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The post “Back in Control: A Surgeon’s Roadmap Out of Chronic Pain” first appeared on Back in Control.

The post “Back in Control: A Surgeon’s Roadmap Out of Chronic Pain” appeared first on Back in Control.

This section is intended to be a resource for those listening to the audio version of Back in Control.

Acute—Sudden onset, severe; requiring immediate attention.

ANTS—Automatic negative thoughts—Term used by David Burns in his book, Feeling Good, which describes the mind’s tendency to gravitate toward negative thoughts.

Adrenaline—A “fight or flight” hormone secreted by the adrenal glands in response to a real or perceived threat. Effects include an increased heart rate, sweating, rapid breathing, muscle tension, and feeling agitated.

Affective component—The emotional component of pain as opposed to the somatosensory aspect (see below).

Anxiety—The feeling that is generated by the body’s stress hormones such as adrenaline and cortisol.

Anxiolytics—Category of medications that directly decrease anxiety.

Axial—Refers to the center of the body excluding the arms and legs.

Bibliotherapy—Applying any type of therapy just through the use of a book.

C-reactive protein (CRP)—A chemical marker that signals inflammation. It can be elevated in the presence of an infection, autoimmune disorder, some tumors, and stress.

Central sensitization syndrome (CSS)—A term indicating the nervous system is more sensitive to stress. The conduction velocity of the nerves increases.

Chondromalacia patella—Pain under the kneecap associated with soft- ening of the cartilage between the patella and the end of the femur. It is especially sensitive when going up and down stairs.

Chronic pain—The classic definition is “pain that lasts longer than the expected healing time.” With recent advances in neuroscience research it has been redefined as “a maladaptive neuropathological disease state” that creates symptoms that are not consistent with the injury or environment.

Cognitive behavioral therapy (CBT)—The branch of psychology that specifically addresses dysfunctional belief systems along with the associated behaviors.

Cognitive distortions—Thought patterns or belief systems that are not consistent  with reality.

Congenital indifference to pain—A disorder where babies are born without a protective pain system. Since they usually cannot protect them- selves, they become quickly disfigured and live less than twenty years.

Cortisol—The body’s stress hormone that regulates metabolism and the immune system. Adrenaline and cortisol are considered the two main hormones that regulate the body’s ability to fend off internal and external threats to survival.

Diabetic mono-neuritis—Elevated blood sugars can cause hypersensi- tivity and severe pain in the pathway of a nerve. It is important that this condition not be misdiagnosed as a pinched nerve.

Dissociating—In the context of mental processes, it is the act of consciously or unconsciously separating from the past. This an extreme form of thought suppression.

Discogram—A procedure where an iodine dye is injected into a lumbar disc in an attempt to reproduce a patient’s low back pain.

DOC (define your own care) process—A self-directed program consisting of strategies to take control of your own treatment of chronic pain.

Endorphins/enkephalins—These are the body’s natural pain killers and are many times stronger than narcotics. They are secreted in response to pain and are a part of the body’s stress response.

Expressive writing—Several hundred research papers have documented that simply writing down positive or negative thoughts and feelings on paper has a dramatic effect on physical symptoms, performance, and mood. It is necessary to immediately destroy the paper so you can write with absolute freedom and avoid analyzing what you wrote.

Facets—Two small joints in the back of each level of the spine. They have the same structure as all other articular joints (have cartilage and are contained by a capsule of connective tissue). There is ongoing debate regarding their role in generating back pain.

Facet rhizotomy—The facet joint capsules have an abundant number of pain fibers. There is debate about whether these sensory nerves are potentially a source of pain. A rhizotomy utilizes heat or cold to destroy these small sensory fibers and if the joint capsule is the source of pain, then LBP will be decreased. The pain fibers grow back within about a year.

Failed back syndrome—Refers to patients who have undergone multiple failed back surgeries. One of the main reasons I am writing this book is to prevent this tragedy from happening to you. The downside of a failed spine surgery can be catastrophic.

Fascia—Envelopes of tissue surrounding muscles that contain and define them. There is an abundant number of pain receptors in this layer.

Flatback—Loss of the curvature of the lower back can occur as the result of surgery or as part of the aging process. As the lordosis decreases, it causes your head to hang forward in relationship to the pelvis. Flatback refers to the decreased lordosis in the lumbar spine.

Functional MRI (fMRI)—By injecting a labeled glucose (this sugar is the brain’s energy source), MRI scans can pick up which parts of the brain are active in relationship to specific activities and emotions.

Hip arthritis—degenerative—Arthritis refers to the destruction of the cartilage of a joint. Cartilage traps water and provides a cushion between bones that allows joints to move. Degenerative arthritis occurs when this cushion wears out and eventually there is only bone against bone. Interestingly, there is no correlation between the severity of arthritis in the spine, hip, knee, or shoulder and the intensity of pain.

Hippocampus—An area of the brain that is responsible for processing long- and short-term memory.

Hoffman Process—In the 1960s, Robert Hoffman founded a process that has evolved into a seven-day workshop. It’s a remarkably effective program that creates an awareness of one’s family patterns, allows you to separate from them, and then reprogram. This book would never have been written without the Hoffman Process workshop I attended in 2009. I still use the tools daily.

Iliotibial band (IT)—A wide tendon that connects the pelvis to the lower leg and stabilizes your leg as you walk.

“Ironic effect”—Dr. Daniel Wegner introduced this term from the results of his research on suppressing negative thoughts. The “ironic effect” describes the process of thinking about something more when you try not to think about it; and thinking about it less if you try to think about it.

Junction box—My term for the sum total of all the nervous system’s activity at a given moment.

Laminectomy—The back part of the spinal canal is protected by a bone that is called the lamina. To surgically address the pathology within the spinal canal it is necessary to remove this bone. A complete removal of the lamina is a laminectomy, whereas a partial removal is a laminotomy.

Leaning into the negative—A term coined by Gabriele Oettingen in her book, Rethinking Positive Thinking, which means allowing yourself to experience your negative feelings. It is important to become aware of your automatic survival responses before you can substitute more functional ones.

Lordosis—One of the functions of the spine is to keep your head balanced over your pelvis. There is a curvature both in the neck and lower back that accomplishes this and the curvature is referred to as lordosis. The thoracic spine has curvature that is the reverse of the neck and lower back and is termed, “kyphosis.”

Maladaptive neuropathological disease state—In chronic pain, the brain rewires in a way that is disconnected to actual sensory input. It is a maladaptive rewiring. With time, these circuits become permanent and create a disease state that manifests as any number of physical symptoms.

Masking—Covering up or avoiding.

Mind-body syndrome (MBS)—See “NPD.”

Myelin—A fatty substance that surrounds nerve cells and improves conduction of impulses, similar to what insulation does for an elec- tric wire.

Muscle memory—Muscles, actually, do not have memory. Muscle memory is neurological memory where repeatable pathways are memorized by the central nervous system. It is unclear how they are formed but myelin is a substance that “insulates” the pathways similar to the insulation on an electrical wire.

Negative love syndrome—This a Hoffman Process term that describes our need to adopt our parents’ behavioral patterns in order to be accepted by our parents. My version of the process is simpler in that I think we just download environmental input. Unfortunately, most of our parents’ coping patterns are normal human survival responses that are not helpful in creating an enjoyable life.

Neural pathways—Describes the repeatable circuits that are imbedded into our nervous  system.

Neuroplasticity—The brain’s capacity to adapt and change at any age.

Neurological—Descriptive term for anything to do with the nervous system.

Neurophysiologic disorder (NPD)—When you are exposed to chronic stress your body experiences prolonged elevation of the stress hormones, adrenaline and cortisol. As your body responds to these hormones, the result is a myriad of unpleasant symptoms. Chapter 2 lists over thirty different symptoms of NPD. Fortunately, as these hormones normalize, the symptoms resolve. Other terms for this disorder include:

• Mind-body syndrome (MBS)
• Psychophysiological disorder (PPD)
• Stress illness syndrome
• Psychosomatic disorder
• Tension myositis syndrome (TMS)

Non-specific complaint—In medicine, the reporting of vague physical symptoms. They can still represent a significant physical problem but are more difficult to sort out.

Non-structural pain—Pain that arises from irritation or inflammation of the soft tissues but has no identifiable anatomical abnormality.

Obsessive-compulsive disorder (OCD)—An anxiety disorder mani- fested by repetitive, intrusive thoughts. The thoughts usually fall into one of four categories: cleanliness, sexuality, violence, and religion. The response can be internal, with counter-thoughts; or external, with compulsive repetitive behaviors such as hand-washing.

Over-adrenalized nervous system—This is the state of your body when your body is exposed to sustained levels of adrenaline. Each organ of the body has a specific response.

Pain generator—Physicians, especially surgeons, are focused on finding a specific anatomic abnormality that is the cause of pain. However, it is much more likely that your body’s symptoms are generated by the chemical response to sensory input from the environment.

Peripheral nervous system—This refers to any part of the nervous system that is distal to the brain or spinal cord. It transmits input from the environment to the central nervous system.

Periosteum—The layer of tissue covering bones. It is loaded with pain fibers and provides important feedback to the nervous system to protect the bones. It’s also the reason that pain is so severe at the points where tendons and ligaments attach to bones.

Phantom brain pain—A term I have coined for disruptive obsessive thought patterns. Humans develop belief systems that are not connected to the reality in front of them and project their thoughts onto other people and situations. These spinning circuits are not responsive to rational conversation.

Phantom limb pain—Almost all amputees have experience of the limb still being there, and over half experience the pre-amputation pain.

Physiology—The function of living organisms.

Pit of despair—A cage used in Harry Harlow’s lab, where he performed extensive research with primates regarding bonding. The cage was smaller at the bottom and the top was covered by a grate. The monkeys would climb up, look out, and slide back down. The monkeys would become depressed within a couple of days. His lab team was so upset by the experiment and called it “the pit of despair.”

Prehab—A program requiring patients to engage in the DOC process for eight to twelve weeks prior to having elective surgery.

Projection—The process of attributing certain characteristics to another person when those thoughts really represent your interpretation of that person. Most of our opinions are simply our view of ourselves projected onto the world. This phenomenon completely clouds awareness.

Psychological reflex—When you’re re-exposed to a similar situation that created a strong emotional response, your body will automatically respond in an identical manner.

Psychophysiological disorder (PPD)—See neurophysiologic disorder.

Psychosomatic disorder—See neurophysiologic disorder.

REM sleep (Stage V)—There are five stages of sleep. REM stands for “rapid eye movement” and it is the dreaming stage of sleep.

Reflex sympathetic dystrophy (RSD)—The pain that results from the autonomic nervous system being out of balance. The pain is often severe and unrelenting, with swelling and discoloration of the limb. It is unclear what sets off an imbalance. This part of the nervous system coordinates the involuntary control of your body and inner- vates smooth muscles, blood vessels, and other nerves. Its functions include dilating and constricting blood vessels.

Reprogramming—Learning any skill involves repetition before it becomes permanently imbedded in the nervous system. Reprogramming is the process of creating alternate pathways to a given stimulus.

Scoliosis—Sideways curvature of the  spine.

Somatosensory component—Pain has both an emotional (affective) and physical component. The part of the nervous system that local- izes the physical sensation to the body part is called the somatosen- sory component.

Stress illness syndrome—See neurophysiologic disorder.

Subacute—Acute pain that persists past the acute phase of several minutes, hours, or days. Pain lasting less than two months is consid- ered subacute.

Suppressing—In the context of the DOC project, this is the conscious choice to avoid thinking and feeling unpleasant thoughts and emotions.

Tennis elbow (lateral epicondylitis)—Tendonitis on the outside of the elbow, from the origin of the tendons to your hands. The area becomes inflamed and painful, and it hurts to grip or engage in any activity that places tension on this area.

Tension myositis syndrome (TMS)—See neurophysiologic disorder.

Triggering—The nervous system’s response to being exposed to situa- tions that are similar to prior traumas.

Unconstructive repetitive thoughts (URTs)—Unpleasant thoughts that become more intrusive the more we attempt to control them.

White bears experiment—A nickname for the experiment designed by Dr. Daniel Wegner regarding thought suppression, where he asked his volunteers not to think about white bears.

The post Glossary of Terms first appeared on Back in Control.

The post Glossary of Terms appeared first on Back in Control.

You have been suffering without an end in sight and are upset about being trapped by pain. You need to do something different. I have witnessed hundreds of patients become pain free over a period ranging from 6 weeks to several years. The DOC process is a framework intended to organize your thoughts and enable you to create your own solution. This first stage lays the foundation for your journey.

Step 1: Learn about chronic pain

• It’s a complex neurological problem.
• It has devastating effects on your life.
• Mental and physical pain are processed in a similar manner.
  • Mental pain has more impact on your life because it creates physical symptoms by altering your body’s chemistry.
    • Am I operating on your pain or anxiety?
  • Understanding Pain: What to Do About it in Five Minutes – A concise overview of chronic pain.

Step 2: Expressive writing 

• The writing is the foundation for the rest of the process. Begin today.
  • There are over 2000 research papers documenting its effectiveness.

Step 3: Active meditation

• Drawing attention to a sensation connects you with the present moment.
  • It’s a reprogramming tool that shifts you off of your pain circuits and calms you.

Step 4: Sleep

• It’s the cornerstone of the solving your pain
  • Real changes won’t occur without adequate sleep

Step 5: Not sharing your pain

• Your brain will develop wherever you place your attention.
  • Don’t discuss your pain with others.
  • Talking about your problems reinforces these unpleasant circuits.  Not sharing your pain

Your family

Solving chronic pain is a family affair. ALL families deeply trigger each other, which invariably increases the pain. (1) We can implement many different interventions but the family dynamics are often (usually) overwhelming. I’d like you to visualize you and your family sitting in the office with me. I’ve evaluated you and we’re coming up with a plan. Addressing your closest relationships  is the starting point. Click this LINK to begin your journey with your family.

Other Considerations

• You can’t control most stressors in your life, but you can control your reaction. The eye of the storm

• Be kind to yourself. Forgive yourself and others. This is the focus of Stage 2.

• Remember to laugh and play, which is also part of Stage 2.

• Strive to exercise for at least 30 minutes 5 days per week. Make sure you enjoy, and mix it up. Consider joining a group fitness class or gym. During this initial stage, the exercises should be light and enjoyable. Increasing your strength, flexibility, and endurance will gradually become more of a focus.

• Eat a healthy diet full of colorful, whole foods, largely plant-based. Aim to fill you plate with 1/2 fruits and veggies, 1/4 whole grains, and 1/4 lean proteins. Drink water and avoid sugary beverages. Save special occasion foods for special occasions. Shop around the perimeter at the grocery store and avoid the aisles, where there tends to be more processed and packaged food. Don’t shop when you are hungry. Don’t keep unhealthy food in your house. Downsize your plate and bowl size. Plan meals ahead. Eat food and enjoy it!

Initially, this will be difficult in the presence of unrelenting pain and anxiety. Food is soothing. Learn to appreciate the   experience and eating more healthfully will evolve. Patients often get focused on weight loss. It’s an added stress that shouldn’t be an initial priority.

Become your own inspiration

Many of these recommendations were created by a family practitioner who became inspired by watching so many of my patient’s successes. I am saying “my patients” in a tongue-in-cheek manner. You are the creator of your own success. The DOC process presents a framework that will allow you to find your own answers.

People wonder why I am so passionate about this process. It is because I’m inspired daily by my patients. The resiliency of the human spirit is incredible. I’m shocked by the depth of misery experienced by many of my patients and amazed at the capacity to turn it all around. I’m honored to be able to contribute my experience to help you begin your journey, but you are the ones that can and do regularly pull off almost miraculous turnarounds to enjoy a productive and fulfilling life. The one factor that predicts success is your willingness to engage with these concepts. Inspire yourself and those around you. You get to pass through this life only once.

“Better Not Look Down”

Charley’s Story – After 17 physicians in three months without success, he has been pain free for years

Resources

Glossary – Intended as a resource for the audio version of Back in Control

Books

1. Back in Control: A Surgeon’s Roadmap Out of Chronic Pain by David Hanscom
2. The Talent Code: Greatness isn’t Born. It’s Grown. Here’s How. by Dan Coyle
3. Feeling Good: The New Mood Therapy by David Burns

Helpful websites

• Unlearn Your Pain
• STOMP Swedish Handout (Structuring Your Own Management of Pain)

References

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.

The post Laying the Foundation first appeared on Back in Control.

The post Laying the Foundation appeared first on Back in Control.