• When you are suffering for any reason, you mind races, which makes it harder to think clearly.
• Doing battle with your thoughts or suppressing them makes it all worse.
• Simply placing your attention on a specific sensation for a short time separates you from your racing thoughts.
• Your body also calms down, your thinking brain functions better, you can better engage in learning, and live your life with more clarity.

 Dr. Daniel Wegner out of Harvard, wrote a paper in 1987 called, Paradoxical Effects of Thought Suppression.¹  He demonstratedthat the more you try not to think about something the more you will think about it. The paper has been nicknamed, “White Bears.” This not news to any of us. But he also demonstrated that there was a trampoline effect, in that you think about it a lot more. When you frame this discussion in terms neurological circuits and programming this phenomenon becomes a huge problem. Disruptive thoughts progress with age.

A basic tenet of many Eastern philosophies is that worrying about the future and thinking about the past causes internal unrest. There is anxiety around the future and many regrets and frustrations about the past. Staying in the present moment is key, but how do you accomplish it?

You cannot control your mind with your mind. When your mind is racing your body will be tense and tight. The harder you try to calm down your thoughts, the faster your brain will spin. Neurological circuits are deeply embedded, especially the unpleasant ones you instinctively fight.

Active meditation

As you cannot fix, repair, or outrun them, one option is shifting from them to more functional and enjoyable circuits. This is quickly accomplished by focusing your attention on a specific sensation from your immediate surroundings. Any sense works – sound, smell, taste, feel, pressure, and sight. My term for this tool is “active mediation.” It is an abbreviated version of mindfulness, and you focus on any sensation for a few seconds up to a minute. You have connected your consciousness to the present moment. The intention is incorporating this practice frequently into your daily routine until it becomes habitual.

Three steps from Eastern philosophy.

• Relaxation
• Stabilization
• Focusing on a sensation

I learned them in a workshop given by Alan Wallace, a prominent researcher in integrating Buddhist contemplative practices with Western science.

Active meditation in practice

I practiced this daily during my hectic days at work. I often did it with my patients in clinic, especially if I was running behind. We sat back in our chairs, let our shoulders sag, jaws relax, took a long deep breath, and slowly let it go. (Relaxation). We stayed relaxed for 5-10 seconds (stabilization), while I had them listen to the ventilation system. Then our attention shifted to voices outside the door, our feet on the floor, and back to the vent. It took about a minute.

Invariably, everyone felt more relaxed and I heard my voice change to a softer pitch. Our attention had shiftedoff of racing thoughts to the current moment through sensory awareness. I encouraged them to do this often until became automatic.

You can also do this much faster for just three to five seconds. Simply engage with any sensation for short periods as often as possible throughout the day. During surgery, I would engage with active meditation with essentially every move I made.  My “go to” sensation was grip pressure on my surgical instruments. There is more feel and control with light touch. Eventually, the sensation and moves I made become so automatic that I developed a “safe zone”, and it would have required a conscious choice to be unsafe. The consistency of my performance improved my enjoyment of the day as well.

Listening

Another rendition of this tool is listening; I mean really listening in a way that you can visualize the other person’s perspective and realizing that the words they are saying mean something different to them than they do to you. It is remarkably more interesting to hear other’s perspectives rather than replaying your own.

The past is the past

You cannot change the past or control the future, and neurological circuits are permanently embedded. Tryingharder to analyze and fix them stimulates and reinforces these patterns (neuroplasticity). Going to battle with them is deadly. Simply shift your attention to any immediate sensory input. That is it and it is that simple.

Homework

1. Begin using this strategy right now. Sit back in your chair and let yourself relax from your head to toe. As you do this, focus on different sensations.
2. Then do this for 5-10 seconds through the day. Just let your attention land on a sensation while you continue your activities.
3. Keep doing this daily and indefinitely. With repetition, you’ll do this automatically. It is an important foundational tool on which to rebuild your nervous system.
4. Small calming steps add up, body chemistry shifts from threat to safety, and your neocortex (thinking centers) function better.
5. You cannot control your thoughts, but you can separate from them and redirect your focus.

References

1. Wegener, D.M., et al. Paradoxical effects of thought suppression. Journal of Personality and Social Psychology (1987); 53: 5-13.

The post Active Meditation – a simple starting point first appeared on Back in Control.

The post Active Meditation – a simple starting point appeared first on Back in Control.

She was a healthy physically active rancher. Her low back pain started in the summer of 2005 after a lifting injury. The pain had become constant and was located throughout most of her back. She was still functioning at a fairly high level, in spite of the pain.

Her prior care

Jean’s care so far had consisted of six visits to physical therapy, and two sets of cortisone injections in her back, none of which had been helpful. She had not been prescribed a ongoing organized treatment plan. On her second visit to a spine surgeon, it was recommended that she undergo a eight-level fusion of her lower back from her 10^ththoracic vertebra to the pelvis. It is a six to eight-hour operation that carries significant risks.

Jean’s x-rays showed that she had a mild curvature of her lower back. Other imaging tests did not reveal any identifiable, structural source of pain. From my perspective as a scoliosis surgeon, I felt her spine was essentially normal for her age.

Instead, I felt that her pain was probably from the muscles and ligaments around the spine. The medical term that we use is myofascial. When an operation geared towards the bones, such a fusion, is done in the presence of mostly soft tissue pain, it rarely works. In addition to the risks, the entire lower back becomes a solid piece of metal and bone. This surgery should only be done if there are no other options. The procedure comes with long-term lifestyle limitations and she was still so active.

At this point, I was perplexed as to why surgery had been recommended when she had done so little rehabilitation. I also didn’t understand why she was continuing to experience such severe ongoing back pain without any obvious cause.

What was missing?

I consulted her spine intake questionnaire to look for clues.

It revealed that she’d had some marital difficulties and had just reconciled with her husband six months earlier. That immediately caught my attention because marital troubles usually indicate significant stress. She then said her job had become much more difficult. Although she worked for the same employer, they had forced her to switch duties without adequate training. She was worried about not only her performance, but also her ability to keep her job – another major problem.

I turned the page. A month before her pain began, her twenty-six-year old son had drowned. I knew that outside stressors played a role in chronic pain, but this factor had never been so powerfully demonstrated. Her case really brought home for me how crucial it was to take a full view of the patient’s life and circumstances, instead of just looking at surgical solutions.

As I sat there stunned, I realized that I needed to do something different. In fact, the whole medical profession needed to do something different. How could a surgeon have recommended a fusion without taking the time to get to know Jean and to hear her circumstances? I have always wondered if she went through with the surgery, but I never heard from her again.

From that moment, some form of structured rehabilitation became my focus with every patient, without exception. I have not taken my eyes off of that vision since that day.

The post My Call to Action first appeared on Back in Control.

The post My Call to Action appeared first on Back in Control.

Last week, I reviewed the films of a young girl who had been in a car accident and was suffering from chronic neck pain. Her attorney sent her to a spine surgeon, who wanted 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 know what will happen with her as I am only peripherally involved in her case. Nothing in our medical training 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 lost, 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.

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

Spine Surgery

Spine surgery is especially problematic because every procedure creates some degree of permanent damage to the spine. I have been on a 10-year search, but still have yet to find a paper that documents the effectiveness of a spine fusion for back pain compared to solid non-operative care. Yet, it is a multi-billion dollar a year source of revenue for health care systems, and spine surgery is often the service line that is the most profitable for the hospital. Procedures are aggressively marketed and surgeons are encouraged to perform interventions that don’t work. “Mainstream” medicine is currently pretending to practice medicine. In addition to the expense and risks involved, it has been shown in primate studies that an effective way to induce depression is to repeatedly dash hopes. (8)

“Breaking up is hard to do”

Breaking up with someone is a painful experience and often elicits strong emotions. Yet, it’s been shown that most people recover from a breakup much faster than they thought and eventually feel better. The opposite occurs when a parent breaks a promise. Almost all of us remember looking forward to going to a big event with our parent, and then having it cancelled at the last minute. Dashed hopes are painful, and the hurt feelings might persist. Repeated broken promises will eventually take a toll on the relationship. It’s better not to make a promise that you weren’t really intending to follow through on or had a low chance of pulling off.

Dashed hopes

I’ll never forget an elderly patient who I had been following during my first year of internal medicine training. We had been adjusting his medications for his lung problems, and he had been doing well. In mid-December he was admitted for respiratory failure. I was stunned and upset when he died 3 days later for no apparent reason. It turned out that his son had not invited him home for the traditional family gathering at Christmas.

Possibly, the most straight-forward orthopedic surgery we perform is a total hip or knee replacement. They usually work well, but not as predictably as you might think. If you’ve had a great outcome with your joint replacement, there is nothing like it and you can’t believe you waited to have it done. However, a significant percent of people have a sub-optimal outcome that includes ongoing pain, stiffness, fractures around the prosthesis, dislocations, loosening, infections, blood clots and death. If you weren’t prepared for these possibilities, then the situation is even worse when one of these problems occurs. No one thinks that they will be the one to have a complication. It needs to be clearly factored into any surgical decision-making.

Would you undergo a spine fusion for back pain if you knew the long-term success was less than 30% and there was a 15% chance of needing a second operation for a complication within the first year? (9) What about having your pain become significantly worse after a well-performed surgery?

What are your expectations?

I had a patient who I had spent several months working on his sleep, stress, medications, etc. before I did his surgery. He wasn’t really buying into any of this chronic pain stuff, and I was extremely clear that I was doing the operation only for his extreme bilateral leg pain. His nerves were pinched so tightly that I felt compelled to move forward without his full engagement in his own healing process. I thought we had a reasonable working relationship. The surgery went well, and he had complete relief of his severe leg pain. He came in for his routine follow up and verbally took my head off. I was excited about the outcome, but he was angry beyond words that his back still hurt. “You screwed me up.” He was livid. He didn’t remember the multiple times I had tried to set realistic expectations about the goals of surgery. I felt bad that I somehow wasn’t able to communicate the expected outcome to him.

Understand pain

Make no mistake about it. Pain is only pain when your brain tells you that a given stimulus is uncomfortable. Your range of responses may range from shifting a little bit in your chair to jumping up and running as fast as you can. Your pain system is elegant and allows you to act in a manner that keeps you safe. The same pain impulse might feel minimal on a day that you are engaged in meaningful activities or intolerable if you are already upset and not sleeping well. One paper demonstrated that just one night of sleep deprivation significantly lowered the pain threshold in volunteers. (10)

Dr. Lorimer Moseley is a leading neuroscientist from Australia who I have enjoyed getting to know. Not only is his work brilliant, he presents his findings in an understandable way. He is passionate about getting the basics of the neuroscience of pain into the public domain and founded the “Pain Revolution” in his country. His vision and commitment are remarkable. This video is an excellent overview of the nature of pain. He and I differ in one obvious way in that I make many attempts at humor, and he’s actually entertaining. You’ll enjoy his TEDx talk below.

Lorimer Moseley – Why Things Hurt

It doesn’t matter from where the pain originates. Most pain initially arises from the soft tissues, and it’s often severe because there are over a million pain receptors in each square inch of the soft tissues. Some of the worst and persistent pains I have experienced are from tennis elbow, achilles tendonitis and plantar fasciitis. Yet there isn’t a test that would identify the exact cause of the pain. The presence of a bone spur doesn’t necessarily mean it’s the source of pain. In fact, it has been clearly shown that disc degeneration, herniated discs, ruptured discs and spinal arthritis are NOT sources of neck, thoracic or low back pain.

There is a trend in medicine to focus on anatomy and treat pain from a perspective of finding the source and fixing it. It is a similar approach to taking your car into the shop for repairs. However, machines don’t have a nervous system. They are dead. There isn’t an interpretive pain function. It is well-documented that chronic pain is a “maladaptive neurological disorder” (11) and therefore wouldn’t be expected to be affected by most structurally-oriented procedures.

Phantom limb pain is one of the more dramatic illustrations of the neurological nature of chronic pain, and it occurs in over half of people undergoing amputations. The source of the pain is obvious with the affected limb being compromised by trauma or lack of a blood supply. There isn’t a more definitive surgery than completely removing the offending limb. Yet the pain may not change – at all. This can occur in any part of the body when the pain is present for more than 6 – 12 months. (12)

Setting expectations

I’ve learned that it’s critical to set concise expectations before making a shared decision about what to expect from a given procedure. I perform a lot of spine surgery for pinched nerves with corresponding arm or leg pain (radicular pain). I’m clear that spine surgery isn’t effective for neck, thoracic or low back pain (axial pain). There may be some relief for 12 to 18 months, but by two years from surgery, the pain in these areas is the same for most people. It is also important to communicate and understand why the surgery is being done. If axial pain is the main concern, then surgery should be avoided. If the surgery is for the arm or leg pain, many patients assume that the axial pain will disappear. It doesn’t, and if it does, count yourself fortunate.

Why am I writing this post? The bigger problem is the dashed hopes. If your expectation is that both your axial and radicular pain will be relieved, you’ll be upset when that doesn’t happen. And when you’re upset, your body’s level of stress chemicals will increase, and the pain can often become even worse. I used to think that relieving the radicular pain would make a person happy enough that it wouldn’t make much difference in the outcome. Wrong!! One my fellows succinctly pointed out that whatever pain that’s left is now 100% of the pain. It took me a couple of decades to figure this out.

Dashed hopes in any realm are a problem, especially with regards to your own health. It is becoming a bigger problem in that doctors are not being given the time to get to know their patients and establish effective lines of communication. If you don’t feel like you’re being heard, or you aren’t being given understandable explanations, then be persistent or move on to another surgeon. If a surgeon doesn’t like being challenged, then run. It’s his or her basic responsibility to communicate with you. Failed spine surgery is especially problematic in that the results can be catastrophic and destroy any semblance of an enjoyable life. Get it right the first time!

Do You Really Need Spine Surgery? by David Hanscom, MD

1. Veehof MM, OskamMJ, Schreurs KM, Bohlmeijer ET. Acceptance-based interventions for the treatment of chronic pain. Pain. 2011;152(3): 533-542.
2. Cherkin DC, et al. Effect of mindfulness-based stress reduction vs. cognitive behavioral therapy or usual care on back pain and functional limitations in adults with chronic low back pain. JAMA. 2016;315(12):1240-1249. doi:10.1001/jama.2016.2323
3. Baikie K, et al. “Emotional and physical health benefits of expressive writing.” Advances in Psychiatric Treatment (2005); 11: 338-346.
4. Baliki MN, et al. “Nociception, pain, negative moods and behavior selection.” Neuron (2015); 87: 474-490.
5. Hossain J, and CM Shapiro. “The Prevalence, Cost Implications, and Management of Sleep Disorders: An Overview.” Sleep and Breathing (2002); 6: 85-102.
6. Hanscom D, Brox I, Bunnage, R. Defining the role of cognitive behavioral therapy in treating chronic low back pain: an overview. Global Spine Jrn. (2015); http://dx.doi.org/10.1055/s-0035-1567836.
7. Peabody FW. The care of the patient. NEJM (1927); 88: 887-882.
8. Blum D. Love at Goon Park. Perseus Publishing, Cambridge, MA, 2002.
9. Franklin GM, et al. “Outcomes of lumbar fusion in Washington state workers’ compensation.” Spine (2994); 19: 1897–1903; discussion 1904
10. Krause AJ, et al. The pain of sleep loss: A brain characterization in humans.J. Neurosci 2019; 10.1523/JNEUROSCI.2408-18.2018
11. Baliki MN and A Vania Apkarian. “Nociception, pain, negative moods, and behavior selection.” Neuron (2015); 87: 474-491.
12. 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 Dashed Hopes first appeared on Back in Control.

The post Dashed Hopes appeared first on Back in Control.

My scoliosis surgery at age 14

This brilliant book (Back in Control) is a must read for anyone who lives with chronic pain, and for anyone whose life is affected by loving someone who has chronic pain.

I have lived with severe, chronic back pain, since a failed back surgery eighteen years ago. When I was 14 years-old I underwent surgery to correct scoliosis. Hardware was place in my thoracic spine (T6 to T12). Within a few short weeks following the surgery, I began experiencing an unusual amount of pain. My spine surgeon, Dr. A told me that the pain that I was experiencing was normal and that it would get better. The pain didn’t get better, in fact it got worse.

You’re a “chronic pain patient”

During the next eight months following my surgery, the pain became so intense that I couldn’t attend high school. Every time I returned to Dr. A to tell him how much pain I was in, he told me that the pain was not a function of the surgery; rather, I was a “chronic pain patient”. Operating under this assumption, I engaged in months of painful physical therapy, chiropractic treatments, and eventually I was referred to a chronic pain specialist, who put me on methadone to control my pain.

The spine surgery was infected

I eventually developed flu-like symptoms (vomiting, headaches, listlessness and high fevers) that didn’t remit. After eight months of dealing with ever worsening back pain, and repeatedly being dismissed by my surgeon, I went to a different spine surgeon for a second opinion. This surgeon was Dr. David Hanscom, and the year was 1995. Within a short time, he determined that it was likely that I had a staph infection in my spine. I was taken in for emergency surgery the next day to clear the infection. Dr. Hanscom was right, and so was I.

Fast forward to 2013… “The pain isn’t going away”

Just one week before my thirty-third birthday, I found myself unable to stand in an upright position – the muscles in my jaw, neck and back were in spasm; and I had a headache so severe that I felt nauseated. No amount of Ibuprofen, analgesic rub, or time laying on an icepack made a difference. I felt trapped and hopeless. Over the years, since my surgeries as an adolescent, I tried every alternative therapy known to man, and yet I still experienced pain on a daily basis. It finally hit me; my pain was not going to go away — it was getting worse. At the age of thirty-three, I felt like an eighty year-old woman. I thought that maybe another surgery would be my ticket out of the chronic pain hell that I had been living in for almost two decades. I had sworn to myself that I would never undergo another spine surgery, but I was at the end of my rope, and desperate for relief.

Stress?

Just before this pain flare-up, I had been dealing with a very difficult client at work. I could not control the trajectory of this issue, or the behaviors of my client; and coincidentally, my back pain was out of control. I had the sense that my back pain and stress with work were loosely connected. I was stressed with work, so it stood to reason that my muscles felt tense. I had no idea just how interconnected my back pain and stress levels actually were.

I have long thought that I had back pain because there was fundamentally something wrong with my spine. I have scoliosis, and had a corrective surgery that failed, and a traumatic experience post-op, with a spinal infection that went ignored, and could have killed me. I also experienced a great deal of anxiety since early childhood, and this anxiety increased in severity, as I got older.

Pain and anxiety are connected

Essentially, I deduced that I had two major issues in my life: back pain from a failed surgery, and anxiety and depression. What I know now is that these two issues are not independent of one another; rather they are one in the same.

It was by divine intervention that I learned about the work Dr. Hanscom is up to now. After visiting Dr. Hanscom’s website, I immediately ordered his book, Back In Control, and read it in two days. Once I finished his book, I signed up for the Hoffman Process, which is something you will learn about in his book. I then made an appointment with Dr. Hanscom, and was able to get in quickly because I was a patient of his eighteen years ago.

Hope

Back in Control blew me away, and it gave me a spark of hope. When I saw Dr. Hanscom in March of 2013, he told me that there was nothing wrong with my spine. Of course, I still had scoliosis, but my spine was solid. I was shocked to learn this! All of these years, I believed full-heartedly that my scoliosis and failed surgery was causing my pain; and for all of these years I was wrong. My pain was a function of pain pathways created by my central nervous system, post-surgery. Essentially, my pain was, practiced pain. This was a concept that was hard for me to grasp! But my faith and trust in the man who saved my life when I was young, helped keep me open to these new concepts.

Pain free!!

As I write this review, I have no back pain. This seems miraculous! The information provided in Back in Control, and my experience participating in the Hoffman Process, has radically changed my life in more ways than I could have ever imagined. I am so grateful!

Instead of my pain being constant, it comes in waves, and once I identify the pattern in my thinking that is the root of my pain, the pain goes away – completely. I used to have back pain 95% of the time, now I have back pain 15% of the time, and the numbers keep improving the longer I stay engaged in this work. Many days, I am pain-free. I don’t wake up with headaches anymore, I don’t grind my teeth at night, and I no longer take anxiety medication to get through my day. I simply don’t need it. I feel more alive than I can ever remember feeling, even pre-surgery. Many of the things that I have struggled with for years seemed to have vanished.

Be open to possibilities

My hope for you is that you read Back In Control, and consider going to the Hoffman Process. No one deserves to live in chronic pain. It tramples your quality of life, and negatively impacts the lives of those around you. Be open to the fact that the source of your pain is probably not what you think it is. We all deserve to be liberated in both mind and body. Living in pain is devastating and dehumanizing.

You are so much more than your physical pain, your psychological challenges, and your patterns.

The post Trapped for 18 Years from Scoliosis Surgery first appeared on Back in Control.

The post Trapped for 18 Years from Scoliosis Surgery appeared first on Back in Control.

Anger

Nonetheless, there are obstacles to becoming pain free. The absolute biggest block that I encountered daily was anger. I honestly didn’t know how to help a patient get past it. He or she becomes irrational. When you are chronically angry, it is your baseline, and you cannot even recognize that you are angry. I personally had no clue that I had any anger issues until I was 50 years old. In fact, one of the first lines to my wife when I first met her was that I was a “good catch” because  I had dealt with all of my anger issues. I am glad that neither of us had any idea that I had not even opened the door to my frustrations, as we never would have made it.

Noncompliant

The problem with anger is that you cannot listen and accurately assess a given situation. The conversation I have with a patient who is noncompliant goes like this. “Doctor, you mean to tell me that there is nothing wrong with my back? I have been in pain for several years and I know that this pain is not in my head. You must be missing something.”

I reply, “The pain you are experiencing is not imaginary pain, nor is it psychological. We know that if we did a functional MRI of your brain right now, the part of your brain that corresponds to your area of pain would light up brightly. All that matters is what is happening in your brain. We also know that the brain can fire spontaneously without an indentifiable source of the pain. I don’t just believe you have pain–I know you are experiencing pain and are frustrated about being trapped.”

I also explain to them that degenerated discs are normal as you age and that there is no correlation between a degenerated disc and back pain. The surgical success of a fusion for LBP is less than 30% with a significant downside of a failed surgery. They then say, “I don’t want surgery. I just want to be fixed and get my life back.” When I reply that we have had very consistent results following the steps outlined in this book, they explode saying, “I don’t want to read a book or anything like this. Just do something to fix my back.” They will then start ranting and often even yelling that no one will help them. Occasionally they will walk out of the room.

Anger is an absolute block to moving on

This is a frequent scenario. I would estimate that at least 50% of my patients fall somewhere in this part of the spectrum. They are noncompliant actually not by choice. I realize that chronic pain causes anger, but It is this anger that is also a complete block to engagement in effective treatment. Anger is destructive and it is multi-directional. It is particlurlarly self-destructive. You also have a strong sense of “being right” when you are angry and an even stronger sense of everyone else “being wrong.” I honestly do not know what to do to break this mind set.  I have tried everything from being confrontive to being incredibly patient. Nothing has worked. In fact, I have found that the longer I spend trying to convince someone to engage, the angrier they become. Angry people become upset when trying to be convinced to give it up. They just cannot hear me.

Address Your Anger

If you are angry or living in one of the above disguises of anger, be careful. You are trapped. You are truly stuck, and no one can even throw you a lifeline. What you cannot see is the havoc you are wreaking on those around you and onto yourself. I do not know how best to quell the anger rooted in chronic pain. I am open to suggestions.

The post Anger-The Absolute Block first appeared on Back in Control.

The post Anger-The Absolute Block appeared first on Back in Control.

Self esteem involves endless judgment of comparing yourself to others around you. I discuss the negative impact that this concept has on us.

For more, see The Myth of Self Esteem.

The post Video: The Myth of Self Esteem first appeared on Back in Control.

The post Video: The Myth of Self Esteem appeared first on Back in Control.

I talk about how the suppression of negative thoughts associated with chronic pain can really fire up the nervous system.  Dr. Daniel Wegner from Harvard published an elegant paper in 1987 demonstratng the impossibity of trying to suppress thoughts. I’ve talked about it before in White Bears and ANTS.

BF

The post Video 16/19: “White Bears” first appeared on Back in Control.

The post Video 16/19: “White Bears” appeared first on Back in Control.

I discuss how anger is the turbocharger that keeps anxiety both covered up and fired up. Until you turn off anger you won’t be able to get a handle on your anxiety or your pain.

The post Video 15/19: Anger Fueled Anxiety-“The Highway to Hell” first appeared on Back in Control.

The post Video 15/19: Anger Fueled Anxiety-“The Highway to Hell” appeared first on Back in Control.

Normally aging discs

As you age, the discs between your vertebrae lose water content and become stiffer. That is a normal part aging.  You lose flexibility. Over age 50 most people have degeneration of at least one disc. There is no evidence that supports the idea that a degenerated disc causes pain. (1)

At age 32, I underwent a disc excision for a ruptured disc followed by a second operation two weeks later for a deep wound infection. My three lowest discs are completely degenerated and collapsed. Other than an occasional muscle strain from my terrible golf swing, I do not experience back pain. I saw patients weekly with “terrible looking spines” and sciatica from pinched nerves. However, most of them had no back pain. The upshot is that most spine fusions for LBP are performed on normal spines for a given person’s age.  The results are poor. There is less than a 30% chance of long-term success. (2)

If there is an identifiable structural problem with a matching pattern of pain, the success rate of surgery is much higher. These are the only situations that I will perform surgery. An example would be a bone spur pinching the 5^th lumbar nerve root while there is pain down the side of the patient’s leg. In this case, there is a strong correlation between the structural description and the pain. This pattern of pain usually disappears after surgically removing the spur.

Mouth pain vs. a cavity

I frequently compare spine surgery with dentistry. Generally a dentist can specifically identify the structural problem causing your pain.  It might be a cavity that has gone down to the root.  The chance that your dentist can solve this problem with a filling, root canal, crown, etc. is essentially 100%.

What if you went to your dentist with “mouth pain,” but the source of the pain could not be identified?  This is also a common occurrence. The pain may emanate from the sinuses, be caused by TMJ, or can even be a “neurophysiological” symptom. What would be the chance of success if your dentist started doing procedures without seeing which tooth was the source of the pain? It would be almost zero.

Fusions for back pain

Currently there are hundreds of thousands of spine fusions being performed annually for “back pain.” Often, they are based on injections into the discs called discograms that have been shown to be unreliable. Or they are based on MRI’s showing “degenerative changes.” We know bone spurs, arthritis, and degenerated discs do not correlate well with back pain. Yet major structural bony interventions are being performed with the surgical world not being able to accurately diagnose the source of the pain. Many surgeons feel somewhat compelled to perform the surgery because it is the “last resort.”

Fusions not only are ineffective in relieving back pain, but the downside risk of complications and breakdown of the spine often creates serious problems. There is even a medical term called “Failed Back Syndrome”. What is not well-known is the extent of the destruction caused on these patients’ lives. I discuss this outcome in the appendix of my books, Back in Control and in Do You Really Need Spine Surgery? Take Control with a Spine Surgeon’s Advice. Many of these situations were catastrophic.

Surgery is not the “definitive” answer for lower back pain. It is usually the wrong answer!!!

1. Boden, SD et al. “Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects: A prospective investigation.” Journal of Bone and Joint Surgery(1990); 72: 403 – 8.
2. Carragee, EJ et al. “A Gold Standard Evaluation of the ‘Discogenic Pain’ Diag­nosis as Determined by Provocative Discography.”Spine(2006) 31: 2115 – 2123.

The post Back Pain vs. Mouth Pain first appeared on Back in Control.

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