Anger

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

Noncompliant

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

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

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

Anger is an absolute block to moving on

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

Address Your Anger

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

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

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

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

For more, see The Myth of Self Esteem.

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

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

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

BF

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

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

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

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

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

Our brain has neurological circuits that can become memorized. In this video I discuss phantom pain, which is more the rule than the exception with amputations. This factor is a significant problem with any chronic pain situation.

The post Video: Memorizing the Circuits: Phantom Pain first appeared on Back in Control.

The post Video: Memorizing the Circuits: Phantom Pain appeared first on Back in Control.

I talk about how the DOC Project can relate to other aspects of our everyday life, including everyday stressors and suppression. This is related to some of what I talk about in “Memorization of Neurological Circuits.”

The post Video: Standard Stress Skills Inadequate first appeared on Back in Control.

The post Video: Standard Stress Skills Inadequate appeared first on Back in Control.

There are over 2200 research papers that document that expressive writing in some form is effective for improving both your mental and physical health. I have been adamant for a long time that you should write down just negative thoughts – not positive ones. That has also been the general feeling of many papers. Interestingly enough, I ran across several papers that documented that writing down positive thoughts is equally effective. It appears that expressing thoughts and emotions works. The debate is how and why it is effective. One theory is that it switches your thinking into a slower, more rational mode, than automatic fast thinking. For me, writing was the first and only effective strategy that pulled me out of a 15-year tailspin. I had been in psychotherapy for 13 years and continued to spiral downward. I am an advocate of psychological interventions but they have to be combined with some other tool that helps to calm and re-route the nervous system.

My first step with every patient is to have them write down his or her thoughts and instantly destroy them. Thoughts are only connections between neurons within your brain.  There is no substance to them – none. However, as your body secretes chemicals in response to thoughts, they seem like real and part of your identity. Your goal is to bring these thoughts to life as vividly as possible and then separate from them. Unhooking from the train Meaningful healing will not occur until you start writing. It has been the one common strategy of essentially every patient I have seen go to pain free. I ask that patients begin this process before they do much reading, as it is the true beginning of the program. Write Your Way Out of Pain

Much of the DOC program is based on neuroplasticity, which is the term for your brain’s capacity to physically change. It can grow new nerve cells, lay down myelin and form new circuits and connections at any stage of your life. In fact, it has been demonstrated that your brain physically shrinks in the presence of chronic pain and re-expands when the pain resolves. The basic steps of the reprogramming process is: 1) awareness 2) separation 3) reprogramming. I feel that the expressive writing accomplishes the awareness and detachment steps simultaneously. There is now a space between you and your thoughts that is connected with the physical sensations of vision and feel. Somehow the brain processes this separation. 

The reprogramming process begins the day you begin to write. Write anything – positive or negative. It is important to immediately destroy them so that you can write with complete freedom. I encourage people to write for 10 or 15 minutes a couple of times per day. I do not encourage writing throughout the day. What I do suggest is to combine the writing with active meditation. You choose a physical sensation to place your mind on for 15-20 seconds as many times a day as you can. You have now shifted your nervous system off of unpleasant pathways to neutral or pleasant ones. I would like to do it more but I probably am successful 20 – 30 times per day. Instead of doing battle with unsolvable circuits you simply shifting your attention to other sensations.

Creating New Pathways

Thoughts are connected with:

• Other thoughts
• Emotions
• Physical sensations
• Mental pictures

Each these associations creates new neurological pathways. With writing, thoughts are connected to vision and feel, which creates new circuits. It clarifies your thinking and it is also the staring point. The writing exercise is not the solution for your pain. You will discover your own solution as the process unfolds.

The post Write and Don’t Stop! first appeared on Back in Control.

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