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.

Dr. Fred Luskin, author of Forgive for Good, my wife Babs Yohai, a professional tap dancer, and I will hold a five-day workshop at the Omega Institute in Rhinebeck, NY. The course is structured around education, hope, forgiveness, and play. It is based on the concepts presented in Back in Control: A Spine Surgeon’s Roadmap Out of Chronic Pain and Dr. Luskin’s work out of Stanford on forgiveness. Babs role is a critical piece in that she engages the group in somatic experiences, which connects thoughts to physical sensations. The activities stimulate the shifting of neurological pathways with many changes occurring during the week.

Pain pathways are permanent

Most readers of this website already know that pain pathways are permanent and tightly intertwined with anxiety and anger circuits. It has also been shown that mental and physical pain are processed in a similar part of the brain. We consider and treat them in the same manner. As you cannot rid yourself of any of these patterns it is necessary to create alternative pathways. This can be done in several ways:

• Awareness, detachment, and reprogramming
  • Begins with connecting negative thoughts with physical sensations and then substituting appropriate alternatives
• Calming down the nervous system
• Play

Play pathways are also permanent. People in pain lose their sense of humor. Reconnecting with those enjoyable pathways is a powerful way of shifting out of pain circuits.

My wife

My wife is a professional tap dancer and accomplished in Balinese mask dancing. She has expertise in rhythm and movement. In 2013 I asked her to be one of the faculty, as these types of practices can quickly reconnect and create new neurological connections. She was somewhat apprehensive about her role but agreed to give it a try. She ended up having a major impact. She began with having us “scan” our bodies for tension and letting it go. Next she had us moving around the room with and without masks. Participants began to relax and interact with each other.

The Cup Song

Then she pulled out The Cup Song, which I had never heard of. It turns out that is it viral on the Internet and has been around since the 1930’s. It was popularized by the movie, Pitch Perfect, starring Anna Kendrick.

The Cup Song

We all sat around the table and struggled at various levels to learn this rhythm with cups. We all began to laugh and the energy of the room changed. We kept trying and laughed more.

The shift

There are many factors that went into the success of the workshop but within a day of “learning” this rhythm, the participants began to experience a significant decrease in their anxiety. By the end of the week five of eleven went to pain free with the rest experiencing various degrees of relief of both pain and anxiety. We are staying in touch and almost everyone is continuing to move forward.

My vision for the week was to present enough of the structured care concepts so that people could implement them at home. I was hoping that most would engage and experience a shift in pain and mood over three to six months. There was not any part of me that envisioned the entire group experiencing a major shift.

Connection

I will be writing about the Omega week in a fairly detailed manner and will learn more as the group gives each other feedback. There were clearly other factors such as videos of patient’s successes, structured conversations, buddies, education, and active meditation techniques. However the concept of “playful” is what transpired as the most powerful force.

I have repeatedly pointed out that the concepts of the DOCC project are not a formula. What heals people is connection – to each other and to him or herself. The best part of who you are is when you are at play. Ready to Blossom

The Cup Song or the gym?

One of the participants had been experiencing quite severe back and leg pain for about five years. He initial improvement was punctuated by the anticipated ups and downs over the months following the 2013 Omega experience. Here is one of his emails:

“Ah, the victim role, that is me seemingly all the time. All of David Burn’s (author of Feeling Good) cognitive distortions are helpful to recognize in myself, but victimhood is the reminder most useful for me. I fall into it so easily!

I had a bad evening with the lower back several days ago. Instead of my usual hour+ strengthening and stretching routine, I practiced The Cup Song for 45 minutes and most of the tension in my back went away. I’m starting to synch the lyrics with the percussion! I’ll need to go back to Omega for The Natural Singer In You to work on my tone and pitch!”

Enjoy your day today

Play is not often mentioned in the context of chronic pain. Could The Cup Song be a key to healing from chronic mental and physical pain?

The post Rewire Your Brain – Omega 2015 first appeared on Back in Control.

The post Rewire Your Brain – Omega 2015 appeared first on Back in Control.

The essence of curing chronic pain is connecting to your own body’s capacity to heal. When you are trapped by any circumstance, especially chronic pain, first your anxiety escalates and then you become angry. Your body is full of stress chemicals and you’ll experience many physical symptoms. Once or twice a year we hold a retreat for people that have been suffering from chronic mental or physical pain.The intention of the workshop is for you to experience a weekend of sharing enjoyable experiences in a structured safe environment and relax. Relaxing is challenging in the context of suffering.

The faculty includes my wife, Babs Yohai, who is a professional tap dancer and movement artist, and my daughter Jasmine Yohai, who is an expressive arts therapist. The weekend begins Friday evening and ends Sunday at noon. We spend Sunday afternoon relaxing by the lake with many of the participants. The core concepts of the workshop are:

• Awareness – It is important to understand the nature of chronic pain and your relationship to it.
• Hope – We enjoy sharing many success stories – and some will be returning.
• Forgiveness – Processing anger is the tipping point of  becoming pain free.
• Play – Relaxation and play are the essence of what Babs and Jaz bring to the weekend.

Jasmine

Jaz has an unusual background in that she graduated as a dance major, has a Masters in psychology, spent extra time learning expressive arts therapy and is currently working for a non-profit organization in Oakland, CA housing homeless people. She is relaxed, although she’ll tell you that she often doesn’t feel as relaxed as she appears.  She exudes concern and compassion and loves to be of service in whatever capacity she can. Her role is putting us through different shared exercises that are calming, and she is excellent.

Babs

When I first asked Babs to be a part of the workshop in 2013, I was becoming aware of the power of play in addressing the power of pain. Chronic pain is a result of memorized neurological circuits in your brain. The more you try to fight and fix them, the stronger they will become because you’re paying too much neurological attention to them. One approach is to create alternative circuits by stimulating new connections in your brain – neuroplasticity. Learn another language Another is to shift back on to your play circuits, which is a more rapid and powerful strategy. Although, that may seem like a forgotten word to you after so much suffering, it is one of the basic foundations of the development of human consciousness. Play exists deeply in all of us even if we can’t consciously connect to it.

In addition to tap dance, Babs is accomplished in Tango, Salsa and Balinese mask dancing. She has a lot of depth in rhythm and movement. I asked her to be one of the faculty, as these types of practices can quickly reconnect and create new neurological circuits. She was apprehensive about her role but agreed to give it a try.

I wasn’t asking her to teach us to dance. I was interested in re-connecting the mind with the body through music and movement. She began with a simple song combined with stepping and clapping. Then she introduced The Cup Song. She and Jaz led us in learning a new language of rhythm, causing a shift from pain to play circuits. We began to relax and laugh.

The Cup Song

A shift in pain

My original concept of the workshop was that I had five days to give an intensive course in teaching the DOC concepts, and then people would learn to implement them at home more quickly than when learning in the office setting. What happened was completely unexpected in that many people experienced a shift their mood and the pain would drop – sometimes dramatically during the workshop. I think it happened for a couple of reasons.

First, it is common, almost the rule, that people in pain become socially isolated, which is a terrible way to live. In fact, research shows that the pain of social rejection shares similar brain circuits to that of physical pain.  One of my goals was to create a structured environment where the participants could be with others in a safe place and share enjoyable experiences. What I eventually realized was that my main function was to create and maintain the structure, and that people heal each other. By connecting to others, you are able to find your way back to you.

Secondly, “neurons that fire together, wire together” is a common phrase among neuroscientists. Anger, anxiety and pain circuits are tightly intertwined, and stress usually fires up the pain circuits. Shifting to the play area of the brain unlinks them and pain drops.

Third, anxiety is an indicator of elevated levels of adrenaline, cortisol and histamines. You are on high alert and one of the results is that these hormones increase the speed of nerve conduction and you’ll feel more pain. The weekend gives you a chance to feel again what it is like when your system is full of chemicals that are elevated when you are at play.

Omega 2019 

The workshop is now three instead of five days and we were surprised to see that it was equally as effective. It feels like the participants are more focused and dive in quickly. Much of the work is done in small  groups of four or five.

It was at Omega that we learned about the deadly effects of people discussing their pain with their family, friends and colleagues. One basic ground rule is to never discuss your pain or medical care with anyone or complain. Your brain will develop wherever you place its attention. Research even shows that belonging to a pain support group or keeping a pain diary is counter-productive. You might as well place your hand right into a large hornet’s nest. You are reinforcing the pain circuits, not moving away from them. I didn’t realize how much time people in pain spent discussing it or endlessly searching for a solution. It is completely understandable.

Although, many mindfulness-based pain programs have impressive results, it is unusual to experience such a shift within a couple of days. What has happened is that the group has tasted freedom from pain. They now have the knowledge and tools to get back to that spot. With practice, a high percent of participants can break free of chronic pain and re-create their life.

The Cup Song or the gym?

Here is an email from one of the participants who has made steady progress over the year after Omega. He had been experiencing quite severe back and leg pain for about five years:

Ah, the victim role, that is me seemingly all the time. All of David Burn’s (author of “Feeling Good”) cognitive distortions are helpful to recognize in myself, but victimhood is the reminder most useful for me. I fall into it so easily!

I had a bad evening with the lower back several days ago. Instead of my usual hour+ strengthening and stretching routine, I practiced The Cup Song for 45 minutes, and most of the tension in my back went away. I’m starting to synch the lyrics with the percussion! I’ll need to go back to Omega for The Natural Singer In You to work on my tone and pitch!

At no point during my career would I have ever anticipated play being a major healing modality.

Enjoy your day today

The post “The Cup Song” first appeared on Back in Control.

The post “The Cup Song” appeared first on Back in Control.

The Midnight Call

About three weeks later, I woke up at midnight with extreme pain in the left side of my mouth. I had never experienced anything quite this severe, but I thought that I could wait until the next morning. I lasted about 45 minutes and then called my dentist. I wasn’t pleased with myself. Although I am happy to be available for my own patients, I really hate being woken up in the middle of the night. Now I was doing the same to another medical professional.

He was incredibly helpful and had me immediately meet him at his office. By 2:30, I was back in bed relieved of my pain after he drained a deep access. I honestly don’t know what I would have done if wasn’t so responsive.

The Same Ache

About four months later, the same pain came back with similar intensity. I was pretty unhappy, as it was early Sunday morning and I was going to have to bother my dentist again at an inopportune time. However, I also knew that I was upset at a situation that was out of my control, and the pain was not quite as bad as the first time. On a hunch, I sat down and re-engaged in some of my own writing tools that I incessantly teach my patients. The pain abated a little and I was able to get through the day. By the time I was going to call my dentist Monday morning, the pain had vanished. About six weeks later, the tooth pain recurred on a Tuesday morning. It again disappeared using DOC strategies. I happened to have a dental cleaning scheduled two days later. My teeth were fine.

Memorized circuits

I have noticed since my residency training days that when patients are under stress, areas of their body that have experienced prior pain will often flare up. Back then, my line would be, “If you had a prior rotator cuff tear treated successfully with shoulder surgery, there is a significant chance that some life circumstance will flare it up.” This was well before I had any idea about embedded pain circuits. When one  is triggered, it will be the familiar pain and often at the same intensity. There does not have to be a new injury. It also does not necessarily have to be linked to an obvious stress.

The post My Midnight Trip to the Dentist first appeared on Back in Control.

The post My Midnight Trip to the Dentist appeared first on Back in Control.

Associations

Riding a bike does represent a new level of freedom similar to learning to walk and drive. For most of us it becomes connected with an innumerable number of life experiences – both positive and unpleasant. Regardless of my thoughts about wanting or not wanting to ride a bike, the skill is a permanently embedded set of neurological circuits.

You can’t unlearn how to ride a bicycle. In fact, you can’t eliminate any of the past experiences from your brain. They just become more difficult to pull up over time. The past can be triggered by a word, comment, or image. Pain is a more intense set of pathways that become tightly connected to your life experiences. The current definition of chronic pain is “…….. it is an embedded memory that becomes associated with more and more life experiences and the memory can’t be erased.” (1)

Reprogram

So you are stuck with deeply ingrained pain patterns and the more attention you pay to them by trying to fix them just reinforces them. It is a miserable state of affairs. What are you going to do?

The key is utilizing the brain’s capacity to change. The descriptive term for this phenomenon is “neuroplasticity”. You can’t control your brain but you can direct it. You have a choice every second regarding what you want to put into your brain. The first step is is become aware of what is. Just awareness begins to create change. Then you create space, which can be accomplished with expressive writing or meditation. Then you’re able to re-direct.

This video, The backwards bicycle, illustrates another process of disrupting circuits by changing sensory input. It also illustrates the complexity of the unconscious brain. Many interactions have to happen simultaneously in order to ride a bicycle. You can’t force your brain to change but you can stimulate it.

1. Mansour AR, et al. Chronic pain: The role of learning and brain plasticity. Restorative Neurology and Neuroscience (2014); 32: 129-139.

The post Unlearning How to Ride Your Bicycle first appeared on Back in Control.

The post Unlearning How to Ride Your Bicycle appeared first on Back in Control.