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By Dr. Mercola
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.
"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."
Despite such findings, spinal fusions are still popular. Each year, 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 in 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."
Over the following decade and a half, Dr. Hanscom struggled to 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 traumas 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.
Expressive writing exercises are now a foundational component of Dr. 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 no 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. "
The man's girlfriend convinced him to try the writing exercises 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:
- 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
When seeing a new patient, for the first month or two, Dr. Hanscom 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 to 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.
The second phase of the treatment is all about learning more about 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."
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 fix 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.”
This happens because sometimes these people are writing all day, 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 more 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.”
I would also encourage you to sit less, 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.