• 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.

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.

The post Reprogram your Brain Around Pain first appeared on Back in Control.

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