ADJUSTED
ADJUSTED
Treating Chronic Pain with Dr. Hanscom
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In this rebroadcast episode, ADJUSTED welcomes Dr. David Hanscom Orthopedic back surgeon and author of Back in Control: A Surgeon’s Roadmap Out of Chronic Pain. Dr. Hanscom discusses chronic pain and how it can be treated without surgery.
Season 8 is brought to you by Berkley Industrial Comp. This episode is hosted by Greg Hamlin and guest co-host Matt Yehling, Directory of Claims at Midwest Employers Casualty.
Visit the Berkley Industrial Comp blog for more!
Got questions? Send them to marketing@berkindcomp.com
For music inquiries, contact Cameron Runyan at camrunyan9@gmail.com
Chronic Pain and Back Surgery Discussion
Speaker 1Hello everybody and welcome to Adjusted . I'm your host , greg Hamlin , coming at you from beautiful Birmingham , Alabama and Berkeley Industrial Comp . And I'm excited to share with you today this rebroadcast .
Speaker 1This episode was one I particularly enjoyed with Dr Hanscom . I actually met Dr Hanscom at WCI Workers' Compensation Conference and she talked a lot about chronic pain and I found his talk very interesting as he was a back specialist who changed his mission from performing surgeries frequently to helping people deal with pain , and I really like some of the insights he's had . Having been in claims for nearly 20 years , one of the things I've seen fail the most has been back surgeries and back injuries that the injured worker still had pain post-surgery . So I was very interested to hear his take on this and how the mind is connected to the back in dealing with pain and where anxiety , depression and other psychosocial issues can impact the outcomes . So I hope you enjoy this episode and look forward to having you join us in a few weeks for our next one .
Speaker 1Hello everybody and welcome to Adjusted . I'm your host , greg Hamlin , coming at you from beautiful Birmingham , alabama and Berkeley Industrial Comp . And with me is my co-host for today , matt Yelling . Matt , if you could introduce yourself again for those who don't know you .
Speaker 2Hello everyone . This is Matthew Yelling and I'm joining Greg and Dr Hanscom from along the banks of the mighty Mississippi in St Louis Missouri .
Speaker 1Always glad to have you , Matt . We have a special guest today that I met at a recent conference or at least heard , guest today that I met at a recent conference or at least heard , and it's Dr David Hanscom , an orthopedic spine surgeon and author of Back in Control a surgeon's roadmap out of chronic pain . So , Dr Hanscom , I wanted to let you introduce yourself a little bit before we get into some of the questions we have for you .
Speaker 3All right . Well , thank you very much . I'm excited to be here and I've probably been as involved in workers' comp issue as any surgeon that I'm aware of . I spent 30 years trying to help workers' comp in the state of Washington , so I practiced orthopedic spine surgery for over 30 years in Seattle , washington . For those years we're in Sun Valley , idaho , which is how this whole project emerged that I'm going through , and so I'm a complex spine surgeon . I'm a deformity surgeon . I train at Minneapolis , minnesota , which is one of the top spine fellowships in the world at the time , and my practice was complex spine and , unfortunately for the patients , most of my practice evolved into what's called failed back spine surgery syndrome and you are all well familiar with that because it's particularly prevalent in the workers' comp situation . So I spent years working with people doing their five-fifths operation , 10th operation . The record was one workers' comp patient who had 29 surgeries in 20 years and I was right there at the end of it trying to salvage his life . And when I did the salvage surgery , I had correct structural problems , but I wouldn't salvage the patient . It was the rehab that actually made the difference . So it took me a long time to figure this out .
Speaker 3So you asked me a question how did I decide to be a spine surgeon ? And I'll just say it was an accident . I was an internist to start out with for two years and I simply interviewed for orthopedics in the state of Hawaii just to write off my trip . And two years later I get a phone call saying do you want to do orthopedic residency in Hawaii ? And I go sure . But in retrospect , to be honest with you , I probably wasn't the personality to be a spine surgeon or surgeon at all . I really liked internal medicine and surgery is a tough field . And then spine surgery is probably the toughest of the tough because you expect perfection , you're doing heavy moves over a delicate structure and I don't know why I happened to choose spine surgery . For goodness sakes I could have been sports medicine , which would have been a lot less stressful world . But the thing is you asked the question what caused me to leave surgery to focus on controlling chronic pain is that in the life that I did , my personality probably wasn't that suited to be a spine surgeon .
Speaker 3I developed chronic pain and I developed severe chronic pain for 15 years . I developed 17 different physical and mental symptoms . I had no idea what happened to me , and it happened in 1990 . I was driving across a bridge in Seattle called the 520 Bridge and I had a panic attack . I'm going , what is going on ? And I did not know what the word anxiety meant . I sort of became a major spine surgeon by suppressing anxiety , and when it exploded on the 520 Bridge , my heart started to raise . I felt faint , sweaty . I thought I was going to die , or at least having a bad heart attack . So it turned out to be the descent into 13 solid years of just pure misery . And again I had 17 different symptoms and I came out of it pretty much by accident in 2003 . And we can talk about that later .
Speaker 3But it took me another six or seven years to figure out what had happened , and I would just say just the last three years to really understand the entire range of the physiology of pain . And so the book Back in Control was written in 2012 first . The second edition was published in 2016. , and it reflects my story , but also reflects my insights of going through the process myself , trying many things that did not work , trying them with my patients , things that did not work , but anytime something seemed to have some promise , I kept gravitating towards that direction . So , to jump into the story , I developed a process called the DLC journey . It stands for direct your own care journey , and it's a sequence of learning and tools that allow people to solve their own chronic pain . And so you have to first understand the problem and then the solution . Is a sequence , and that's what we'll talk about a little bit later here . But , yeah , the reason why this process has been , I think , quite successful , because I was so miserable for so long . How's that ? For a short answer to a short question ?
Speaker 1No that's great . So you talked a little bit about leaving spine surgery because you know you kind of went on this journey yourself . How do you differentiate between acute pain and chronic pain ? Because this is something we hear about a lot in the workers' comp field . With our injuries , you know , we see the more recent injuries that start out with acute pain and then sometimes it branches into chronic pain , and I'm just curious if you feel like there's different ways to treat those things or what's your thoughts about them .
Speaker 3So , first of all , acute pain is completely different than chronic pain , okay , so let's talk about acute
Understanding Chronic Pain and Stress
Speaker 3pain for a second . So there's a range of responses that the body has to stay alive and protect you . So remember , pain's a signal , that's it . It's a signal that allows you to protect a specific organ . So if something's too hot , you protect your skin by pulling away . If you stir a breath that's too light , you protect your eyes by moving away from the sun . You don't step out into a street . So if you walk in a hot pavement , you put your shoes on or get off the pavement , etc . So pain protects us . It's a gift . It's called nociceptive pain and then the pain persists a little bit longer , while it's uncomfortable and it's pleasant , but you still find a way to escape the acute pain . So people that are born without a pain system , by the way which does happen they live about 10 or 15 years because they can't protect themselves . They break down their skin , they break bones , they get infections . They don't survive for very long . So pain is a gift . The problem is , with chronic pain it's like a car alarm that's gone off when there's no problems . So it's incredibly annoying to have an alarm go off in a car that doesn't stop . Well , acute pain is unpleasant and when that acute pain turns into chronic pain , it becomes indescribably unpleasant . So it turns out that after about six to 12 weeks , these pain circuits which keep firing at your brain become memorized . Your brain starts a short circuit . It changes your body's chemistry . So it turns out that chronic pain by now defined out of Chicago in 2014 , is an embedded memory that becomes connected with more and more life events and you can't erase the memory . And you've all heard of phantom limb pain . Well , okay , I learned that in residency . Nobody really explained to me why it exists , and it's still not explained in medical school why phantom limb pain exists . But think about it the leg is gone , the arm is gone . Why is there pain ? Because your brain has short-circuited . The alarm is on and you can't turn it off . So we'll go into the details about the physiology of chronic pain later . But just understand , chronic pain is completely different . And we've also found out that chronic pain is a chronic disease state that is similar to other disease states . So it turns out that osteoporosis , cancer , alzheimer's , heart disease , obesity , diabetes are all metabolic inflammatory disorders . It turns out that anxiety , depression , ocd , bipolar and schizophrenia are all metabolic inflammatory disorders . So I learned this . In the last couple of years we formed a national work group actually international work group that discusses the really deep basic science research and the technology in the immunology world and electron microscopy and genetics and the mitochondria , which are the small engines of the cell . The technology is incredible . What is revealed ?
Speaker 3There's a common link to every chronic disease , every one of them , mental and physical , as one of my friends says , who I think is a genius , simply says it's all the same soup . So what happens ? You now have a body that's under we call it threat physiology . So it's sustained fight or flight . And when your body's under sustained threat physiology , it's like driving your car down the freeway in second gear it's going to break down .
Speaker 3So the essence of all chronic disease is sustained stress . It's been documented for decades , way before we had the technology to prove it , that stress kills , causes major diseases . Why , why does that happen ? I mean , if you want to call it death psychological , so be it , but it's not . And the other thing that medicine has done ? We've gone down this rabbit hole of thinking there has to be something wrong , something wrong , something wrong for there to be symptoms , it's the opposite . So they say , well , I can't find anything wrong . That's not true . Your entire body chemistry is off , you're in full inflammation , your metabolism is up , your brain is sensitized , your nerve conduction increases , the blood supply shifts away from your gut and your bladder . So , again , that's why there's so many physical and mental symptoms and diseases caused by sustained what we call threat physiology .
Speaker 3The real problem here is that we say , well , this is psychological wrong . So again , everything's wrong . When your body's physiology is off , it's powerful , it bathes every cell in your body and every organ is going to respond in its own different way . That's why there's so many symptoms and diseases brought on by sustained what we call threat physiology . So the essence of chronic disease , including chronic pain , is sustained exposure to what we call fight-or-flight or threat physiology . Again , for the audience , physiology is how the body functions and the essence of the solution is promoting what we call cues of safety . So stress , people keep . Is it a first to even say that stress is quote psychological ? People think that right .
Speaker 1No no , not at all .
Speaker 3But a lot of people do . They think , well , I'm stressed out , it's just a psychological issue you have , your stresses are just life . You have things coming at you that threaten your livelihood , either financially or physically or whatever relationships . So stress circumstances , it's just life . And then it's your body's response to that stress . That's where the trouble comes in . So stress psychology is part of the response We'll talk about that in a second also but it's your body's total response . I'm sorry , it's your total body response to a threat , or stress is the problem . So the term psychology is a funny term because we do have mental input that creates this physiological response . But stress in and of itself is your body's physiology on fire but stress in and of itself is your body's physiology on fire .
Speaker 1I think that's fascinating and one of the things I've . You know and I think Matt and I've talked about this before one of the big issues with workers' comp is we only focus on what's wrong physically , and a lot of times it's a lot more complicated than that and you know , any of us who've been doing this for a long time have seen these injured workers who have a lot going on and the only thing that's focused on , you know , is there a rotator , cuff , tear or what is wrong with the spine that could be causing it ? And it's often treated like our bodies are like a vehicle that could have a part replaced and a different part put in and that if it's not working , then it must be that it needs to have something put in , and then , when it doesn't work , everyone's upset that the surgery failed . So talk to us about I mean , you've done a lot of spine surgeries . How did you reach the position you're in now where you wouldn't recommend surgery ?
Speaker 3Well , let me just back up for a second on the car analogy . And now where you wouldn't recommend surgery . Well , let me just back up for a second on the car analogy , because it's interesting you use that . So 90% of symptoms in the body 90% at least , maybe more are caused by the body's physiology . Less than 10% are caused by structural problems . So think about a car parked in the street . How many symptoms does a parked car have ? None , yeah , you have to turn the car on . Right , right , right , okay , that's the physiology of the car is turning the car on . So if it's out of gas which again , humans get exhausted , so it's not going to work . Now , if there's a structural issue , like the timing chain is off or there's a missing spark plug or two , then yeah , you replace the structural problem . Then you have to tune up the car . So it's still how the car runs as a physiology that creates the symptoms . So the structural part is the smallest part of this whole deal and we have it so backwards it's unbelievable . So that's my mission right now . I love that .
Anxiety as the Driving Force
Speaker 3I want to jump to this one point about anxiety and anger . So it is the pain . How do you feel if a dog jumps out at you and threatens to bite you . How do you feel if a dog jumps out ?
Speaker 1at you and threatens to bite you . How do you feel ?
Speaker 3Threatened . So yeah , I mean you feel anxious , you do yeah .
Speaker 1I remember when I was on the reservation I'd always have to there were dogs that would hide underneath the trailers . You climb , you go up on those steps and if they , if those healers , came , came out from underneath , you definitely kept them in front of you , never turned around on them , right ? So what were ?
Speaker 3you feeling .
Speaker 3I mean you're feeling , the body's chemistry . So anxiety is just a chemical state . It's a neurochemical , physiological state . It is not psychological . So remember , it's the result of stress , it's not the cause . So my cat has the same response . Result of stress is not the cause . So my cat has the same response . And so humans have a word that we call anxiety .
Speaker 3So anxiety is not a psychological diagnosis . It's the driving force behind almost all dysfunctional human behavior . We'll do anything to avoid that sensation Because , as a survival reaction , the species of creatures who did not pay attention to the sensation simply didn't survive . Now what's so critical about that is that the survival response , anxiety slash anger says survival reaction . It's a gift . It's always going to be unpleasant , because if it wasn't unpleasant we wouldn't pay attention to it . But the problem is it is a one million times stronger than your conscious brain . Your unconscious brain is processing about 20 to 40 million bits of information per second . Your conscious brain processes 40 . It's a million to one ratio . You can't solve anxiety with mind over matter . And the problem is we have all these things like addictions , we have all sorts of disability and people have crippling anxiety disorders . Well , anxiety is not a disorder , it's a gift of life . It keeps us alive , but it's going to be incredibly unpleasant . So it's a driving force . It's just a word we use to describe activated threat physiology . So in our world we're trying to get rid of the word anxiety and simply put in activated threat response or activated threat physiology . So again , if I had one message to give to the world right now is that I did not know this .
Speaker 3I went through my own chronic pain issues and you ask well , how can I have 17 different symptoms ? Well , remember , every organ has its own set of cells . It's all response to chemistry . So the kidneys are different than the stomach , they're different than the bladder . So , and I had extreme anxiety . Well , let me just talk about this for a second . So let's talk about the mental part of it . When you're under constant threat , half your brain is inflammatory cells . Your brain is actually part of the immune system . So your brain itself becomes inflammatory , sensitized by these little molecules called cytokines that fire up an inflammatory response . Then the speed of nerve conduction doubles from the inflammation . So now you actually physically feel more pain because the nerve conduction has increased and your brain is now sensitized . So of course , you're gonna feel the pain more acutely .
Speaker 3So the problem is that I'll just tell you some of my symptoms , which your clients trust me , everybody that's in chronic pain has at least five symptoms . So I had migraine , headaches , rain in my ears . I had stomach issues . I had neck pain , back pain , I had skin rashes come and go over my entire body . I had allergies . My feet were burning like crazy . I had extreme anxiety , depression . But I also developed a full-blown obsessive compulsive disorder , which is one of the ultimate anxiety disorders , but again , it's just the sensation generated by my stress chemistry . I went to psychotherapy for 13 solid years . That's a lot of psychotherapy and things get way worse Because , again , this mismatch of this unconscious survival reaction compared to the conscious brain , talk therapy is remarkably ineffective .
Speaker 3And we'll talk about , maybe , the therapies that are effective , because there are therapies that are actually necessary to actually solve the problem , but talk therapy is not one of them , because it's that million to one mismatch . So , going to one of the core points we're making is that anxiety actually is the pain . That's what it is , and so what happens is that your physiology translates to physical symptoms all over your body , and then , when humans have a major problem is that we know that mental pain is processed . It shares the same circuits as a physical threat . But humans cannot escape their thoughts , right ? So the research term is URTs unpleasant repetitive thoughts . So what happens ? You can't escape your thoughts , which fires up the physiology . Then what's even worse is that repressed , negative thoughts are worse because they not only fire up the physiology , more they actually shrink the hippocampus of your brain , which is the memory center . So hence brain fog , which I also had , that too for a while . So you know , long COVID , that's another threat physiology state . So again , threat physiology just creates havoc on your body , creates havoc on your life . And so what's the answer ? There are ways of simply lowering the threat physiology . We call it dynamic healing .
Speaker 3And I still I know I segwayed just slightly off your question why do I no longer recommend spine surgery ? So let me just stop for a second . This is regroup . Sorry , I keep taking off on these pretty major tangents , but I just think I'm fascinated . It's just what's going to be really frustrating to you is that I think you have my resources together . I'll send you a set of my resources , but you're going to find out that the solution is very self-directed . In fact , by definition , the person himself has to direct the process . This is not psychological and again we'll talk about the solution in a second but the reason why I don't recommend spine surgery anymore , because it has nothing to do with the anatomy . So this is the most perverse illustration of what I'm talking about .
Chronic Pain Misconceptions and Surgery
Speaker 3So you mentioned before that , okay , something has to be quote structurally wrong , otherwise doctors ignore it . Okay , so let me ask both of you two a question here . Did we learn in high school about ?
Speaker 1fight or flight . No , yeah , yeah , no , yeah , I remember it , yeah .
Speaker 3So why don't we understand that after medical school ? Why do we completely ignore the fact that if you feel threatened , your whole body reacts ? This is high school physiology , high school science class . We learned about this and somehow medicine just turned a blind eye to the fact that most symptoms in the body essentially all symptoms in the body are created by your body's malfunctioning because of the physiology . So this is the classic illustration about why I quit spine surgery . Okay , so you know the data that says that disc degeneration , bone spurs , arthritis , bulging disc , herniated disc are not a source of pain . Have you seen that data ?
Speaker 1No , well , I mean , I know that we see MRIs all the time that have bulging discs , that our injured workers get really upset about , right , and I think Matt , and I would say anybody who's my age 40s up is probably going to have something show up in that MRI . But that may not be associated with any of the reasons you're having problems .
Speaker 3It's not , may not , it is not . The data shows really clearly that those bone spurs everything you just talked about are simply not a source of pain . They are not . And we now know that chronic pain is a neurological disorder and wherever the back pain starts is somewhere in the tissues , the muscles , the tendons , the ligaments . And , for instance , we know that sleep lack of sleep has been shown in a major study out of Israel in 2014 , that lack of sleep actually causes chronic low back pain . It causes it . It causes it .
Speaker 2How many ?
Speaker 3surgeons , do you think , are asking the patients about sleep before they do major surgery . Okay , so here's the perverseness of it , and I just that's why I quit Because it turns out we're actually operating on anxiety and the success rate . So then you have a disc that's been documented , deeply documented , to not be a source of pain . Yet one of the most common operations we do in the United States is a fusion for back pain . So I can speak to some authority , because I actually was one of those surgeons for my first eight years in practice who was aggressive , doing surgeries for back pain . I thought it was the right thing to do .
Speaker 3Seattle had nine times the rate of spine fusions compared to the rest of the country per capita . I was part of that juggernaut . We had some new instrumentation back then called Steffi Plates , which you may or may not remember that name , and we were some of the original cult researchers . So I asked one of my senior partners one day I go what's the data on this ? He goes I don't know . Okay , so a spine fusion is a big operation . So I'm doing these big operations .
Speaker 3And then I found out from a friend of mine , dr Gary Franklin , who's the medical director of Workers' Compensated Washington .
Speaker 3They published a paper in 1994 that showed that the success rate from a spine fusion for back pain in the Workers' Comp population was 22% at two years 22% .
Speaker 3Then there's data out there which I was not aware of until recently that shows if you operate in any part of the body for any pain that's chronic more than six to 12 months , that you can in any part of the body for any pain that's chronic more than 6 to 12 months , that you can induce chronic pain at the new surgical site or make it worse 40 to 60% of the time . So you have a fired up nervous system . There's always so many pain circuits in the brain but you have these pain circuits fired up and then you start plugging in body parts . So the chances of making you worse with surgery are double of the success rate . So we're operating on normally aging spines that have been documented not to be a source of the pain . We're doing a major intervention that has a 20% success rate and it continues to be one of the most aggressively done operations in the country . Go figure . It's why I quit .
Speaker 2So , with all that data , with that information , with what you just shared , how do you talk to an injured employee and successfully convince them that the doctor that told them that they need this surgery and this procedure , that that doesn't need to happen and what they need to do is go download your app and avoid surgery at all costs ? I guess that's probably our biggest . You know , if Greg and I agree , like you know , surgery , you're going to have the same result in two years , whether you have the surgery or not . You know , how do you convince somebody that's been told by a guy with these initials behind his name and done this ?
Speaker 2procedure a hundred times or a thousand times . You don't really need that surgery .
Speaker 3So you're not going to like my answer . I know .
Speaker 2Let's go right . Let's go right , okay , but I have to ask the question . That's what we're here .
Speaker 3Well , first of all , I mean I'm really upset at my profession . I mean we're predatory . So instead of doing one and two level fusions that don't work , we're now doing 8 , 10 , 12 , 14-level fusions that don't work . And I actually was the chairman of the non-operative care committee for the scoliosis-richness society that I organized 50 people into eight work groups . We came up with a 100-page document , which I'm happy to send you , showing that there's no data that says scoliosis is a cause of pain . So , instead of doing a 1 and 2-level fusions that don't work , we're now doing eight , 10 and 12 and 14 level fusions that don't work , with a very high complication rate , devastating results . And we're still doing them more and more and more . So the answer to your question going backwards is that , as frustrating as can be that my profession is even offering an operation to patients that has no data , I mean think about this . I mean it's not really the patient's responsibility to figure this out . I mean you trust your doctors and I'll just tell you right now , a certain percent of doctors right now , the last five years , maybe the last 10 years , are simply lying to their patients . So I don't know . I mean there's lots of good surgeons I don't want to throw my colleagues under the bus because I was one of those surgeons . If I had not gone through my own chronic pain process , I did the same thing . I would still be doing the same thing . I just had no insights into it . Because you're so trained of structure structure , structure structure and surgeons were trained that we don't really have the responsibility to treat the whole person , we just have to do our job well . And the problem is with specialization . We do an operation . It doesn't work Well . We did our job . It didn't work Well . Have a good life , okay .
Speaker 3So going back to your question , is it ? Patients and workers comp are trapped . So what happens when you're trapped by anything ? Remember we said anxiety is a physiological state . So you feel a threat , you take action to solve the threat and you move on . But what happens if you can't solve the threat and you're trapped ? Your body kicks in more of a stress response and you become angry . And your workers' comp ? You truly are trapped by everything the pain , the circumstances , doctors , I mean . Nobody's telling you how to get out of this hole . So you're trapped and what happens ? Your body really fires up and your thinking brain simply goes offline . So the metabolic activity in the blood supply shifts from the neocortex , your thinking center of your brain , down to the midbrain or survival center , and you also have a brain fog . And when you're angry and frustrated , all you want to know , you just want to be fixed . You don't want to deal with the issues , you don't want to deal with abstract thinking and I will send you a paper writing right now that , when you were angry , is an absolute block to getting better . So I no longer engage in the conversation about trying to convince them that this is the way to go . This is the way to go . So I say , look , here's my book , here's my website . I'll see you back in two weeks . So if they're curious enough to start looking at it , it's game on , because it's not that hard to understand . I think we had a pretty good conversation . Hopefully I explained it pretty well today .
Speaker 3So everybody is so programmed society , the patient , workers' , confidence . If there's not a structural problem , you have to live with it . So I'm here to tell you the reason why I quit my practice . I've seen hundreds and hundreds of patients go completely pain-free , including myself . No risk , minimal resources , it's self-directed . And not only do people go pain-free , they just thrive at a level they just never knew was possible . It's unbelievable .
Speaker 3So , conversely , I'm watching patients three to five patients every week kind of be with multiple surgeries being done , with the life way worse . The most common statement I heard was if I just knew how bad it could be , I never would have done the surgery . Then I have another issue with the patients being so angry at their surgeons that fail because the surgeons are very optimistic , you know , let's give it a shot , it's a big intervention . And so they get really optimistic about it and do the operation . So they're promised a solution , it sounds great , and then I'm telling them that it's not going to work .
Speaker 3Number one . So they want to shoot me . To be honest with you . Second of all , they go . What are you talking about ? So all I can tell you is that if you look at this process called the DOC journey the doc journey it starts with your skepticism . Why went it so ? Remember , the essence of the solution is lowering threat , physiology and increasing safety . But you also have what you're actually doing is connecting to your own body's capacity to heal , whereas you just connect with what is , and you just connect with what is , and what is is pure disbelief . You're angry , you're frustrated and lashing out why wouldn't you ? So the process actually starts connecting with your disbelief . It's not about believing , david Hanscom . It's not believing about anything , about anything . It's just simply starting the process and allowing your brain to change . So I have not . That's where when I deal with workers' comp situation . Actually , I figured this out about five years into practice , because doctors , as you know , label their patients especially workers' comp . They're lazy , they're maligners , they're drug seekers , whatever it is . But what physicians don't know ?
Speaker 1and I learned this a few years ago also , that the mental health effects of being off work are devastating .
Speaker 3That's a great point . Yeah , none of us likes . I mean . There's a huge paper out of Australia showing that the mental health effects of sitting around the house are bad . Right , and humans don't like sitting around doing nothing . I don't care who you are and I would say maybe 5% of patients , maybe 10% of the very most , are malingerers , but in a way they don't have a choice because they're not given any alternatives to heal , right ? So the answer to your question is I say look , here's the book , here's the website , use my resources , use somebody else's resources . But it's not about generating belief in David Hanscom or in the Doctrine or some other person's book . It's about actually connecting with who you are in your healing capacity . So once you can allow yourself to feel the rage and frustration which is there and start doing techniques to start calming things down , your brain starts going back online , you start going from the midbrain or survival centers back into the thinking centers and things start to change .
Speaker 3So you mentioned the question what does expressive writing have to do with chronic pain ? And the doctoring starts with some basic tools that start the process . First of all , just understanding . There is a different way of looking at pain . You don't have to understand it from the beginning , but you just have to understand the concept that chronic pain is different , it's totally different than acute pain . So it's sort of an ongoing education process that starts .
Speaker 3The second thing is the expressive writing . So what happens is called expressive writing . So what happens is called expressive writing . You simply write down your thoughts , positive or negative on a piece of paper and you tear them up . You go well , that's ridiculous . Well , there's a book right here in my hands , written by Dr James Pennebaker , who's going to be in my podcast next week , and he started the original research in the 1980s on expressive writing . There's over 2,200 papers that document that it works . So it lowers viral load , it improves wound healing , it lowers anxiety and depression . It's unbelievable what this thing does .
Healing Through Writing and Meditation
Speaker 3So in my 15-year journey in chronic pain , the first thing that broke up my pain patterns was expressive writing . Now , I didn't know it at the time . It started by accident . I read a book that says start this writing exercise . So I started it . Within two weeks I felt a shift and by six weeks I'm going wow . So it was the first shift I felt in my pain for 15 solid years Now . It's not the solution . I have to be really clear . It's not the final solution , but it's the necessary starting point . It is the only one mandatory aspect of the entire healing journey is simply start the writing .
Speaker 1And so when you say expressive writing , so like if I was doing that , I would sit down and write the thoughts that are . You know , whatever I'm thinking as far as pain goes , what's on my mind all that get it out on paper and then throw it away or rip it up at that point .
Speaker 3Well , get it out on paper and then throw it away or rip it up at that point . Well , and you're not trying to get rid of these things . Remember , there are trillions of thoughts . You cannot control your thoughts . What you're doing is simply a separation exercise .
Speaker 3So the thoughts are on the table , you're here and you tear them up for two reasons . The first one is to write with absolute freedom , because there's a lot of crazy , despicable , bizarre thoughts in our brains . Everybody's brain , every human being has this problem . So , even without being in chronic pain or trapped in disability this is my biggest goal the next year is looking at these obsessive thought patterns is that they are brutal . You can't get rid of them . They torture people and they're rampant , especially in this younger generation . So these thoughts create the physiological response .
Speaker 3This generation right now is tortured with anxiety . My generation had its share too , but right now this anxiety thing is brutal . But it's this obsessive thought pattern , okay . So what you do you ? You tear them up for one reason , that's to write with absolute freedom . The more unpleasant the thoughts , the better , but you have to have to be careful . You start actually writing these thoughts out . Your body can react pretty quickly to that . So the second thing is , the reason to tear them up is that when you write , all these issues come up . They're not issues , they're just thoughts . So if you keep them and analyze them and try to rehash them and write them down again , and again and again , you've actually reinforced the problem .
Speaker 1You're empowering the ideas instead of just letting it go .
Speaker 3Right the problem You're empowering the ideas instead of just letting it go Right . Well , yeah , it's just letting go separate . It's just an exercise . That's it Just simply a separation exercise . So the first part of the doctrine is embracing your disbelief , saying , well , just start the writing . You don't have to believe in it , just do it . The third thing is called active meditation . Is that your brain's erasing thoughts , so simply switch sensations . So both of you just sit back in your chair for a second . I'll do it myself . All right , drop your shoulders , take a deep breath . That's it . We used to do it in surgery all day long . We did mindfulness-based surgery . So we start getting erasing thought patterns and getting frustrated . I mean , spine surgery is a little stressful . So if you find yourself getting ramped up , just sort of take a step back , take a deep breath , let it go . Then re-engage with your move . I don't know . So , matthew , how did that feel ?
Speaker 2So relaxing and I did download your app , the DOC Journey , and I thought it was clever . You know it talks about the people and their thoughts are racing and that cute little example of all the guys thinking about is yogurt or whatever it's a beginning , right , I mean I can relate to that because I'm trying to do a daily 10 minute meditation thing and your mind starts to go like to the opposite thing .
Speaker 2Where you're trying to think about right thing and your mind starts to go like so the opposite thing where you're trying to think about right . You're like trying to be silent and reflective and think about your day and what's happened and all of a sudden you're thinking about yeah , I'm hungry , right , whatever .
Speaker 3Well , I mean , just let the audience know . So there's two things that I have . Well , a bunch of things , but the main resources are it's called the Doctrine course . It's called the Doctrine course . It's a computer-based course . So the second thing is an app where it's based on our workshops that we put together . It's called the DOC Journey app and about a year into developing this app , my wife came over and looked at the app and she goes that's not an app . So my wife is a tap dancer and we put these workshops together based on awareness , hope , forgiveness and play . Turns out that play is the opposite physiological state of pain , right ?
Speaker 2So it's not about distracting .
Speaker 3It's not about play to distract yourself from the pain . It's actually taking your body's physiology and really connecting with that energy . It changes your body's physiology and in every one of our workshops that were three to five days long , about 80% of people went to pain-free within the week every time and I could not figure out what the heck was going on . So it's based on structure , shared experiences , some education , and my wife's a tap dancer , so we did the cup song juggling starves , so the app's full of those resources , and so the Doctrine app is a resource . The Doctrine course is a resource resources , and so the Doctriney app is a resource . The Doctriney course is a resource . And then we have I do coaching twice a week for an hour , tuesdays and Thursdays at noon . It's just a group session , very light , we cannot discuss your pain , and so those are resources that help things move along relatively quickly . So the Doctriney app and course have evolved over 20 years of my own experiencing watching 100 patients go to pain free and again watching people . Not only do people go pain free , is that for all of us ? When you quit fighting anxiety and anger , which are again gifts they're supposed to be unpleasant . People thrive at a level that they never knew was possible . It's unbelievable and it's consistent . So I just want to jump into some concepts here . Well , let's just finish the starting point of the doctrine .
Speaker 3So we talked about embracing your pain . Second of all , the expressive writing . Third , we call it active meditation . And you know , matt , as you talked about is that you're trying to meditate , which I think is fine . I think it's a great tool , but it's hard . It is hard . Just drop your shoulders for a second , that's it . I mean it doesn't take any time . It's pretty soon to become sort of automatic . That you found . You find yourself a little bit tense . Just drop your shoulders , listen to a sound , not three to five seconds . So the next thing is sleep huge .
Speaker 3So chapter 14 of my book is based on sleep . It's not the ultimate answer , but when I was in practice doing this on my own in Sun Valley which is how I learned the process with my patients everybody was able to sleep within six weeks , no matter what . Now a few people I had to send to the sleep center to get that done . But nothing really happens without sleep . Remember we talked about how earlier that lack of sleep actually causes chronic pain . So again say how can that be ? Well , we do know that lack of sleep is actually inflammatory , and so by getting sleep you actually it's also at nighttime , through a form of the lymphatic system called the glymphatic system , that your body empties out the wastebasket . That's how you clean out . Your brain is at night . If you're not sleeping , it is devastating .
Speaker 3So the final thing on this leg one of the doctor journey is , we call , never discussing your pain . So I was one of those people that probably 60 to 70% of your waking hours are spent on the internet discussing medical care , complaining to your friends and family about your pain . But where's your attention ? You're reinforcing the pain , so people's eyes get consumed by their pain and again , from a neuroplasticity standpoint , your attention's on the pain , on the problem , on trying to find a solution , on trying to fix the problem . So you're dramatically actually reinforcing these pain circuits . So I say , look , mental pain and physical pain are the same thing . So when you walk in and I do do this on the first visit so I always say , greg , when you walk out the door of my office , you will never discuss your pain , ever again , no exceptions , especially your family with your family , friends or colleagues . No discussing your medical care with family or friends , but also no complaining . No giving unasked for advice , no malicious gossiping . Quit watching the news , because that's the input that fires up your system .
Speaker 2Yeah , no , you're right .
Speaker 3People also look at it .
Speaker 2I love it .
Speaker 3Don't bring your work home .
Speaker 1Well , you know , dr Hanscom , you've hit on something . Like you know , I don't talk about it a lot , but I've had , you know , dealt with anxiety on and off throughout my life , and one of the some of the things that I just discovered on my own was one stop watching the news , turn it off and start eliminating the triggers of the things in my life that I don't have control over , right .
Speaker 1And the other thing you said was sleep . You know , believe it or not , that's a huge one . I find I get sick more frequently when I don't get my rest Right and you know , my anxiety is worse . All those things are worse when I don't do those things . So I mean , it's huge .
Speaker 3Well and again , the problem with workers' comp situation is that you really are trapped and I sort of got segued , as I've been doing all day today , on my original answer . But I figured out 30 years ago that patients in workers' comp weren't malingering . They were legitimately trapped and they were angry . And I didn't know about anger being physiological state at the time . But I just knew that the labeling and everything they get , I mean they're abused , Sure they're abused by the system , so it's legitimate anger , Yep .
Speaker 3So I mean I'd love to do another podcast with you on the anger .
Speaker 3There's a bunch of I mean I'd love to do another podcast with you on the anger there's a bunch of I mean , there's a whole whole energy about these obsessive thought patterns . But also the effects that chronic pain has on the family is just brutal , brutal , and so it wipes out family . So your family , instead of being a source of peace and joy , you bring this energy into the home , and of course , the family's not stressed out , which stresses you out . So you get this massive cosmic ping pong game going , and so chronic pain just devastates households , and so that's a whole different topic that I would love to talk about , but I do want to sort of summarize here a little bit about what we're trying to do .
Dynamic Healing and Pain Management
Speaker 3So there's a model I have called dynamic healing . So what I mean by . You have your stresses or circumstances , that I call the input . Then you have your nervous system itself , which can be either calm or hypervigilant . Then you have the output of your body's physiology . So , no matter which portal you come into , you want to lower your body's physiology from threat to safety . But this happens multiple times a day , every day , because I mean life comes at us . We have to process things . So it's not a matter of avoiding stress , no matter how you process it . So there's ways of processing the input of the stress differently to minimize its impact on the nervous system . There's ways of literally rebuilding the nervous system so it's more resilient . Then , like this little breath work we just did , actually directly lowers the physiology . So , whether it's the input the nervous system or the output , you're trying to lower the physiology . So we call it dynamic healing . So it allows the patient themselves to address any one of those portals on a given day . It's very self-directed , by definition . You cannot do it . Nobody else can do this for you . So what I want to summarize with is there's two parts to healing . So it's based on neuroplasticity and the body's chemistry .
Speaker 3So we talked about how anxiety and anger are massive survival reactions . They're much stronger than the conscious brain and you have no control . They're automatic , they're hardwired . We have no control . So the way you lower anxiety and frustration is simply lower the stress physiology . That's it . So there's a bunch of tools that allow you to do that .
Speaker 3So you learn how to process these massive reactions . Well , first of all , you separate your identity from them , because they're not who you are , they're what you have to survive . So you separate from these reactions , learn to calm them down , so that's one skill that doesn't solve the pain . Learn to calm them down , so that's one skill that doesn't solve the pain . The way you really solve the pain is that you move into joy and a good life . So it's like learning a new language . So you're not going to learn French by trying to fix your English . You're not going to live this joyful life by trying to fix your survival life . So you want your attention on the solution , not the problem . But you don't want to do things that are enjoyable to distract yourself , because it's a million to one mismatch . So there are two sets of learned skills I call becoming a professional at living your life .
Speaker 3So you learn how to process and separate from anxiety and anger . Learn how to move into joy good food , good wine , good friends , whatever you want to call it . That's where the healing occurs , because it's all based on neuroplasticity . So as you learn to actually nurture these circuits into where you want them to go , it's game on , and that's why people thrive , because they're not fighting anxiety and frustration anymore , and as they quit fighting that , then they actually get to nurture a new life , and it's consistently unbelievable and actually why I quit my practice .
Speaker 3So my message is that , look , mental pain is the bigger problem . You cannot really treat physical symptoms without addressing the mental pain , because you can't escape your thoughts . We think that the driving force behind all chronic pain is human consciousness . Call it psychological if you want , but you have mental threats and physical threats . You cannot solve the physical symptoms or mental symptoms , by the way , without addressing the mental threats Not possible . That's where workers' competence is down such a rabbit hole with their process , because they're going absolutely backwards on it .
Speaker 3Now , as you calm down the nervous system , I will admit that things do calm . I mean it's bidirectional . I mean I don't want to make it too simplistic here , but it's a bi-directional process and you cannot separate these two out . So I don't use the term mind-body anymore . We're just a unit , and the term mind-body implies there's a separation and the brain's actually part of the immune system . For goodness sakes , it's just a unit .
Speaker 3How do you fly a Boeing jet without a computer , right , right , how are you going to run the hand and body without a nervous system ? You just can't do it . So it's just an intertwined system . So my message is look , I don't care if you're a workers' comp or not , it is harder to get out of pain in a workers' comp because the how do I say this ? You're trapped . You are legitimately trapped , and the more legitimate your anger , the harder it is to let it go . But you have to do it , it's doable . I have lots of workers' comp people that come out of chronic pain . I would definitely say it's harder and one of the hardest part is that engagement point , because you're so angry and frustrated and legitimately so that your brain's not actually functioning properly , you know what I mean it's a catch-22 .
Speaker 3So that's my wish is to actually work with workers' comp people to create a better entry point , and we've gone for a long time with this . But then again , two parts to healing , processing the survival skills and nurturing the consciousness or joy , and they're separate skills but they're obviously linked . So anyway , the Doc Journey takes you through the sequence , the course and the app . Both do the same thing . The Backend Control book gives you the background of what's going on . It's not a self-help process , it's just a framework that allows you to understand the problem in a way you can create your own solutions , very much self-directed . You do not need a pain clinic . We do often add on resources as you go along , but until you have that foundational process in place , it's really hard to understand the whole process .
Speaker 1Well , Dr Hanscom , I've just been fascinated . I could listen to you for like two more hours because I think some of the things you're saying resonate with what I've seen personally and professionally in managing workers' comp for as long as I have , and I know that what you're doing definitely makes an impact . I think Matt would probably say the same thing , but I wanted to . One of the things we're doing this year as we wrap up is I wanted to ask each person we interviewed what their favorite part of what they do each day is , because I feel like you've kind of headed at some of this . There's a lot of negativity out there in the universe and one of the things I'm trying to do is put good , good vibes out there , and so I've wanted each last year we had each of our guests tell them the last time they were truly happy , who were they with and what were they doing . This season , I want to talk about what's your favorite part about what you do each day and why does it bring you joy .
Speaker 3Well , I love seeing patients get better . I mean , that does drive me harder than I should . I hate seeing people being damaged . So again , why it drives me so much
Embracing Joy and Stress Management
Speaker 3. But I mean things I do to actually keep myself going is I'm learning Italian . My wife's fluent in Italian . We have a ping pong table in the backyard . I do weight training type thing . Those are things that I do as hobbies and stuff . I do a guy's ski trip every year , which I'm getting ready to get that organized right now .
Speaker 3So yeah , I'm actually challenged by this concept of nurturing joy , because that's not the first word in a surgeon's vocabulary , I have to tell you . But yeah , I'm taking that to heart . One of my biggest mentors has really challenged me to actually work on that particular part of it . So yeah , I'm trying to actually work on my own process of putting my brain where I want it to go . So again , also for the group I'm talking to right now , everybody has anxiety , everybody has stress . So if you're inclined to start going through either the app or the doctoring on your own , maybe 15 , 20 minutes a day at the most , it's a learn skill and it does dramatically change the way you process life in general . It's a great stress management tool , so I'd love to help some of you through this . That's fantastic .
Speaker 1Well , I appreciate your time , Dr Hanscom , and I know our audience will really enjoy hearing from you . And just remind everybody our motto to do right , think differently and don't forget to care . And that's it for this episode of Adjusted . And just again , feel free to reach out to Dr Haskin if you have questions about this program . Thanks everybody , Thank you .