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Spine Surgeon Reveals Roadmap Out of Chronic Pain
November 22, 2015
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As many as 8 out of 10 Americans struggle with back pain,
and many resort to surgery as a solution. Unfortunately, this often
does not resolve the problem, and in some cases simply worsens the
situation.
Dr. David Hanscom, an orthopedic surgeon with a practice in Seattle, is unusual in that he tells most of his patients they don't need surgery. He's written a book detailing his novel approach to chronic pain treatment, called “Back in Control: A spine surgeon's roadmap out of chronic pain.”
Spinal Fusions Rarely Cure Chronic Back Pain
Spinal fusions are a lucrative business and great source of revenue
for the hospital and surgeon. Unfortunately, they rarely work for the
patients. Spinal fusions arose from the assumption that disc
degeneration was a source of back pain.
Therefore, it was thought that by fusing the disc together with the
bone, which eliminates motion, you would get rid of the pain. However,
that has since been proven false.
"Disc degeneration actually does not cause back pain. That's been well-documented," Dr. Hanscom says.Despite such findings, spinal fusions are still popular. Each year,
"The success rate of the spinal fusion for back pain was about 24
percent, but we still kept doing it. Then, in 1994, when this paper
came out Washington showing that the return-to-work rate one year after a
spinal fusion for back pain was 15 percent, I just stopped.
Every paper since then has showed pretty much the same dismal
results; there's maybe a 20 to 25 percent success rate of spinal fusion
for back pain...
And the downside of a failed spine surgery is terrible. It's
really bad. These people are condemned to live their entire lifetime, 30
to 40 more years, in chronic pain."
some 600,000 spinal fusions are performed in the U.S. with a high
percentage of them being performed for non-specific low-back pain, at a
cost of more than $600 billion.
Neurophysiological Disorder (NPD)
By 1988, Dr. Hanscom was suffering from burnout, which included 16
NPD symptoms. He did not know the nature of the problem and would be in
this state for another 15 years.
Chronic pain was one of his symptoms. He inadvertently solved his
chronic pain in 2003 and it took another few years before he understood
that he had full-blown Neurophysiologic Disorder (NPD). He began sharing
his experience with his patients in 2006.
NPD is rooted in chronic stress and anxiety. Your body becomes full
of adrenaline, and every organ system starts responding and acting up.
According to Dr. Hanscom, there are over 30 symptoms created by an
adrenalized nervous system.
"Some of my 16 symptoms included migraine headaches, ringing inOver the following decade and a half, Dr. Hanscom struggled to
my ears, burning on my feet, itching on my scalp, migratory skin rashes,
and post-traumatic stress disorder (PTSD).
It was brutal. What I didn't realize... is that anxiety is
actually one of the classic manifestations of neurophysiological
disorder. I developed extreme anxiety. I did not become a major spine
surgeon by having anxiety; I became a major spine surgeon by suppressing
anxiety.
As you know, when we try not to think about something, we think
more, right? Interestingly, the burnout rate in medicine is about 50 to
55 percent and has a lot to do with suppressed anxiety.
Whenever I give lectures on burnout and I use the 'anxiety' word,
the whole room just goes absolutely quiet. If I hadn't gone through it
myself, I would not really be able to talk about it....
We also found out that anxiety or mental pain and physical pain
are processed in the same part of the brain. They're essentially the
same thing."
recuperate, and through a combination of pure luck and trial and error,
he eventually developed a system for treating chronic pain by addressing
not just the physical, but also the emotional/mental component of anger
and anxiety.
While there's nothing particularly new about this process, it
involves going through a sequence of strategies that allow you to calm
down and de-adrenalize your nervous system. Hundreds of patients have
now tried this system, and lead pain-free lives.
This system includes:
- Addressing your sleep
- Expressive writing
- Relaxation techniques
- Nutrition and mild medications
- Physical therapy and rehabilitation, including structure strengthening exercises
The Therapeutic Value of Expressive Writing
One of the strategies that had a profound impact on Dr. Hanscom's own
recovery was expressive writing — the act of writing down your negative
thoughts and emotions. Interestingly, there are over 200 research
papers published since 1982 documenting the effectiveness of expressive
writing.
“The research began with expressive writing around prior traumasExpressive writing exercises are now a foundational component of Dr.
and many different formats have been studied. The most straightforward
method is ’negative writing.’
This is where you're simply writing down your current negative
thoughts – the darker, the better – and you're destroying them
instantly. You're not writing positive thoughts; you're writing down
your negative thoughts.
You are not destroying them to get rid of the thoughts. They are
permanently etched into your brain. You are allowing yourself to write
with complete freedom, so the exercise separates you from your thoughts.
Again, when you try not to think about something, you think about it
more. None of us like unpleasant thoughts, so we keep tossing them
aside. Dr. Daniel Wegner out of Harvard pointed out that by simply
writing down the thoughts you're trying to suppress, it breaks the
cycle," he explains.
Hanscom's program. By breaking up the psychological pathways of anxiety
and frustration, it allows you to reprogram your brain. Back pain is a
classic type of chronic pain that responds well to expressive writing.
An interesting study showing the emotional aspect of back pain was
published last year.
Using MRI brain imaging, they showed that while people feeling acute
back pain had an activated pain center, as you would expect, people who
have been in chronic pain for more than 10 years experience pain in the
emotional center of their brain only. The pain center was completely
dormant.
Patients in the acute pain group were then rescanned every three
months, and they found that within 12 months, if the pain still
persisted, it migrated from the pain center to the emotional center. So,
chronic pain is experienced in a completely different part of your
brain compared to acute pain.
An Extreme Success Story
Dr. Hanscom recounts one rather extreme example of how effective this
technique can really be. A gentleman broke his back in a horse riding
accident. He subsequently needed surgery on most of his thoracic spine,
which led to severe chronic pain. By the time he came to see Dr.
Hanscom, he'd been in pain for eight years. Two other surgeons had told
him he needed a fusion from his neck all the way down to his pelvis for
pain. He came to Dr. Hanscom for a third opinion.
"He had disc degeneration, but he had a straight spine. He had noThe man's girlfriend convinced him to try the writing exercises
indications for a major spinal fusion surgery. I said, 'Look, I don't
think you need a surgery no matter what. There's just nothing there to
operate on. By the way, here are your writing exercises. Take a look at
the book, see what you think, and call me in a couple of weeks.' He's a
Ph.D. scientist and he thought I was just absolutely out of my mind. "
despite his skepticism, and by the third writing exercise—about three
days later—he was 80 percent pain-free. After participating in one of
Dr. Hanscom's workshops at the Omega Institute, he became completely
pain-free, and he's now been pain-free for a year.
“He’s doing normal things now after eight years of chronic pain,
he’s even back riding his horse in the hills at a full gallop. If he’d
had those operations, he’d have a spine as stiff as a board, the chance
of getting rid of his pain is almost zero, and it would’ve been
disaster.”
Three Components to Treating Chronic Back Pain
According to Dr. Hanscom, disc degeneration is never a reason for
surgery. In his view, surgery simply isn't the right solution for back
pain or neck pain.
Sciatica and leg pain may be relieved through surgery, however. When it
comes to treating back pain, he believes there are three components to
getting better:
When seeing a new patient, for the first month or two, Dr. Hanscom
- Learning about the mechanics of chronic pain and understanding that it's a neurological disorder
- Treating all the variables simultaneously. This includes sleep,
stress, medication, nutrition, mental outlook on life and physical
conditioning. "There's never one answer for chronic pain. People
say, 'I tried a chiropractor, it didn't work.' Well, that could help 10
percent, but if you're not sleeping, it's not going to work. You have to
combine modalities to get better," he says. "Sleep is No. 1. The entire project is null and void unless you're sleeping"- Taking control of your own care. For example, for some people
chiropractic or acupuncture may be very helpful, whereas it may not work
for others. You need to take an active role in determining what's best
for you, and pursue treatments that work in your case
works with simple medications to address sleep problems and pain. Then
he will immediately ask you to start the expressive writing exercises,
which teache you awareness and detachment, allowing you to reprogram
your brain. Active meditation is also used.
"I simply have them put their brain on sensory input, maybe 20 toThe second phase of the treatment is all about learning more about
30 times during the day. If you're anxious and frustrated, you simply
listen to your sensory input. Instead of fighting the pathways, you
place your attention elsewhere.
chronic pain, and addressing the physical part of your pain. He also
stresses the need to work on forgiveness. Since pain pathways and anger
pathways are linked, whenever your anger pathways are fired up, your
pain pathways are going to be fired up, and vice versa. Dr. Hanscom
recommends the book, “Forgive for Good,” by Fred Luskin, the
director of the Forgiveness Projects at Stanford University, and who did
four major research projects on forgiveness.
A retired physician and professor in the Department of Rehabilitation
Medicine at NYU School of Medicine, Dr. John Sarno, was a forerunner in
the field of using forgiveness to address chronic pain, and many of
Sarno’s concepts have formed the foundation of what Dr. Hanscom now
teaches.
It's also important to realize that working on your anger and anxiety issues
may be a long-term process. An old issue may be triggered at any time,
and unless you immediately address it, your pain may come back right
along with your anger and anxiety. As noted by Dr. Hanscom:
"It can be base level stress or quirky stress. But you will get
triggered. It took me a long time to accept that fact. I teach this
stuff. But when I get triggered, I get angry about being triggered."
Surgery Is Best Reserved as a LAST Resort
In many if not most cases, pain can be resolved using very simple
strategies. The key is to find what works for you, and more often than
not, there's an emotional component that needs to be addressed. Dr.
Hanscom, like me, strongly recommends leaving surgery as a very last
resort. I also struggled with back pain for about five or six years,
despite getting regular exercise and trying a large number of different
treatments. Still, I persisted and continued to try different
strategies. The approach that finally resolved my back pain was simply
to avoid sitting! I now sit about one hour per day, and I have no back
pain.
"I can't tell you how bad the suffering is for people with failed back surgery," Dr. Hanscom says.
"I see people like you all the time, where some simple intervention
solved the problem. And then I'm watching another person come in with
five back surgeries in five years. They started out just like you. It's
hard to watch.
I'm incredibly determined to bring this right to the mainstream
public. I don't think mainstream medicine is going to buy into it, but
I'm incredibly determined to get this out into the general public
knowledge because, right now, the business in medicine is doing
procedures that don't work because they make a profit, period …[But] I'm
working very hard about creating my own gravity around the situation,
and we're making some definite progress here at the hospital. My
partners and I are looking at [pain] differently."
More Information
To learn more, I highly recommend picking up a copy of Dr. Hanscom’s book, “Back in Control: A Spine Surgeon's Roadmap Out of Chronic Pain.” Please
do keep in mind that while it may initially seem like there’s nothing
new here— perhaps you’re already familiar with medication and physical
therapy for example, and therefore think it simply will not work for
you— it’s the process that makes it work. And most importantly,
your willingness to truly and fully engage in the process will
determine much of your outcome. Dr. Hanscom views his book as a
framework that presents known solutions to the various aspects of pain.
Once you understand your situation in light of this structure you will
find your own solution.
“It’s a very paradoxical process. You actually can’t fixThis happens because sometimes these people are writing all day,
yourself. [But] you are putting tools into place to allow your brain to
heal,” he says ... “For instance, a lot of people have read the
book and started their writing. Nothing really happens until those
writing exercises start. Usually by the second or third … phone call
they’re sort of doing the tools but they’re heading for the wrong
direction.”
long, Dr. Hanscom explains, and that’s actually counterproductive
because you’re trying to capture your thoughts and “fix” them—which is
another form of trying to regain control.
“This is a process about letting go of control, not having moreI would also encourage you to sit less,
control,” he says. It’s completely opposite of what we’ve been taught
about stress. That’s why I think finding a coach of some sort who can
guide you through the process is critical.I do think a psychologist can
be very helpful for guidance and wisdom ... There’s just not an exact
answer for different people. It’s more like a menu of options. But the
key is staying persistent with the process.”
as sitting may actually be aggravating your back or neck pain. Cut it
down to about three hours a day or less if you can. Also, while it's not
a popular idea, consider being grateful that your body is wise enough
to tell you that there's something in your life that needs to be
changed, be it emotional in nature, or physical. A book that addresses
this is “Pain: The Gift Nobody Wants,” by Dr. Paul Brand. Once you pinpoint the real problem, your pain can finally be released.
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