A straightforward decision

I rarely make a surgical decision on the first visit, but his situation seemed so straightforward that I decided to make an exception. He also wanted to proceed quickly, as he was frustrated by his limitations. As I walked out the door to grab the pre-operative letter that describes the details of the fusion, he quietly said, “My son just died a few months ago.” I immediately turned around and sat down with him. His son had died from a massive heart attack. I let him know how sorry I was about his loss, and also told him that I was not comfortable with him making such a major decision in light of the situation. He agreed. I gave him the pre-op letter and asked him to return in a couple of weeks. I gave him a copy of my book, Back in Control, which is an excellent resource for dealing with stress, as well as chronic pain. A week later he called and told me that he really wasn’t into reading my book and just wanted to proceed with surgery. I asked him one more time just to glance through the book, as it does help with post-operative pain and rehab; and I signed him up for surgery.

The pre-op appointment

He came in with his wife for his pre-operative appointment to coordinate the final details around the operation. I wanted be sure that I was on the same page regarding the severity of the pain and his understanding of the procedure. He said, “I am feeling better. I have read some  of your book and think that maybe I should work through some of the issues around my son’s death.” We had a long conversation about the effect this degree of trauma can cause. He asked me if it was OK with me for him to delay his surgery for a while.

I saw him a month later and he had no pain in his back or down his leg. He was fully active and had just re-joined the gym. I asked him what seemed to be the most helpful strategy in resolving his pain. He had continued to read the book. However, I am well-aware that reading my book, or any book, is not going to take away pain. It requires some level of engagement. For him, it was awareness. Just understanding the links between anxiety, anger, trauma, and pain helped him make sense of the different emotions he was trying to process. He was also now talking to his friends about his loss, who were offering a lot of support. His whole demeanor had changed and he was now more concerned about how the situation was affecting his wife.

How do I decide who needs surgery?

It is becoming increasingly unclear to me what severity of pathology requires surgery to solve a given problem. His constriction around his 5^th lumbar nerve root was severe and he had a classic history that matched. Had I done the surgery, his leg pain would have resolved; but not his emotional pain. He now is moving forward, as his emotional pain is being addressed. His back and leg pain are gone. He did not have to undergo the trauma and risks of surgery. He will return to being a productive person and provide emotional support for his wife. Although, not the main reason, there was essentially no cost involved.

“I know when a patient is at risk for a poor outcome”

I have witnessed many stories that are similar to George’s; and I am more diligent in making sure that there not major life stresses occurring while making a final decision regarding surgery. There doesn’t need to be one specific event. More commonly people hit their breaking point from cumulative stress, and they don’t see a way out. Physicians almost uniformly feel that they can detect emotional distress in their patients. As I have been doing spine surgery for so many years, I feel like I am really able to detect patients with anxiety and depression in my clinic. However, research shows that physicians are correct in this regards only 25-43% of the time. It does not matter whether the doctor is a junior resident or senior staff physician. George’s story again reminded me that I cannot figure any of this out either. There is too much going on in the middle of a busy clinic – especially on an initial visit. (1)

Physical versus mental pain

The areas of the brain that interpret physical and emotional distress are located in close proximity to each other. (2) It also seems that there are abnormalities of a given person’s body that are not quite severe enough to cause pain. But when the pain threshold is lowered, in the presence of adversity, these specific areas can become symptomatic. As one of my workout buddies points out, “It is the weak area that lights up.” Prior pain circuits can also be activated.

There are hundreds of research papers documenting the link between anxiety and depression with pain, and poor outcomes with treatment. For many reasons, these factors are not being routinely addressed. The culture of medicine is geared towards performing procedures, and not on talking to you about other options or providing the necessary resources. It is critical that you have done everything possible to calm down your nervous system before you undergo a surgical procedure. In this medical environment, you will have to take on that responsibility.

1. Daubs, M, et al. Clinical impression versus standardized questionnaire: The spinal surgeon’s abilityto assess psychological distress. JBJS (2010); 92; 2878-2883.
2. Hashmi, JA et al. “Shape shifting pain: chronification of back pain shifts brain representation from nociceptive to emotional circuits.” Brain(2013); 136: 2751 – 2768.

The post “My Son Just Died” first appeared on Back in Control.

The post “My Son Just Died” appeared first on Back in Control.

• Many people are focused on controlling anger and anxiety with behavioural approaches.
• These powerful reactions are not controllable and suppressing them increases threat physiology.
• We all need to be heard, supported, and taught methods to regulate and lower these responses.
• Avoiding or suppressing stress causes damage to our bodies and causes chronic illnesses.

How many of us have heard the phrase, “children should be seen and not heard?” Or what about, “spare the rod and spoil the child.” How often were your parents not really there for you when you were upset?

DimaBerlin/ AdobeStock

Kari is a woman who I met in 2018 when she asked me to speak at her company’s annual disability conference. I presented the nature of chronic pain and approaches to solve it. I did not realize that she jumped right in with both feet and learned the concepts. She contacted me about a year later, and shared how excited she was about how much her life had improved. We have remained in close touch and here is her recent email. I had told her about a remarkable turnaround of a 24-year-old gentleman who had broken out of his bipolar disorder, anxiety, major depression, and pain migrating around his entire body.

Her letter

Hi David, is this the young man with Bipolar you mentioned during our call?  What an incredible transformation! 

You know what hit me the other night, few children are taught how to process anxiety so they do the best they can on their own and usually create inaccurate perceptions of themselves and learn ineffective and often damaging behaviors to deal with it (the 7-year-old creates the 50-year-old).  Parents should be doing this, but many parents are trapped in their own heads with repetitive negative thoughts and don’t know how to teach their children these skills as they haven’t learned them either.  And the cycle of dysfunction continues….

A little personal story here….My aunt gave me my grandmother’s book of prayers.  My grandma was an extremely anxious woman and pretty OCD.  I was thumbing through her book and noticed my grandma had written in the margins, underlined certain passages, etc.  In the section on anxiety, she had underlined several times that “anxiety is a sin.”  My poor Grandmother thought she was a sinner her entire life because she was anxious!  How awful!

My mother was also very anxious – no surprise there.  In 6^th grade, I had a boyfriend, nothing very serious at that age of course, but I went to school one day and here my best friend was now with my boyfriend.  I came home and was crying in my bedroom, mostly because my best friend had stabbed me in the back over a boy.  My mom came in and asked me what was wrong and when I told her, her response was, “get a real problem”. 

My mom was very stressed at the time with my two younger siblings and my dad always being at the bar – he was no help.  From that moment on, I never told her anything about my life that wasn’t positive and became very depressed all through junior high and high school. Not having a parent to support me emotionally really messed me up and caused me to create all these negative perceptions about myself that took me 40 years to get over.

I am grateful that I have broken the cycle of dysfunction with my son – we talk openly about these things, and he is a very high functioning and happy person. 

It’s all just so insane and sad.  Anyways, thanks for letting me share.  It was the sequence of concepts you presented that broke the cycle for me. Kari

Anger and love

Anger is a trait that blocks openness and engagement. One aspect of flight or fight physiology is that your necortex (thinking areas) are down regulated from stress hormones, the limbic system (fear) regions are activated, and you don’t even have good access to your rational thinking. Frustrated people are not rational, and there are no exceptions. Even more disturbing is that you can become crosswired and pain can be connected to “love”.

Our friend Sheila was standing in the checkout line at a grocery store when she heard a young mother screaming at her young five year-old daughter to put something back on the shelf. She suddenly hauled off and slapped her with a full swing. Almost at the same time the young girl began to cry, she held out her arms and ran to her mother to comfort her. Who else was there to console her? Talk about becoming cross-wired – the girl’s source of pain was also her bastion of love and protection.

My childhood experience with “love”

My mother would fly into rages that would last for two or three days. We never knew what would set them off, although we imagined many possibilities. We thought it was associated with our behavior, but no matter how hard we tried to avoid upsetting her, it just happened. After every tirade she would profusely apologize, and tell us how much she loved us. It was quite confusing. What even seems more bizarre in retrospect was that I was convinced that our parents loved us. I recall telling friends of mine in middle school that although my parents had some faults, at least I knew they loved us? Really??

The answer really is yes. My mother spent hours driving us around, volunteering at school, and talked about us in glowing terms to anyone that would listen. What I did not know as a young child is how disconnected anger (she also had chronic pain) can make you. She essentially entered a different reality when she became upset. From our perspective this was all a part of parental support and love.

It was so mixed up in my head that I did not even realize that anger was part of my life until I was almost 50 years old. It was just normal for me to become “frustrated” and since I was “right”, I did not have a clue that this was what anger looked like. I don’t think those close to me felt the same way. But at the same time, I was experiencing over 17 different physical and mental symptoms. I was disconnected.

What is your concept of love?

When you are an infant or child your mind is a blank slate being downloaded from your environment. If your symbols of love and protection are combined with mental or physical neglect or abuse, your concept of love will be much different than someone who was raised in a warm, caring, nurturing, and loving environment. In retrospect it is disturbing to me that I was so verbal about how much my mother loved me in the midst of a violent environment.

Sviatoslav Kovtun/AdobeStock

We all need to be seen AND heard

The common theme of these three situations is that a child was anxious and upset. The interventions took the form of suppressing and attempting to extinguish these behaviors, which were caused by a powerful unpleasant survival reaction. Many of us are taught from an early age that, “it is better to look good than feel good.” The root problem causing the reaction is often not addressed. You don’t feel heard, and you quickly learn that suppressing your feelings is better than having to deal with them. Except, what you don’t realize is that suppressing thoughts and emotions is like turning the heat up on a pressure cooker. The consequences are usually severe. The hippocampus of your brain (memory center) both shrinks and malfunctions.

The solution lies in the saying, “you have to feel to heal.” And then using strategies to regulate your flight or fight state to safety physiology. By dampening the driving force, not only will behaviors improve, but you can also live life in awareness and freedom.

References

1. Hulbert JC, et al. Inducing amnesia through systemic suppression. Nature Communications (2015); published 3.15.2016. 7:11003 | DOI: 10.1038/ncomms11003

The post Threat Physiology Can’t be Controlled with Behavioral Approaches first appeared on Back in Control.

The post Threat Physiology Can’t be Controlled with Behavioral Approaches appeared first on Back in Control.

• 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.

• Mental and physical pain are processed in similar regions of the brain.
• Our inability to escape from RUT’s relentlessly drives flight or fight physiology, and people may become ill.
• There is a healing sequence to solve them – separation of identity, thought diversion, lowering anger, moving into creativity, and dissolving your ego.
• It is a dynamic process with all of these happening daily. Eventually, as it becomes automatic, and you are free to live your life.

Obsessive Compulsive Disorder (OCD) is manifested by extreme anxiety that is driven by Repetitive Unpleasant Thoughts (RUT’s). Most people associate it disruptive compulsive behaviors such as hand washing, climbing up and down stairs, following a rigid daily regime, and the list is endless. However, there is also a form of OCD called, “internal OCD” where a person has an unpleasant thought and “counteracts” it with a pleasant thought. Either form has no endpoint and is considered a diagnosis to be managed and not solved. That is simply not true.

RUT’s are universal

Essentially every human being has some level of RUT’s. At what point do they become severe enough to be considered OCD? Why not discard the diagnosis and consider the process on a spectrum of human consciousness. The classic definition of OCD is when the thoughts/behaviors interfere with your capacity to carry out activities necessary to live a functional life.

What about enjoying your life? With internal OCD, there are no outward manifestations, but your quality of life might range from unremarkable to miserable. There also many “acceptable” behaviors such as working hard, overexercising, “passionate pursuit” of a hobby or vocation. All of these can be just fine, but what is driving them?

As I have talked to patients carefully over the 40 years, I gradually learned that mental pain is a much bigger problem than physical pain. I would ask patients that if could get rid of their physical pain with surgery and they would still have their ongoing anxiety versus resolving their anxiety and living with the pain, the majority of people wanted to get rid of the mental pain.

Related behaviors

There are also come cousins of OCD. Consider them in the context of behaviors to cope with the unpleasant sensations created by anxiety (threat physiology). They include:

• Hair pulling
• Nail biting
• Eating disorders
• Excessive attention to physical appearance
• Hoarder’s syndrome
• Skin picking
• Cutting
• Extreme convictions regarding religion, politics, or any social issue
  • Imposing these “ideals” on others is the next step because control lowers inflammation. The more power the more control.

Any addiction is an attempt to mask anxiety.

Avoiding anxiety (threat physiology) drives most human behavior

Avoiding anxiety is the driving force keeping all living creatures alive. It is the result of stresses and challenges, not the cause. Amongst the many stressors in our lives, the inability to escape from our thoughts is a major one, maybe the worst. Although we cannot control our thoughts, many activities create sense of control. Suppressing RUT’s just makes them-worse.

“Worrying” seems normal to many people. But is not particularly enjoyable. Why do we spend so much time worrying about so many things, many of which we have no control over? One reason is that it provides a feeling of control. Somehow, worrying enough will help solve the problem. What it does is that it keeps your brain and body fired up and you have less energy to effectively deal with challenges.

Or maybe you have an “anxiety disorder.” Everyone has anxiety, so why would we call it a disorder and why would you personalize these intentionally unpleasant sensations that evolved to keep you alive. It is what you have, not who you are.

What about those who don’t have any of these behaviors. Even many well-adjusted people living normal enjoyable lives can experience a level of RUT’s that interfere with their quality of life. Actually, when life is relatively calm, these repetitive thought patterns can significantly increase. Then as one pursues pleasurable activities to distract themselves, it doesn’t work and is actually highly inflammatory. The data shows that a hedonistic lifestyle creates aggressive inflammatory cells called “warrior monocytes.” In addition to attacking viruses and bacteria, they also go after your own tissues. The other factors that stimulate their formation is social isolation and CHRONIC stress.¹ Your body knows how to effectively deal with acute stress, but it needs a break to rest and regenerate.

Degrees of OCD

Obsessive thought patterns are inherent in human cognitive consciousness. There are degrees of intensity, and they vary day-to-day depending on the level of your stressors and the state of your nervous system – calm or hyperactive. Again, even if your life is relatively calm, they can also be problematic.

OCD, the extreme manifestation of this situation is considered a diagnosis to be managed and can’t be solved. However, medicine has not consistently addressed the body’s physiology. When you are in a flight-or-fight state, your brain also becomes inflamed and these thoughts will fly out like clay pigeons at a shooting range, except there are trillions of them. The medical profession has also not acknowledged the seriousness of the effects of less intense RUT’s on people’s sense of well-being and health. They still drive threat physiology. They are often referred to as a “monkey mind” or he/ she is just having a nervous breakdown. These thinking patterns are a problem and our inability to escape them is even more problematic.

Solution principles

There are four aspects of solving RUT’s and each of them will be discussed in detail in future posts. They all happen simultaneously and indefinitely. Eventually, as your brain evolves away from them, you no longer have to “work at dealing with them. They are:

• Diverting, not controlling, them – mindfulness, expressive writing, cognitive behavioral therapy (CBT)
• “Turning down the heat” – when you are trapped by anything, your threat state fires up even more, and you are angry. Anxiety is activated and anger is hyper-activated threat physiology.
• Nurturing creativity and joy. This is where the real healing occurs as you move away from these spinning circuits.
• Dissolution of your ego – we work hard to attain enough self-esteem to feel better about ourselves. However, most of it is based on cognitive distortions that drive RUT’s even more. Without an ego to defend, these racing thoughts will abate – often dramatically.

This set of approaches evolved from my own 15-year ordeal with severe “internal OCD.” Not only do I not experience these vivid, almost visual thoughts, I don’t seem to have the random distracting thoughts I had before I became ill. There is also a vast amount of research looking at the mechanisms of why and how they occur, and now there is lot of neuroscience data supporting these ideas. The challenge is to present them in a manner so you can pursue your own healing journey. No one else can do it for you.

As your brain heals, your body heals. As your body heals, your brain will heal. The reality is that they are just part of one unit – you.

Recap

Our inability to escape our unpleasant thoughts is inflammatory. Since half of your brain has inflammatory receptors, it also fires up. The diagnosis of OCD is considered to be relatively uncommon, except many people suffer from RUT’s that interfere with the quality of their life. Obsessive thought patterns are considered to be unsolvable and just managed. However, medicine is not generally addressing the physiology. There are four aspects of dealing with OCD that will lower the intensity of these thoughts:thought diversion, lowering anger, moving into the creative part of your brain, and allowing your ego to dissolve. They are solvable.

 Questions and considerations

1. What percentage of your waking hours are you occupied with racing thoughts?
2. Do you find yourself avoiding thinking about certain things? Do you notice how often they keep popping up?
3. Are you aware how common they are and how many people are bothered by them?
4. The medical world doesn’t consider OCD a problem that can be solved and the lesser issue of RUT’s is not often addressed. By using all of the approaches presented, they are not only solvable, but you can move into a wonderful life
5. RUT’s are a function of the mechanics of the mind. Talk therapy alone is ineffective and it can be likened to having a conversation with the engine of your car.
6. It is important to understand that these “stories” and thoughts become embedded in our brains as concretely as any physical object. The problem is that since this is your frame of reference, how can you really see the problem? They become normalized.

 References

1. Cole SW, et al. Social regulation of gene expression in human leukocytes. Genome Biology (2007); 8:R189. doi:10.1186/gb-2007-8-9-r189

The post Four Aspects of Solving RUT’s first appeared on Back in Control.

The post Four Aspects of Solving RUT’s appeared first on Back in Control.

• All of us are “wronged” every day and often multiple times. The wrongs may be real or perceived.
• Your choice centers around how you want to process them.
• Do you hold on to it them or let go and move on?
• You always have this choice. One problem is that the more legitimate your anger, the harder it is to let it go.
• Recognizing the nature of a “grievance story” is the first step.

I have held three and five-day workshops at the Omega Institute in Rhinebeck, NY with Dr. Fred Luskin, a Stanford psychologist and author of Forgive for Good,¹ my wife, Babs Yohai, a professional tap dancer, and my stepdaughter, Jasmine, who is an expressive arts practitioner. The tightly-structured seminar is based on awareness, hope, forgiveness, and play. Most people experienced major shifts in their pain and mood during the week and continue to improve following their attendance.

There were three ground rules: 1) you could not complain about your pain or let the other participants know where you were hurting 2) medical care could not be discussed 3) no complaining – period. Most participants were initially thrown off by not being able to discuss their pain, but quickly realized how important it was in contributing to his or her healing. What I had not realized prior to conducting these workshops is how much people complain – not only about their pain, but also about life in general. How can you enjoy your life when you are continually upset?

Your Grievance Story

One of the first concepts that Dr. Luskin presents in his book, Forgive for Good,¹ is that if you tell the same story of woe more than three times to others where you are the victim, you have a “grievance story.” He points out that this person or situation is “renting too much space in your mind.”

Directing your attention

Your nervous system will rewire and mature in whatever direction you place your attention. How much time do you spend thinking (obsessing) about your pain? How aware are you of other’s needs? What percent of your conversations are spent discussing some aspect of your suffering? Do you really enjoy discussing your pain? Don’t you become tired of it? Are you driving friends and family away?

BTW, talking to your dog or cat is OK. It is a variation of expressive writing, and they listen.

Recognizing your grievance stories

Grievance stories are common and every day, life does not go exactly as you planned. It becomes easy to look at “patterns” and feel that this person always does this to you, or your employment situation is adverse. The home is also a great source of grievance stories. Dr. Luskin defines a grievance story as being you telling the same story of being wronged to three different people. It is a simple yet sobering definition because we are upset, it feels good to vent and feel supported. Maybe once is fine, but how long do you want to remain a victim of circumstances? The only person who will continue to suffer is you. If you apply this simple concept to your life and conversations, you might be shocked at how many of these stories you have and how often you share them.

Bringing grievances home

People commonly bring their complaints about work or the day home. They somehow feel it is important to share and “download” the problems. Even if you are not upset at your family member or others in the house, it brings in an unpleasant energy and upsets your home. Home is a place to rest and regenerate and complaining about the day doesn’t create peace. Through the mirror neurons effect of the brain, you’ll directly fire up similar areas in other peoples’ brains. We all know that just being around someone who is frustrated is not great.

Frequently, the scenarios at work or with your disability situation are not solvable, the grievances may be legitimate (they usually are), and you’ll continue to remain upset and disrupt your family. All parties eventually get worn down. Whatever your issue is, you own it. It is not others’ responsibility to solve it or even make you feel  better. So, what is the end point? It is you. You have a choice of how you relate to your troubles. You don’t have be happy about what is happening, but it is important to stop complaining. Recognizing your grievance stories is the first step. They are not only “renting too much space” in your mind, but they have also moved into your house.

Georgia

One of the most dramatic turnarounds I have witnessed was a patient who came to me to treat her scoliosis. Her curve was about 60 degrees and she was suffering from chronic back pain. There is little evidence linking scoliosis to chronic pain. Since her spine was still balanced, I was not inclined to consider a surgical procedure. It would have involved at least 8 hours of surgery with a complication rate of over 50%. She had been wheelchair-bound for about 10 years and was taking a lot of narcotics. I told her that I would consider surgery only if she engaged in the rehab process as outlined in my book. I asked one of my colleagues to help out with her healing process. Within a couple of months, we realized that she was not taking any responsibility for her condition and was unwilling to put forth any significant effort. We decided to discharge her from our care, as we clearly were not being helpful.

About a year later, she re-appeared on my schedule. I have to confess – I was dreading walking into the room, since I had already given her so many admonitions to engage. I opened the door and she was standing there without any support, was off all of her narcotics, and did not have any pain. She was working out in the gym and getting back to re-engaging with her friends. I was stunned.

Of course, I was more than a little curious about what had happened. She admitted that she had been sitting in her house for years,  obsessing about everything that had gone wrong in her life. Essentially, all of her conversations were focused on her problems that were created by her pain. She had been in a couple of car accidents and had gone through a bitter divorce. She resonated with the forgiveness section of the DOC project, and quit talking about her miseries. She decided to let go and move on. Within six weeks the pain began to abate, and by four months it was gone. And even though I saw her at a later date in the hospital (she had a fall), Georgia was still living the life she had always wanted to live and radiated energy and joy.

Recap – Stop it

Stop discussing your pain, medical care, or even any of your troubles with the world – NOW. There are no shortcuts. You are not going to move forward while hanging on to your grievances. Every day is an opportunity to begin anew. Behavioral patterns are so deep that changing your conversation to enjoyable topics may be difficult. It will initially be challenging, but you will be surprised at the effectiveness of this simple strategy. Can’t do it? Really? It’s time to ask yourself – how badly do you want to heal? It is surprising at the number of people who unconsciously hold onto the power of their suffering.

Questions and considerations

1. Make a list of stories of woe that you often share with others and then focus on three that seem the most important. Then just stop talking about them. Eventually you’ll be less inclined to discuss them.
2. A major aspect of healing is nurturing joy. Consider how often you are doing this compared to the amount of time spent complaining.
3. Ask people who are close to you about how much time you spend sharing your problems and how they feel about it. What are some of the themes? You may not like the answers, but you’ll understand the importance of changing your patterns.
4. Consider how you feel when one of your close friends or family is constantly complaining? How do you think you appear to others when you are in this mode.
5. Are you being the person you would like to hang out with?

References

1. Luskin, Fred. Forgive for Good. Harper Collins, New York, NY, 2002.

The post Grievance Stories first appeared on Back in Control.

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A patient’s story – spine surgery gone bad

I had anterior/posterior surgery on election day 2008. I was taken directly to the furthest room from the nurse’s station with no monitors. My husband came in to visit me and I was not breathing. As he called out…I had an out of body experience watching the doctor enter the room and watched him yelling for nurses. They put me into ICU for 4 days.

A number of things happened including the doctor ignoring me when I told him of things I felt were wrong. When they sent me to rehab, they sent me sitting up in a wheelchair van. PAINFUL. I was an inpatient for three days. The 2nd day home I was sent to ER with MRSA, sepsis and three blood clots. In total, I was in hospitals for 2 months.

The end results were that I couldn’t sit for any length of time without pain forcing me to retire on disability….sex was and still is impossible. Even a slight jolt shoots pain through my back. Cannot motorcycle any longer. Can’t walk on uneven surfaces like beaches. Can’t walk long distances. And am permanently on 2 pain meds to be functional without pain. My whole life changed in many ways as a result of this surgery directly and indirectly. At one point they dropped me…hitting the NG tube and knocking it out. That damaged the interior of my nose, and it has never been the same.

I wish I’d never had it. But because I couldn’t walk for more than 3 days before I was in bed with debilitating pain, I didn’t feel I had a choice. I was fused from L2 to S1 (bottom four levels of the lumbar spine).

My perspective

I am going simply list the issues in this situation.

• This surgery was probably performed for degenerative disc disease and back pain. Disc degeneration is not a disease, is part of the normal aging process, and has been well documented to NOT be a source of pain.¹
• The success rate of a spine fusion (welding vertebrae together with metal and bone) for back pain is < 30%.² There is not one research paper that has ever shown that a lumbar fusion for chronic LBP is effective compared with thoughtfully implemented rehab.
• The data also shows that when you have an operation in the presence of untreated chronic pain, you can induce chronic pain at the surgical site (or make it worse) between 40-60% of the time.³ In other words, there is almost double the chance of making a patient worse than solving the problem.
• There is little attention paid to optimizing the chances of success of an elective spine surgery. One paper showed that only 10% of surgeons addressed the known risk factors for poor outcomes prior to surgery.⁴
  • For example, lack of sleep has been shown to CAUSE chronic low back pain. How many surgeons are attending to just that one detail prior to recommending surgery?⁵
• The more levels of the spine that are fused, the higher the complication rate. This person had four levels fused and was fused both through the front and back of the spine. This is a big operation.
• People will undergo surgery because “everything else has been done.” That is simply not true. By systematically addressing all of the factors that affect the complexity of chronic pain, it is a consistently solvable problem.
• 90% of all chronic mental and physical symptoms in your body are physiological and created by sustained exposure to flight or fight stress chemistry. When your body stays revved up, it will predictably break down. The solution lies in learning ways to regulate your threat physiology to that of safety.
• Many surgical decisions are made quickly on the first visit and sometimes you may not even meet the surgeon. This makes no sense. Chronic pain is complex, you are unique, it impossible to deeply understand a situation in any domain of life on one visit.
• We put all of our patients through a minimum of 12 weeks rehab before any elective surgery, and longer if the variables affecting pain weren’t successfully addressed. The process was called, “prehab.”

Do You Really Need Spine Surgery?

I could write a book on this situation, and I did. It is Do You Really Need Spine Surgery? Take Control with a Surgeon’s Advice.⁶ It breaks down the decision-making around spine surgery into two factors.

• The nature of the anatomy
• The state of the nervous system

You’ll fall into one of four quadrants and the choices are clear. If you have a specific anatomical problem with matching symptoms and your nervous system is calm, surgical outcomes are much more predictable. Every other situation is problematic but still solvable.

I am not just trying to sell a book today. My mission is to do what I can do to slow down the juggernaut of aggressive spine surgery.

I was a surgeon who was called a “salvage surgeon.” I would see patients that had many surgeries over their lifetime, and their lives were destroyed. I was able to help many of them out, but it was more with the rehab than with the additional surgeries. At the same time, I was seeing so many patients break free from the grip chronic mental and physical pain with the concepts presented in The DOC Journey, that I could no longer just sit on the sidelines. There were minimal costs, no risks, and patients would thrive. All of the treatments are based on effective and deeply documented modalities.

Be careful

Please do not jump into any spine surgery without really understanding the issues and maximizing your chances of success. Certainly, do not allow any decisions of this magnitude to be made on the first visit. This person had better choices, but they were not presented or implemented.

Chronic pain is a solvable problem, with or without surgery. Surgery is only an option if there is a surgical lesion. A normally aging spine is not in this category. Do not become one of the patients in this blog who has had their life destroyed. As bad as your chronic pain is at the moment, it can be made a lot worse with an ill-advised operation. It is even more tragic in that the solution, as many of my patients have said is, “disturbingly simple.” Do not just trust a physician you barely know. The basic step is to develop a relationship with him or her. Then take control of your decision, pain, and life.

There is still hope

I don’t want this article to end on a down note. As bad as this situation looks, it is still a solvable issue. Your brain is incredibly adaptable, and you can reprogram it in any direction you choose. I have seen many patients in this bad of shape eventually become free of pain. One gentleman had undergone 28 surgeries in 22 years and has now been free of pain for over six years. In fact, he says that “I have never felt better in my life.” Another woman had been in pain for 50 years and has done well for over seven years.

The main factor that determines success is simply your willingness to engage or as one my successful patients has said, “suspend your disbelief.”

Please share your story of a failed spine surgery. I am more than aware that there are many successes, even for chronic low back pain. It is just that the success rate is not high enough to justify the risks of surgery and there are alternatives that are so much better. The world needs to know the downside of a failed spine operation in order to make more informed decision.

Questions for your surgeon

References

1. Jensen MC, et al. Magnetic resonance imaging of the lumbar spine in people without back pain. NEJM (1994); 331:69-73
2. Carragee EJ et al. A Gold Standard Evaluation of the ‘Discogenic Pain’ Diagnosis as Determined by Provocative Discography. Spine (2006) 31: 2115 – 2123.
3. Perkins FM and H Kehlet. Chronic pain as an outcome of surgery: A Review of Predictive Factors. Anesthesiology (2000); 93:1123–1133.
4. Young AK, et al. “Assessment of presurgical psychological screening in patients undergoing spine surgery.” Journal Spinal Disorders Tech (2014); 27: 76-79.
5. Agmon M and Galit Armon. “Increased insomnia symptoms predict the onset of back pain among employed adults.” PLOS One (2014); 9: 1-7.
6. Hanscom David. Do You Really Need Spine Surgery? Take Control with a Spine Surgeon’s Advice. Vertus Press, Oakland, CA, 2019.

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There is a growing group of health care professionals who are determined change the current trajectory of medical care. There is an ever-increasing burden of chronic mental and physical disease¹, current approaches are not working, yet we are continuing to embrace them.

The core of chronic disease

Chronic disease is created by your body’s sustained exposure to stress hormones, increased metabolism (fuel consumption), and inflammation. The term is for this situation is, “threat physiology.” The solution lies in learning methods to bring your body into safety physiology, which is necessary for regeneration and healing.

An informal workgroup was created in early 2020 consisting of research scientists and clinicians. We meet twice a month for an hour and have discovered that there is deep research documenting the effects of chronic stress on your body.^2,3,4 Historically, these scientists have not had a consistent forum to communicate with each other and most of this knowledge has not entered clinical care.

A deeper understanding of the nature of chronic disease, including chronic mental and physical pain, offers possibilities of solutions. Indeed, many clinicians have watched many patients break free from chronic pain as they have learned the principles and tools to alter their body’s physiology from threat to safety.

Is your body a parked car?

A parked car has no “symptoms.” You have to start it so see what is going on and then systematically test it if it is not running well. But what if it is a new car that runs out of gas, or the wrong fuel was put into the tank? What if you drove it in second gear for days at 80 mph? There will be “symptoms” before there are structural changes from it breaking down.

Of note, your body is never “turned off.” In fact, the complexity of interactions happens at around 20-30 million bits of information per second.⁵ It is well-beyond human comprehension about how it all works together although we are gaining some ground. We have no clue about human consciousness. We know rough concepts about what part of the brain lights with what input. One of my more skeptical spine fellows pointed out that current technology is a start, but he likened it to seeing what a person is making for dinner from a plane flying at 35,000 feet without magnification.

The myth of MUS (Medically Unexplained Symptoms)

How would you feel if you tried to run a marathon without any training? What if I decided to play NFL football, even for one play? My body is “normal” (could be better) but I would quickly develop symptoms. Most bodily symptoms, illness, and disease are physiological issues and not structural. Medicine has gone completely the opposite direction, addressing most problems as structural, and if they can’t “find” anything, it must not be “real.” There is even a new term that arose in 2002 called, “MUS” (Medically Unexplained Symptoms).⁶ That could not be farther from the truth. Looked at from the perspective of the body’s function, the correct term would be, “MES” (Medically Explained Symptoms).

This summit brings together pioneers of many disciplines of care who have dedicated their lives and careers to making life better for everyone – providers and patients. You will hear the research and data directly from them. I will warn you that you may not understand some of the deeper data in some of the presentations, but you will definitely get a feel of the concepts.

A letter from some of the presenters

Thank you so much for joining us for this paradigm-shifting two-day virtual Summit about the common basis for chronic disease, including chronic pain.

 Stephen Porges, Les Aria, DR Clawson, and David Hanscom have been working together with an extended community of doctors, scientists, and researchers to better understand each other’s fields of expertise and how they fit into addressing chronic pain. It has been fascinating and exciting to see the evolution of so many concepts and how they fit together in a cohesive model.

The Speakers

This group of speakers has been researching and documenting best practices around solving chronic pain. They include EAET (Emotional Awareness and Expression Therapy), PRT (Pain Reprocessing Therapy), and ISTDP (Intensive Short-Term Dynamic Psychotherapy). They  developed, refined, and documented the effectiveness of these approaches.

• Howard Schubiner, MD – EAET, PRT
• Tor Wager, PhD – Documented the effectiveness of PRT with fMRI’s
• Allan Abbass, MD – ISTDP
• Yoni Ashar, MD – PRT

These speakers are true pioneers in their fields.

• Steven Hayes, PhD – Founder of ACT (Acceptance and Commitment Theory)
• Angelos Halaris, MD – Early pioneer in the field of psychoneuroimmunology
• Richard Gevirtz, PhD – Deep research documenting the role of the autonomic nervous system in the creation of disease.
• Stephen Porges, PhD – Originator of the Polyvagal Theory

Some researchers that have made core contributions are:

• Sue Carter, PhD – International expert on oxytocin/ vasopressin
• Naomi Eisenberger, PhD and Robert Lustig, MD – renowned for linking mental health to physiology, metabolism, and neural circuitry.

Clinicians who are presenting the implementing these ideas include some of the above speakers and:

• David Clawson, MD – physiatrist/ chronic pain/ rehab
• Nicole Sachs, LCSW – leader in mind/ body medicine
• Steve Overman, MD – rheumatology
• Les Aria, PhD – chronic pain/ clinical psychologist
• David Hanscom, MD – orthopedic spine surgeon

Bruce Lipton, PhD is the author of the “Biology of Belief” who was also a pioneer in presenting many of these ideas over 30 years ago.⁵ He is the final speaker. What is fascinating is how modern neuroscience has confirmed many of his concepts. Your belief systems affect the expression of your genetic code (epigenetics), your inflammatory markers, the function of the mitochondria (fuel generators in each cell), and are connected with many chronic disease states.

Mental threats are the bigger problem

This brings us to the second day where we present the data on how mental stress creates sustained threat physiology, and the result is many physical and mental symptoms, including chronic pain.

Bringing so many disciplines together has been deeply rewarding and enriching for all of us and we hope it will be for you too. Pull up a comfortable chair and immerse yourself in the weekend. We are looking forward to exploring these ideas together and setting the foundation for next year’s progression of these concepts.

The Summit is intended to present these emerging ideas to a wide audience and further deepen the cross-fertilization of ideas amongst the participants. Whether you are a doctor, health professional working with chronic pain patients, caregiver, sufferer yourself, or a basic science researcher, you will discover a different way of looking at the source of the issue as well as some innovative solutions.

Best regards,

David Hanscom

Steve Porges

Les Aria

DR Clawson

The Summit

Many of the presenters have educational materials, books, courses, and apps that are useful for both clinicians and patients. They will be organized, and links provided at the course.

You can register here. The Summit will be recorded and with registration the recordings will be available for 30 days after the conference.*

*CME credits are available only for those who attend the live conference.

This is not just another pain summit. It is the coming together and flow of innovative ideas and concepts. Be a part of our efforts to bring medicine closer to practicing and implementing known and documented effective interventions for chronic mental and physical disease.

References:

1. O’Neill Hayes T and S Gillian. Chronic Disease in the US: A Worsening Health and Economic Crisis. AmericanActionForum.org, September 10^th, 2020.
2. Dantzer R, et al. Resilience and immunity. Brain, Behavior, and Immunity (2018); 74:28-42.
3. Cole SW, et al. Social regulation of gene expression in human leukocytes. Genome Biology (2007); R189. doi: 1086/gb-2007-8-9-r189
4. Naviaux R. Perspective: Cell danger response Biology—The new science that connects environmental health with mitochondria and the rising tide of chronic illness. Mitochondrion (2020); 51:40-45.
5. Lipton, Bruce. The Biology of Belief. Hay House, Los Angeles, CA, 2016.
6. Edwards TM, et al. The treatment of patients with medically unexplained symptoms in primary care: A review of the literature. Mental Health and Family Medicine (2010); 7:209-221.

The post Not Just Another Pain Conference – The 2nd Annual Pain Summit first appeared on Back in Control.

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• Awareness is at the center of life. You cannot make good decisions without understanding the relevant variables.
• It is also an important tool in and of itself. By understanding the different types of awareness and knowing where you are in given moment, you can navigate life’s challenges more easily.
• The “circle of life” represents three states of the human experience and reflects the state of your body’s physiological state.
• Combining awareness skills with the “circle of life” allows you to selectively use tools to regulate your body’s chemistry.
• You can navigate life on your terms.

Awareness is both at the core of survival and also thriving. These are learned and separate skills. Survival is instinctual and whatever tools you have become embedded over your lifetime. However, many of our actions are not only ineffective but can make situations worse. Acquiring effective stress processing skills is important.

Thriving is not as instinctual and it must be cultivated and nurtured. If you are trying to use pleasant experiences, power, and material possessions to compensate for unpleasant survival emotions, it can’t and doesn’t work. You cannot outrun your mind. They key to thriving is developing a “working relationship” with anxiety and anger, and then you are able to create the life you want. Solving problems doesn’t yield a good life. You have to live a good life to have a good life.

Additionally, awareness is critical to processing life. You can’t solve problems in any domain without understanding details from both your perspective and also that of other involved parties. If you are projecting your views onto a given situation, you are not going to come up with consistently viable solutions. For example, you may have repeated troubles with relationships at home and work and can’t figure out why.

Putting awareness to work

The first necessary step in using awareness is looking at clues that you are not as aware as you think you are. BTW, if you think you are “aware” or “enlightened”, then you have already demonstrated that you are not aware. Any labels, positive or negative, block awareness.

Then seeing your unawareness will allow to deepen your awareness and start you down the pathway of using awareness as a tool.

Second, understanding and nurturing the different types of awareness enables you to learn skills in each of these arenas. Here are four suggested types to use as a baseline.

• Environmental
• Emotional
• Judgment/ “The stories”
• Ingrained patterns

Environment awareness a tool to be used daily and as you train your brain to connect to specific sensory inputs, it takes your attention away from disruptive thought patterns. As you continue to practice, it becomes more automatic, and your mind can calm down.

Emotional awareness is difficult in that you are training your brain to experience pain that you have been suppressing and repressing. Remember, emotions are what you are feeling in various physiological states – safety versus threat. They drive your behavior in order to avoid danger and seek safety. Since mental and physical pain are processed in a similar manner, emotional pain actually hurts. So, why would you want to feel it? Because suppressed/ repressed emotions fire up your body’s nervous system and chemistry even more.

Awareness of the stories you create about your life to make sense out where you fit into the world is particularly deadly. Many of these stories have been programmed in by your family, friends, and society. A high percent of them are actually cognitive distortions that continue to keep you ramped up even when your circumstances are good. The good news is that you don’t have to do anything about them because they are not based on reality. You can just become aware, separate, and move forward. If you choose to prove them wrong or ignore them, you have inadvertently reinforced them.

The ingrained patterns are the essence of who you are, make up your life view, and evolve to become the lens through which all new information is processed. Since the human brain is programmed by interacting with others, each individual is incredibly unique. The early input is critical as it sets the trajectory for the rest of your life. By definition, you cannot see these patterns without outside help as they are your frame of reference. Creating a clear awareness of your past programming is a necessary powerful way of switching your life from a reactive to a creative mode. It is also a much more interesting way of interacting with others, as opposed to constantly projecting your views onto them.

Third, once you become more familiar and skilled in developing these levels of awareness, you can actively use them as tools to calm down and re-direct your nervous system. Some people make the strong argument that awareness is the only tool you need to heal. We know that you can’t “fix” yourself. Your attention is focused on the problem and from a neuroplasticity perspective, you are reinforcing it. With awareness, you can watch yourself respond, somehow you are getting out of your own way and allowing yourself to heal. You have become an observer of your own healing. Remember, the steps required to create neuroplastic changes in your brain are: 1) awareness 2) separation (create some “space”), and 3) redirecting your attention.

Finally, the “circle of ife”, which contains the “ring of fire,” can be used as a foundational template for implementing awareness into your daily life. On a given day or moment, you can quickly assess your relationship with any of the four kinds of awareness and see which part of the “circle of life” you are in. You then have a choice of using your tools to move in the direction of your choice. But you can’t redirect unless you know where you are starting from. You will notice that moving easily between all aspects of your life on your terms is the goal of The DOC Journey. Then you are beginning your real journey of life.

The” circle of life” is the signature tool of The DOC Journey. The challenging aspect of this tool is that you must allow yourself to feel everything – but only as you can tolerate it. Allowing yourself to feel anxious is difficult because no living creature is programmed allow vulnerability. The consequences are harsh. Yet with language, we have the capacity to develop complex relationships, which requires vulnerability. It is a frustrating aspect of the human condition.

The good news is that once you are aware of where you are at in the circle, you do have choices. You can remain where you are – even if you are in the red, take a “refueling break by entering the green center, or move on by engaging in blue activities.

Freedom is being fully immersed in every element of your circle of life – on your own terms. It begins with awareness.

Recap

The essence of chronic mental and physical disease is being exposed to sustained levels of threat physiology. Your body is consuming resources for survival, and you cannot heal in this scenario. Healing can only occur when you feel safe enough to replenish your reserves. But a major block to seeking safety is not recognizing your body’s cues that you are in flight or fight. There are many ways of it covering it up, but your body is still in high gear.

You must learn to become aware of your physiological state and choose where and when you want to go or stay . Whatever set of tools you decide to implement begins with awareness. Where in the “circle of life” are you at this minute?

Questions and considerations

1. There is a tendency to look for a definitive cure for pain, which doesn’t make any sense. Your body’s interaction with the world is dynamic and your physiology changes by the millisecond. Life keeps coming at us.
2. When you are in fight or flight, you simply aren’t going to feel good. You are not supposed to, as the sensations evolved by creatures paying attention and taking action to survive. The species who were not aware enough did not survive. So, anxiety is intended to be so unpleasant, we’ll do almost anything to avoid it.
3. That is what makes awareness so challenging. You must feel and acknowledge your threat physiology before you can change directions.
4. Your tools will allow you to process stress more efficiently so as to minimize your time in threat physiology. Healing occurs as you learn how to feel safe.

The post Awareness as a Tool – The “Circle of Life” first appeared on Back in Control.

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• Understanding the nature of chronic disease and the principles behind the solutions, allows you to fully engage in your care.
• Characteristics that keep us alive are what also create disease states.
• Chronic pain is a neurological diagnosis that has profound effects on your body’s physiological state. Existing in flight or fight breaks down your body.
• Survival depends on the protection of anxiety and anger. Letting go of trying to fight or change them releases energy to live your life.
• The essence of chronic illness is living in sustained threat and the solution lies in finding safety.

Here is a review of some characteristics of staying alive, which are the same ones that cause illness and disease.

Your health is dependent on the amount of time your body is in a physiological state of threat compared to feeling safe. Life is dependent on feeling safe in order to regenerate and also dealing with threats in order to survive. But, when you are exposed to sustained threat physiology, your body will break down.¹

Physical and mental symptoms are the result of each organ system in your body uniquely responding to your body’s chemical makeup.² In addition to the multiple physical symptoms, the sensations created by the flight or fight inflammatory state are called anxiety and anger. They are the result of threats, not the cause. They are also powerful, uncontrolable, amoral, destructive, and necessary to maintain life.

The starting point

Picture a complex circuit board that has trillions of etched-in circuits that represent your lifetime of programming. These circuits are not alterable for several reasons. First, they are memorized, similar to riding a bicycle.³ Second, any time you spend trying to analyze and figure them out is counterproductive. The more attention you pay to these patterns of activity, the more they are reinforced. Finally, as the powerful unconscious brain is estimated to process 20 million bits of information per second⁴ (compared to your conscious brain only processing 40 bits per second), rational interventions alone, such as talk therapy, cannot hope to make a dent in these circuits. It is like trying to move a high mountain peak with a shovel. It is not going to happen and much of your life’s energy is consumed in the process of trying.

It sounds discouraging. You have these permanently embedded pain circuits in your brain and the harder to try to fix them, the more they are reinforced. They are also necessary and much more powerful than your conscious brain. So, what do you do?

Solving the unsolvable

Understanding that you cannot solve or improve these unpleasant circuits is the first and necessary principle behind the solution. You must put down your shovel and move on. Instead of trying to “fix yourself,” new strategies are needed to create fresh circuits in your brain. Most of these approaches utilize methods that connect with the unconscious part of your brain with repetition. It’s similar to diverting a river into a different channel. You begin with small steps to create these new channels, but eventually the water’s flow will aid the process.

So why would we ever take anxiety or anger personally? They are inherent for survival but have little, if anything, to do with who we are. By letting go of trying to solve an unchangeable situation, you’ll experience a huge energy surge that allows you to move forward.

The second principle is that since it is impossible to fix your pain circuits, you must develop or shift onto a new set of circuits that aren’t painful. There are many ways of stimulating these changes, and the process is called, “neuroplasticity.” It is similar to installing a new virtual computer on your desktop. With repetition, it is remarkable how quickly these changes happen. Since your brain will develop wherever you place your attention, you must move towards your vision instead of continually trying to fix yourself. As you embrace wellness, you’ll crowd out pain.

Third, you cannot move forward until you have let go of the past. This is difficult because when you are trapped by a chronic disease, you are legitimately angry. However, you are also stuck. There are ways to effectively process anger and there are tremendous benefits to learning these tools.

Fourth, The DOC Journey is simply a framework that organizes your thinking and presents tools in a way that you can apply them in a focused manner. The steps in healing are:

• Awareness – you have to understand a problem before you can solve it.
• Treating all aspects of pain simultaneously – it is similar to fighting a forest fire. Every treatment can contribute to a good outcome, but nothing will work in isolation.
• You take control of your care. Since chronic pain is complex and you are a unique individual, each person’s situation is incredibly complicated. You are the only person that can possibly solve it with guidance. If you are not in charge, nothing can happen.

Fifth, a core concept of The Journey is awareness. It includes awareness of:

• Your emotions
  • Suppressed emotions are especially problematic
• The impact of your actions on others and theirs on you
• The nature of chronic pain
• The principles behind the solutions to chronic disease
• Your specific diagnosis
• Your vision of what you want your life to look like

Finally, since your sense of well-being and health is dependent on the composition of your body’s physiological state, all of your efforts are intended to stimulate it directly or indirectly into a safety state. There are three areas of focus:

• Input – how you process your stresses
• The state of your nervous system – calm or hypervigilant
• Output – it is desirable to remain in balance or safety and minimize the amount of time you are in a threat state.

The desired safety state allows you to feel content and secure, have a slower metabolic rate (rate you burn fuel), less inflammation, and lower levels of stress hormones. Optimizing your body’s physiological state from threat to safety has a profound effect on your health and quality of life.

Recap

The solutions to solving and preventing chronic disease lie in understanding the principles behind them. Embedding these of concepts allows you to continually practice them. This is in contrast to randomly learning techniques to fix yourself. The process gives you control of regulating your body’s physiology from one of threat state to safety.

Questions and considerations

1. Consider that it is your whole body that responds to your immediate set of circumstances in order to optimize your chances of survival. Your nervous system is the processing center for sensory input and an integral part of the reaction. There is absolutely no separation of the mind and body and why even the use of the term, “Mind Body” is inaccurate.
2. Why would you take your powerful survival reaction personally? It is intended to feel so unpleasant so as to force you to act. It is what you possess and not who you are.
3. You’ll be taken on a journey that will allow you to depersonalize this flight or flight reaction. It is just a part of your daily life.
4. Take some time to review the above principles of solving chronic disease. They will eventually enter every aspect of your life and become automatic. As you spend a lesser amount of time in a threat state, you will be able to move forward into a new life and thrive.
5. You can’t fix chronic disease. You must let go and move into wellness.

References:

1. Torrance N, et al. Severe chronic pain is associated with increased 10-year mortality: a cohort record linkage study. Eur J Pain (2010);14:380-386.
2. Schubiner H and M Betzold. Unlearn Your Pain, 3^rdMind Body Publishing, Pleasant Ridge, MI, 2016.
3. Hashmi, JA et al. Shape shifting pain: Chronification of back pain shifts brain representation from nociceptive to emotional circuits. Brain (2013); 136: 2751 – 2768.

4. Trincker, Dietrich. 1965 lecture at the University of Kiel. German physiologist

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Under threat, your blood flow to your frontal cortex (thinking, consciousness) shifts to the lower functioning levels of the brain, your demand for fuel (glucose) increases and some of it is taken from the neurons, and your immune system stimulates inflammation through cytokines (small signaling proteins), which when sustained causes destruction of brain tissue.

Mental or physical threats are processed in a similar manner. Examples of mental threats are unpleasant thoughts and emotions, worry, catastrophizing, emotional abuse or neglect, fear of authority, lack of opportunity, and social isolation. Repressed emotions are also a major problem. Physical threats include lack of food, poverty, bullies, viruses, trauma, predators, and being trapped by pain.

Although both are problematic, mental threats are a much bigger issue in that humans cannot escape their consciousness. The resultant sustained elevated levels of stress hormones and inflammation causes both mental and physical disease. One example, is that it is well-documented that the brain physically shrinks in the presence of chronic pain. It will return to its normal size when the pain resolves. (1)

Fortunately, you have complete control about which direction you would like your brain to develop. It depends on what you decide to program it with.

Pavlov’s Dogs

One experiment that demonstrates the power of reprogramming is the famous one by Ivan Pavlov, a Russian researcher. Pavlov showed how the brain can be trained, through repetition, to have certain reactions in certain circumstances. Recent neuroscience now backs up his findings.

Pavlov set up a situation where every interaction a dog had with food would involve the sound of a bell. Eventually just the bell sound would cause the dog to salivate, even without seeing or smelling food.

One of Pavlov’s lesser-known experiments is when he coupled the dog’s interaction with food with an electric shock to one leg. With repetition, the dog would eventually seek the electric shock to obtain food and wouldn’t react to the shock with a pain response. However, this phenomenon was “paw dependent” in that if the same shock was applied to its other leg, the dog would scream with pain.

Ears, Eyes, and Touch

There have been numerous studies examining the interaction between the senses when one is absent. For example, it is well-known that people who are blind have more sensitivity in their fingertips, which allows them to more quickly learn to read Braille compared to someone with sight. Part of this is from the brain’s capacity to adapt through neuroplasticity, but it can happen much more quickly through changes in the areas of brain activity.

One experiment involved applying very tight blindfolds on volunteers for five days and measuring brain activity with fMRI’s (functional MRI’s). (2) These scans measure blood flow and metabolic activity in the different areas of the brain. They demonstrated that the brain regions associated with hearing and touch quickly became active and compensated for the lack of sight. There was a rapid shift of activity in addition to neuroplastic changes. When the blindfolds were removed, it took a few hours for the brain to re-adapt to processing visual input. Additionally, the blindfolded volunteers underwent intensive training in reading Braille. They demonstrated the occipital lobe of the brain (vision processing center) became active during touch. The brain adapts quickly and there are many underlying “silent” functions that become activated when needed.

Take control of your programming

I have become slowly convinced and am astonished that you can program your brain around almost anything. The key is stimulating neuroplasticity. You must move towards what you want in your life instead of trying to solve the problem. Otherwise, you’ll just reinforce the pain.

Some examples of the power of neuroplasticity include:

• Jen had 15 years of chronic neck, low back and leg pain, severe anxiety, headaches and depression. She shifted out of pain within a week at one of our workshops and six years later, continues to thrive.
• Richard was in severe pain for over 20 years, was dealing with substance abuse including opioids and alcohol, and had undergone over 25 surgeries. He has been free from pain for over four years and has not felt this good since he was in his 20’s.
• Vicki had been suffering from generalized pain and anxiety for over 50 years. It took about a year of trying different approaches, but she has been doing well for over five years. She coined a unique word, “neuroshment.”
• We have now seen several cases of severe phantom limb pain resolve.

These are just a few examples of hundreds of patients who have broken free from the grip of chronic pain. The key is simply engaging in the series of tools that allow your brain to change. You can’t fix yourself, but you can practice behaviors that re-direct and calm your nervous system.

You can’t turn back

I realized a few weeks ago that once you have gained an awareness of the nature of pain, practice the tools that change your brain, and allow yourself to heal, there is no going back. Some people begin the healing journey but quit quickly. But there is a tipping point, where you have changed the nature of the way you process the environment and your brain will keep changing in that direction. Since is so self-directed, people continue to move forward, and many, if not most thrive at a level that they never knew existed. That includes me.

Jane

This realization of not being able to turn back hit me while I was talking to a young friend who I had been informally helping for a couple of years. She had known about the DOC process for several years but had engaged with the journey only after a long conversation where she was ready to try anything. She dove into my book, Back in Control: A Surgeon’s Roadmap Out of Chronic Pain and the stages of the website, www.backincontrol.com,  which outlines the action plan. She also sought some additional support. Within six months, her 15-year misery of suffering from severe anxiety, low energy, depression, and back pain ended. She was ecstatic. I warned her that the downside of feeling good is that when you inevitably have periods of re-experiencing pain, it is a higher fall and extremely frustrating. She heard me but wasn’t so convinced. Last summer, not only did she have a recurrence, she was more miserable than she had ever been. I will admit, I was a little worried. She was in the abyss of pain for almost six months. But the key is using the same tools you learned to heal in the first place. She didn’t and then she did.

When I talked to her a few weeks ago, she was on fire. Her energy was back, she had moved to a new city, was beginning to re-engage in her art, and her anxiety was back down to a minimal level.

I am never happy when I personally dive back into the pit of pain, but I do have the tools. Once you understand what it is like to feel good and have the tools to get there, you will find your way back. I did explain to her that the good news is that each time you are challenged like this (and there is more to come), you will become more skilled at shifting back onto the circuits in your brain that allow you to thrive.

The DOC Journey

We have now created The DOC Journey, which more clearly presents the core strategies that are most quickly effective and creates the experience of “feeling safe.” It is more interactive with the core of it being an app that will be available later this fall.

Use the power of your brain’s adaptability to create the life that you want.

References:

1. 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.
2. Merabet, LB, et al. Rapid and reversible recruitment of early visual cortex for touch. PLoS ONE (2008);3(8): e3046. doi:10.1371/journal.pone.0003046.

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