• Learning any new material or skill is an active process than can only be acquired through repetition. There are few people with a photographic memory and even they need repetition to embed a skill.
• Living your life in the manner you wish requires many different skills, and most of us are not taught them at any point in our learning experience.
• To have a good life, you must live a good life and also learn to efficiently process adversity.
• The Talent Code presents the concepts of how genius is created and illustrates the process with many interesting examples.
• Chronic pain evolves from repetition of specific sensory input and your brain becomes excellent at feeling pain. It requires the same process to create an alternate set of more pleasant circuits.

I have recommended an educational and entertaining book, The Talent Code,¹ to illustrate how new information assimilated by our brains. The author compiled knowledge from experts and explains how genius is formed. It is rarely an inherent trait. Although, the neuroscience is outdated, the concepts of how learning occurs are correct. There are three parts to creating genius.

• Deep learning
• Master coaching
• Ignition (obsessive repetition)

Deep learning involves reprocessing new information in your mind in a retrievable way. This is critical to use in any advanced learning. For example, one my medical school classmates would read through his pages of notes only once. But he would look at a page and not go to the next one until he could say it back to himself or write most of it down. He was number three in my class. This is in contrast to another college buddy of mine who would read for hours and hours and not retain the material.

In medical school, I would memorize for 20 min and lay down and nap for 10 minutes and keep repeating the cycle over and over again. I would also “rearrange” the material on my own “internal mental grid” that I would construct as I gathered new information.

By using deep learning, you can increase your capacity to learn by 500-600%. That is not an exaggeration. Sometimes in medical school, we would come home with 75 – 100 pages of notes to learn in a day. You cannot passively process this information and be successful at mastering it. Conversely, the author points out that random repetitions decrease your learning by 15-20% and you are wasting a lot of time.¹

Master coaching is critical in that you want to practice specific tools and techniques in a precise manner. You have heard the phrase that, “practice makes perfect.” What if you are practicing the wrong techniques or the right ones in an incorrect manner. You’ll embed bad habits. Often, it takes an outside observer to pick up the small details and keep your repetitions in a narrow constructive range. It is perfect practice that makes perfect.

The DOC Journey is largely self-directed but if you can engage a coach to keep you on track, it will hasten the process. It is difficult to see your own behaviors. Additionally, you must experience a huge shift in your thinking from “fixing” to “letting go and moving forward.” In other words, you are learning a new set of skills while using an old approach. Even when you think you “have it”, you may still unconsciously be trying to fix yourself.

Coaching is also helpful for support. It is common to become socially isolated and human contact is healing.

Ignition refers to being excited enough about what you are doing that you begin to do endless repetitions. Again, it has to be in a narrow range, but the more the better. Consider something that you have become skilled at, whether it is your work, a hobby, music, art, or play. Nothing changed until you consistently practiced. What is commonly called “muscle memory” is really neurological memory from circuits etched into your brain.

As you  become more engaged and excited about your new life, you’ll instinctively increase your repetitions. However, early on, you just have to do it to get over the hump. When you are in pain, it is difficult to get excited about anything. The DOC Journey will not solve your pain. It is providing tools and approaches for you to learn and master in order to navigate your life more competently and at first you may have to “grind it out.”

You are already a “genius” at feeling pain

Unfortunately, the development of chronic mental and physical pain fits the criteria for creating genius. The impulses are “deep learning” in that you predictably react to them, and as you try to cope with them, you are reinforcing them.

You don’t need a master coach in that the impulses are already in such a narrow range and usually predictably affected by specific factors.

The ignition or obsessive repetitions goes without saying as the pain signals are rapid and relentless – especially with obsessive thought patterns that quickly become memorized. The current definition of chronic pain is that “……it is an embedded memory that becomes connected with more and more life experiences and the memory can’t be erased.”² You are not going to change the trajectory of this complex problem with simplistic random interventions. You must use the same programming principles to become a genius at feeling pleasure.

Recap

It is critical to conceptualize your pain and response to it in terms of programmed circuits. Using re-programming tools, you can create “detours” around them or shift onto circuits that do not include pain. It appears that you can reprogram around almost any pain in any part of your body regardless of the length of time it has been there. The brain’s capacity to adapt is remarkable.

It takes tens of thousands of swings for a major league baseball player to be able to hit a baseball coming at him over 90 mph. There is also a huge variation in speed and trajectory. I think it is one of the most incredible feats in the human experience. With chronic pain – mental or physical, you’ll receive a lifetime of “baseball swings” in a matter of weeks. We do know that chronic pain can be memorized in a matter of six to twelve months.³

Additionally, since pain circuits are linked to anxiety/ anger ones, any situation that fires up your frustrations will fire up pain and of course pain will fire up the anxiety/ anger circuits. The good news is that all of this can calm down with the same set of approaches.

Become a genius at running your life and take back control.

Questions and considerations

1. Consider a skill you acquired at any point in your life. The degree of expertise was proportional to your time spent on it. Consider navigating your life as a learned skill.
2. There are many components to living a successful and enjoyable life. Each one needs to be considered in relation to the big picture.
3. We have discussed the importance of creating a vision of what you want your life to look like. What set of unique skills to you need to acquire to get there?
4. You have already spent an endless number of hours pursuing a cure for your pain. Why not get focused and solve it with a fraction of the time and effort?
5. How committed are you to creating deep change versus holding onto your old life?

References:

1. Coyle, Dan. The Talent Code. Random House, New York, NY, 2009.
2. Mansour AR, et al. Chronic pain: The role of learning and brain plasticity. Restorative neurology and neuroscience (2014); 32:129-139. doi: 10.3233.RNN-139003
3. Hashmi JA, et al. Shape shifting pain: chronification of back pain shifts brain representation from nociceptive to emotional circuits. Brain (2013); 136: 2751–2768.

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• Most of us intellectually understand that the only moment we have in life is this very one. That is it.
• Being in medicine for over 40 years has shown me the incredible unpredictability of life. Life changes in second – sudden heart attack, bad car accident, diagnosis of terminal cancer, and the list is endless.
• But our minds play tricks on us by constantly worrying about the future and hanging onto regrets from the past.
• This problem arises from our unconscious mind that is protecting us. It is continually scanning the present looking for situations from the past that were perceived or were actually dangerous.
• So, your actions today are a result of your cumulative perceptions of what is safe – or not.
• You can’t control this response but by using tools to stay connected to the moment, its impact is lessened.

Commitment to change is one thing but sticking with it is challenging. One way to help yourself along is to bite off small bits at a time and proactively make the choices all day long. It will become a habit and your norm. A starting point is repeatedly asking yourself a simple question, “Who do I choose to be today?”

A tough start to my day

One morning I woke up feeling low, having just completed eight straight 15-hour workdays, including a long weekend. As I lay there exhausted on a Tuesday morning, I reviewed my choices: either 1) stay in bed feeling sorry for myself; or 2) give thanks for the opportunity to help so many patients during the week, be grateful for how well the week went, and meet my work-out group early at the gym. I chose the second alternative. I got up, worked out, went into the office, and gave 100% to each patient and my staff. I’m not saying it was easy; but it turned out to be a great day.

Proactively choosing how to experience your day is the farthest thing from “positive thinking.” No one is asking you to pretend to be happy when you are coping with a difficult situation, especially your ongoing pain. On the contrary, you must be aware of the depth of your frustration before you can choose to live a full and productive life with or without pain – or decide to enjo. Positive substitution—filling your life with positive experiences— is the essence of neurological reprogramming.

A Tough Beginning

Recently, I was talking to a friend’s teenage son. This kid was good-looking, athletic, and personable; yet he felt isolated, insecure, anxious, and emotionally unstable. He continually compared himself to others and tried to fit in. He was also justifiably upset about his family situation. His father, who was extremely critical of him, had essentially abandoned him by moving out of the country. I  understood where he was coming from, since his experience was not much different from mine at his age.

About halfway through our conversation I realized that he too, had a choice. I pointed out that, after years of stress, he had remained remarkably intact. He could choose to be proud of his resilience in the face of adversity and use this gift to take on new challenges. I could see his eyes light up.

Some suggestions

FOMO (Fear of Missing Out) seems to be rampant in this modern era. Maybe it is because we are overwhelmed with options? What we are missing out on is enjoying our day. It is a deeply embedded thinking pattern that doesn’t resolve over time. It requires specific approaches.

You can’t “solve” FOMO. By trying not to be this way, you’ll actually reinforce these circuits. The answer lies in cultivating connection, meaning, and purpose. Trying to be “happy” actually doesn’t work due to the “ironic effect.”¹

• Nurture deep gratitude for you have. It may not be as much as you want but focus on it.
• Compare your situation to those who are less well off than you. It may not seem possible in light of your pain but start somewhere.²
• Become aware of how frantic you get about your “to do” list and how endless it is. It is endless for all of us.
• Then don’t put ANYTHING on your list that you are not going to do TODAY.
• Frequently practice active meditation or breath work to calm yourself. It is one tool that connects you to the moment you are in.
• Listen to some of your favorite music – especially if it is connected to enjoyable experiences from the past.
• What is one thing you can do today that brings you pleasure? – a cup of coffee  your favorite donut; a call to a close friend; a compliment to a family member or friend; anything. There is an endless of list of small deeds that can change your day.

Recap – Your choice

What do you want out of your life? Is it more than being a sufferer enduring pain? Do you really want to live your one life this way? Of course not, you may be thinking. But trust me. It is unlikely that you will magically wake up one morning and find your troubles gone. Focusing on solutions is an ongoing conscious choice because your powerful unconscious brain automatically gravitates towards the problems. There are no shortcuts.

So, who do you want to be today? Choose carefully because you will either be reinforcing old neurological circuits or creating new ones. What is your choice this year, this month, today, the next 15 minutes, or this minute? Carve a few minutes out every morning to ask yourself that question, ponder your options, and commit to whatever choice you make.

Questions and considerations

1. The impact of chronic pain on your life has been documented to be that of having terminal cancer – except worse.³ So, first of all, honor your own suffering and give yourself a break.
2. Depending on the severity of your suffering, you may not feel like nurturing a better life, even for a few minutes. This is one point in your journey that you must begin somewhere, and the next 10 minutes is the place.
3. Then you have to keep repeating it, whether you feel like it or not.
4. Even when you are feeling better (and it will happen with practice), you’ll still gravitate towards the negative because that is what your powerful unconsciousness brain is supposed to do – protect you from danger.
5. To have a good life, you have to live a good life. It is just the way your nervous system works.

References

1. Wegner DM. The seed of our undoing. Psychological Science Agenda (1999); Jan/Feb:10-11.
2. Dalai Lama. The Art of Happiness. Penguin Random House. New York, NY, 1998.
3. Fredheim OM, Kaasa S, Fayers P, Saltnes T, Jordhøy M, Bortchgrevink PC. Chronic non-malignant pain patients report as poor health-related quality of life as palliative cancer patients. Acta Anaesthesiol Scand (2008); 52:143-148. 

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• All of our actions this minute are determined by all of your past experiences up to this very second. Each of us has a unique perspective on life.
• Awareness involves seeing past your own personal biases and seeing the world more as it actually is.
• You cannot change anything until you know where you are starting from.
• You must allow yourself to feel your mental as well as physical pain before you can reprogram in new circuits.
• Without awareness, healing is impossible.

 Awareness is a necessary step on your journey to health, as what you’re not aware of can and will control you. If you’re unaware of the impact of your circumstances/ stresses on your body’s neurochemical response, you will be ruled by feelings that you have no idea of where they are coming from.

 Additionally, how can you solve a problem in any realm if you don’t understand the relevant aspects of it; especially if the problem is complex? Consider the complexity of building a skyscraper or launching a spaceship. There are endless details that have to not only be addressed but mastered. None are unimportant.

When the Challenger space shuttle exploded in 1986, killing the seven crew members, it was discovered that a small “O-ring” leak was the root cause of the explosion. What is disturbing was that there was knowledge of the potential problem from the beginning in 1971 that was repeatedly covered up. So, the people making the final decisions were not fully aware of it as the signal was given to launch the spacecraft. However, the complexity of the Challenger launch pales when compared to the intricacy of the human organism.

The human body

There are about 30 trillion cells in the human body and 80 billion brain cells. Each neuron is connected to 10,000 other neurons. This central control system maintains a precise balance of the body’s chemistry, organ function, acid base balance, metabolism, blood flow, temperature, heart rate, and this list is almost infinite. Every bodily function is balanced by opposing input  that maintains these delicate reactions. The baseline state is called, “homeostasis.”

You, through various sensors, are in constant contact with the external and internal environment to monitor and control your responses in order to survive, regenerate, and thrive. Pain is just one of the many sources of sensory input. You cannot interpret or treat a patient’s symptoms (reactions to the environment) without understanding the world they live in and also their coping capacity.

But one step deeper is the need for the patient to become fully aware of all the factors that are affecting his or her’s bodily functions. The only person than can really figure this out is you. The way you process the world around you is based on your unique early childhood programming. It is the “filter” by which you interpret sensory input – whether it is physical or mental. If you were raised in a chaotic family without feeling nurtured and safe, you have been programmed to view the world from a hypervigilant perspective. So, your baseline existence is on “high alert.” This creates a chronically defensive neurochemical state in your body and the data shows the people become ill with serious diseases and don’t live as long.¹

Defining Awareness

Awareness is seeing the world as it actually is – not just through your interpretation of it. Pure awareness is essentially impossible in the human experience; we all look at life through our pre-programmed perceptions of reality that starts to develop at birth. But the closer we can come to pure awareness, the more functional we can be as human beings.

Awareness is the key to developing meaningful relationships; in a one-on-one encounter, the greater your capacity to see a situation through the other person’s eyes, the greater chance of developing intimacy. As important awareness is seeing the effects of your behaviors on others. Intellectually, we understand the importance of awareness, and yet most of us continue to struggle with gaining true awareness. Why is that? Consider the following:

• Anxiety clouds awareness, but we are often not aware of our anxiety until it becomes disruptive.
• Awareness and anger cannot co-exist. When you are angry, the blood supply is shifted from the neocortex (thinking centers of your brain) to the lower survival centers. By definition, it is not possible to accurately assess all the variables of a situation and come up with a creative solution.
• We all know that nothing really is accomplished in a heated argument. Anger is destructive.
• This situation is worse when you are trapped by chronic mental or physical pain. The most challenging aspect of healing is breaking through this barrier and nurturing awareness.

Becoming Aware

There are several types of awareness that are necessary to learn for you to solve your chronic mental and physical pain.

• Understanding the nature of chronic pain. It is a neurochemical problem that is rarely amenable to structural interventions such as injections and surgery.
• Becoming aware of the principles underlying the solutions. They are centered around rewiring around the unpleasant (and permanent) circuits in your brain and also learning how to lower your body’s inflammatory response to threat.
• Awareness of how your environment is affecting your sense of well-being. For example, if you are in an abusive relationship, no medical interventions will counteract your body’s need to survive. The root cause must be addressed, and every situation is different
• What was your home life like during the first 12 years of your life? Was it loving, supportive, and nurturing or chaotic? It sets the stage for how your brain develops the rest of your life.

Awareness – the foundation for stimulating neuroplasticity

 Using techniques and approaches that stimulate your brain to physically change structure is a core concept in solving chronic pain. All of our basic survival skills are memorized and are automatic. For example, you don’t think about which muscle to fire next when you walk or talk. How about learning an athletic or artistic skill? The same holds true for unpleasant experiences, such as disruptive thought patterns or pain. Just like riding a bicycle, they are permanently embedded in your nervous system. In order to reroute or create new and more enjoyable circuits, you have to be aware of what is already there. If you are continually doing battle with an unknown opponent, how effective are your efforts going to be?

Also, these survival circuits are hardwired in and not responsive to rational interventions. We spend a lifetime trying to solve or outrun these survival sensations, yet you might as well be talking to the engine of your car. The only approach (and it is effective) is reprogramming them with awareness and repetition.

So, one basic aspect of solving pain, is to allow yourself to feel it. You might say, “I am already in pain and feel terrible.” But what is usually happening is that we are suppressing emotional pain, which is processed in a similar area of the brain. If you don’t allow yourself to feel emotional pain (being vulnerable) then you will experience physical symptoms. There is no place to run.

The basic steps of stimulating neuroplasticity are:

• Awareness
• Separation
• Reprogramming

You have to feel to heal.

Chronic pain is resolvable once you become aware of its nature, your reactions to it, the relevant variables that affect your perception of it, and learning your set of tools to drop it down and reprogram your nervous system.

Recap

You cannot solve any problem unless you understand it in detail. Chronic pain is a complex problem, and each person has a unique experience. Being aware of all of the factors that affect your pain is critical. You also cannot move forward until you understand where you are at right now.

Every living creature has to be continually aware of its circumstances to ensure survival. Humans have another layer added in the form of language and consciousness. To enjoy rich and fulfilling relationships requires being aware of another’s needs as well as your own. When you are trapped in pain, awareness cannot exist as the blood supply shifts away from the thinking centers of your brain to the lower survival centers. You attention is only on you.

Breaking through this barrier to awareness is a challenge, but once it occurs, life becomes an abundance of opportunities instead of an endless barrage of challenges.

Questions and considerations

1. Many people are so used to being in a survival mode that they are not aware of the possibility of living a great life. Could this be you?
2. Even though you might be miserable, somehow the idea of change is more threatening, and you may not try anything. How badly do you want to heal? Many people when confronted with that question, actually do not want to change.
3. Pain and anger are addicting. They feel powerful and no one wants to give it up. Understanding this scenario is important.
4. Awareness requires you to feel the pain and stop fighting it. Then healing can occur.
5. It is easy to be aware of other’s “flaws.” Are you able to see your own?

References  

1. Keller A, et al. Does the perception that stress affects health matter? The association with health and mortality. Health Psychol (2012); 31:677-684. doi:10.1037/a0026743

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For some, the holidays are synonymous with a strong sense of familial closeness and love. However, this is not the case with many family gatherings, where relatives trigger each other, and chaos quickly ensues. If this describes your experience with the holidays, then this article is for you.

I’ll never forget one Christmas break during my second year in medical school. I hadn’t been home for two years because of study and work demands. I was excited to see my family. Within five minutes, my mother launched into a fight that had started two years earlier. She picked it up almost to the sentence. I was both dumbfounded and upset. This wasn’t part of my vacation plans.

This isn’t an uncommon occurrence.  You’ve waited all year to be with those who you love, and people aren’t getting along. It goes both ways in that loneliness is also magnified. The medical wards are usually full because many patients have increased problems around drugs and alcohol. It doesn’t make sense, except it does if you understand the mismatch between the conscious and unconscious brain and the nature of triggers. So what happens?  Happy holidays – not

Triggers

Any time you are anxious or angry, you’ve been triggered. Your nervous system has connected a current situation to a similar unpleasant past event. It doesn’t matter if the present or prior event represented a true threat. It just has to be perceived that way and the body will secrete stress hormones in its effort to resolve the problem. The sensation created by these chemicals is anxiety. Anxiety is the result of the reaction, not the cause. When you can’t solve the issue, more hormones are secreted, and you’ll become angry.

The reason why family dynamics can be so volatile, is that most of your reactions are programmed by your parents during the first 12 years of life, especially the first two. It matters little what your parents teach or preach; it’s their behaviors and attitudes that become embedded in your nervous system. If you have come from an abusive family, your reactions to the present will be intense, although the present “danger” might be minimal. It is well-documented in the ACE (adverse childhood experiences) studies that the incidence of chronic pain, anxiety, depression, obesity, heart disease and suicide are higher than the norm. You needed to be hypervigilant as a child and it doesn’t change as you age. You are and will continue to be hyper-reactive out of proportion to the circumstance. All of this is exacerbated in families dealing with chronic pain.

During the Holidays, you are around the sources of your triggers from your parents, siblings, children and other relatives. No wonder they can be problematic. Landmines are everywhere.

How did this happen? I watch parents with babies and young children laugh, hold and play with them. It’s a precious time and they would do anything for them. Yet by five or six years-old, there is often a lot of arguing and fighting between parents and children. Suffering from chronic pain doesn’t help. I don’t have to detail what frequently happens during the teen years. The household can be a battlefield — a war without any hope of an end. I don’t how common this scenario is, but I am seeing it frequently in my practice. I only need to ask a few questions and be observant. Many family situations are intolerable.

Learned behaviors

The problem is that we program our own triggers into our offspring. They watch their parents become upset with them or each other and they learn their own behaviors in response to similar stressors. Then they become the cause of deep reactions in their parents. Why else would you yell at this person who used to be this incredibly wonderful child you brought into this world? But you are the adult and you are now in the same boxing ring as your 12-year-old. It’s your role and responsibility to provide a safe environment where your family can feel safe and nurtured. Only then can your child connect with his or her creativity and thrive.

You also may be critical of them. Really?? Anytime you are critical of someone, you have projected your view of you onto them. Remember that you are the one who taught them these behaviors that are now upsetting to you. It is remarkable the number of friends we have whose parents continue to be incredibly critical of them well into adulthood. The negativity is often intense and occurs in the face of the son or daughter doing the best they can to help and be supportive. The intensity of the verbal barrage is unbelievable to me and seems to worsen with age.

So, you have planted your own landmines. Would you yell at a stranger with the same intensity that you talk to your child or spouse? How do you think you appear to them when you are upset? Is that what you want your children to see?

Now it’s the Christmas season, and these deep triggers are coming back into your world. You have missed your family and want to be with them. What are you going to do? How are you going to handle being triggered, because it is inevitable you will be set off at some level. The two faces of Christmas

Here are a few suggestions, most of which I have learned the hard way.

• Remember the problem with the strong familial triggers and concentrate on enjoying your family. Play may be challenging, but it’s also the reason you want to be with them.
• Don’t give any unasked-for advice. They have survived the year without you and have you ever heard of a child listening to a parent’s criticism at any age?
• Remember that when you are volunteering advice, you are really saying, “You aren’t good enough the way you are.” That is probably what your parents did to you when you were young. It’s also why most of us have the “not good enough” voice in our heads.
• Visualize yourself being angry and what your family is seeing when you’re in that state. Be the person you want others to be.
• If you get upset, quickly leave the room. Nothing is ever solved in a heated argument.
• Be curious and genuinely interested in what your family is up to.
• Don’t discuss your pain, medical care, politics, religion, or complain – about anything. After all, it is the season of joy regardless of your belief system.
• Read Parent Effectiveness Training by Dr. Thomas Gordon. It is a classic and the most influential book that I have ever read on any topic.

I want to re-emphasize the powerful irrational nature of being triggered. It is only you and not them that is responsible for your anger. (I well-know that it still feels like it is him or her that upset you). Own it. It is yours.

You’re the one who created the behavior in your child that is now upsetting you. Own that too! Remember how excited you were when they came into the world. Remember the good times and don’t spend time on past differences. Why? It’s done.

A Cigna insurance study in 2018 demonstrated about 40% of Americans feel socially isolated.(1) During my pain experience, loneliness might have been the one most crushing aspect of my ordeal. It was brutal. Connect with gratitude and remember how lucky you are to have friends and family. If you are someone reading this who is socially isolated, work on finding a way to re-connect with someone or give back. I am aware how terrible a feeling this is, and I’m really sorry. The Holidays do make it worse. But by being aware of the impact, you have a higher chance of dealing with it.

Make a commitment to enjoy your holiday season and if you detonate a landmine, use the situation as an opportunity to practice your own tools of staying connected and centered. Become the source of Holiday cheer!

1. Cigna U.S Loneliness Index (2018).

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There are three parts to solving your pain:

• The first is to understand chronic pain. It is a neurological problem that is different than acute pain.
• Second, all the variables relevant to your situation must be addressed simultaneously.
• Finally, every successful patient has taken control of his or her own care.

Introduction to Chronic Pain

 Pain impulses begin with stimulation of pain receptors and are sent to the brain through peripheral nerves and the spinal cord. In the brain a substance called myelin is laid down with repetition that etches in these pain circuits. Myelin can roughly be compared to the insulation around an electric wire that improves the speed of conduction. The process is similar to an athlete, artist or musician learning a skill. However the frequency of chronic pain impulses is more like a machine gun. Pain circuits become deeply embedded in the nervous system within six to twelve months. Similar to knowing how to ride a bicycle they are permanent.

Pain signals danger, which creates anxiety. Your body secretes adrenaline, cortisol and other stress chemicals, which protects you by increasing your heart rate and increasing the blood flow to your muscles. It also shuts down the blood supply to the frontal lobe of your brain (your thinking center) and amplifies the sensation of pain. Every millisecond of your life has evolved around avoiding anxiety. It is the only reason the human organism has survived. Your bodily responses to the environment are not centered on having a great time. Anxiety, Anger, and Adrenaline

Trapped by Pain

When you continue to be trapped by pain (or any life circumstance) you will become frustrated and angry. Anger results from loss of control. Any time you cannot fulfill a basic need such as air, food, or water you will become anxious then angry. Not being in pain is a basic need. Maslow’s miss Anger stimulates the body’s physiological response to meet that need. Therefore anger is anxiety with a chemical kick. Now the adrenaline levels really are elevated, which does improve your chances of solving a given problem. But it destroys the quality of your life, especially your close relationships. A terrible vicious cycle ensues – more pain, more adrenaline, more pain, and so on. Where and how does it stop? For most people it does not and it consumes them and everything around them. It is the worst part of the human experience. Your Hand Stuck Over the Stove

Anxiety is a neurophysiological response to a threat. It’s a mental reflex that sets off an automatic protective response. So similar to pain circuits anxiety pathways are also permanently etched in and become stronger with repetition. That is why every human experiences increasing anxiety with age. If they don’t, then their body will adversely respond with other physical responses. There are over 30 different symptoms that may occur. There are no exceptions. It is just a matter of degree, type of manifestations and coping skills.

As chronic pain always creates anxiety and frustration they are neurologically linked. Neuroscientists have a saying, “Neurons that fire together, wire together.”

It sounds like a dismal situation and it is if you approach the problem with traditional methods. Trying to deal with irrational pathways with rational means cannot work. The unconscious brain is a more than a million time stronger than the conscious brain. The more attention that is paid to what I call “The Terrifying Triad” of pain, anxiety, and anger the stronger they will become. If you try to ignore them then it becomes even worse. The more you try not to think about something you will think about it more. So what is the solution? White bears

Neuroplasticity

It has been recently discovered that the brain has a tremendous capacity to change at any age. The descriptive term is “neuroplasticity.” We do know that in chronic pain peoples’ brains physically shrink. Fortunately it re-expands with resolution of the pain. It is possible by using simple tools to both shift off these pathways onto non-painful circuits and to stimulate the formation of new pathways. Although there are many ways of accomplishing this I am presenting the starting point, which has been the foundation for essentially every patient I have seen successfully become pain free.

Stimulating Brain Change – Awareness, Separation, Reprogramming

 There are three steps to shifting and creating alternate brain pathways.

• You must first become aware of your automatic response to a given stress. It will always be a rapid protective response.
  • Stress by definition is always a threat – otherwise it wouldn’t be stress.
• Then you must create a space, or separate, in order for you to substitute a more appropriate or functional reaction.
• Reprogramming is the final step.

Awareness and Detachment – Expressive Writing

Humans have a problem in that unpleasant thoughts create the same response as a physical threat but you can’t escape from them. They key is to simple separate from them. I have discovered the easiest and most effective way of developing an awareness of my response to stress is to simply write down my negative or positive thoughts and destroy them. It has been shown in over 300 research papers that this is an effective way of changing the body’s response to stress. Stress isn’t the main problem. It’s your response to it.

There are two reasons to tear up, shred, or burn your writing. It’s not to get rid of the thoughts. They’re permanently embedded. The first is so you can write with complete freedom. Any thoughts, positive or negative will do. Write and Don’t Stop The more important reason it to not spend any time or energy analyzing them. Your attention will be focused in that direction and you’ll be reinforcing them. You might as well place your hand into a hornet’s nest.

In my opinion the writing accomplishes several things.

• It creates an awareness that these random thoughts are in your nervous system and that they are just thoughts.
• As the paper is a physical distance from you it allows you to separate from these thoughts. It is easier to see that they are just thoughts and have nothing to do with your reality.
• This space is connected with vision and feel, which connects with the unconscious.
• As you are connecting a thought with a physical sensation, you are creating new pathways.

Expressive writing creates awareness and separation with one exercise. It is simple and concrete – and doable. It was the first treatment that was helpful for me after trying to solve my chronic pain for over 15 years. I was lucky to have discovered it, as I was nearing the end of what I could tolerate. Video: Write Your Way Out of Chronic Pain

Warning: Please note that many people may experience an early decrease in mood and sense of well-being. Pain may also initially increase. This is not a bad prognosis for a long-term beneficial effect. It is recommended that you limit the writing to about 20 minutes per time until you are feeling better. If you feel too uncomfortable stop the writing immediately and contact your physician or mental health professional. The Dangers of Positive Thinking

Reprogramming

Reprogramming can be accomplished in thousands of ways such as music, hobbies, talking to friends, acupuncture, etc. However there is one core method that I feel is basic to the reprogramming process. I call it “active meditation”. It is more often referred to as mindfulness. It is simply placing your attention on sensations. Any one will do – taste, feel, sound, pressure, etc. There are three steps and it just takes five to ten seconds per time. (1)

• The first step is to relax
• Let yourself stabilize
• Finally, place your attention on any sensation. Taste your food. Feel the breeze. Listen to sounds.

I feel the active meditation accomplishes several things. As you relax your body will begin to secrete less adrenaline. By placing your attention on a given sensation your nervous system is no longer on the pain pathways. You have shifted off of them and are now truly in the present moment. As you continue to do this throughout the day it becomes more and more automatic. Eventually as you use the pain pathways less they will become weaker and the other pathways will become stronger.

One metaphor that comes to mind is that of diverting a large river into another channel. There is very little water that will initially flow through the new riverbed but with continued excavation there will be more and more flow. Eventually just the force of the water will create a new river. The old riverbed is still there. (It is permanent) but is much less developed. As you use your pain pathways less and the new pathways more, at some tipping point you will go to pain free.

Begin the writing/ active meditation NOW

The DOC project addresses the other factors that affect your pain experience. But the expressive writing/ active meditation is the core starting point. I ask all of my patients to begin that evening. I suggest that they write once or twice a day for at least 10 to 15 minutes. The active meditation should be done as many times as you happen to think about it. I am guessing that I do it 20 – 30 times a day. It eventually becomes an unconscious habit.

As nothing really changes until the writing/ active meditation begins I ask my patients to begin these exercises before they do much reading. I can instantly tell on the second visit whether they have started the expressive writing. People notice changes in their mood quickly although the pain may not have resolved. The research does show that most people will experience an initial dip in their mood and sometimes increased pain for a few days or weeks. Then I know they are actually writing.

Expressive writing/ active meditation alone is not the solution to your pain any more than reading my book. But these exercises are incredibly powerful especially considering how simple they are. BTW, what is the downside? How high are the stakes? Do you really want to continue to live like this? Was this your high school dream? You have once chance at this life. Take it!!

1) Learned from a workshop put on by Alan Wallace, PhD

The post Introductory DOC Concepts first appeared on Back in Control.

The post Introductory DOC Concepts 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.

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Jim

One day, I happened to hit a nerve with a patient regarding his family patterns. Jim needed a back operation for a pinched nerve that was causing pain in his right leg. Moody and uncooperative, he hadn’t followed up on anything we’d discussed in his appointments. I couldn’t get him to engage in any of the stress management tools.

Finally I gave up. “Look,” I said. “I am going to cancel your surgery. I cannot engage with you if you don’t want to participate in learning the tools I’m trying to give you to get better. It’s just the way I work.”  I had a sense that Jim’s resistance to stress management stemmed from his background experiences, so I also added, “We are all programmed by our past. For example, if you were raised in a family that was active in the Ku Klux Klan, what do you think your belief system would be?” His fiancée suddenly burst out laughing hysterically. It didn’t seem that funny to me, particularly since I was frustrated with his unwillingness to engage.

I thought I’d picked a completely random example, but Jim looked me in the eye and said, “My father and grandfather were Grand Knights in the Klan.”

I cancelled the surgery, but my example of family programming apparently hit home, as Jim finally began to engage in the DOC Project. The surgery was done three months later and was successful in relieving his leg pain. He has made a great deal of progress with stress management skills because he shifted his thinking and came at the process from a different place. Jim’s struggle to learn a better way to deal with stress borders on heroic. I hear from him every few months and he continues to evolve. His skills have created a better life for himself, his wife, and their three small children. Chronic pain is a high stakes game.

Once the reprogramming foundation is established, my patients work hard to apply the principles to their lives. The only patients I’ve seen that do not experience significant benefit from reprogramming exercises are the ones who did not fully engage on a long-term basis. With full engagement, success in eliminating your pain is probable, not just possible.

More to This Story

After I performed Jim’s surgery, he did pretty well for a while and then began to slide back into his old pattern of pain. We had had the conversation that the surgery would address his leg pain but would have no effect on his back pain. In spite of his ongoing back pain, he kept trying to become more functional. His leg pain had not completely disappeared.

His living circumstances were difficult. He was living with family in cramped quarters.  Although workers’ comp had paid for some counseling, it was limited. He and his fiancé readily admitted that they fought all the time and were becoming increasingly worn out by the ongoing battles. As they had no other resources, I would see them back about once a month and do the best I could to help them out. As Jim had been raised in the KKK environment, that was his baseline. He did not view his life as being filled with anger.  However, his reactions said otherwise. Both he and his fiancé were incredibly determined to make things work, but it was clear to me that they did not have the tools to pull it off. I was incredibly frustrated because their situation was potentially very solvable with the right support and counseling. I saw them both about a year ago and it seemed that things were beginning to take a turn for the better. This is the letter I received last week.

The Letter

Hello Dr. Hanscom!

This is Connie, Jim’s wife. (Little redheaded lady, with the two kids and husband who you performed surgery on.) I believe in your book, Jim was used as an example.  I wanted to give you an update on how he’s doing.

For several years, He struggled with emotional ups and downs, a lot of chronic pain, and how to deal with it all. We ended up getting married. For a long time to follow, I nearly regretted that decision. With both of us working, going to school, money was tight,  two kids and Jim’s pot addiction, it was too much.

We had an unusual fight about a year and a half ago. He had been taking some kind of pills that were supposed to help his moods, according to the doctor he was seeing at the time. Needless to say, the pills in fact had a very negative effect on him. By the time the argument was over, he spent the night in prison. At that point, I was ready to walk. This was enough, the last straw.

The night passed, I picked him up, and explained it was over. We had done it all. Seeked professional help, taken the pills, read the books. I saw no end. There wasn’t anything left. This was who he was, and I couldn’t do it anymore. My boys were not going to grow up in this sad, depressing, unstable environment. He begged, and said he realized something in jail that night. He said he needed God. As a “devout” atheist, he decided he had no options, and as a last resort, maybe God would be somewhere to look. The next Sunday, we were in church.

Since then, our life has changed more than it ever has. We don’t argue. We get along, and better than that, are in love again. We both have stopped smoking pot. For Jim, this was a big step. He was using it for both mental “well being”, and pain control.

I have started working again. Found a great job. Flew to Denver in January to be trained. It’s been amazing. One of the highlights, Jim is working on developing his own business. He has decided to be a gunsmith. For the first time in years, he is doing something to better himself. He’s been taking small steps, one at a time, and I believe he will make it. It’s the first time in a long time I’ve seen him with drive, and with passion. As long as he’s happy, I will be there to support him.

Plus much more.

God has touched our lives, and helped turn it around 180 degrees. He’s got a lot of love to give, and I’m thankful to see Him sharing that with my family.

I know as a Doctor, you may think that’s crazy. I still wanted to share.  I wanted to take a moment to say thank you, for investing the time with him that you have. It’s very appreciated. We needed you. He needed someone to tell him he was worth it. I know he still thinks about that, often. Thank you sooo much.

Please keep in touch, I would love to hear from you once and a while.

Best regards,

My Final Thoughts

I want to make something very clear at this juncture. The DOC Project entails four stages of five or six steps in each stage. The final stage is “Expanding Your Consciousness.”  Another name I have used for this stage is “The Spiritual Journey.”  It can take many different forms, religious or otherwise. I have seen many patients benefit greatly from their church community as part of their healing process. I think that being in a group of people jointly acknowledging a power greater than themselves is incredibly helpful.

However, this is a much different experience than having a rigid religious belief system that is intolerant of others. I have uniformly seen my patients in this mindset fail, or more frequently not engage in any open dialogue about the possibilities for healing.  Rigid belief systems, religious or otherwise, are a thinly disguised form of control and anger. Remember that your judgment of others is a mirror of your own self-judgment and vice versa. Judgment is a problem. Period.

I personally am not involved in a religious organization. I did learn through my Hoffman experience how critical it is to acknowledge a higher power outside of ourselves. Only then are you truly able to give something back.

BF

The post The KKK and a Spiritual Journey first appeared on Back in Control.

The post The KKK and a Spiritual Journey appeared first on Back in Control.

Then I read an extensive review on the nociceptive pain system. (1) This is the part of the your nervous system that signals a given stimulus is uncomfortable and evasive action needs to be taken. What I learned is that your brain unconsciously keeps your behavior in a range to avoid injury and you feel pain when this threshold is exceeded. For example, your body continuously is shifting while you sit to avoid skin breakdown. Paralyzed patients lack this protective sensation and pressures sores are an ongoing concern.

It has also been demonstrated that the severity of pain in the presence of arthritis in the shoulder, hip and knee does not correlate with the severity of the joint destruction. In other words, people with complete loss of cartilage often have little pain and others with minimal arthritis will experience severe pain. The pain correlates almost perfectly with the level of stress.

It is important to understand that your brain has to unscramble all sensory input to assess its importance to your survival (not well-being). For example, your eyes have no inherent capacity to see. If you have a stroke of the back part of your brain, you will be blind in spite of having normally functioning eyes. It is called, “occipital blindness.” The same holds true for pain. You cannot feel pain without your brain interpreting the impulses as unpleasant.

Pavlov

One experiment that demonstrates the power of reprogramming is the famous one by Ivan Pavlov, a Russian researcher. Pavlov showed how the brain can be trained, through repetition, to cause certain reactions in certain circumstances. His results corroborate the theories behind the Mind Body Syndrome.

Experiments

Pavlov set up an experiment in which every interaction a dog had with food would involve the sound of a bell. Eventually just the bell sound would cause the dog to salivate, even without food. The sound became its own pleasurable experience.

One of his lesser-known experiments is one where he associated a dog’s interaction with food with an electric shock. With repetition, the dog would look foward to the shock.  “Within a few weeks the dog would actually wag its tail excitedly, salivate, and turn toward the food dish in response to the electricity. It was “paw dependent” in that if the same shock was applied to its other leg, the dog would react violently.”  (2)

Pain and the Brain

It is well documented that patients suffering from chronic pain experience a significant decrease in the actual size of their brain. It is unclear exactly why this occurs, but it is a consistent observation. It makes sense to me that if much of  your brain is stuck in the repetitive thought patterns associated with pain, then the parts of your brain that normally experience close friends, excellent wine, great food, new experiences, etc. are going to atrophy. It has also been shown that the phenomenon is reversible with active interventions such as reprogramming. Chronic pain sucks the life right out of you—including brain cells. Don’t let that process continue!

It appears to me that pain from any source can be re-rerouted. I can not predict who will respond or when. I am fascinated by the human body’s capacity to heal.  I am relentless and I encourage my patients to never give up on themselves.

1. Baliki, M and A Vania Apakarian. Nociception, Pain, Negative Moods, and Behavior Selection. Neuron (2015); 87: 474-486.

2. Brand, Paul. “Pain the Gift that Nobody Wants”. Harper Collins, 1993, p 206.

3. Seminowicz DA, et al. “Effective treatment of chronic low back pain in humans reverses abnormal brain anatomy and function.” The Journal of Neuroscience (2011); 31: 7540-7550.

BF

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