal costs and risks.

Beware of IES (Incorrectly Explained Symptoms)

When there is an obvious anatomical abnormality and the symptoms exactly match the lesion, that would be considered a structural identifiable source of pain. An example would be a painful inflamed tooth. It is a straightforward process to diagnose it by testing with hot and cold or pressure. A root canal or pulling the tool will quickly solve the problem.

But this discussion is complicated by the fact that there is an emphasis in modern medicine to explain reasons for pain from a structural problem when the anatomical abnormality is not actually the cause of it. Many symptoms are attributed to normally aging anatomy and the cause and effect are not supported by medical research.

For example, pain is commonly attributed to scoliosis and there has never been a research paper documenting that it even contributes to back pain unless the deformity is severe and unbalanced (your head is not directly center over your pelvis).

Degenerative disc disease, bone spurs, arthritis, ruptured discs, bulging disc, and spinal arthritis have all been documented in multiple research papers that none of these “diagnoses” are the cause of chronic neck or back pain. (7)

There is marked debate about small tears of the structures around the hip and shoulder. Even severe hip, knee, and shoulder bone-on-bone arthritis has little correlation with pain. There is actually more of a relationsip to stress. (8)

How can you figure this out?

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.

There are many ways to accomplish this. The DOC Journey is one platform that presents proven medical treatments in a way that allows you learn and implement these strategies. All three aspects chronic illness must be addressed.

Output (stimulation of the body’s anti-inflammatory response)

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

State of the nervous system (decreasing sensitivity and stimulating neuroplastic changes in your brain)

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

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

What really does not work is just “coping”, which is what most of us have been taught to do. It requires specific approaches and tools to effectively create the desired changes. Regardless of what approach you use, the key is to learn how to utilize these tools to consistently process threat in way to keep you in homeostasis or a state of safety.

Finally, you must commit to taking charge of your own body and health. The first step is understanding the nature of chronic disease. The solutions lie in implementing strategies we already know are good for our health–healthy diet, sleep, regular exercise, taking time for yourself, process addictive behaviors, and nurturing close relationships. The common theme with all of these interventions is that they lower inflammation. Ongoing inflammation directly destroys tissues throughout your body.  It sounds daunting but it is more doable than you think. Not taking control may have more severe consequences than you can imagine.

Chronic pain is one of the MUS diagnoses. It is one that is particularly untrue. By understanding the nature of chronic mental/physical pain and the principles behind the solutions, it is a Medically Explained Symptom (MES) and a consistently solvable problem.

MUS must go!

References:

1. Edwards T M, Stern A, Clarke DD, Ivbijaro G, & Kasney LM. (2010). The treatment of patients with medically unexplained symptoms in primary care: A review of the literature. Mental Health and Family Medicine, 7, 209–221.
2. Eisenberger NI, et al. An experimental study of shared sensitivity to physical pain and social rejection. Pain (2006);126:132-138.
3. Schubiner H and M Betzold. Unlearn Your Pain, 3^rdMind Body Publishing, Pleasant Ridge, MI, 2016.
4. 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
5. Porges Stephen. The Pocket Guide to the Polyvagal Theory: The Transformative Power of Feeling Safe. Norton and Co, New York, NY, 2017.
6. Dantzer R, et al. Resilience and Immunity. Brain Behav Immun (2018);74:28-42. Doi.10.1016.j.bbi2018.08.010
7. Jarvik JG, et al. Three-Year Incidence of Low Back in an Initially Asymptomatic Cohort. Spine (2005); 30:1541-1548.
8. Wise BL, et al. Psychological factors, and their relation to osteoarthritis pain. Osteoarthritis and Cartilage (2010);18:883-887.

The post The Myth of MUS (Medically Unexplained Symptoms) – It’s MES first appeared on Back in Control.

The post The Myth of MUS (Medically Unexplained Symptoms) – It’s MES appeared first on Back in Control.

• There are many different physical and mental symptoms that are possible when you are in sustained flight or fight physiology.
• At my lowest point, I was experiencing 17 of them. No one could tell me what was happening despite seeing many physicians. I suffered for over 15 years.
• The mental pain was the worst part of my ordeal.
• One reason this process has been effective for so many people was that I learned many important details from my own harsh experience.
• My symptoms resolved and I am grateful I can pass along the healing principles.

I was driving across a bridge late one night, when my heart began to suddenly pound at a furious pace. I couldn’t breathe. I was sweaty, light-headed, and I thought I was dying from a heart attack. I was only 37 years old. This was the first of many panic attacks I would have over the next two years. In one minute, I went from being a fearless spine surgeon to experiencing relentless, progressive anxiety. I wouldn’t emerge from this slow spiral into hell for 13 years. What happened and why so suddenly?

The beginning

My first migraine happened on the 4^th of July. I was five and excited because the local fireworks were being set off in the town commons, directly across the street from our house. But as the sun set, my head began to throb and by 10 o’clock I felt like I was being hit with a sledgehammer. The fireworks less than 100 yards away weren’t helpful.

This was the first of 17 symptoms of a stressed nervous system I developed over the next 50 years. My suffering included tinnitus, burning feet, prolonged tendonitis, insomnia, anxiety, Obsessive Compulsive Disorder (OCD), major depression, migratory skin rashes, crushing chest pain, sweats, PTSD, back and neck pain, heart palpitations, light-headedness, and tension headaches. At my lowest point, I was experiencing all of them simultaneously.

The “perfect” family

My father was a family doctor in a small, New England town. He was highly respected and appreciated. My mother was active in many local activities. I was the oldest of four children, with two brothers and a sister. People would often comment on our  “beautiful family.” We were – from the outside.

Inside our house, my mother was in an intense rage most of the time. She was physically and verbally abusive to me and my three younger siblings. My father wasn’t around much, and he didn’t comprehend the full extent of the situation.Since this was all, we knew, we thought this was what life was supposed to be like.

Interestingly, one of the few things that would cut her anger short was one of my migraines. She would instantly become a loving and nurturing mother, placing cold compresses on my forehead, and keeping everyone quiet.

My new identity

When I entered high school, I felt a deep shift. I was increasingly aware that my family life was not ideal, and I decided that I had had enough. I “shut the door” on my past

Although I still lived at home, I mentally separated from the chaos. I embarked on a quest to create a new identity. I became an excellent student, trumpet player, hard worker, leader, and athlete. During my junior year in college, I took 18 to 21 hours of credit every quarter, worked construction 10-20 hours a week, played sports, had an active social life, ran for student body president, and pulled off a 4.0 GPA. I was having the time of my life. I wasn’t sleeping much.

I continued to graduate from medical school with honors and was accepted in a competitive orthopedic residency in Hawaii. With a great wife, a home in Hawaii, and a promising career, I thought I had it made. I was unaware that I was keeping busy to outrun my past and I had also become a master at suppressing unpleasant emotions.

I completed two years of internal medicine residency before I entered surgical training in Hawaii. Most orthopedic residents undergo a couple of years of general surgery residency before specializing and are comfortable in the operating room. I had never made a skin incision or even knew how to tie a knot. However, handling stress was such a core part my existence, I did not feel it. I was wrapped up in my identity of being “cool under pressure.”

I noticed that my feet burned while I was jogging, which I thought was due to the warm, Hawaiian pavement. My migraines were more frequent, and I had a reoccurrence of warts over both of my hands. One afternoon, while in a weekly orthopedic conference, I noticed some vivid, intrusive thoughts entering my mind. I didn’t think too much about it, but I felt a bit unsettled. Still, I was on top of the world, enjoying my family, learning, and living in a paradise.

Stress

The wheels started to come off when during my post-residency spine fellowship at one of the top programs in the world. It was not as physically demanding as the rest of my residency, but the expectations were extremely high. My migraines were occurring every other week, my ears started to ring, while my feet continued to burn. I pushed through it all.

My “iron man identity” continued to evolve. It seemed that I could handle an unlimited amount of stress. It was my badge of honor. The obstacles I encountered in private practice dwarfed any prior challenges in my training. I recall sitting at my desk one night after working yet another 14-hour day. A patient had developed a serious postoperative wound infection. Another one had gotten into a fight with a security guard. I discovered I wasn’t getting a paycheck that month because of the high office overhead. My mindset was, “ Bring it on.”

A few weeks later, I crashed with the panic attack.

It was only the beginning

Little did I know how severe these symptoms would become and how many more would occur. Skin rashes popped up and disappeared all over my body, my scalp itched, my nightmares became more intense, I had deep aching pains in my upper back, and intermittent crushing chest pain.

There were other terrible aspects of my ordeal. I am a social person and since I didn’t feel great, I quit spending as much time with my friends. The loneliness was crushing. No marriage could have survived all these untreated symptoms because I was often not in a great mood. I worked at hiding it from almost everyone.

As my family disintegrated, I descended into a full-blown obsessive-compulsive disorder (OCD). I had the internal version, which is experiencing vivid intrusive thoughts, that I would then try to counter with “good” thoughts. I was in an endless, unwinnable battle and my thoughts progressed to disturbing impulses. Along with my many other symptoms, I was in bad shape. I then made the mistake of reviewing some articles on OCD and discovered that the prognosis was (and still is) poor. The best outcome would be to somehow manage or diminish the symptoms with medications or behavioral therapy. I became totally despondent. There was no escape and I sunk into a major suicidal depression. Still, no one could explain to me what was going on or how to solve it

Penetrating the facade

I now understand that major life changes, especially around family dynamics, create more stress and symptoms. The stresses can be positive or negative. The problem with major family events is that they penetrate the façade, and I had been working on mine for decades. A major shift in my symptoms occurred with the birth of my son. My divorce was disastrous. The burning in my feet increased to the point where they felt like they were in a toaster oven. The ringing in my ears was intolerable, I couldn’t sleep, all my other symptoms worsened, and the unrelenting anxiety was the worst part of my ordeal.

I pursued many self-help books, took medications, saw other physicians, underwent multiple diagnostic tests, and aggressively pursued psychotherapy and counseling. I was both open to anything and desperate.

I would’ve thought that meeting my current wife would have been the answer to my suffering. We had an instant connection and I fell in love – except it felt like I was falling off a cliff. I lost more control. When I mustered up the courage to tell her that I was in love with her, she thought I was going to tell her that I had terminal cancer. My suffering dramatically worsened, and I was beginning to seriously give up. No avenue of treatment was working. I had no hope.Slowly, things changed. I escaped the grip of chronic pain in 2003 and continued to gain a deeper understanding of the problem, as well as the principles behind the solutions.

Recap

One reason that the concepts presented in Back in Control  have been helpful for so many people is that they evolved from my prolonged suffering. Almost everything I tried failed, and when I experienced the faintest glimpse of a way out, I kept building on it, step-by-step. Not only I am I doing well, but I am thriving. It is my  privilege to share these strategies with you and be a witness to your healing journey.

Chronic pain has multiple manifestations. Each person has a different experience and must find their own way out. But contrary to common perception, chronic pain is a solvable problem. I am one of the success stories.

The post My Descent Into The Abyss first appeared on Back in Control.

The post My Descent Into The Abyss appeared first on Back in Control.

Objectives

• Providing yourself with cues of safety is essential to healing. However, your body instinctively gravitates towards being aware of threats.
• Even when life is good, your brain is constantly scanning your surroundings (including your consciousness) for danger. It is your “personal brain scanner.”
• As disruptive as anxiety is, it is your protector and gift of life. You are not going to get rid of it or transform it into a pleasant sensation.
• Efficiently dealing with it daily allows you to nurture joy and live the life you wish.

Abraham Maslow was a prominent psychiatrist who looked at the human condition in terms of the hierarchy of needs.¹ At the base of it were basic physiological needs such as food, air, clothes, water, heat , sleep, sexual intercourse, light, hygiene, shelter, urination, and excretion. Without these basics being met, it is unlikely we can or will pursue the higher levels of needs with the top being self-actualization.

What he didn’t mention was that “not being in pain – mental or physical” is not only a foundational need but it is a driving force for most human behavior. People will do almost anything not to feel anxious and vulnerable. It is bi-directional in that lack of the above-mentioned resources will clearly create anxiety and meeting those needs will help lower it. I again want to acknowledge the depth of suffering that occurs in this scenario, and it is almost impossible to pursue a healing journey under severe adversity.

Stress = threat

However, if these needs are being met, then stress (threat) is not the problem. It is the reaction to it that creates so much chaos within you. Avoiding stress doesn’t work and becomes its own stressor. Remember the most impactful stresses are the ones you cannot control. So, that is why learning how to lower your threat physiology through the different portals is so critical.

The metaphor of a bathroom is relevant because you cannot get rid of anxiety and survive. It is part of everyday life. It is important to develop a “working relationship” with it and let it do its work. So, it is a matter of processing life every day, dealing with the waste, and visiting this room as many times as you need to. If your stress reactions build up without an outlet, you will eventually become ill.²

As you learn to develop this relationship with these emotions as opposed to fighting them, you’ll become more skilled in processing them, and your reactions will become fewer and less intense. There are three aspects of lowering this neurochemical inflammatory reaction.

• Separate your identity from this response. It is what you possess, not who you are! It is also universal and there is no reason to take anxiety personally.
• You can directly lower these hormones and inflammatory markers with tools such as humming, breath work, nasal breathing, and calming sounds.
• By stimulating neuroplastic changes in your nervous system, your automatic reactions are less disruptive, and the real healing comes from the creation of new circuits that are pleasurable and creative. There are infinite possibilities and the metaphor of building your new home is a foundational framework.

Emotional flexibility

One solution to dealing with anxiety is control. It is what this sensation is intended to do – be so unpleasant so as to compel you to solve threats – and it works. You are alive and reading this lesson. However, since mental and physical threats are processed in a similar manner, and humans can’t escape their consciousness, we are all trapped by our thoughts to a greater or lesser degree.³ Most of us instinctively fight disruptive thoughts and feelings, but this only reinforces them.

The other strategy, which is actually fairly effective is mental and emotional rigidity. If you train your mind to focus and become immersed in any number of belief systems, your mind is occupied, and unpleasant thoughts are largely “pushed aside.” The beliefs can take any number of different forms such as religion, politics, strong opinions about morality and people who are different than you. What is problematic is that humans are programmed by their own lives and infinitely unique. None of us see anything exactly the same way – even solid objects. Rigid thinking works quite well for decreasing anxiety for the person, but not for those around him or her. You have lost awareness of the needs of others and pigeon-holed them into your way of thinking.

One definitive solution for anxiety is giving up the need for control. In other words, you must learn that anxiety protects you, and is the gift of life. It is also why you have to separate your personal identity from this reaction and develop a “working relationship” with it. It is never going to be a pleasant sensation, but as you become more “emotionally flexible” you’ll learn to tolerate, even become comfortable with it. It needs to be processed daily, all day long.

Emotional perfectionism is a problem. You monitor your progress, feel like you have” failed” if you dive back into being anxious or angry, and your self-critical voices start talking to you. You are now a victim of these thoughts (and you really are), and you are not going to outrun them. Even if you can for a while, they are relentless and will wear you down.

Recap

Anxiety is a physiological state. Glance though the lessons in Leg 3 of this course. It is challenging to deeply change your concepts of anxiety. Most of us are raised to feel that this is a psychological issue and if you are overwhelmed by it, you are not tough enough. “If you can’t take the heat, get out of the kitchen.”

Nothing could be further from the truth. Suppressed anxiety is a disaster, causes damage to the memory center of your brain,⁴ and disrupts every aspect of your life. You are so used to doing it (who taught you otherwise), you may have no idea that this is what you are doing. Being “tough” was at the core of my own descent into The Abyss.

The main focus of The DOC Journey is learning ways to methodically become aware of and process anxiety and anger so you can live a life that reflects who you really are. To have a good life, you have to live a good life. However, this also requires learning how to efficiently separate from and deal with your survival reactions. Being anxious or angry isn’t good or bad. It is life.

 Questions and Considerations

1. Emotional pain hurts. Why would we want to feel that pain? We don’t. However, learning to live with it is essential to healing.
2. Anger effectively covers up feeling vulnerable, which we instinctively dislike. No one EVER wants to give it up, and we can’t. It is another factor in becoming emotionally flexible.
3. It is difficult to understand the necessity of anxiety and anger and also be aware of its impact on you and your life. These emotions preclude awareness and the reason why specific skills are required to break through this catch-22.
4. De-personalize these sensations and develop skills to deal with them. You must let go to move forward.

References

1. Miles Vich. Maslow’s leadership legacy. Journal of Humanistic Psychology (2008); 48: 444–445.
2. Smyth J, et al. Stress and disease: A structural and functional analysis. Social and Personality Psychology Compass (2013); 7:217-227. doi:10.1111/spc.12020
3. Eisenberger NI, et al. An experimental study of shared sensitivity to physical pain and social rejection. Pain (2006); 126:132-138. doi:10.1016/j.pain.2006.06.024.
4. Hulbert JC, et al. Inducing amnesia through systemic suppression. Nature Communications (2015); 7:11003. doi: 10:1038/ncomms11003

The post Processing Anxiety/ Frustration – They are not Going Away first appeared on Back in Control.

The post Processing Anxiety/ Frustration – They are not Going Away appeared first on Back in Control.