• There is deep basic science research that has revealed the nature of chronic pain and this understanding will allow you to discover your version of a solution. The essence of the problem is sustained exposure to threat and the core of the solution lies in finding safety.
• Create safety by learning skills to:
  • Stimulate neuroplasticity – create and shift to new neurological circuits in your brain.
  • Learn to regulate your body’s neurochemical response to threats (stresses).
• As you learn about chronic pain, it is helpful to simply get started using some of these core tools to “jump start” the healing process.
  • Expressive writing
  • Active meditation
  • Restful sleep
  • No discussing your pain or medical care with others – especially your family

Many years ago, I would spend hours explaining chronic pain to my patients in the office but it was too complicated and it wore me out. That is when I decided to write, Back in Control. Patients would have a better understanding but there was no action. The website, www.backincontrol.com was the action plan and evolved into a self-directed process that allowed hundreds of people to break free from their chronic pain. The DOC Journey is the next rendition of the program. But the healing process begins when you begin to use methods that stimulate your brain to change. During the last few years of my practice I would ask patients to simply begin to learn and use the basic tools as quickly as possible and the rest of the concepts would fall into place. This is the first lesson of The DOC Journey.

 The nature of chronic pain (mental and physical) – sustained threat vs. safety

The essence of chronic illness, including chronic pain, is your body’s reaction to sustained stress because it responds with profound elevations of stress hormones, metabolic activity (rate of fuel consumption), and inflammatory markers (destroys invaders and your own tissues). The result is many different disruptive mental and physical symptoms.

The solution lies in learning the tools to create sense of safety, which normalizes your body’s survival fight or flight reaction. Successfully implementing these strategies causes a shift your mood, pain, and other physical symptoms. I am suggesting to dive in and begin using some of these basic foundational strategies right away. Why wait?

Creating Safety

Neuroplasticity is a term that describes your brain’s capacity to change its structure. You can form new connections, grow cells, increase the insulation around the nerves (myelin), and shift from unpleasant to pleasant circuits. Your brain physically changes in shape and structure based on programming.

As you learn strategies to regulate your body’s responses to stress, you have regained control, which creates safety. There are many ways to accomplish this and with repetition the process becomes automatic. It is like an athlete or musician attaining a high-level of skill. It cannot be done by just reading a book.

Let’s begin with these core strategies – Now

• Begin expressive writing. It is the one mandatory step to start. People can improve without doing it, but I have rarely seen people go pain free without engaging in this exercise. It has been documented in over a thousand research papers to be effective in creating significant shifts in multiple organ systems. (1)
• Practice active meditation. This involves placing your attention on a physical sensation for five to ten seconds as often as you can remember. You are switching to neutral or pleasant sensory input which causes less of a reaction in your nervous system. It requires minimal time and effort.
• Adequate sleep is critical. Lack of sleep has been shown to cause chronic pain. (2) With a multi-pronged approach, restful sleep can usually be achieved within 4-6 weeks. Medications may be needed for a few months.
• Never discuss your pain or medical situation with anyone except your medical providers. The solution for chronic pain lies in rewiring your brain around your memorized pain circuits. Your nervous will develop and evolve wherever you place your attention.

Why should this program work?

An important early step is to acknowledge and embrace your skepticism. Why should this DOC Journey work? You have been bounced around, promised relief time and time again, undergone failed interventions, and your pain is worse than ever. There is not any reason to think that this is going to work. I agree. In fact, primate research has shown that you can induce a major depression by repeatedly dashing hope. (3)

Every treatment offered in this program has been well-documented by decades of deep medical research; implement what is already known. I have watched well over 1500 patients break free from chronic pain and not only regain their life but thrive at a level they had never experienced at any point in their lives. It happened by them learning and using this DOC Journey sequence that evolved from my experience coming out of severe chronic pain and discovering what was effective with my patients.

What is not helpful is “believing” in the DOC Journey or David Hanscom, using positive thinking, or affirmations. It is about connecting with your current reality, which is unpleasant enough for you to sign up for this Journey. You are rightfully angry, frustrated, and trapped. It is the starting point. Feeling and knowing where you are at allows you to learn the strategies that allow you change direction. One successful patient commented what you need is a, “suspension of disbelief.”

Anything is possible

The DOC Journey begins with acknowledging doubt, learning awareness, and allowing hope to re-enter. Research has shown that hope and optimism are anti-inflammatory. (4) There is a lot of hope in hearing about other’s successes. I am increasingly convinced you can stimulate your brain to rewire around almost any pain regardless of the source.

I got another reminder when a patient who I never personally treated resolved his pain largely through The DOC Journey approach. He is now in his late 60’s and had experienced severe pain for over 22 years. He lost his marriage and business, ended up addicted to high-dose narcotics and attempted suicide. During this period, he underwent 28 surgeries. He has not only been free from pain for over five years, but he is enthusiastic that he has not felt this good since he was 30 years old. Historically, I would never have thought that this was possible in light of the severity of his trauma.

Please acknowledge your disbelief, embrace it, start with using these basic tools, and you’ll learn as you go. Helping patients emerge from The Abyss of chronic pain has been the most rewarding phase of my career. I am continually inspired by the resiliency of the human spirit and I am honored to be a part of your journey.

Recap of Lesson one – “Let’s Start Now”

Healing your pain requires repetition of tools that simulate your brain to change (neuroplasticity) and calm down your body’s survival response. The sooner you can engage with these strategies, the quicker you can begin to heal. That is why you might as well begin to use them ASAP. You will learn more about the nature of chronic pain and the principles behind solving it in a logical stepwise sequence throughout the rest of the course.

The next lesson will expand on the concept of threat vs safety and then more detailed explanations of these basic tools will be presented as you progress through leg one.

References:

1. Pennebaker JW and JM Smyth. Opening Up by Writing It Down. The Guilford Press, New York, NY, 2016.
2. Agmon M and G Armon. Increased insomnia symptoms predict pain among employed adults. PLoS One (2014);9:e103591. doi:10.1371/journal.pone.0103591
3. Blum D. Love at Goon Park. Perseus Books, New York, NY, 2002.
4. Dantzer R, et al. Resilience and immunity. Brain Behav Immun (2018);74:28-42. doi:10.1016/j.bbi.2018.08.010

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The sequence of becoming angry is:

• Circumstance or person who has wronged you (real or perceived)
• Blame
• Victim
• Anger

There are many ways to forgive, but anger is so powerful that no one ever wants to let it go. Becoming aware of your unwillingness to move on is the first and most critical step. Being a victim is a strong role, and it helps you feel safe, whether you are or not. You are never going to wake up one day and feel that you want to give it up. You must keep making an ongoing choice to forgive.

 

The first step is becoming aware you are in a victim role. There are many disguises. Unfortunately, the hyper-vigilant neurochemical state manifested by anger, shuts down the rational frontal cortex.. Anger, which is part of the process, also blocks access to being open to treatment and healing.

Then you have to decide whether you want to remain in this role. There is no magic. It is a simple intellectual choice of, “I don’t want to continue being a victim.”

Methods of forgiveness

Then there are many ways of accomplishing forgiveness. Most of this I have learned from Dr. Fred Luskin, who is a friend of mine and author of Forgive for Good. (1) Some suggestions include:

•  Understand how detrimental it is to hold on to the past and not live in the present. Dr. Luskin calls this scenario “renting too much space in your mind.”
•  Just “let go.” Is this person or situation worth disrupting your day and peace of mind?
•  Reframe the situation. Make a choice not to view yourself as a victim and look at challenges as opportunities.
• Cultivate awareness—just being aware of your anger will dissolve it. Especially when you realize that it exists only within you.
•  Identify your grievance stories—Dr. Luskin also makes the observation that if you tell the same story more than three times where you are the victim, you have a “grievance story.”
  • This is particularly relevant when suffering from chronic pain when it really was someone else’s fault. How long do you want that person or employer to run your life? They are not worth your time.
• The unenforceable rules—There are many situations and people in life that you wish would be different, but you have no control or say. It is fine to want a better scenario, but when that wish turns into a mental demand, it is problematic. Spending time being upset about things you have no control over is a complete waste of time.
• Have compassion—I mention this gingerly because this step is difficult and not mandatory to move on. However, if you can develop deep compassion for someone who has wronged you, your life will change, and you really will be free. Most people, including me, can’t achieve this without professional help.
• This is particularly relevant when suffering from chronic pain when it really was someone else’s fault. How long do you want that person or employer to run your life? They are not worth your time.

Anxiety and anger

Remember that anxiety is simply a physiological response to a threat and is the sensation generated by elevated stress hormones. When the situation resolves, your body will return to its baseline chemical balance, and you’ll move on. When you can’t escape the stressor (pain), then you’ll secrete even more stress chemicals in an effort to regain control. That is anger. It is an even more powerful irrational survival reaction that is not subject to control. It is turbocharged anxiety.

Anger traps you when you hold on to the story of the wrong. You can’t change the situation, but you do have a choice to let it go through whatever forgiveness method that you can connect too. I will never forget Dr. Luskin’s comment at a workshop where he pointed out the insanity of holding onto your childhood trauma. Few of us had perfect childhoods, and many of us had horrendous ones. His point was that it was fine to blame your parents for your problems until you were 18. But then it was time to admit that you were now the one in charge of continuing to destroy your own life.

 

 

The key to dealing with anxiety and anger is using specific methods to lower these hormones, and it is not just an intellectual exercise. Processing anger is truly the tipping point of solving chronic pain and ushering in a new life that you may have never experienced even prior to the onset of your pain. Learning to forgive is your biggest opportunity to thrive and create a circle of joy in your sphere of influence—especially within your family.

References

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

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Suppressing

The most common way of dealing with anxiety and anger is to suppress it. It has been documented that when you try not to think about something, you’ll think about it more – a lot more. There is a trampoline effect. (1) Although you might be successful in consciously suppressing thoughts for a while, your body will be full of stress hormones. The consequences of suppressing thoughts are high, but stuffing emotions is even more of a problem – especially anger. Many people don’t like feeling angry, so they don’t allow it. One method I used was attaching to an identity of “being cool under pressure”. It worked and I was able to become a complex spine surgeon with the mindset of, “bring it on.” Then this approach failed and in one hour in 1990, I went from being bulletproof to having panic attacks. I didn’t see it coming.

I now understand how skilled I was in suppressing and disguising anxiety and anger. But the same energy that took me up the hill took me down the other side. Anxiety and anger are necessary for survival and you can’t get rid of these emotions. The key to dealing with them is to learn to experience them and train yourself not to react with such strong responses. As your body’s levels of survival chemicals lessen, your anger and anxiety will pass and you can move on. Initially, this is a challenging skill to learn, but it will change your life and your pain. Here is a poem that was sent to me that illustrates the concept.

THE FIRE OF ANGER

Anger is not wrong.
Anger is not unspiritual.
Anger is not against life.

Anger is like fire.
You respect the fire, you tend it, allow it to burn.
No need to smother the fire or put it out now.
No need to push the fire onto someone else.
The fire is safe, when you let it burn.

Anger is energy, neither good nor bad.
Breathe into it.
Let its fiery sensations move in the body; in the head, neck, chest and belly.
Feel the power there.

See how anger calls you to remember your dignity, your worth, find your voice, speak your truth, protect those who cannot protect themselves.
To smother the fire would be to smother the fire’s intelligence.

Anger brings gifts that sorrow cannot.

Find a middle way. Not repressing anger’s fire, nor throwing it.
But feeling it.
Bowing to it.
Knowing its beauty.

Until it burns out.

Jeff Foster

Anger is destructive

I still don’t like the way I am or how I feel when I’m upset. I now realize that anger is only destructive, since it’s the body’s response to regain control. It is damaging to all relationships, especially within your own family. It’s ironic and tragic that our closest relationships represent our deepest and strongest triggers. Instead of home being a place of safety and peace, it’s often chaotic and unsafe.

When I’m angry, I want to lash out and I still have a tendency to suppress it. Then a situation may occur that is quite mild, and my reaction is WAY out of proportion to it. A mantra came into my head a few months ago that’s been helpful.

“No action in a reaction.”

I realize that there is nothing I can say or do when I am upset that’s helpful, and I just zip it. I fail more often that I’d like to admit, but I’m gradually improving.

How do I look?

Another strategy that has helped is to picture how I appear to others when I’m frustrated. I’m sure it isn’t great although I can’t see it. My wife and I have a saying, “Anger isn’t attractive.” It’s true and this is a humbling exercise.

Remember, that in addition to training your body to be less full of stress chemicals, you can learn to stimulate “play chemicals” such as oxytocin (the love drug), serotonin (anti-depressant), dopamine (reward system) and GABA hormones (similar to Valium). It’s a learned skill that isn’t possible while you are doing battle with those around you. But picture your body full of these hormones. How do you feel when you are laughing? What’s it like when you are on the couch relaxing with your family or friends? Have you done that lately?

Learn to be with your anger, anxiety and pain. As you quit fighting, paradoxically you’ll be able to move on and stimulate a pleasant chemical environment in your body, regardless of your circumstances. Then you can create the life that you want.

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

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It’s the sensation created by elevated levels of stress chemicals.

• Adrenaline – increases sensitivity and alertness
• Cortisol – mobilizes energy stores/ inflammation
• Histamines – immune system/ inflammation
• Endorphins – modulates the stress response

Anxiety is an automatic survival response. The unconscious brain is estimated to process 11 millions bits of input per second whereas the conscious brain deals with 40 per second. It is a huge mismatch. That is why it’s not subject to rational psychological interventions alone.

Decreasing your body’s level of stress hormones causes anxiety to drop.

There are two ways of accomplishing this:

• Relaxation strategies
  • Mindfulness, meditation, “active meditation”, forgiveness, play, medical hypnosis, biofeedback and many more.
• Stimulating the brain to change (neuroplasticity), so there is less reactivity to stress.
  • Learning to “be with your pain”.
  • Not discussing it with anyone.
  • Expressive writing
  • Moving forward with your life with or without your pain.
  • “An enjoyable life”

There are two more critical concepts:

Since anxiety is a unpleasant deeply seated core survival reaction, you’ll do almost anything to avoid it. Essentially, anxiety is the pain. The basic intent of it is to cause you to act in a manner to diminish a threat (control) and move on.  When you can’t escape a mental (thoughts) or physical threat, your body will secret more stress hormones to increase your chances of survival. The sensation generated is anger. Anger is anxiety with a chemical kick. It’s even less subject to rational interventions.

Not only are there strategies to decrease the stress hormones, there are powerful ways, to stimulate increased levels of relaxation (play) chemicals, such as:

• Oxytocin – bonding, the “love” drug
• Dopamine – reward
• Serotonin – mood elevator
• GABA hormones (the body’s equivalent of Valium).

This dramatically different chemical environment generates a deep sense of well-being.

Your capacity to enjoy your life depends on your skills in minimizing your levels of stress hormones and stimulating your “play” chemicals. Modern neuroscience has documented why “Laughter is the best medicine”.

Explanation of anxiety: Converstion with David Elaimy

Wake the fun up

Listen to the Back in Control Radio podcast Anxiety Basics.

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Awareness

You cannot successfully address any problem without understanding its root cause. But many people in pain stubbornly insist that, “The problem is that I am in pain,” and leave the solution to their health professionals. Unfortunately, the neuroscience research has not worked its way into mainstream care and they don’t understand the problem either. A recent paper that reviewed hundreds of studies stated that “chronic pain is a maladaptive neuropathological disease state.” (1,2,3) You cannot successfully solve a neurological problem with interventions aimed at structural issues. It is just not possible. This approach can’t and doesn’t work. That is why over 1 in 3 American adults are suffering from some level of chronic pain.

The body processes both emotional pain and physical pain by responding with stress hormones? Both kinds of pain are successfully treatable using similar strategies? Given a choice most of my patients would like to eliminate their emotional over their physical pain. Paradoxically, as the emotional pain drops, so does the physical pain. It doesn’t work the other way around.

My friend, Fred Luskin, author of Forgive for Good, pointed out that the human body is designed for survival, not necessarily for quality of life. All stress–real or imagined–is perceived as a threat and triggers your body to secrete adrenaline and cortisol. If you are under constant stress you may not even notice it, but your body will continue to secrete these chemicals that keep you in a continual “fight or flight” mode. You may be so used to being in this state, that it seems normal. The first step in healing is to become aware of your state of mind, life outlook and the effect they have on your body’s chemical balance. You have to understand your current state of being before you can change direction.

Hope

Hope is a critical component for thriving and living a meaningful life.

The observation and experience of core group of physicians and some other health care professionals is that of chronic pain is solvable. However, most physicians view it as a diagnosis to be managed. They simply haven’t been trained in utilizing an effective approach. They are almost as frustrated as their patients because they went into medicine to help people. Most of my patients have been to many providers and undergone multiple treatments without success. Additionally, since no one has provided them a plan should the treatment fail, there does not seem to be any way out.  They feel trapped. The indescribable anger and frustration really crank up their stress chemical output, which increases the pain. How many times can you experience that kind of disappointment and still keep moving forward?

Dr. Viktor Frankl, author of Man’s Search for Meaning, was an Austrian psychiatrist who survived the WWII concentration camps. In his book, Dr. Frankl described how the worst part of the ordeal was not the indescribable physical suffering, but not knowing when if and when it was going to end.

Every week I see huge smiles on the faces of patients who are now pain free after years, sometimes decades, of pain. They cannot express their feeling in words, and I feel privileged that I have been able to provide a framework for them to pull themselves out of the hole. It began with awareness and hope.

Forgiveness

You will not heal while you hold on to anger, no matter how justified your anger might be. In fact, the more legitimate your anger, the harder it is to let it go. How can you move forward while hanging on tightly to the past? There are many resources out there to help you process your anger, and Stage 2 of this website is a solid starting point. The method does not matter as long as it enables you to truly let go. Remember, that to stimulate your brain to develop new pain-free pathways you have to move forward with or without your pain. I highly recommend Dr. Luskin’s book, Forgive for Good. When it entered the DOC program, I began to see many more patients free themselves from their pain. I consider acknowledging and processing anger the “Continental Divide” of chronic pain.

Several studies have shown that the vast majority of people in chronic pain still blame the person or situation that caused their injury. Interestingly, the person they blame the most is themselves. (4) When patients tell me they are not angry I often will ask them how critical they are of themselves. The most important person to let off of the hook is you. Knowing how anger obstructs healing and creates more pain, why do you insist on holding on to it? Is it really worth it?

Pain free after suffering for decades

Iris became pain free after decades of severe chronic pain. She had been on high-dose narcotics and using a walker. Now she is off her meds and walking unassisted.  She wrote me, “The book you have written has saved my life. It is so much more than a book on back pain; it is back in control of my sanity, my depression, my self-worth, and my caring. I had no idea that anger was behind my anxiety and depression.” I have never met her but was able to talk to her a few months later. The key to her healing was awareness and letting go.

Play

Anger and play could not be farther apart. Anger disconnects us from others, from ourselves and from life; while sharing play is the essence of life.

Play is an essential aspect of child development. It is how we learn to constructively interact with others. Play areas of the brain are powerful and permanent circuits present in every human being; but they can get buried in the hubbub of daily life and the distraction of chronic pain. They’re present even in someone who did not develop an overabundance of them in childhood. But although play exists in all of us, they must be nurtured by making conscious choices to play. You do not need to continue to live your life in anger.

About ten years ago, I made a conscious decision to re-inhabit my play pathways when I chose to enjoy my day regardless of the circumstances. I am not always successful; but I committed to re-engaging with these circuits as quickly as possible when I wandered off course. Eventually, the labels “work” and “play” have merged into one. Play for me is curiosity, gratitude, awareness, letting go and simply deciding to enjoy and appreciate what I am doing at the moment.

Three of the principle methods for eliminating chronic pain are: 1) “de-adrenalizing” the nervous system, which slows the speed of nerve conduction and decreases the level of pain; 2) building new circuits that circumvent the embedded pain ones; and 3) shifting to new and more functional areas of my brain.  Play does all of this.

Omega Workshop

I didn’t realize how powerful play pathways were until a five-day workshop I facilitated at the Omega Institute in Rhinebeck, New York. Fred Luskin worked with us during the forgiveness portion, and my wife and daughter helped us play together. Feeling safe and relaxed, we began to laugh. Many attendees went pain free within five days and have remained that way. Even I did not expect such a powerful outcome. The Cup Song

My book presents a robust framework to help you organize your thinking about pain. Using awareness, hope, forgiveness and play will allow you to discover your own way out. Give it a go. Those of us physicians who use some version of this approach feel strongly that the majority of our patients will significantly improve or free themselves from the grip of pain.

1. Davis KD and M Moayedi. “Central mechanisms of pain revealed through functional and structural MRI.” Journal of Neuroimmune Pharmacology (2013); 8: 518–534.

2. Baliki MN and A Vania Apkarian. “Nociception, pain, negative moods, and behavior selection.” Neuron (2015); 87: 474-491.

3. Tracey I and MC Bushnell. “How neuroimaging studies have challenged us to rethink: Is chronic pain a disease?” The Journal of Pain (2009); 10, 1113–1120.

4. Eccleston C, et al. “Patients’ and professionals’ understandings of the causes of chronic pain: blame, responsibility and identity protection.” Social Science & Medicine (1997); 45: 699–709.

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REACTIVE

CREATIVE

If you can “C” first, your life will change.

Don’t take action while you’re in a reaction.

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