My vision is to bring the DOC (Direct your Own Care) principles into mainstream consciousness. It has become clear that the DOC project is one that is best implemented by primary care physicians. Back in Control is a wellness book, not a “solving chronic pain” one. Most of you know that you can’t solve chronic pain because your attention is still on your misery. You have to move toward your vision of how you want to live your life with or without your pain. Paradoxically, as you become healthier, your pain will abate or resolve. We have witnessed this phenomenon hundreds of times. I also practice these concepts daily.

My focus will be in several areas:

• Building a business structure that scales the DOC process to reach a much wider audience.
• Teaching medical providers in any realm how to treat chronic pain. Only about 20% of physicians are comfortable treating chronic pain and less than 1% enjoy it. We aren’t trained correctly in spite of recent neuroscience research providing many answers.
• Educating the public to take responsibility for their own care. This requires learning about chronic pain.
• I am writing three more books:
  • Do You Really Need Spine Surgery?
  • Chronic Pain and Your Family
  • Optimizing Performance In and Out of the OR Applying Athletic Performance Principles
• We are scaling the workshops that we have held at the Omega Institute. It turns out that the group setting is a powerful resource we have seen to move people out of pain.
• I am starting a movement around physician wellness. The burnout rate among physicians is between 50-60% and steadily rising. It has a tremendous impact on patient care. The DOC process is just a framework of care that allows productive discussions to occur and the patient is able to create their own solutions. However, the doctor/ patient relationship is a critical piece of it. It is hard to reach out to patients when you are trying to personally survive. Physicians have 2-4 times the suicide rate of the general population depending on gender and specialty.
• Finally, my biggest focus is on changing the fee structure for medical care. Many recommended interventions in spine care and other specialties have been documented to be ineffective while most effective treatments are generally not covered by insurance. The most necessary part of care is for your physician to listen and you to be heard. It is the one aspect of care that that has been taken from all of us. Creating a fee schedule that allows providers to take the time to get to know you will change the nature of medical care.

Grassroots effort

I am asking for your help. It’s clear that change is going to have to occur from the ground up. The business of medicine has firmly embedded a production approach to your care. It is not going to change. Here is a quote sent to me by one of my mentors.

A new scientific truth does not triumph by convincing its opponents and making them see the light; but rather because its opponents eventually die, and a new generation grows up that is familiar with it.

–Max Planck

How can you contribute?

People often ask me how they can pass on what they have learned. Here are some suggestions that would be of great help to my efforts.

• Continue on your own healing journey. The concepts presented in the DOC process are ones that need to be practiced for a lifetime. Patients often feel well enough that they stop at Stage 2. Stages 3 and 4 are the creative parts of it and where it all really happens. Don’t stop.
• Your personal transformation will have a strong healing effect on those you are close to. There is a direct mirror neurons effect.
• Encouraging friends and family to sign up for the weekly email updates on backincontrol.com.
• Share links on social media.
• Write a quick review of Back in Control on the Amazon or Barnes and Noble websites.
• Let your providers know about the DOC concepts and that they can contact me. My intent with the combination of the book and website is to enable the patient to take control of his or her own care and form a partnership with your physician and other medical professionals. Not only are your visits productive, but are more enjoyable. There isn’t a day in clinic that I don’t emerge more energized and inspired.
• Share your personal success on the “Stories of Hope” section of this website. Hope is a powerful force in healing pain.

Thanks to all of you for your interest and support. It’s what keeps me moving forward. For me, it is truly a new horizon and adventure and I am looking forward to seeing how it evolves.

The post Moving Forward – A New Horizon first appeared on Back in Control.

The post Moving Forward – A New Horizon appeared first on Back in Control.

So, when the patient’s partner is snippy, critical, or hostile, the patient tends to feel worse, too. The region of the brain that elicits a bad mood simply is stimulated. Conversely, if one partner is in a great mood, the other tends to be happier.

That is why—indirectly for my patients’ sake and directly for that of their partners—I believe it is vital that both partners learn tools such as expressive writing and adding more play into their lives, that enable them to live a joyful life.

Where is the support?

However, there may be an additional issue beneath the surface because it is remarkably difficult to convince other members of the household to engage in these tools. If you care for your family member, why would you not try to do as much as possible to help him or her heal? I ran across this article that partially explains why. Family members may not believe that a patient really is experiencing that much pain. It may be more common than I believed. Therefore, their compassion may understandably be limited.

Couple’s study

A multi-center published in 2013 (1) measured the following variables in 105 couples over two weeks:

• Patient’s pain
• Spouse’s observations of patient’s pain behaviors such as complaining, grimacing or grabbling.
• The patient’s perceived criticism or hostility from his or her partner

The following observations were made:

• Patient’s pain increased for over three hours when they felt hostility or were criticized.
• Patient’s observed pain behavior consistently created a negative reaction from their partner.
• These interactions were consistent. The assumption was that long-term low level negative interactions will erode relationships and quality of life.

This interaction is similar to what has been found in depression research. Depressed patients act in ways that cause rejection from others, which in turn exacerbates the depression.

There is no question that chronic pain is a family issue. The couples study does not even take into account the damage an angry person in chronic pain can inflict on his close relationships. The family unit can become a living hell and it can seem like a hopeless situation. But, like the patient’s condition, the family dynamic can get better, with the right tools. It did with me.

Pain = anger= abuse

Feeling Good Together

David Burns, MD is a Stanford psychiatrist and the author of Feeling Good. I attended his five-day seminar a few years ago where advanced Cognitive Behavioral Therapy (CBT) techniques were presented. One afternoon was devoted to relationships. He had been given a large advance to write a similar book applying (CBT) to relationships. He then used these techniques on 50 couples without any success. He returned the advance and went on a five-year quest to find out what was really going on. Subsequently, he wrote a second remarkable book called Feeling Good Together. One stunning insight from this book that hit me hard was that, when your partner acts in a way that upsets you, of course you want to blame him or her; but you are the one who set it up. It was your actions that caused your partner to react in a way that made you angry.

That insight had a major impact on my awareness of my own behavior—not just toward my wife, but in my relationships with everyone. However, I found it to be by far the hardest part of my journey. Whenever I feel upset as a result of something my spouse says or does, it still feels like it is she, not I, who caused the upset. It has taken me years to consider the effect my words and behavior have on others’ feelings. I still have a long way to go. It is unbelievably humbling.

Protect your family from your pain

The Marriage-go-round

How do you break the cycle of pain behavior, criticism from your partner, and more pain? Let’s face it: You have the choice whether to engage in pain behavior or not. At some level you must know that your partner is going to react negatively to it, but you do it anyway. When you feel the hostility and criticism from your partner, your pain increases. This is expected, since we know that stress chemicals increase the speed of nerve conduction, resulting in more pain. (2) Since there is seemingly no end to the pain, the cycle can continue for a long time. You’re already mad at your partner; why not continue to be irritating?

If endless conflict is damaging your whole family, consider it an opportunity to work through the solution together and come out stronger than ever before. The solution for chronic pain is not difficult once you understand the nature of the problem. It turns out—and I say this from experience—that anxiety and anger are the pain. Use the DOC tools to help you, your partner, and other family members to live a life you all cherish.

Listen to the Back in Control Radio podcast The Chronic Pain Marriage Go Round

1. Burns, JW, et al. Temporal associations between spouse criticism/ hostility and pain among patients with chronic pain: A within-couple daily diary study. Pain (2103); 154: 2715-2721.
2. Chen X, et al. “Stress enhances muscle nociceptor activity in the rat.” Neuroscience (2011); 185: 166-173

The post The Chronic Pain Marriage-Go-Round first appeared on Back in Control.

The post The Chronic Pain Marriage-Go-Round appeared first on Back in Control.

It’s not them, it’s us

Regardless of your political leanings, our politicians are not the problem with our society. I am not a great historian but it was clear all of our recent political candidates for president exuded anger, righteous indignation and were human verbal flame throwers. Whatever happened to focusing on the issues and the different choices in solving them? They are not the problem. It is us. We are angry and politics are simply a reflection of our collective consciousness. It would not have mattered who won. The problem is deep and has been there throughout human history. Cultural angst festers, explodes and re-accumulates. We continue to espouse world peace but have never been able to break this cycle. This time we can and world peace is a possible.

Insanity is 

Doing the same thing

Over and over

And expecting a different result.

-Albert Einstein

It is a possibility because we just underwent a bloodless revolution. We irrationally threw out anything that had to do with the current political structure and tore through both the Democratic and Republican party. How is this possible? You might be thinking that my line of thinking is implausible. It is not. We now have a choice of deciding what we really want – as a people, not by political leanings – unless you want to hold on to it.

Anger/ Rage

Anger is the problem. It does not matter what religion, race, political belief, sexual preference you are. It also does not matter how justified you are in your anger. The more legitimate your anger, the more difficult it is to let it go. It will still destroy you. There are many problems created by continuing to remain in this state.

• You cannot think clearly when you are upset. It is a self-centered reactive survival response that happens in your powerful unconscious brain. Dwight Eisenhower finally realized that he could not make good choices when he was angry.
• Through a neurological phenomenon of mirror neurons your anger will stimulate anger in those around you. Have you noticed that when you yawn others around you will yawn? It is a direct stimulation of that part of the other person’s brain. That is why it is so critical for a leader not to negatively set off this process on a large scale.
• The only way issues are solved through anger is a fight and the most powerful entity wins. Is that what we want?

What is the solution?

The solution is you? You have heard the oft-repeated quote, “The only person you can change is you.” It is true and it works. The first step is awareness of:

• Your anger
• Its effect on your quality of life
• Your family’s experience when you are upset.
• Your co-workers’ reactions and impact on their quality of life.
• Your personal impact on society.
• The nature of anger
  • It is driven by anxiety
  • It happens when you lose control

Healing

Awareness is the first step of healing. You cannot solve a problem that you don’t understand. One of my remarkably successful mentors made a comment about a recent turn of events, “Never waste a crisis.”

We are now painfully aware of our societal anger and we can choose to be a part of it or look at it as an opportunity learn how to personally process it and share our awareness in our circles of influence. Once you are aware of the nature of the problem you can find the solution. If you choose to remain angry, you have also lost your right to complain. You have made a choice to continue to spiral down into your own personal societal abyss. No politician or external circumstance will ever bring you deep happiness and joy.

My challenge – to you and me

I am challenging you to wake up, look up and move forward – with your individual and societal pain. You will soon leave your pain behind and also made a significant contribution to our collective consciousness and planet.

The second edition of my book is based on the recent neuroscience research that is demonstrating that emotional and physical pain are equivalent entities since they are processed in similar areas of the brain. Since you cannot escape your thoughts, you are trapped – and angry. This is not a political problem.

Become aware of the relationship between anxiety and anger, incorporate the principles into your own life and become part of the solution. There is not another alternative. World peace then becomes a possibility and at some tipping point becomes a probability. It is the next step in the evolution of human consciousness.

I am upset about many terrible trends that are occurring and the fog of anger that is engulfing us. I have my own work to do………

The post Society’s Pain and World Peace first appeared on Back in Control.

The post Society’s Pain and World Peace appeared first on Back in Control.

I have been aware that many partners remain noticeably silent during my interviews with the patient. At the end of the visit I assign homework. The first step is to have my patient learn about chronic pain. I give them a copy of my book or suggest that they read any book that they might prefer. I schedule a repeat visit within a few weeks to discuss the concepts and develop a plan.

I will also ask his or her partner to learn about pain and fully engage in the DOC project. “If you don’t have chronic pain, just use the word ‘stress’ or ‘anxiety.” I point  out that it would be beneficial for them personally to immerse themselves in the concepts. The tools are excellent stress management technique

The benefits to the patient

But the main reason I ask his or her partner to fully engage is that there is a neurological phenomenon of mirror neurons. Actions and words directly stimulate similar parts of the other’s brain. For example, when you smile at a baby he or she will usually smile back. It is not because the baby is happy. The smiling center of the baby’s brain was stimulated. It is a similar process when a person’s laugh will usually cause others to laugh – even though they have no idea what they are laughing at.

I then ask my patient’s partner the question, “What is your day like when your partner is having a bad day?” The response is uniformly, “Bad.” I point out that what do you think your partner’s day is like when you are upset. Many have not thought about that possibility. Maybe they are ruining the day for him or her? I explain that this is not a psychological phenomenon but it is neurological through the mirror neuron effect. Conversely, if he or she is also healing and growing it will stimulate the healthier parts of their partner’s brain. I have long observed that couples who both participate benefit greatly.

In spite of my being as clear (blunt) as I can, it is rare that a partner will engage without me nagging three or four times and even then they resist. This is often true even when they observe their partner experiencing dramatic healing. Why?

Why won’t partners engage?

I just have some thoughts. Based on my personal experience being raised by a mother in chronic pain it is clear that the person in pain has a lot of power within the family. My mother was endlessly angry and was physically and emotionally abusive. She also always got her way – regardless of the consequences. Anytime she was challenged she retreated to her room because she did not feel well. Her pain and behavior would delay and destroy simple family events. She felt she had the right to lash out at anyone anytime she wanted to. Pain=Anger=Abuse

No matter how committed a partner might be it is very difficult to live with someone in pain. How could you not be resentful? Although you might consciously want your partner to feel better, I am guessing that there might be some deep, buried feelings that would block supportive action.

What needs are being met?

Chronic pain is also a complex family issue in that to remain together as a couple there must be needs that are being met by their partner being ill.   Do they have an unconscious need to be controlled? Has he or she been abused in the past and it is a familiar pattern? If a person in a family gets better then it calls the others out. They have lost some of their own excuses not to heal. I have witnessed patients improve, even for a few years, get pulled back into the disabled role by intense family pressure. Breaking Loose – Not Quite

Dr. Bernie Siegel’s Observations

I have enjoyed getting to know and work with Dr. Siegel, who is a surgeon and author of several books, including Love, Medicine and Miracles. He has taught me a lot about human nature and has helped many people with serious diseases tap into their own healing powers. He has some insights into the family dynamics around pain.

“If I don’t have my pain how do I get attention?”

SIEGEL’S SIGN

When everyone in the family looks worn or ill and one person doesn’t guess who has the ‘pain’.”

“One family told me they hired a nurse for their sick sister and she would wake them up at night and let the nurse sleep. Also I guaranteed her a cure at her next office visit and privately told the family to watch what happens. She never returned to the office but would meet me in the ER now and then for help.”

It has become clear to me that many people don’t want to give up their pain. Even though they are still truly suffering, they somehow become addicted to power of it and the ability to retain the attention of the whole family. There is also the trend for a family member to assume the identity of a caretaker to the point of neglecting his or her own needs.

Are you really willing to give up the power of your pain? It is anxiety-producing to give up lifelong behavioral patterns? You might be one of the people I have asked to help out with healing my patient and your life partner. How serious are you about really wanting him or her to experience a rich and full life? Could you be the person who is having some your needs met by taking care of someone who is disabled? Most of this occurs at a deep unconscious level. I am encouraging you to take a good look at your family dynamics. The fact you are reading this post is a good start.

The Crab Bucket 

The post Pain Rules the Roost first appeared on Back in Control.

The post Pain Rules the Roost appeared first on Back in Control.