Conscious vs. unconscious brain

Thoughts are protective mental links to the environment. They cause chemical responses in your body that create anxiety, which enables you to survive. (not thrive).  They are  automatic, unconscious and one million times more powerful than your conscious brain. That is also one of the reasons using rational means to solve problems arising from the unconscious brain is not very effective.

“Recent neurological research has demonstrated that the brain has the capacity of neuroplasticity, or the ability to create new nerve pathways in response to life events. For example, when you learn to play the piano or swing a golf club, your brain cells have developed a new pathway that is connected to your body. These pathways consist of millions of nerve cells.The more that pathway is activated or practiced, the stronger it becomes. What most doctors do not know is that pain can be caused by this type of learned pathways. Even when there’s no tissue damage in the body, such as a tumor, a fracture, or an infection,  a learned pathway can cause real, physical pain.” -Dr. Howard Schubiner-

• Take Dr. Schubiner’s test to see how many NPD symptoms you have. (He uses Mind Body Syndrome – MBS)
• Read “Unlearn Your Pain” by Dr. Howard Schubiner

DOC Principles Address NPD

The DOC model is a framework that organizes well-established spine care concepts. It allows you to organize your thinking and care to enable you to take full charge of your life.  Your providers are resources and coaches. The concepts are the polar opposite of what most of us have been taught regarding how to manage pain and stress.

• Learn the framework of the DOCproject.
• How does it apply to you?
• Use this website as an ongoing resource. It will be updated regularly.

My patients’ success is proportional to the degree of their commitment. I have observed a consistent improvement in my patients’ pain and quality of life. I am guessing that every person has at least three to five other NPD symptoms. I was experiencing 16 of the 33 symptoms during the worst part of my burnout. Most of these will also resolve.

Caring for my patients in chronic pain using the NPD approach has become the most rewarding and enjoyable aspect of my practice. This has been an unexpected development in this phase of my surgical career.

Anxiety, Anger, and Adrenaline

The post Neurophysiologic Disorder first appeared on Back in Control.

The post Neurophysiologic Disorder appeared first on Back in Control.

The source: Three Sources of Chronic Pain

• Possible structural problem
• Inflammation of soft tissues
• Neurophysiological Disorder – “short circuits”

The receptor—your brain

Three additional variables affect your perception of pain:

• Sensitization
• Memorization
• The “Modifiers” –1) anxiety 2) anger 3) sleep

Chronic pain is a complex problem and even more so, as each person is unique. It won’t respond to isolated simplistic treatments. The approach that is successful in solving pain is similar to that of fighting a forest fire.

“I Can Only Fix What I Can See”

These concepts apply to pain in any part of the body regardless of the source. I will discuss low back pain as one example. The exact source of your LBP is usually unclear.  Many assume if you are pursuing a diagnosis with your doctor then there must be an indentifiable problem that is solvable with surgery. Surgery is felt to be the “definitive” solution.

• It is only definitive if you can see the problem.
• Even then the potential benefits must outweigh the risks.
• I often compare spine surgery to dentistry. (Back Pain vs. Mouth Pain)

A high percent of spine surgery should never be performed.

• What many surgeons are defining as “structural” is simply normal aging anatomy.
• Degenerative disc disease is not a disease.
• All intervertebral discs lose water content with age.
• They have been shown not to be the source of your chronic LBP.
• A fusion for a degenerated disc has a success rate of < 30%.

Video: “Get it Right the First Time”

Surgical Results Overly Optimistic

Marsha’s Three Needless Spine Surgeries

The post Understand Chronic Pain first appeared on Back in Control.

The post Understand Chronic Pain appeared first on Back in Control.

Perception versus reality

But our minds are tricky. We are continuously scanning the environment for danger. Your brain is your own personal brain scanner, always looking for danger. Basic issues are oversimplified and threats are magnified. In spite of the mass shootings we actually live in the safest era in history. One of my friends sent me this article pointing out the sharp decline in violent deaths since 1980. Human history is essentially one of violence and power. The vast majority of police officers are remarkable role models and frequently perform acts of heroism. Just walking out the door in a uniform, knowing that he or she could be a sniper target from 200 yards is an act of courage. Massive decline in gun violence

However, the media visually dramatizes stories and focuses on the negative aspects. Every violent act is captured in detail on smart phones. We are helpless to enact common sense social changes due to major political and corporate interests blocking the efforts. This feeds into a collective state of anxiety regardless of how safe we really are and also our tendency to blame others. We have more material possessions and comforts than any society in the history of the world. Shouldn’t that calm us down? What is the problem? Why are we so angry and reactive? The DOC starting point 

It’s anxiety. The root cause of our societal angst is relentless anxiety, which is the driver of anger. Unfortunately, the medical profession treats anxiety as a psychological problem when it is really the body’s chemical response to unpleasant sensory input. It is a universal physiological reaction that enables living creatures to survive on this planet. Here is how it goes.

The neurophysiological basis for emotional and physical pain

Your unconscious brain processes 20 million bits of sensory input every second. Each sensation, sound, touch, taste, smell, vision has to be interpreted by your brain as pleasant, neutral or unpleasant. It continuously interprets the sum total of this input and directs your organs to secrete hormones that are relaxing and enjoyable (dopamine, GABA, oxytocin), or signal danger (adrenaline and cortisol). When you feel anxious or afraid you are experiencing the surge of these chemicals in your body.

Any stress, real or perceived, signals danger and your reaction will always be this survival response. The effects of adrenaline and cortisol include sweating, rapid breathing, shortness of breath, hyper-attentiveness, tightness in your stomach, urinary frequency, and a rapid heart rate. Anxiety, anger and adrenaline

The curse of consciousness

The curse of the human experience is that thoughts are also sensory input that cause the same chemical reactions as a physical threat and are competing for sensory attention. The problem with thoughts compared to the other senses is that you cannot escape them. You will consciously or unconsciously act in a manner to avoid unpleasant physical sensory input. Although you can try to suppress or mask disturbing thoughts, they will keep coming at you and will become progressively more intense with repetition. It is also a problem that is made worse by the fact that our lifespans are now about 30 years longer than in the early 1900’s.

Every human faces this problem. If you come from a difficult background or are trying to meet unrealistic expectations, physical symptoms and illness will begin earlier. If you have a great upbringing you may make it through your entire life without too much trouble. I had a rough beginning but thought I had figured it out until I began having panic attacks and extreme anxiety in my mid-30’s. I achieved my “success” through extreme suppression of my thoughts and did not have any sense of anxiety or anger. My body (brain) knew better.

Since you cannot escape your thoughts, you’ll be under a greater or lesser degree of constant chemical assault. Your progressive anxiety may become disruptive. I was in this state for over 15 years, with the last seven of them being intolerable. My battle with NPD Even in the presence of physical pain, most of my patients tell me that they can deal with the physical pain better than the constant worrying and anxiety. Am I operating on your pain or anxiety? What does all of this have to do with the current societal angst and ongoing violence? Anxiety and anger are the same entity.

Anger = anxiety with a chemical kick

Anger occurs when you have lost control. When you do not have the ability to alter an anxiety-producing situation, your body will secrete even more adrenaline in an attempt regain control. Anger is anxiety with a chemical kick. Anger = loss of control

With the correct diagnosis and treatment approach, relentless anxiety is eminently treatable with remarkably simple strategies. It involves:

• Stimulating the formation of new neurological pathways.
• Shifting onto more functional and enjoyable brain circuits.
• Decreasing the adrenaline rush by training yourself to chill out in presence of stress.

Anxiety is a public health issue

These are easily learned skills that should be part of the basic learning curriculum in elementary school. With the added stresses of over-population, etc. it is rapidly becoming a skill that needs to be learned by every one of us quickly and especially by the medical profession, who society has entrusted with its healing. Societal disintegration – untreated anxiety

This conceptual framework is the basis of the second edition of my updated book. We are not going to solve any of this planet’s problems until we address the root problem of sustained anxiety and anger as a major public health issue using the correct therapeutic approach.

The DOC starting point 

Listen to the Back in Control Radio podcast Neurophysiological Basis of Pain

The post Neurophysiological Basis of Pain first appeared on Back in Control.

The post Neurophysiological Basis of Pain appeared first on Back in Control.

Trying not to think about something will cause you to think about it more. All of us know this phenomenon but we don’t know how to deal with it. The deadliest emotion we suppress is anxiety. It is a survival response and our whole being is repulsed by it. Prolonged exposure to raw anxiety is the worst part of the human existence. It is a universal problem that few people want to admit to much less discuss.

Nate

A few weeks ago, I was discussing the problem with one of my best friends, George. He has an 11-year-old son, Nate, who is personable, athletic, good-looking, and has many friends. He has a wonderful family life. George has engaged his family with many of the principles of dealing with Neurophysiologic Disorder. (NPD) One of the exercises is the writing down of his  thoughts and throwing them away. Recently he suggested that Nate draw a picture of himself with these thoughts.

He showed me the drawing. It was brutal. “I am ugly. I have no friends. No one likes me. I am stupid.” The list went on for 15 thoughts that were equally as negative. How could this be? He is living a childhood that remarkably rich and supportive. It reinforced to me that every human being struggles with disruptive thoughts.

Harvard study – white bears

In 1987 Dr. Daniel Wegner, a Harvard psychologist published a paper, The Paradoxical Effects of Thought Suppression. (1) The experiment is commonly referred to as “White Bears”. He asked a group of students not to think about white bears. He designed it in a way that demonstrated that when you try not to think about something, not only do you think about it more; you think about it a lot more. He used the term, “trampoline effect.” He pointed out in an essay; The Seed of our Own Undoing, that simply writing down or saying the thoughts you are suppressing interrupts the phenomenon.

“ANTS”

David Burns in his book, Feeling Good (2) uses a term he calls “ANTS”, which stands for “automatic negative thoughts”.  These ANTS are a universal part of the human experience. Since I picked up his book in 1990, I have always wondered why we don’t have “APTS” or “automatic positive thoughts.”  WE DON’T SUPPRESS POSITVE THOUGHTS.

Pain, ANTS, and white bears

People suffering from chronic pain lose their sense of humor. Pain causes anxiety and when you are it, extreme frustration and anger will run your life. Anger results from loss of control. What causes the need for control is anxiety. Anger is just anxiety on steroids. One step worse than suppressing anxiety is suppressing anger. The eventual outcome is rage. My term for the darkness that consumes my patients in pain (and historically me) is the “Abyss.”

There is a solution

I have learned that pain, anxiety, and anger are classic symptoms of the Neurophysiologic Disorder (NPD). Dr. John Sarno first described it in the 1980’s under the term, “Tension Myositis Syndrome” (TMS).  (3) There are least 30 other MBS symptoms connected to and caused by the nervous system. (4) The nervous system component is NOT psychological it is a programming issue. Like any learned skill such as riding a bicycle these pathways are permanent.

Anxiety is a physiological reaction to sensory input of any kind including thoughts. It results in behavior that causes you to react in a way to protect yourself. You can talk about it all day long, but you cannot get rid of anxiety whether it is from a  mental or physical source. It is a symptom of NPD.

Fortunately your conscious brain focuses on one thing at a time. That is why we are not safe texting and driving. When your mind is here it is not there. By creating alternate pathways around your fixed circuits, you can shift your nervous system into a new set of pathways. Additionally, we now know your brain can grow new nerve cells at any age. The term is “neuroplasticity.” At a certain tipping point your pain pathways will become dormant. The switches are turned off. Anxiety and anger also will dramatically drop.

I experienced 17 of the 33 symptoms of NPD disappear. I not only have my life back, but I also have a new life.

Connecting thoughts with physical sensations is one way of creating new pathways. One foundation of treating NPD is the simple the act of writing down your thoughts and immediately throwing them away.

Patients won’t write

But I often cannot persuade my patients to begin this exercise. It’s the necessary foundational step of the reprogramming process, which is to create an awareness of these ANTS. The thoughts can be positive or negative. I have my tear them up both to write with freedom and not to spend any time analyzing them. This exercise is only a separation process from your conscious thoughts.

Regarding the negative thoughts that arise, my patient’s first response is, “This is not who I am.” That is correct. These thoughts are not who you are. They are JUST neurological connections and the opposite of you who are. Otherwise, you would not be suppressing them. You are only giving them life by blocking them. Your brain will develop wherever you place your attention.

We all know that being reassured that our hidden thoughts aren’t valid does not make them disappear. I could collect dozens of signatures and testimonials from Nate’s peers and give them to him. He could win a “greatest human being contest” along with a big trophy. How would that work? I predict, based on my personal experience with NPD, the next set of thoughts would be centered on, “They don’t really know me.”

Possibilities

What if we could teach these simple writing exercises to our children in pre-school? We would have a shot at solving chronic pain at a societal level.

References

1. Wegener, D.M., et al. “Paradoxical effects of thought suppression.” Journal of Personality and Social Psychology (1987); 53: 5-13.
2. Burns, David. Feeling Good. Avon Books, Harper Collins, New York, NY, 1999.
3. Sarno, John.Mind Over Back Pain. Berkley, 1999
4. Schubiner, Howard.Unlearn Your Pain. Mind Body Publishing, 2010.

The post Inability to Escape from Our Thoughts first appeared on Back in Control.

The post Inability to Escape from Our Thoughts appeared first on Back in Control.

I tried everything to get rid of these things. I would shave them down with a razor, which I did several times a week. I tried multiple medications. I had them frozen off, but they always re-appeared. Through college and medical school, it was ongoing battle. They gradually seemed to get larger and more numerous regardless of my efforts. I became more self-conscious of them as I progressed through my medical training. I felt very awkward examining patients with what felt like were pretty disfigured hands. Of course, no one noticed them nearly as much as I did.

Orthopedic Residency

My first year of orthopedic training was stressful. I had done two years of internal medicine residency instead of the usual two years of general surgery. I was thrown right into the fire trying to catch up with the other residents. I honestly don’t know if stress was the issue, but my hands were worse with four or five large warts. I went to a skin specialist who used liquid nitrogen to burn them off. Not only was the initial burning very painful it continued burn for a couple weeks. It felt like an underground fire. I could not sleep well with the pain and I was getting increasingly frustrated. A friend gave me the name an older dermatologist who supposedly had experienced success with difficult skin problems.

My elderly dermatologist

He was nice and also really old. He looked at me and said that he didn’t think that there was much that could be done. He suggested that I rub some fresh aloe vera plant over them and that might help. I looked at him in disbelief and was now pretty despondent about ever getting rid of these things. As he handed me a couple of aloe vera stems he proceeded to say that, “I don’t really think it works. It is just probably some type of placebo effect.” At that point I become really upset. Even if the placebo effect was possible it seemed like he was even taking that option from me.

 “I’m done”

I remember standing there and I felt a profound shift deep inside of me. I recalled the recent suffering I had experienced after the last attempt of burning them off. The feeling was intense. I could almost re-experience the pain. I was “done” and simply wasn’t going to put up with it anymore. My whole being said, “No!!!”

I rubbed the aloe vera stems over my hands a couple of times and tossed them. Two weeks later the warts completely disappeared and six weeks later my skin looked as if they were never there. I have never experienced another wart in over 30 years. Clearly some type of immune response occurred. I don’t know what precipitated the healing response, but I could feel it and still can recall almost exactly what it felt like.

 “I’m done” – round two

The only other time I experienced that feeling was in 2002 after being stuck in a severe burnout. One of the worst parts of being depressed was feeling sorry for myself. It was endless and manifested itself in endless conversations and racing thoughts. Somehow, I became aware for the first that I was actually in a victim mode. I realized that there was no answer to being in the victim role. It was too powerful. I experienced the same deep feeling of mixed desperation and determination that I was no longer going to live this way. I was simply done. Within the next few months I began to heal. Many of my physical symptoms I had suffered with since childhood disappeared and over the next year essentially all of them resolved.

My Battle with Neurophysiological Disorder (NPD)

Also “done”

Janet had been suffering from chronic pain for years and seen by several dozen doctors. By the time she saw me, she was ready for surgery – except there was no surgical lesion that I could address. When I told her that her spine looked fine, she flipped out and began to yell at me about the whole medical profession and then some. I briefly told her about my book and website and asked her to return in a couple of weeks to discuss her options. I honestly thought I would never see her again. Much to my surprise, she not only returned, she was free of pain (and remained that way). She related a similar story to mine in that she was fed up and just going to move on without the help of doctors. She also described a deep shift that she couldn’t put into words.

Another story

I recently received this email from a reader.

Dear Dr. Hanscom,

“I was just told by a neurosurgeon today that the only way to stop my back and hopefully nerve pain in leg is surgery. I have a herniated disc at L5-S1 and he thinks it’s cartilage that is pressing on my S1 nerve. Anyway, I came back to my hotel and started googling and found your backincontrol.com site.  I really connected with it as I have started a mindfulness-based stress reduction course 2 weeks ago and am feeling some benefits already.

But what really connected me was your story on warts. When I was a young teen I also had warts on my hands. Tried the freezing and burning by physicians, but they always came back and sometimes more. One of my mom’s friends told me to steal a neighbors dishcloth and bury it in the garden, as for some reason it has worked.  I thought she was nuts!  I contemplated doing it but just couldn’t steal from my neighbors or anyone for that matter. But it got me thinking why that might work; it was using your mind. So, I started something where every night at bed I would visualize the warts going away and I have to say that I still remember the intense feeling I got in my body – something I have never again experienced.  I don’t even remember how long it took but my warts went away and never came back.

I now am trying that for my back, but not getting quite the same feeling this time. Reading your info on your Website had me motivated to try again as I really don’t want surgery if I don’t have to. I am going to follow your steps as well and already let my family know that there will be no talk about my pain.  If it works I will let you know.” Best regards, Janet

The formula??

I wish I could give you a formula to re-create the phenomenon at will. In both instances there was a deep sense of resolve that I was finished living in this manner and I said “no”. What I can’t figure out is why that feeling suddenly went so deep and was so strong. It was well beyond just willpower.

We know that the placebo response is the most powerful “drug” in existence. (1) You are simply connecting to your capacity to heal. It is the desired response. Somehow the perception of it has been distorted to be that there must not be anything really wrong if the body responds to a placebo. Every drug has a placebo effect and we also know that the bigger the intervention the greater the response. For example, and injection is stronger than a pill and surgery is even more powerful. The response tends to decrease with time. The problem is that you don’t want to incur harm while eliciting this response and unfortunately that is what often happens with spine surgery. Major adult deformity operations have a complication rate well over 50% and many of them are serious and permanent.

It has also been documented that you don’t have to “believe” placebo works to be effective. A powerful healing effect has been demonstrated even when patients are aware there are no active ingredients in the pill being administered. (2)

I have known for a while that DOC process presents creates structure and clarity for a given patient’s situation so he or she can take charge of his or her own care. There is not one answer to a complex chronic pain scenario and this is not a “how to” program. Freedom occurs when you’re able to calm down your nervous system enough to connect to your own healing powers. Each successful person has a different journey. You’re the only one with the key to unlock the door and move forward.

1. Dispenza J. You are the Placebo: Making Your Mind Matter. Hay House, 2015
2. Carvalho C, et al. Open-label placebo treatment in chronic low back pain: a randomized controlled trial. Pain (2016); 0: 1-7.

The post Healing Power Within—Warts first appeared on Back in Control.

The post Healing Power Within—Warts appeared first on Back in Control.