A chaotic, even abusive upbringing predicts a long and harsh life. There are many chronic mental and physical health issues that occur that shorten lifespan and also markedly compromise quality of life. Raised in this environment, a child cannot reach his or her full potential when so much energy is consumed by trying to survive. Consider a young plant in rich soil with plenty of sunlight and water. Compare it to the same plant in poor soil, limited sunlight, little water. It may even look a different species.

Feeling unsafe

When we don’t feel safe, we’ll do whatever we can to achieve it. Feeling unsafe drives many, if not most destructive behaviors. Feel trapped causes us to react aggressively to solve the situation. The physiological response is called anger, which represents the body’s powerful last-ditch effort to regain control.

Since the most stressful problems are ones we can’t solve, sustained anger (threat physiology) turns into rage, destructive behaviors, and chronic illnesses as the body breaks down. Consider how many life situations are unsolvable. One of the deadliest and universal problems is feeling trapped by our thoughts.

We cannot escape our thoughts. Suppressing unpleasant thoughts fires up the threat response even more than experiencing them. Suppression causes the hippocampus (memory center) of the brain to shrink¹ and increases craving for opioids.²  Distracting ourselves with experiences, pursuing pleasure, adventures, and achievements also fires up the immune system.³

So how do we behave?

ADDICTIONS

Addictions create a sense of safety while engaged in the activity, but obviously are not long-term solutions. The reason addictions are so destructive is they temporarily mask mental and physical pain, and pursuing relief is compelling.

POWER

A deadly outcome of feeling chronically unsafe is the relentless pursuit of power in order to gain more control. It can’t and doesn’t work, but few of us are taught alternatives. The manifestations are almost infinite and infiltrate every domain of our lives and relationships with others. People closest to us are the most affected. No one wants to be controlled, yet trying to control others is almost universal. Anger is generated in those being controlled and also in those exerting control. There is never enough to assuage the unconscious brain. Unfortunately, anger is intentionally destructive, as it is your body’s last-ditch effort to survive emotionally or physically.

The data is deep, beginning in the schoolyard. We try to avoid anxiety, or – if we already have it – we try to get rid of it. Nothing enhances our feeling of control more than by gaining power in some way. This need is expressed in our interactions with each other; in fact, it dictates much of human relations.

Every child has significantly increased anxiety when they leave home to begin school, regardless of their family situation. They want to be accepted but there is also the greater need to diminish their fear. The need to get rid of fear and gain power is played out in forming cliques, excluding others, and overt bullying.

Researchers did a study of students who have been bullied versus the bullies to see if there was any difference in their physiological makeup. ⁴ They looked at the levels of a substance called C-reactive protein (CRP), which is elevated in the presence of inflammation; it’s often drawn to determine the presence of a hidden infection. Chronically elevated levels also indicate a stressed and overactive immune system. It is not desirable to have an elevated CRP.

The study revealed that children who had been bullied had significantly elevated levels of CRP compared to those who had not been bullied. Being bullied as your introduction to the real world is not a great start. What I find even more disturbing is that the levels of CRP in bullies was lower than the norm. As it turns out, there is both a social and physiological reward for possessing more power. How all of this plays out in adulthood is not subtle. Why would you want to give up power and control? Especially when feeling the pain of anxiety is the other option.

Every child has a strong need to be accepted, yet what should we make of the fact that it gives him or her more power (and self-esteem) to reject someone else? This is an endless loop, the root cause of which is the solvable problem of anxiety.

SELF-ESTEEM

The other as futile effort to counteract these deeply upleasant survival sensations is to pursue more self-esteem. This is problematic for seversal reasons. First, it is a gross mismatch of your unconsious brain overpowering your conscious brain by about a million to one. Anxiety and anger are hardwired automatic survival reactions over which we have absolutely no control.

Second, the unconscious brain never stops for a millisecond and is always on the lookout for danger. It is why we evolved and stay alive. The conscious brain’s attention is not sustainable and we quickly develop cognitive fatigue trying to stay happy. We also become physically tired as 20 to 25% of your entire body’s energy is used to run your brain.

Third, we are programmed by everyone around us about who we should be or not be. These voices in our heads become as concrete as any object and we act on them. Unfortunately, the “stories” in our heads are essentially all cognitive distortions. Self-esteem represents a huge distortion of labeling. We expend a tremendous amount of energy building up our ego, and then spend endless efforts defending it. The relentless pursuit of self-esteem disconnects us from the reality immediately in front of us. In other words, you lose awareness of other’s needs and relationships are compromised. Look at the human experience of how terribly we treat each other as individuals and societies. We have the resources to create a planet that could thrive yet we are at the mercy of our personal and societal “stories.”

What can you do?

Learn vulnerability. Being vulnerable is at the core of meaningful human relationships, but there is no reward in nature for being physically vulnerable.  Since emotional pain is processed in similar regions of the brain as physical pain, there are penalties for being emotionally vulnerable. Language creates a massive problem causing emotional pain that is much more complex than in other mammals. Anger, as unpleasant as it is, is powerful, addicting, and masks being vulnerable. Anger creates a sense of emotional safety, but no one around you feels safe. How do you learn to be vulnerable when you are used to dealing with a lot of anger?

DYNAMIC HEALING

Needing to pursue the above-mentioned destructive behaviors drops as you address the root cause of sustained threat physiology. You cannot control the survival reactions but there are numerous ways to regulate your physiology. When your body is bathed in safety physiology, you feel safe, connected, and incredibly relaxed. We use the term, “dynamic healing”, which addresses factors affecting your physiology.

• Input – dealing with life’s challenges in a manner that less impact on your nervous system.
• State of the nervous system – calm or hyperactive
• Output or the physiology – can be directly regulated from threat to safety.

The details of the Dynamic Healing model are beyond the scope of this discussion. The focus is on you and learning skills in each category to create “cues of safety”, and not on fixing or solving your pain. It is a healing process, and not “self-help”.

RUTs (repetitive unpleasant thoughts)

Regarding the onslaught of unpleasant thoughts, consider the metaphor of a hornet’s nest, with the nest being your brain, and the hornets your thoughts. At rest, the hornets are busy collecting food, building the nest, cleaning house, and reproducing. If the nest is shaken, the hornets will become aggressive and defend themselves. When your nervous system is inflamed and hyperactive, your thought patterns become intense, since your conscious brain interprets your internal physiology.

The usual approach is to use cognitive rational techniques to counter bad thoughts with good thoughts, which is an impossible task. Then we put up our “shield” (self-esteem, self-affirmations) to protect us. It also overwhelming and wears us down. Exerting increased control (suppression) is also futile. Then the more attention you pay to the thoughts your brain is fired up even more. It is a bi-directional process.

The answer lies in “quit shaking the nest.” The hornets will calm down and return to their usual activities. As your nervous system calms down, your unpleasant thought patterns will lessen, which in turn helps calm your brain. Although cognitive approaches lower the input into the nervous system, calming it down is a separate skill. There are endless other ways besides unpleasant thoughts that fire it up.

There are four aspects of creating a safe relationhip with your thoughts.

• Thought separation
• Calming the nervous system (processing anger)
• Creativity – stimulating new neurological circuits away from the unpleasant ones.
• Dissolution of the ego – once you learn to feel safe, there is less need for it.

Calming your nervous system allows you to feel safe. It allows you to break free of ruminating thought patterns frees you up to create and live life on your terms.

References

1. Hulbert JC, et al. Inducing amnesia through systemic suppression. Nature Communications (2016); 7:11003 | DOI: 10.1038/ncomms11003
2. Garland EL, et al. Thought suppression as a mediator of the association between depressed mood and prescription opioid craving among chronic pain patients. J Behav Med (2016); 39:128–138. 10.1007/s10865-015-9675-9
3. 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
4. Copeland W, et al.” Childhood bullying involvement predicts low-grade systemic inflammation into adulthood.” PNAS (2014); 111: 7570-7575.

The post Our Need to Feel Safe first appeared on Back in Control.

The post Our Need to Feel Safe appeared first on Back in Control.

I went skiing for the first time when I was 14. Our family was not a ski family, but my father decided to take us on a ski vacation at Mammoth Mountain. The whole trip was somewhat of a disaster as we were so unprepared. I got to the mountain too late for ski school, so my brother, who had skied once said he would teach me. We ended up on an intermediate slope. In spite of his best non-efforts, I twisted my knee, tore one of the ligaments, and ended up in a long leg cast for eight weeks.

No choice

For those of you who have never skied, being on a slope that is above your skill level is not only frightening, but it can also border on terrifying. Most skiers have experienced this scenario at least once. But any situation in life where you are in above your head elicits a similar response. What makes skiing unique is that you have no choice. You must get down the hill by the end of the day.

You must also make it through life. Consider life as a major ski resort with many choices except one. When you check into the ticket window early every morning, instead of buying a ticket, you are assigned to ride one chairlift. You must ride it regardless of the difficulty of the run or your expertise. No one is going to help you down.

Ski runs

The difficulty of a run is rated by colors. The easiest slope is called the “magic carpet.” You stand with your skis on a moving belt and get off on a hill that is almost flat. Green circles are usually accessed by chairlifts and the runs are smooth and gentle for beginners.  A blue square indicates a somewhat steeper slope for intermediate skiers. Some runs have bumps called moguls. Black diamond runs are steep, usually ungroomed, and often have many moguls. Double black diamond runs are challenging even for high level skiers and dangerous for beginners. There are many warning signs saying, “experts only.”

Life

One problem we all face is that life is full of double black diamond runs. However, it is all relative. Anytime you are on a hill that is beyond your skill level, it is problematic. A beginner skier on an intermediate hill is not having a great time. Consider a beginner skier who has to navigate a double black diamond run. It is truly terrifying.

The core cause of all chronic mental and physical illness is sustained levels of stress. Stress can be defined as threat physiology or flight or fight. This state is necessary in order to keep you alive. The reason why chronic stress is so deadly is that you have no time to rest and regenerate. For example, the reason your heart can function for so long is that it rests between beats.

Dynamic Healing

There are three aspects of staying alive: 1) your input or stresses, 2) the nervous system which processes sensory input, 3) and the output, which is your body’s physiology. It can be in threat or safety. Sustained threat physiology is what creates mental and physical illnesses. It is the balance between your circumstances and coping mechanisms that determines your body’s chemical state. The essence of healing is decreasing your exposure to threat physiology and increasing time in safety. These are acquired skills.

They consist of processing input (stress) so it has less impact on your nervous system, calming the nervous system so as to be less reactive, and directly lowering your threat physiology. All three portals are accessed daily, and it requires repetition to make them automatic. Over time, you will be a “professional at living life.”

On the slopes

Taking this back to the ski resort metaphor, anytime you are in over your head, you will be in threat physiology. Your goal is to increase your skill level to the point where you have less of a chance of being on a hill that is frightening to you. Before you begin, you must have equipment that is safe and comfortable, including  being dressed according to the weather (too hot or too cold is a problem). Skiing requires strength, flexibility, and endurance, so conditioning is also important.

But the next step once your skis are on, is that you must learn to stop, regardless how steep the hill is. Even on a bunny hill, this is critical. On expert terrain, you must be able to set a firm edge. You cannot learn anything until you can stop. My wife endlessly reminds me that the first time I took her skiing, I neglected this detail, and she stopped by running into a building. It was a slow speed, so she wasn’t injured; but she wasn’t that happy.

Why do you ski? Why do you live?

Your desire is to enjoy your experience as much as possible. For example, if you are an intermediate skier on a blue slope, you can feel relaxed, work on skills, let the skis do the work, and have a great time. Isn’t that the reason you are skiing? But what if you are a blue skier on a black run or a green skier on a double black diamond run. It really is terrifying, and one experience will cause people to quit forever. But you have no choice. Life keeps coming at all of us and there is no end to the challenges. What are you going to do? You cannot stay on top of the hill all night. You don’t want to fall down a double black run at a high speed. It happens and people get hurt.

Then consider the scenario of an expert skier on an intermediate run well below his or skill level. Normally, it is an enjoyable experience. But today is 12 degrees, the wind is blowing about 20 mph, it is foggy, hard to see, and extremely icy. The expert skier must go into a defensive survival mode and might be OK. But it isn’t  much fun. What if you are green skier on a double-black diamond run in these conditions? It is beyond terrifying and also life threatening.

Good luck – or is it luck?

You cannot control most of the circumstances in your life, but you can develop skills to deal with them more effectively. Many more days will be enjoyable, and you also possess the confidence to deal with severe adversity. Your body frequently goes into threat physiology because it is protecting you. But you don’t have to stay there.

Few of us are taught the life skills of regulating our physiology (stress) and even fewer are taught to nurture joy. You might say, I don’t want to learn how to ski. I don’t like it. Good luck. You still have to check in at the ticket window and get your assignment for the day. We spend a lot of time learning many different skills but not much attention is spent on learning how to navigate life.

The post Downhill Skiing is Dangerous – So is Life first appeared on Back in Control.

The post Downhill Skiing is Dangerous – So is Life appeared first on Back in Control.

• Connecting to every aspect of your life is difficult but is at the core of allowing your body to heal.
• “Being” with your past may be challenging but is necessary in order to learn and grow.
•  It is the opposite of pursuing self-esteem, which separates you from you.
• The “C” quence is connection, confidence, and creativity. Creativity is where deep healing happensthrough neuroplasticity.

Connecting to your past provides “neuroshment”¹ for healing.

Safety vs. threat

Feeling safe is a basic need and core driving force of life. We’ll resort to whatever means required in order to achieve it. A state of safety allows growth, regeneration, optimum function, good health, and a deep sense of contentment. Feeling threatened causes your body to go into a “flight or fight” reaction, which consists of stress hormones, increased fuel consumption, excitatory neurotransmitters, inflammation, and anxiety. A term for this reaction is, “threat physiology”.

Life is sustainable because the body regenerates and heals, but it must be in a safe state for enough time to refuel, strengthen, and build up reserves to fight another day. Even severe stress can be dealt with when there is enough time in safety to regenerate. So, healing happens by decreasing time in threat and increasing time in safety. These are separate, but linked sets of skills. One is using methods to lower the levels of stress chemicals and the other is learning to nurture joy.

This journey is reflected in a metaphor of a tree that I call, the “C”quence of healing allowing you go from reactive to creative.

• Connection
• Confidence
• Creativity

CONNECTION – the soil

The ground represents every second of your entire past and is the source for learning and future growth. There is one major root in any tree, called the taproot, which grows straight down in search of water and nutrients. The trees with deepest ones are found in harsh dry environments. A tree may initially show little growth for a few years until the taproot is more mature. Roots grow relentlessly and will even grow through rock. The more developed and complex the root system, the better the chances for survival and growth.

All humans have experienced some degree of trauma. Our needs are not always immediately met even in the best of circumstances, and adversity never stops. Many people have suffered severe, even extreme childhood trauma, and there is plenty more to be had in adulthood. We don’t feel good about it and might even feel ashamed.

As a result, considerable time and energy is spent on analyzing, fixing, covering up, whitewashing, or suppressing the past. Somehow, we feel that by spending a lot of time dealing with past, we’ll have a better life. The problem is that your attention is focused on the problems and not the solutions. Since your incredibly adaptable brain develops where you place your attention, you are magnifying the unpleasant aspects of your life. Focusing on fixing the past also requires a lot of energy that could be used in dealing with the present, and thriving.

“Neuroshment”

Specific skills are required to allow you to be with your past, as much of it may be unpleasant, painful, and difficult to be with. Digging in and being with your past is the opposite of seeking self-esteem. One patient who successfully broke free from 55 years of pain coined a term for using the past for future growth,“neuroshment.” Your brain physically changes its structure as it adapts to ongoing sensory input. This property is called neuroplasticity, and you can create the brain of your choice.

TRUNK—SKILLS

The trunk represents the confidence that emanates from being able to deal with every aspect of your life and not run from it. Since, there are many ways to effectively process the past, you are grounded and can deal with even severe adversity.

The term for this set of skills is “dynamic healing.” It acknowledges the interactions between you and your circumstances that create flight-or-fight body chemistry. There are many tools in each portal, none of them are difficult, but require learning and repetition to master them.

Anytime you are anxious or frustrated, you are reacting to something unpleasant from the past. You are in flight or fight, the blood flow to your neocortex (thinking brain). It is impossible to think clearly. You have also lost awareness of the present moment. These survival reactions are powerful, automatic, and you have no control over them. It is the reason that being with the past is difficult and specific tools are required to regulate your body back into safety. Deeply connecting with who you are provides “neuroshment” for future growth and confidence to deal with life’s challenges. This is a sharp contrast to seeking self-esteem to “feel better” about yourself. You are not grounded.

THE BRANCHES—CREATIVITY

Connection and confidence represent the skills needed to regulate your threat physiology, but healing occurs with creativity. Brain circuits are stimulated reflecting the life you want as you “rebuild” the brain (life) that you choose. You cannot “fix” yourself. Your attention is on the problem and where your brain will develop (neuroplasticity).

But you can’t pursue pleasure in order counteract the survival circuits. They are too powerful and relentless, and your creative brain doesn’t work well while in threat physiology. Pursuing pleasure to outrun your unpleasant survival sensations has been shown to increase inflammation.²

The concept of healing through creativity is possibly the most important and difficult to comprehend and put into action. We are programmed to react and fix and are uncomfortable letting go. But you must let to in order to move forward. If you take the letter “C” out from “reactive”, it becomes “Creative.” You must become aware, create some “space” to see first in order to be able to make rational choices.

Deep healing

Sustained stress keeps your body activated, breaks it down, and increases the odds of developing a chronic mental or physical disease. The relevant issues are the intensity, duration, and your coping skills. Consider how long it would take for your car to break down if you were driving down the freeway at 70 mph in second gear. What if the car (your body) wasn’t tuned up, hadn’t had regular service, or was a cheap model? Compare this scenario to cruising in a well-maintained luxury car in 5^th gear at the same speed. You could drive for a long time. Your body isn’t so different. What model of car are you and how are you caring for you?

Recap

“Neuroshment” from a complex root system and solid trunk, allows a tree to grow branches of all sizes. You willconnect into your creativity and train your brain to evolve in any direction. This is where the deepest healing occurs. You are moving towards joy and away from pain.

Nurturing joy requires skills that few of us are taught. Creativity requires awareness, and you must see “C” first in order to know where you are at and then make ongoing proactive choices.

In order to reach higher, you must first dig deeper. Consider a tree as a metaphor for your healing journey. Become a professional at living life and watch your life change from ReaCtive to Creative.

Questions and considerations

1. Many, if not most of us have a less than ideal past. The human experience is messy. What you perceived as dangerous as a child is probably not threatening as an adult. But your brain doesn’t know that and will continue to react similar cues.
2. How do you feel when your attention lands on emotionally difficult situations from the past or is triggered by an event today? Reassuring yourself that you are OK actually places your attention on the problem and reinforces it.
3. Connecting with every aspect of your past and allowing yourself to be with a wide range of unpleasant emotions causes them to lessen. However, the discomfort you feel may be intolerable. There are ways to train yourself to be with these feelings and move forward.
4. Consider how much effort we spend trying to “fix” ourselves. It can’t and doesn’t work. Remember when you felt that life had endless possibilities. How did it feel? That is where you want to return.
5. The most important shift in thinking about having a better life is that it happens by nurturing creativity and joy. But you have to let go in order to move forward. It is a daily ongoing process that allows you to “rebuild” your brain and live the life of your choice. Quit fighting darkness; turn on the lights.

References

1. Term coined by Rita Salvador who learned to thrive after being in chronic mental and physical pain for over 55 years.
2. 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 The “C”quence of Healing Chronic Illness first appeared on Back in Control.

The post The “C”quence of Healing Chronic Illness appeared first on Back in Control.

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

My perspective

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

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

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

What’s currently being done?

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

1. Not addressing the root cause

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

2. Inadequate training

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

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

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

3. Known data is ignored

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

4. No one is listening

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

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

5. It’s the mental pain

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

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

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

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

6. Simplistic thinking

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

Finding relief any way that he can

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

The viable solution

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

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

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

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

References

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

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

Why is Anxiety Considered a Psychological Diagnosis?

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

 Staying alive

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

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

Threat physiology

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

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

These are some of drivers activating threat physiology.

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

Anxiety is a physiological state

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

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

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

A paradigm shift

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

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

“Dynamic Healing”

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

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

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

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

Let’s do this!!

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

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

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

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The root cause of disease

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

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

• Response
• Symptoms
• Illness/ Diseases

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

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

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

Dynamic Healing Overview

The nature of your body’s physiology under threat

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

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

Defining threat

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

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

Systematically addressing the root cause – circumstances versus coping capacity

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

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

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

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

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

State of the nervous system (calm or hypervigilant)

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

Output (physiological profile – safe, neutral, threat)

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

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

Modern medicine is continuing down the wrong road

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

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

Dynamic Healing Medicine

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

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

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

Join us in bringing Dynamic Healing into mainstream awareness.

References:

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

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The post Dynamic Healing first appeared on Back in Control.

The post Dynamic Healing appeared first on Back in Control.