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
Hello 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.
Understanding Chronic Pain and Stress
Speaker 3So, first of all, acute pain is completely different than chronic pain, okay, so let's talk about acute pain 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.
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.
Chronic Pain Misconceptions and Surgery
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. So 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.
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.
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.
Embracing Joy and Stress Management
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. 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.