Self-esteem

Every human is judgmental. It is an inherent aspect of survival.  However, it is not a trait that engenders close enjoyable relationships or peace of mind. It is made worse by our cultural programming that having self-esteem is essential for happiness. Nothing could be further from the truth. To attain and maintain high self-esteem requires endless comparison to those around you and also to norms that society, your family, friends, and you have set for yourself. You will eventually wear down and crash. There is not an endpoint to this process.

The pursuit of self-esteem can’t and doesn’t work. At some level, we all know this. Whenever your peace of mind and/ or identity is at the mercy of external circumstances, including other’s opinions, you’re at the mercy of them. Also, it gives others power to shut you down, which is one of their efforts to improve their self-esteem. You are riding on a universal merry-go-round that will never let you get off. The eye of the storm

Envy

As these attempts at “improving self-esteem” eventually and miserably fail, the next level of emotion is envy. It isn’t pretty and interferes with almost every aspect of life from work to your personal life. Although you may be on the same pursuit of happiness like the rest of us, it can’t happen if you are perpetually envious. Happiness and envy are not compatible emotions. What is even more ironic is that when you are judging someone else, you are just projecting your view of yourself onto someone else and broadcasting your insecurities to the world.

I have an exercise you may want to consider. Think of someone that you dislike. He or she usually isn’t too difficult to identify. Then in one column, write down as many things about them that you dislike. The to the right of each pronouncement, write down what you dislike about you in a similar area. You may not like his or her work ethic. Maybe you think they are lazy?  Do you procrastinate? Or are you in a reactive pattern where you are a workaholic? “He’s fat!” Are you happy with your weight? Maybe people think you are too thin. You don’t like her political views. Who is to say yours are more correct.

What is fascinating and disturbing is that many people are often unhappy about other’s success, even if they are a close friend.

Schadenfreude

There are two basic types of envy. One is being unhappy with another’s success, whether it is a friend or competitor. The other is silently rejoicing when someone you are envious of suffers a loss. The term for this second scenario is “schadenfreude”. Both elicit feelings of guilt because we know we shouldn’t feel this way. But when you try not to feel a certain way, it becomes worse. It’s even more problematic if you feel the person you have envied didn’t originally deserve his or her success.

In light of the current neuroscience research, we now understand the impact of sustained frustration on your body’s chemistry and the resulting physical symptoms. This unknown writer succinctly points out that good health is the essence of living a good life. Yet, when we spend our energies comparing ourselves to others, we are frequently frustrated. This chronic anger with the attendant elevated levels of stress hormones wreaks havoc with every organ in your body and you’ll eventually get sick.

Envy and pain

I’ve had as much of a challenge with self-esteem and envy as anyone. I came from a tough household and it seemed if everyone had a life that I wanted. I was envious of friends, accomplishments, adventures, families, and the list went on. What is now obvious in retrospect was that my mother was insanely envious and our family’s situation was never good enough. She would become unhappy to the point that our whole family would move to another town to start over. The cycle would begin again and she would complain about any and everything. By the time I was 18 years old, we had lived in 11 different houses. After I refused to move from my high school area in Napa Valley, they kept on moving. It’s clear where I learned this pattern of behavior.

When I ended up in chronic pain, it all become much more intense. It seemed everyone had something I wanted. The first thing I was envious of was not being in pain. Then it seemed that everyone had a better family life than I did. I become more and more socially isolated and I withdrew even more. Although, I wanted to re-engage with friends, my fear of rejection became almost a phobia. Holidays were particularly unpleasant. It seemed like every person in the world was having a better time than I was. Of all the terrible experiences I endured, the loneliness was crushing. It is one of the reasons I have described the world of chronic pain as, “The Abyss”.

Self-destruction

Additionally, anger is destructive, including self-destructive. One of the ways this plays out is disregarding your own health. All of us have a choice of how we choose to treat our bodies. Chronic frustration is possibly the main reason why you wouldn’t choose to feel physically great. It’s hard to really enjoy life if you don’t feel vigorous and energized. Ongoing self-neglect is a form of slow suicide. You’re angry and take it out on yourself. We all have some degree of self-destructive behavior and many of us have a lot. So, the emotions that you might be feeling from another’s success are sucking you dry. You now have less of a chance of “being successful” whatever that might mean. Jealousy and frustration aren’t solving much.

Moving forward

I have undergone many phases of healing. However, I have never forgotten the intensity of the loneliness and envy. It was the accidental discovery of the expressive writing exercises that halted the downward descent and it is still the one necessary starting point of the healing process.

One exercise I frequently discuss with my patients is similar to the one I presented above. I ask them in the room to visualize someone they dislike. They have read enough of the DOC process to quickly understand where I am going. I point out that they know the being judgmental is problematic and then I ask them what happens when they try to not be judgmental. Of course, you will become more judgmental. So, whether you are judgmental or not judgmental, your nervous system remains fired up. What can you do? Write down your specific thoughts and immediately destroy them. This allows you simply to separate from your thoughts, not to solve or change them. You may not become friends with this person or even like them. But in that “space” you’ve created, possibilities arise. Once you can see your judgements as a projection of you, you may be able see this person in a different light. At a minimum, it certainly makes life more interesting.

The Way to Love

So, the solution doesn’t lie in “not being envious.” Another key to dealing with it is to become more aware of it and the impact on your quality of life. I have now incorporated Anthony DeMello’s book, The Way to Love, into the DOC process. He defines love as awareness.  I frequently re-read a few pages. He’s clear on the consequences of being attached to your external circumstances for your peace of mind. Becoming aware is a critical step and a significant part of the solution.

Although, it’s a daily, minute to minute exercise in awareness, not being caught in the quicksand of envy has been a remarkably freeing experience. Try it. At least become aware of your resistance to living a different life.

1. I was going through some old files and happened to find this paragraph that I had clipped out over 30 years ago when I began my spine practice. It initially had a big influence on me and I would read it intermittently to remind myself to keep both feet on the ground regardless of major successes or failures. Life began to cave in on me and I lost touch with these concepts amongst many other losses. I don’t know the source but the wisdom of it struck a deep chord with me. A reader just let me know the writer was Aleksandr Solzhenitsyn.
2. Schadenfreude: Understanding Pleasure at the Misfortune of Others. Wilco W. van Dijk, Jaap W. Ouwerkerk; Cambridge University Press, Jul 24, 2014.

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At some tipping point, this becomes the new trajectory of your life. Life’s challenges continue to come at all of us. As life becomes easier to navigate, your body is exposed to less threat (stress) physiology and more to safety. Safety is where fuel moves into cells, and your body regenerates and heals.

The metaphor for this navigated course is the ski slope. No matter what your skill level, you must get down the hill. If the ski run is above your skill level, you may not be only stressed, it can be terrifying. The goal is become an expert at life skills and learn to feel safe a higher percent of the time. Here are the prerequisites.

• Have a working knowledge of The DOC Journey course.
• Understand the natural resistance to change.
• Review the “circle of life” with the “ring of fire.”
• Begin to connect to your vision of what is possible.
• Your healing emanates from feeling safe and creative.
• Constructing your new home (life) is the final focus of the journey. Enjoy!!

Overview

First of all, congratulations for reaching this level. The key to healing is persistence and you have already shown a willingness to fully engage in learning to create and live the life you want. Before you began this journey, that may not have seemed possible. But to be clear, your journey is not about completing a course or believing in David Hanscom. It is about connecting your own capacity to heal. Healing of any part of the body is nothing short of miraculous, but so is the gift of life.

Many people arrive at this point of their journey and they feel better. So, being back to their baseline, they quit. “I am good enough,” and they move on with their life. I think that it is tragic to stop now. Your creative brain is coming alive and the potential for future learning and growth is unlimited. Why would you want to stop?

There are actually a few reasons why this happens so often.

• Humans are programmed by every second of their lives. Our brains unconsciously memorize everything. Familiar patterns are not noticed since not only are they embedded in our brains, but they are our version of reality. Any new or unusual data catches our attention and stimulates some level of threat physiology. We feel anxious and instinctively resist change. So, maybe you are back to a comfortable baseline state. Why would you wish to continue?
• There is a lot of anxiety with success, if you are used to simply trying to survive. When is the shoe going to drop? A classic example is golf. It is remarkably predictable that when you have shot well for three or four holes that your anxiety levels rise. Of course your muscle tension increases, and suddenly it seems like you don’t which end of the club to hold. The same scenario holds true in any performance arena at home, work, or even relaxing.
• Examples are present in every kind of performance. Maybe you have been promoted and have a higher profile in your sphere of influence. More eyes are on you, and many people might jealous of your success. They may look for any opportunity to cut you down. There is a term for this phenomenon called “Tall Poppy Syndrome.” It is easier to just blend in with the crowd.
• Understand that the shoe will always drop. That is life. If your goal is to be in an endless state of bliss, you’ll fail. Life presents an endless number of daily challenges and at some level of stress, your body will respond with threat physiology. Maybe it will last for an hour or even days. It is what your body is supposed to do – protect you. But you now have choices regarding how long you wish to remain there.
• A different problem arises in that now you have tasted what it is like to be in the green center, and you don’t want to leave. Additionally, when you are triggered and in the red, the contrast is sharp and you may get more frustrated about what is possible compared what you are experiencing in the moment. I call this, “the curse of awareness.” What you want to do is nuture emotional flexibilty, be present with whatever state you are in, and move in the direction of your choice.
• I experienced a common scenario in that I had no idea that there were other possibilities about the way I negotiated my life. All I ever knew was anger and chaos. Although, I attended workshops, read self-help books, and underwent extensive counseling. I did not connect with how angry I was until I was 50 years old. It was an incredibly unpleasant experience and I did not have the tools to deal with it. Healing happens with connection – to yourself and then to those around you. Not wanting to experience unpleasant emotions may be a major reason why people don’t engage in this process or pull up short of really moving forward. One of my friends has often quoted the phrase, “you have to feel to heal.”

The ”circle of life” containing the “ring of fire” is the signature tool of this journey. A version of it was created by Dr. Paul Gilbert, who was the founder of compassion-based therapy. Compassion (love) as defined by Anthony DeMello in his book, The Way to Love, is awareness. Anxiety blocks awareness. But as you nurture awareness, you’ll actually feel more anxiety, and it requires tools to tolerate it. This is a bidirectional interaction. So, this final level is focused on not only learning to nurture joy, but also to better tolerate anxiety.

The metaphor is building and decorating a new house. Each room represents an aspect of your life that must be addressed. Use it daily as a quick mental checklist as you go from room to room in your own home. The “lot” is the green center of the circle of life. With repetition, you’ll create the life you want. “To have a good life, you must live a good life.”

Books to read

Art of Living: The Classical Manual on Virtue, Happiness, and Effectiveness

Happiness and freedom begin with a clear understanding of one principle: Some things are within our control, and some things are not. It is only after you have faced up to this fundamental rule and learned to distinguish between what you can and can’t control that inner tranquility and outer effectiveness become possible. The Stoic philosopher Epictetus was born on the eastern edges of the Roman Empire in A.D. 55, but The Art of Living is still perfectly suited for any contemporary self-help or recovery program.

The healing journey progresses from “reaCtive to Creative”. You must first see where you are at before you can change direction. You can’t heal by focusing on problems. Healing occurs with creativity and moving away from unpleasant neurological circuits. The wisdom of the Stoics is remarkable in that it is as, or more, relevant as it was 2000 years ago. Regaining a healthy life perspective is the definitive solution to decreasing your suffering.

On the slopes

A world class skier can ski anything humanly possible if the conditions are reasonable. I used to think I was a double black diamond skier until I was exposed to US Ski Team skiers who were far above a level than I ever imagined. They not only possess a high level of skill, but they are supremely confident as a result of putting in thousands of hours of practice.

Many years ago a group of us where on the back side of mountain at Alta Utah. It was a gorgeus day with a lot of new soft powder. We were all “expert” skiers. We were standing in a narrow line waiting to head down the hill and my son, who is a US Ski team level mogul skier was on another transverse about 30 feet above us. We wondered what he wanted us to do. What he wanted was fresh untracked powder and he took off and jumped over all of us. It must have been a 40-foot drop and he landed about 50 feet down the hill. There was no hesitation. He kept going until the bottom skiing at a high speed. I realized that his was a reality I was not familiar with.

But consider any performance from art, music, dance, athletics, mechanics, business, and work. Every endeavor can be manifested at the highest level. You might be thinking, “I could never accomplish this level of expertise, and in a given field, you probably won’t. Or maybe you already have. However, life skills are accessible to everyone and anyone who wants to commit the living an excellent life. All that is required is a willingness to continue to learn and practice. The DOC Journey presents a foundational set of concepts and tools and there are endless additonal ways to enhance your journey.

The only “goal” of this course is to allow you to connect to the moment you are in and with awareness can be in any color of the “circle of life” on your terms. You have the choice to remain there or move in any direction.

Why not attain the highest level of expertise in living your life? The focus is on attaining skills and not reaching for perfect, where you beat yourself up for “failing.” It is about just learning to execute what you know regardless of the circumstances. Outcomes are usually beyond our control, but you can up the odds of success.

This level is a jumping off point for living the rest of your life. Let yourself think big and enjoy your day.

The post Be an Expert at Living life first appeared on Back in Control.

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Hi Dr Hanscom,

I have been meaning to check in with you for a while now and let you know that the DOC program seems to have worked for me. My lower back & leg pain has disappeared and I’m a firm believer in the process, especially the concept that anxiety is the driver of tension and pain in many cases. I picked up the book, Forgive for Good at your recommendation back in the winter and found it to be excellent. I’ve also been doing mindfulness training and it’s been extremely helpful.  If you aren’t familiar with the book, The  The Mindful Way through Depression, I’d definitely recommend checking it out.

I hope you are doing well and enjoying the summer now that it’s finally arrived.

Best, Jean

My Perspective

This patient is the daughter of an esteemed colleague of mine. She had burned out of practicing law and had embarked on a pre-med pathway at the age of 38. She had experienced low back pain for over two years. There was also significant pain, numbness, and tingling throughout her right leg. She had a normal MRI of her thoracic and lumbar spine. Electrical testing of her leg did not show any specific problems with the nerves. As I knew her father so well, I was especially anxious not to miss anything that might be serious. I could not find a structural cause for her symptoms.

I first saw her about 18 months ago, and on our last visit six months ago, she was just a little better. I tried not to be too discouraged but, I was not sure she was going to improve.

What is remarkable about her recovery is that it was truly self-directed. She did not see me in follow-up nor did she see another physician. I had recommended a mental health professional, as I thought she might be depressed. But she wouldn’t engage in that conversation. She did use the Feeling Good book and was diligent writing in David Burn’s three-column format. She also pursued obtaining a good night’s sleep, utilized the re-programming tools such as active meditation, and worked out regularly in the gym. Two years later she is re-pursuing her medical school dream.

This story is not an exception. With full engagement with a structured program the results are consistent.

The post Depression Masking as Pain first appeared on Back in Control.

The post Depression Masking as Pain appeared first on Back in Control.

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.

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.

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• Chronic mental and physical pain are complex. Isolated interventions cannot and don’t work.
• Surgery is often considered a “definitive solution.” For chronic symptoms, it is not. It is simply one tool.
• Only two factors must be considered to make a decision regarding undergoing surgery – the anatomy and the state of your nervous system.
• Please make the right decision for you and make sure you know your surgeon and he or she knows you. A wrong decision can destroy your life.

Surgery on a normal neck??

Last week, I reviewed the films of a young girl who had been in a low speed car accident and was suffering from chronic neck pain. Her attorney sent her to a spine surgeon, who want to perform a five-level fusion of her neck. Her MRI was COMPLETELY normal with minimal bulges and no pinched nerves. Additionally, even if there was disc degeneration or arthritis, these factors have been documented to NOT be a cause of neck pain.

As a complex spine surgeon, I routinely saw patients with multiple failed surgeries with devastating effects on their lives. Most of the time when I reviewed the original imaging studies done prior to any surgery, there were no abnormalities other than normal changes you’d expect with ageing. Operating on a normal ageing spine can only be damaging, yet somehow the medical profession has held up surgery as a definitive solution regardless of the anatomy. It is only an answer if there is something structurally wrong.

I don’t what will happen with her as I am only peripherally involved in her case. There is nothing in any aspect of our medical training that says we should operate on a normal spine. Unfortunately, a five-level fusion is not only risky, but a significant amount of normal motion is gone, and there is a high chance that she will have neck problems indefinitely.

Making the correct decision about spine surgery

The decision of whether to undergo a spinal surgery is not as difficult as you might think. There are just two factors to consider that enter into the decision. One is the anatomy and the other is the state of your nervous system.

Is there a clearly identifiable source of your pain causing symptoms that correspond to it?  Or is it arising from irritation of tissues that cannot be seen on an imaging study?

The second factor is the state of your nervous system. If you are feeling stressed for more than three months, the body’s chemistry is on “high alert”, which affects every cell in your body, including the speed of your nerve conduction and inflammatory state of your brain. (1) You will not only experience more pain, your capacity to cope with it is compromised.

The other issue when you are feeling trapped is that your brain activity switches from the neocortex (thinking region) to the lower parts of the brain (survival). So, you cannot physiologically think clearly and by definition, your decision-making will be flawed. You are not going to be thinking about philosophy while you are running from the lion.

With these two variables of the anatomy and state of your nervous system, there are four scenarios to consider:

• IA—Structural lesion, low risk for chronic pain
• IB—Structural lesion, at risk for chronic pain (high stress)
• IIA—Non-structural lesion, low risk for chronic pain
• IIB—Non-structural lesion, at risk for chronic pain (high stress)

An overview of how this looks is presented in this grid:

The Treatment Grid

The implications of this grid are important in making your decisions, and can be the basis of discussions regarding the role of surgery in your care. I quickly observed early in my practice that if a patient was not under a lot of stress (Type A) then outcomes were consistently positive if a structural problem (Type I) was solved. However, if that same person was in the midst of a major personal or professional crisis, then the results were less predictable. Surgery might have still been helpful but the other factors needed to be addressed.

Patients who don’t have a lot of extra stress and are experiencing pain without a positive imaging study (Type IIA) simply do not want or request surgery. Why? It is just pain that will resolve and it usually does.

The biggest problem we have in spine surgery is performing surgery on people who are stressed and the source of pain can’t be identified. Since mental and physical pain are processed in a similar area of the brain with the same chemical response of inflammation, adrenaline, histamines, and cortisol, the pain is often intense and people become desperate. First of all, surgery is never indicated without identifying the cause (Type II – non-structural). So the chances of success are already low, and then you add in the other factors that have been shown to adversely affect surgical outcomes (poor sleep, anxiety, depression, fear avoidance, poor physical conditioning, smoking, duration of pain, younger age). It is well-documented that there is a significant chance of patients getting worse.(2) It is surgery being aggressively performed in this group that is creating a lot of ongoing pain, suffering, and disability. Do not allow this to happen to you.

I quit

I was watching so many people experiencing catastrophic outcomes from surgery on normally ageing spines that I could not do it anymore. Additionally, I was witnessing hundreds of patients breaking out of chronic mental and physical pain with minimal resources and no risk. The factor that predicted success was a person’s willingness to learn and engage in the healing journey. The greatest block was patients feeling that something was being missed and that surgery was the only option.

You might be thinking to yourself that you had a back or neck fusion and it was successful. I also saw many of those patients. I think that is great and I am happy if worked for you. However, I also saw those people that were five to ten years out from a successful operation whose spines were breaking down around the fusion. These were often complex problems with limited options.

Resources

I wrote a book in 2019 that presented my decision-making over the last 15 years of my career. I am not against surgery at all if the problem is clearly identifiable and my patient’s condition was optimised before surgery. The research is clear on what should be done to accomplish this. Why would you not want to have your chances of success maximised? Do You Really Need Spine Surgery? Take Control with a Surgeon’s Advice provides the information you need in enough detail for you to make a better decision.

I also created two options for an action plan to optimise your condition prior to surgery. One was an app and the other a computer-based course. They are called, The DOC (Direct your Own Care) Journey. They provide a foundational knowledge base that you can build on and take control of your own care. Either one is the most effective by spending 15-20 minutes a day with them, as it requires repetition to learn the skills to regulate your body’s physiology.

Here is a link to the rest of my efforts that address a wide range of mental and physical disease states. It appears that most chronic diseases are caused by your body being exposed to sustained levels of stress chemicals and healing occurs in the presence of safety.

I need your help

The situation is getting much worse with bigger operations being performed with a higher complication rate. It should not be this way. It is the medical profession’s responsibility to listen, talk to you, and offer well-documented effective treatments. There is not one research paper in the last 60 years that has shown that a fusion works for back or neck pain compared to an organised rehab approach.

My efforts have helped many people individually, but the juggernaut of aggressive surgery is moving forward while non-operative resources are being eliminated. The only chance of slowing all of this down is from a grass roots effort. I am asking each of you to do what you can to share the message that chronic pain is solvable using research-based principles, which includes appropriate surgery. There is no data supporting spine surgery on normally ageing spines. Those of you suffering from failed spine surgery already know this all too well.

References

1. Chen, X et al. “Stress enhances muscle nociceptor activity in the rat.” Neuroscience (2011); 185: 166 – 173.
2. Perkins, FM and H Kehlet. “Chronic pain as an outcome of surgery: A Review of Predictive Factors.” Anesthesiology (2000); 93: 1123 – 1133.

The post Make the Right Decision About Spine Surgery – The Grid first appeared on Back in Control.

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Anxiety, Power, and Bullying

To be connected to other people is one of the strongest human drives. Humans evolved by interacting with other humans. We also have a deep need for acceptance. This sets up a serious contradiction because our even deeper need is to avoid anxiety.

We try to avoid anxiety, or – if we already have it – we try to get rid of it. One common method we use is to increase our sense of control. Nothing enhances our feeling of control more than by gaining power in some way. This tendency comes out 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. 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. (1)

Every child does have 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. The myth of self-esteem

Sartatoga Teen Hangs Herself

I don’t know how you can measure the impact of bullying on our society. The suffering encountered at such an early and innocent age is deep and it’s rampant. Three 16 y/o boys raped a young girl in the Bay Area. What is much more disturbing is that instead of rallying to support her in a time of extreme distress, her classmates turned on her. A photo went viral. She was verbally abused both directly and over cyberspace. “Slut”. “Will you have sex with me?” She is now dead from hanging herself.

I was talking to a patient who was a middle-age school teacher. She was experiencing total body pain. She was clearly a broken woman and could hardly lift her head to look at me. She had been severely bullied throughout middle and high school and couldn’t shake it. The conversation with her was incredibly discouraging.

One of my colleagues had her son bullied badly beginning at age seven. Nothing seemed to work to stop it. Finally, at age 25 he simply gave up. He could no longer tolerate the relentless anxiety engendered by the experience. As sad as his mother was telling me his story, she felt that he was finally at peace. It was an intense moment to hear her say that about her own son.

Some observations

First, most bullying occurs at a level well below the teachers’ radar. Just being excluded from a group can be devastating. It is not going to be possible to put the responsibility solely on the their shoulders.

Second, our children are at an age where they are discovering and creating their identity. Most of it depends on some type of approval from their peers. For some reason the approval usually needs to come from the person or group who is the least likely to give it. When someone else defines your identity, that person has power over you.

Third, people wring their hands and point out that all of this should be done in the family. There are several significant problems with this thinking. I resent the term “dysfunctional family”. That implies that there are functional families. I have yet to see one. Humans consistently have significant problematic behavioral patterns, and is most deeply played out in the home setting.

Even if a child comes from a less dysfunctional family, they may become targets for the bullies. They are similar to a domestic animal turned loose into the wild. They either fold or become tough. Neither is great.

Fourth, the argument goes that school is an important socialization process. Really?? Going into an environment where peace, love and joy are hammered into the ground does not create a person who is loving and compassionate. They are just learning dysfunctional survival skills. Behavioral patterns set before age 12 are permanent. Bullies as children have a high chance of exhibiting aggressive behavior as adults as well as experiencing chronic pain. Many children with their egos destroyed will live the rest of their lives in fear.

Fifth, home-schooled children have been shown to do well later in life. My observation of several families that have taken it on is the their children are more creative and thrive without the hierarchy of the schoolroom. Here is an example of the work of some close friends of mine. They have been home-schooled and creativity oozes out of them. Beautiful

Sixth, look at what is happening to our society. We have a life that any generation prior to a hundred years ago could not imagine. Are we happier and more loving? We are passing along peace and love to our kids – especially in school. External possessions and accomplishments don’t change human nature. The incidence of chronic pain has skyrocketed in adolescents. (2)

Finally, there is a high correlation between the ACE score (Adverse Childhood Events) and disability. As pain drives anxiety and frustration and vice versa this shouldn’t be a surprise. These pathways are linked. We are not going to solve the chronic pain problem, which is crippling our society, unless we tackle it beginning in kindergarten. (3)

Solutions

Human behavior and survival revolves around avoiding anxiety. We’ll do anything to avoid the feeling, including holding on to our pain. Any change creates more anxiety. The key is learning to process and live with anxiety, so as to not have such a need for power.

Neuroscience research has shown us the powerful full body reaction that creates anxiety. You can’t control it, but you can calm and re-direct it. It is the core of the DOC process. Anxiety is the pain.

We’re also observing the power of the family in programming behaviors. Were you ever a bully? Do you still intimidate your co-workers, colleagues or family? Could your child’s bullying be learned from you? Were you bullied when you were younger? What effects of it might you be bringing into your current life? Are you often frustrated, angry or upset? What effect do you think it’s having on your quality of life? Do you even want to give up the power of your pain? You might have a legitimate reason to hold on to remaining upset? But who’s continuing to suffer?

Awareness

I think almost everyone agrees that bullying is a problem. However, we may not be aware that we might be part of the problem. The first step is understanding how your behavior might be perceived by those close to you. I can tell you it is a humbling exercise. A book given to me by a close colleague has had an impact on me. It is called, The Way to Love, by Anthony DeMello. He defines love as “awareness.” How can you meet someone’s need without understanding them or getting to know who that person is. Bullying would be the antithesis of awareness, as you are meeting only your own needs. I read a few pages weekly to remind me of the concepts.

Treating anxiety and anxiety with the correct approach on a widespread basis would have an effect on bullying, your child’s quality of life, and on your life. Commit to your own healing and reach out to heal your family. Watch the impact.

Although bullying is physically healthier than being bullied, it destroys the essence of life, which is healthy, thriving relationships. Bathing your body in reward chemicals emanating from giving back, a sense of purpose and play is a much better way to live.

1. Copeland W, et al.” Childhood bullying involvement predicts low-grade systemic inflammation into adulthood.” PNAS (2014); 111: 7570-7575.
2. Simons L, et al. “Pediatric Pain Screening Tool: rapid identification of risk in youth with pain complaints.” Pain (2015); 156: 1511-1518.
3. Anda RF, et al. “The enduring effects of abuse and related adverseexperiences in childhood. A convergence of evidence from neurobiology and epidemiology.” European Archives of Psychiatry and Clinical Neuroscience (2006); 256: 174–186.

The post Bullying is Good for Your Health first appeared on Back in Control.

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This is a river rock that I painted with the ocean scene to express “The healing journey is not linear!” There are highs and lows like the waves and the tides, progress and struggle but it’s all part of the healing process. One of my greatest challenges has been being with the pain flares when they happen and not fighting them. Feeling sorrow for the suffering but not adding to the suffering with negativity but rather practicing compassion toward self. Having a strong knowing that this is all part of the journey and never, NEVER, letting go of my hold on hope, faith and trust that my body when in calm physiology has the ability to heal itself and will in time. It’s empowering to know that I can change my physiology with knowledge and the tools taught in the DOC Journey.

Brooke Milo’s painting of river rocks is calming and triggers joy and creativity for her. “I love creating and the river and the ocean are my favorite places to be as they consistently soothe my soul.”

The post Hope first appeared on Back in Control.

The post Hope appeared first on Back in Control.

• When your nervous system is inflamed and hyper-reactive, lesser levels of stress cause your body to go into flight or fight.
• In contrast, you are able to more easily deal with challenges if you feel safe and calm.
• Four categories of factors influence your baseline physiological state of safety versus threat: 1) sleep 2) diet 3) exercise/activity level 4) childhood programming/ patterns.
• All of these factors are addressed throughout the course, but the initial focus is on getting adequate sleep.

Your nervous system gathers about 20-40 million bits of information per second, and interprets the sum total as safe or threatening. Signals are continuously sent out to adjust the body’s physiology (output) and actions to optimize your function. The reactivity of your nervous system ranges from calm to hypervigilant. These four categories of factors influence the sensitivity of the nervous system.

• Consistently restful sleep is necessary for your brain to refuel and empty waste products.
• Lack of exercise affects your physiology and also your capacity to cope with both mental and physical stress.
• A poor diet is inflammatory.
• Your baseline physiology is also affected by your past. Survival depends on learning what is dangerous and then avoiding it in the future. If you were raised in a chaotic abusive environment, many situations were dangerous or perceived as such. That doesn’t change as you age even when you intellectually know you are safe. So, more scenarios in the present seem threatening with less stress than you might expect.

Although all these variables affecting your nervous system are presented throughout the course, successfully addressing sleep is a high priority. The DOC Journey approaches will be marginally effective if you aren’t getting 7 or 8 hours of restful sleep. Not sleeping is NOT an option. No major decisions regarding your medical care should be made until you feel rested during the day. This is particularly true regarding surgical procedures.

Systematic Approach to Sleep

Insomnia is consistently solvable with a stepwise approach regardless of the level of your pain. The key is focus and persistence. It is a myth that you need less sleep as an adult and at least seven hours of sleep is desirable. Few patients suffering from chronic pain are getting adequate sleep.

Incorporating sleep into the treatment was my first step in conceiving the DOC protocol. I had a new resource that was effective and measurable. My patients’ sense of well-being improved and often other symptoms diminished.

Sleep and pain

I originally thought that people suffering from chronic pain couldn’t sleep because of their pain. But a large study out of Israel demonstrated that lack of sleep induces chronic low back pain, and that the reverse was not true – that pain caused insomnia.¹

Another study documented that consistently poor sleep was a greater predictor of disability than the severity of back pain. Even more interesting was that this was also true for leg pain (sciatica), which surgeons generally feel is an incredibly disabling symptom.²

I treated one businessman who had experienced chronic neck pain for almost two years. There was no specific injury. He continued working as an owner of a small accounting firm, but he was miserable. He had been through multiple courses of physical therapy. I started him on a strong sleep medication, which immediately allowed him to experience restful sleep. I saw him back at two weeks and noted the medication was working well. I was planning on starting aggressive physical therapy on the next visit. When he returned six weeks later, I was surprised that he was pain-free without any other interventions.

Start sleeping – NOW

Most people find a way to sleep using a combination of the suggestions listed below. If you are still struggling after a few weeks, Discuss sleep with your primary care physician. The details of each of these suggestions are outlined in chapter 14 of my book, Back in Control. Please use this as a resource.

Approaches to Insomnia

Self-directed

1. Sleep hygiene – well-known set of principles to optimize sleep.
2. Stress management at bedtime – i.e., don’t read business emails for at least an hour before going to bed.
3. Exercise – Physical conditioning improves sleep, but don’t exercise late in the evening.
4. Expressive writing –  shortens the time it takes to fall asleep.
5. CBT-I –  Cognitive Behavioral Therapy Insomnia is documented to improve sleep. Online resources are readily available.
6. Over-the-counter sleep aids – I do not have specific recommendations. They may be helpful, but should not be used long-term. Alert your physicians if you are using them.

Under the guidance of a physician

1. Prescription Medications – Many stronger medications are effective for treating insomnia. I have observed that if you are suffering from chronic mental and/or physcial pain that you often need a kick-start with strong sleep meds. Once your nervous system quiets down you can and should come from them relatively soon. Using narcotics for sleep is not recommended and creates many additional problems.
2. Diagnosing a sleep disorder – there are over 100 sleep disorders with the most common one being sleep apnea. Sleep apnea is caused from your airway intermittently becoming partially occluded. Oxygen levels drop as you gasp for air. Sleep quality is poor, and daytime sleepness is one of the hallmarks of this disorder. More importantly, your heart is stressed and its function is progressively compromised. It is important to diagnose and treat it if there is any suspicion. Restless Leg Syndrome is another common sleep disorder that is treatable with the correct medications.

Recap

The other factors affect the reactivity of your nervous system, buy a consistently restful night’s sleep is necessary for healing. It must be not only be addressed, but at least partially solved as an early step. Most people improve their sleep with simple self-directed interventions, but you should not hesitate to seek help from your physician.

Questions and considerations

1. Assess your sleep.
   1. How many hours do you sleep per night?
   2. How often do you wake up?
   3. How long does it take for you to fall asleep?
   4. Do you feel rested in the morning?
   5. Do you fall asleep easily during waking hours?
2. Do you notice a difference in your physical and mental symptoms after several nights of restful sleep? What symptoms are worse with poor sleep?
3. From a practical perspective, how can you really enjoy your life if you are tired? Why pursue so many other treatments without covering this base?
4. Temporarily push away the other aspects of your situation and focus on sleep. It is a clear and measurable variable.
5. “I can’t sleep because of my pain.” You have to flip that idea around. Remember, it is lack of sleep that is causing so many problems.

References

1. Agmon M and Galit Armon. “Increased insomnia symptoms predict the onset of back pain among employed adults.” PLOS One (2014); 9: 1-7.
2. Zarrabian MM, et al. “Relationship between sleep, pain, and disability in patients with spinal pathology.” Archives of Physical Medicine and Rehabilitation (2014); 95:1504-1509.

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