Welcome back to the Healing Pain Podcast with David Hanscom, MD

In this episode, you’ll get to meet my friend and colleague, David Hanscom, MD. He is an orthopedic surgeon whose practice at one time focused on patients with failed back surgeries. He eventually quit his spine surgery practice to pursue his passion and present his insights into solving chronic pain, which evolved from his own battle and struggles with it. Dr. Hanscom has written two books on the topic of chronic pain and now guides patients more clearly through the complexities of solving chronic pain. In this episode, we explore the connection between anxiety, PTSD and chronic pain. It’s a great episode to share with someone who is struggling with chronic pain but healthcare practitioners, specifically orthopedic surgeons and primary care physicians. Let’s get ready and let’s meet David Hanscom, MD.

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Unwinding Anxiety, Trauma, And Chronic Pain With David Hanscom, MD

David, thanks for joining me on the show.

Thank you. I’m excited to be here.

I’m excited to talk about this topic. Pain and consciousness are two words that belong together, but we don’t necessarily often see them together. It’s a big topic. The word consciousness means lots of different things to lots of different people. Some people don’t understand what consciousness is and what that has to do with pain, with regard to the conscious and unconscious nature of things. I know you’ve done a lot of work around anxiety, both through personal experience as well as through your own research, writing books, and treating people with pain. I think a good place to start is to describe and explain the nature of anxiety as you see it.

I’ll briefly reiterate why it’s such a big deal to me because I went from being a fearless spine surgeon. In 1990, I was trying to cross the 520 bridge in Seattle and I had a panic attack. Your heart races, you sweat and you feel like you’re going to pass out. It’s an incredible anxiety-producing situation and I swear before that moment, I did not know what anxiety was. My thing was, “I was fearless.” My attitude was, “Bring it on. You could not give me enough stress.” I keep trying to tell my wife that normal people don’t become spine surgeons. They just don’t. We’re incredibly good at mastering suppression. We’re incredibly good about suppressing stress. We suppress anger and anxiety. You almost have to be that way to become a spine surgeon and a spine surgeon is stressful.

What I didn’t know is that the suppression of emotions is a huge problem. All of a sudden, it exploded. It was like the top coming off of a pressure cooker. From that moment on, for the next thirteen years, I could not put this thing back in the bottle. I could not control my anxiety. I went to worldnosis. I went to thirteen years of psychotherapy, once or twice a week. That’s a lot of psychotherapy. I thought it was a psychological issue. I eventually developed what’s called an obsessive-compulsive disorder, which is the ultimate anxiety disorder. The prognosis for that disorder is horrible. It still is and I didn’t know what to do. I’m like many chronic pain patients who just lost hope. I had severe anxiety, back pain, neck pain, migraines, and stomach issues. My feet were burning. My mouth was burning. It was unbelievable. I have seventeen different symptoms at that time.

I thought anxiety was psychological and that’s why I treated it as such. It turns out that anxiety is a response to a threat or stress that says danger. It’s your body’s total response to the environment in order to survive, just like pain physically says danger and anxiety mentally say danger. As you and I have talked multiple times is that there’s no separation between the mind and the body. It’s a unit. You cannot fly a Boeing jet without a computer. The body can’t survive without a nervous system coordinating the traffic. It’s a unit response. Anxiety is a result of a threat. It’s not the cause.

That’s a great way to open. The story that you particularly tell is shared by many people who struggle with anxiety and the various mind-body symptoms that go along with that. To be a spine surgeon almost requires you to push these emotions down. I’ve worked with many orthopedic surgeons, many of who do incredible much-needed work. Physical therapy has changed over the years. It can be very mechanical. A person comes in, we give them exercises and certain weights, reps, etc. It’s in a more therapeutic context. I’m trying to articulate a point, but orthopedic surgery can be very similar. A person comes in, you take an X-ray of their knee or back, you do an MRI, identify a structural deficit, and do the surgery, the exit, so to speak.

Hospitals and medical systems have quotas for professionals to work under. Quotas typically don’t ever ease up. Most big companies, especially hospitals, like to see money increase over time because things are increasing over time. With regard to emotion regulation, which is common in Cognitive Behavioral Therapies, mindfulness and third-wave therapies, is there a place for that in the training of orthopedic surgeons? How do you think the majority of your colleagues would respond to, “I’m going through an orthopedic residency. It’s stressful. I’m learning all these things about basic science and how to perform surgery. Where does this fit into my professional career?”

They should be taught probably even in grade school, but certainly, by medical school, they should be a flat-out part of the curriculum. What happens in medicine in general is it’s a very competitive world. People are very perfectionistic, which sounds like a virtue, but you know that perfectionism is a disaster. It was always that, “Not good enough.” That drives you to the top and the same drive takes you right down to the other side. The burnout rate in physicians is between 60% to 70%. Burnt out physicians do not perform well. I may have nineteen medical colleagues who died from suicide. That’s a lot of people. The incidence of suicide amongst physicians is about twice that of the national average in men and four times the average in women medicine doctors.

What happens is it suppressed stress. It suppressed emotion. It suppressed anxiety. What kills people is anxiety because here’s the deal. The antidote to anxiety is control. Anxiety says danger. When you control the situation yourself to solve the anxiety, we lose control. You become angry. You kick in more chemicals to solve the problems. Anger is the final, last-ditch effort to regain control and it is destructive. The ultimate act of destruction is self-destruction. Suicide is not an act of depression. It’s an act of anger. In my book, I’m pretty clear I was suicidal. I’m very close to a lot of these people, unfortunately, who committed suicide. It’s suppressed anxiety, yet when I give a lecture on burnout or use the word anxiety, everybody wants to drop right through the floor. What should happen?

On top of that, we are under incredible stress, horrible hours, and demands. We’re walking a tightrope every day of our life, especially spine surgery. I remember after doing 3,000 surgeries, I’m going, “When does the anxiety disappear?” I stuff it and do the next case, but the problem is, complications happen. You have to come to that same spot on the next case, so you suppress it. What you do is you develop cumulative PTSD. They never can understand why a significant number of spine surgeons would quietly quit practicing spine surgery at about 5 to 7 years in their practice, but they couldn’t suppress it anymore.

What I taught my fellow starting in 2006, I hired my golf instructor to be my performance coach. We taught mindfulness-based surgery. By suppressing anxiety, you’re going to focus, but your attention is on focusing and it’s not on the actual mood. With mindfulness-based movements, we usually drop your shoulders, take a breath and we go to a light touch. It’s by connecting to the touch. We’re connected to every move. Instead of having thousands of thoughts in our brain throughout a case, in a ten-hour case, I might have five distracting thoughts. My complication rate dropped probably by 80%, but it was about connecting to the mood. The answer is to funnel.

 

With the supervision of medicine, we’re being hired, controlled, and monitored. First of all, we’re not taught stress management tools. If we seek any help of any way, shape, or form in medicine, we’re sanctioned. We’re in an incredible pressure cooker. We’re not given stress management skills. We’re sanctioned if we seek any assistance at all. They say that you don’t, but they’ll take away your license. They’ll take away hospital privileges. It has become rough on physicians. That’s where I’m actually concerned about the medical system completely dissolving because doctors are quitting. I don’t blame them. I went from a horrible burnout for about ten years. In other words, I would call my time in chronic pain a true burnout. People don’t call it chronic pain. They call it burnout, but it is burnout. It is chronic pain.

I came out of it and the last ten years of my practice were incredible. I was so excited about going to work. I was able to connect with myself, my patients. I have seen patients who have no hope get back to their hope and their life and thrive. It’s incredibly rewarding. I went from the darkest of the darkest hole to be totally excited and inspired by my patient. I quit spine surgery to bring these concepts out into the real world or into mainstream public opinion because chronic pain is solvable, anxiety is solvable, but you have to get the right concept of what it is before you can solve it.

I have a lot more questions for you about anxiety and the nature of anxiety with pain. We were on a wonderful tangent because I’m enjoying this conversation with you about spine surgeons and orthopedic surgeons in general. There is a term in the literature, which is called vicarious PTSD. Vicarious PTSD is any healthcare worker that in essence, is working with people who are suffering, which would be psychologists, physical therapists, physicians, everyone, but especially in the chronic pain world. That each day as you work with these patients, in some way, you’re subjecting yourself to a small or potentially a large dose of PTSD. In my mind, I’m also connecting that to the fact that I believe all of us who have come to healthcare want to help people. We want to serve people on the highest level.

As a spine surgeon, when we look at the positive outcomes with regards to various types of spine surgery, they’re quite poor in general. Outcomes are not very good just from spine surgery alone and you have people coming back to you. First of all, I think many physicians say, “This is going to ‘fix you,’ this microdiscectomy, this fusion, this laminectomy, etc.,” and then it doesn’t work. People come back to you, “Doc, this didn’t work. I still have this pain and sometimes the pain is worse.” I’m wondering if that vicarious PTSD rings true to you.

It’s horrible. We know the literature shows that the way you induce depression is repeatedly dashing hopes. You promised something that doesn’t work. The thing about spine surgery that’s so horrible is that the success rate of a spinal fusion for back pain is about 25%. There’s a 40% to 50% of making your pain worse after spinal fusion for back pain. The chance of making you worse is double the chance of making you better. There’s not one research paper that says spine surgery works for back pain. There are multiple papers showing that mindfulness, pain clinics, ACT, CBT, and all these things work. The problem is that they’re not covered by insurance. We don’t have enough effective treatments. We’re not doing those.

There’s another type of burnout. There’s post-traumatic PTSD because we keep failing the patients and ourselves. We’re not fulfilling their needs. There’s also one called moral injury. We’re in the trenches watching patients undergo procedures that the hospital administrators know don’t work. The data says these procedures don’t work. They monitor us on productivity on procedures that don’t work. We’re watching these patients being damaged.

There’s not much we can do about it, honestly. I finally had to quit my practice to do this because I was so under the thumb of this hospital with the computer systems that monitor every keystroke that we do. It has become very intense. That’s why I worry about the medical system in general. That’s where with the COVID pandemic, we’re harvesting the results of an illness model as opposed to a wellness model. We’ve got to switch gears and this is probably the time to do it in the midst of this pandemic.

In so many words, you’re not saying that we should not do spine surgery at all. You are not advocating for that. Is that correct?

Correct. There are lots of data that shows if you prep your patients for surgery that the surgical outcomes are spectacular, but the data also shows that only 10% of surgeons, both neurosurgeons and orthopedic spine surgeons, are acknowledging the data before they do surgery. Many times, major decisions are made on the first visit. That makes no sense. I started to prehab my patients before surgery for about 8 to 12 weeks before every elective procedure. Patients started canceling their surgery, even with surgical lesions. At the end of my practice, I was only operating on 4.6% of my patients because they get better. When we did the surgery, their outcomes were spectacular.

It’s not hard to do, but I want to say one final thing going back to the burnout part of it. Whether you’re a physical therapist or a physician of any specialty, it’s mind-numbing repetition. There are only so many things we can do. What makes medicine infinitely interesting is talking to the patients. The patients are incredibly interesting. With the business of medicine, limiting our time with the patients and not allowing us to talk to the patient are major factors. The patients aren’t being heard. We don’t know them. They don’t know us. There’s no energy there that keeps us going. One of the biggest factors reversing burnout is talking to our patients and we’re in a horrible cycle.

A lot of what you are talking about points to things that you and I talk about. Some of the mindfulness and acceptance-based approaches to what’s happening and how they impact not only practitioners in positive ways but how they can also impact patient outcomes and then patients directly. Most of it probably centers around the therapeutic relationship, which is ultimately what you’re talking about. Getting back to that concept of anxiety and your story that’s wrapped in anxiety, which eventually turned into a panic disorder and led to more grave consequences, why do you feel that anxiety is the pain? Because some people would say, “Pain is the problem. Anxiety is the mediator,” but what you’re saying is, “Anxiety is the problem and pain is the mediator.”

You have an impulse. You put your hand on a warm surface and your brain signals a little bit of danger. Pain could be too bright or loud. It could be lots of different things, “What is pain?” Anxiety is just the mental manifestation of danger. Anxiety and pain are the output of your brain. It’s not the input. Your brain is gathering sensations from touch, feel, sight, vision and smell. All those have ranges that are safe versus dangerous. The way every living creature survives on this planet from bacteria to mammals is that we seek safety and avoid danger. Your body is processing 40 million bits of information per second to keep you safe. It’s on automatic pilot. My pupils dilate and constrict. My mouth closes automatically. I sit in my chair. All of these are automatic.

 

My cat has the same system. She stays alive. She hunts. She looks at different things. She avoids danger. She likes to be held. Those are all things that animals do, including us. What happens is that humans have a language. That’s why I think chronic pain is a disease of consciousness. There are very few animal models for chronic pain. Remember, pain is critical for survival. Anxiety is critical for survival. If you didn’t have anxiety, you wouldn’t survive. What happened if you’re threatened by anything, a car, a boss, a bully, intrusive thoughts, or whatever it is? Your body responds with a response that says, “Survive.”

What I didn’t realize is that it also includes the immune system, which includes the inflammatory system. Since human can’t escape their thoughts, we’re all subjected to sustained levels of those chemicals. The difference between my cat and humans is that the humans have a word called anxiety. We put a word on it. All of it is a total body response to any threat. What happens is that we have this word called anxiety. The problem is that the unconscious brain processes about 40 million bits of information per second. The conscious brain processes 40, 40 million versus 40 is a million times difference. I tried mind over matter. It didn’t work. It turns out the suppressed emotions are more of a threat than expressed emotions, so it’s a complete mismatch.

When you say mind over matter, what does that mean? Because that’s an interesting concept that some people are using.

That’s what I did. My nickname in high school and college was “The Brick.” I thought it was a compliment. It was not a compliment. We don’t like being anxious and feeling angry, so we don’t. We just stuff it. What else are we supposed to do? That’s what we’re taught to do. You’re stuffing this 40 million bits of information per second versus 40. It’s a million to one ratio. In psychotherapy, I was trying to understand the idea that, “Knowledge is power. The more I knew about my past or whatever, I could solve the problem.” The situation turned out to be that the more I talked about the problem, my brain started to develop in that direction and reinforced it.

I’m going to ask you a rhetorical question that I don’t expect you to know. I’m just asking rhetorically for the audience. Anxiety is a sensation generated by the body’s survival response. There are different things that can threaten you and put on the survival response but you have a fired-up metabolism. You have a fired-up inflammatory response. Adrenaline, cortisol and all these things are on fire. You’re hypervigilant. If you can’t escape your thoughts and deal with this with rational means because it’s such a mismatch, how do you lower anxiety?

My perspective is you learn to relate to your thoughts in a way that’s different.

That’s a technique. It’s a rhetorical question. I try to get to start with simple answers. That is a way of doing it. The bottom line is that you simply lower the levels of stress chemicals, whatever it is. Changing your thought patterns is one way of doing it. What happens, for instance, what we found out working with Dr. Porges in the polyvagal theory is that deep breathing stimulates the vagus nerve, which is anti-inflammatory. It turns out that humming stimulates the seventh nerve in the back of your throat, which stimulates the vagus nerve, which is anti-inflammatory. Certain music like lullaby stimulates the vagus nerve. Mindfulness, meditation, your interventions and a nice massage all stimulate the vagus nerve. They give you what Dr. Porges calls the cues of safety.

The number one factor in healing chronic pain is your relationship with your provider, physical therapist, psychologist, physician, surgeon, or whatever it is. You want to feel safe. There are not that many places in life that we feel safe. Your family may not be safe. Your workplace may not feel safe. You may not feel safe with your thoughts. There are techniques to separate yourself from your thoughts using music to calm down the inflammatory response. Remember, there are three parts to it. You have the output, which can be either threat, stress chemicals, neutral or safe. You have your nervous system, which can be calm or hyperreactive, then you have the input.

I put together a process called the DOC Journey, the Direct your Own Care Journey, which is the evolution of about fifteen years of experience of people getting better, including my own experience. We now know neuroscience much better, but you can’t just jump from pain to happiness one step. You’ve got to understand the whole process and then there are direct ways to calm down the nervous system. What you’re doing is that whenever your stresses overwhelm your coping capacity, you develop symptoms. You could do two things. You can learn to process stress in a way that’s not so impactful on your nervous system or you can increase the resiliency of your nervous system. When you get that balance back in place, the symptoms disappear.

That’s why chronic pain is solvable because once you have the root causes of the interaction between your nervous system and the environment or your circumstances, once you learn how to process these two, then you could solve the symptoms. What medicine has been doing for a long time is treating just the symptoms. We don’t have the time anymore to know our patients. We usually don’t know their circumstances. You and I both know well that unless you know those two factors, the symptoms are going to continue to be a problem and we have to do something quickly.

There are 150 million Americans with a chronic disease. Thirty percent of those 150 million Americans have five or more chronic diseases. It turns out that every chronic disease is inflammatory, cardiovascular disease, peripheral vascular disease, diabetes, hypertension, obesity, anxiety, depression, OCD, bipolar are all inflammatory disorders. It’s all the same stuff. Again, your body is responding as a total body response to threat and that’s the essence of the problem. The solution comes down to creating safety, which means you learn how to control your body’s chemistry. That’s why I did mention the title of this talk, “Chronic pain is a disease of the consciousness.”

I know we’ve straightened a lot of different directions here, but let me try to bring this back together in one concept. Remember, my cat has a survival response. She gets anxious, but she doesn’t have a word for it. She takes physical action. She avoids the threat. Problem solved. She lays down and takes a nap. My boss screams at me and I go home. I don’t just lay down and take a nap. What does my brain do? It keeps spinning away. It turns out that emotional pain and unpleasant thoughts have the same effect on your brain as a physical threat, but since we can’t escape our thoughts, we have this ongoing repetition. It turns out to be a programming problem because what your brain does is translates the environment into symptoms.

 

These mental threats or this ongoing consciousness fire up your immune system and everything we’ve talked about. Animals do have some model of chronic pain, but I don’t know of that. I don’t know that well enough but probably very pretty rare. It’s our consciousness and language that give us an impact on our nervous system that we can’t escape. It’s a learned skill to simply learn how to control this process, control the reactions, learn the tools, learn the skills, and what doesn’t work. Again, I’m a huge fan of Psychology, but Psychology is just part of the solution. I’m a huge fan of physical therapy, but physical therapy by itself isn’t the solution.

As you pointed out earlier, the mind and body are one unit. You work on the body part of it. You work on the mental part of it. It’s all the same stuff. Medicine has to get this diagnosis of anxiety correct. If I give a surgical patient a choice of getting rid of their light pain or arm pain of surgery or getting rid of their anxiety, they want to get rid of the anxiety. They can certainly tolerate the pain, but they can’t tolerate the relentless anxiety.

I’m playing devil’s advocate. If a mental health professional is reading this, they might say, “Let’s have every orthopedic surgeon use the DASS form, which is a measure of stress and anxiety.” Why should we not screen for it and send everyone to mental health?

There are two reasons. I’m going to be blunt here. First of all, you have to treat it. As you get screened for it and do it, it was happening for decades. We go through a process of simply screening people, but we don’t treat the anxiety and frustration. We start to go through a process. Maybe it is never too from a psychologist. Anxiety is not a psychological problem. It’s a physiological response to the environment. There’s a group of somatic psychologists who are now changing pretty rapidly. I think in a few years, psychologists could be completely different because you know this with your Acceptance Commitment Therapy.

We talked about that on our show is that you train your body to be with unpleasant thoughts and emotions and if you calm down that chemical response, it’s game on. It’s a set of skills that psychologists in general don’t have. They don’t understand chronic pain. They don’t understand this body response. Again, when your body is full of inflammatory cells, you hurt. You’re increasing nerve conduction. Those inflammatory cells are in the brain itself. It sensitizes the nervous system. That’s my message. We’re still treating anxiety psychologically where it’s not.

I did some work with an ACT psychologist who’s very interested in using the body or combining the body with ACT. We did some wonderful things together. One of the great challenges with it is we piloted to a couple of psychologists and they said, “Because it involved placing your hands on people.” These are psychologists from various countries and states. They all said, “We can’t touch people.” I wasn’t talking about manipulating their spine with a Grade 5 manipulation. These are just basic movements, gentle pressure, and touch in a way that is appropriate with informed consent as well, but they don’t have it in their practice of ACT.

Now, things are changing. There are many different types of somatic experiencing techniques, but it’s one of those things. It’s taken a while and it’s still happening for physical therapists to bring into their skillset the idea of psychological techniques. We’re not psychologists. We don’t want to be psychologists. We don’t think Psychology is the answer for chronic pain. It’s a part of a bigger problem. If someone has psychiatric comorbidity, then they should be seeing a mental health professional. When I’ve tried to explain to some of these professionals that, “Touch, placing your hands on people, getting them to move in ways that are safe is extremely powerful and actually a form of psychologically-based care.”

Some of them know it on a scientific level, but it’s like, “That’s not what I do. I sit in a chair and I talk to someone.” I’m not a big proponent of what I reconsider as “talk therapy.” As you mentioned before, “If we’re going to talk about anxiety or if we’re going to talk about pain, there’s some pretty good research that it’s going to create more pain and create more anxiety, or at least not help it in a certain way.” It’s interesting how you’re bringing up how interoception in the body influences the safety mechanisms of the mind.

Again, I started working with Dr. Porges and the polyvagal theory. I was shocked and flabbergasted. I knew that anxiety was a response to a threat, but there are hundreds, maybe even thousands of research papers that show that anxiety, depression, and bipolar are all inflammatory disorders. They’re metabolic it. This is critical because anxiety is a word that describes a sensation generated by your body’s response to a threat. That reporter hates the word anxiety and I don’t disagree with him. I said, “Steve, this is a bridge word that this is the sensation people feel. They’re using this word to describe it.”

One of the first things we do with anxiety is we say, “It’s necessary for survival. It’s not going away. You have to develop a working relationship with it because if you didn’t have anxiety, you wouldn’t breathe, eat and do anything. You have to have this. How we evolve is how we survive.” This a way of learning skills to process it, move through it and make it part of your life every day, but if you fight it or try to solve it or fix it, you’re totally trapped. The first thing we do with people when we deal with anxiety is, “Get rid of the work. Take the word anxiety out of your vocabulary. Visualize a large thermometer on the opposite wall. Visualize the elevation of your stress reaction. If you feel anxious, then it just means to drop it back down. There are lots of ways of doing that, which you well know.”

The key issue is anxiety is what you have, but it’s not who you are. It’s a gift. For me, since I’ve understood this much better, I have this conversation with patients to explain the nature of anxiety. They dropped their shoulders and went, “I don’t feel bad about this sensation.” I went, “No, it’s necessary.” Let me remind people that it’s a survival sensation. It’s intended to be so unpleasant that it forces you to take action because the species or creatures didn’t pay attention to this feud and survived. It’s not only survival with the fittest, but it’s also the survival of the most anxious. We are the most anxiously anxious species of creatures who have lived over hundreds of millions of years. The people who were so relaxed didn’t survive.

That’s the key issue. That’s why it’s such a critical issue because the burnout chronic disease is horrible. It’s crushing our society. We have mental health issues, physical health issues, and all of the same stuff unless medicine can get this diagnosis correct. I love the work you’re doing. We can talk about this for a long time, but I read your book, which was very concise. What’s the name of your book again, Joe?

It’s Radical Relief.

 

I loved it because it was very concise and nails it right there. There are lots of tools that work. What we’re doing in medicine is we’re just flat-out hurting people because we’re thinking, “There’s this chemical reaction and we call it anxiety.” If we can’t find a structural problem for it, we say, “We have to live with it.” It’s not true. We start doing procedures that have nothing to do with the pain. We’re actively harming people.

I will say it’s the physical therapy group, the chiropractors, not so much the psychologist or physicians, but I would say the two groups I’ve worked with the most I’m excited about have been the physical therapists and the chiropractors. They have lots of knowledge about the body, how it works and how it moves. They have lots of groups that train your profession on the neuroscience of chronic pain. I’m excited about the potential change, but mainstream medicine has to make this change a lot faster than they are.

Definitely, physicians like yourself who are writing books. You have two books, Back in Control, and then you have a book, Do You Really Need Spine Surgery?. Those books raise awareness. Episodes like this raise awareness. I’m sure you get lots of inquiries as well as curious questions from spine surgeons who probably wonder, “What is this guy talking about?” I want to go back to anxiety because, like pain, anxiety is a survival mechanism. It’s not going away. We cannot turn it off. You don’t want to turn it off because if you turn that off, many negative things would happen that.

When you work with people and you’re helping them reframe anxiety, do you ever get to the place where you’re helping them realize that, “You can use anxiety to your benefit?” It’s almost like building energy. There’s a little bit of anxiety before I talk. Oftentimes, I have a little bit of anxiety before I lecture at a conference and I have learned how to re-channel that. As you mentioned, that thermometer on the wall, instead of it relating to my anxiety, relates to energy, purpose and excitement for what I’m about to do. Taking it back to a spine surgeon, having to be at the hospital at 4:30 in the morning and having ten spine surgeries lined up takes energy and concentration. Is there a way to use that anxiety in a way that’s healthy for certain situations?

Yes, the term I like to use is called focused force. You have to be alert to do spine surgery. You have to be alert to navigate life in general relationships. You have to read visual cues. I’m just going to put a crazy number out to like, 80% of anxiety is probably unnecessary because from ACT and CBT, Cognitive Behavioral Therapy, it’s a lot of the things that are based on cognitive distortions. That’s why I think chronic pain is a disease of consciousness because Dr. Burns, in his book, Feeling Great was talking about the ten cognitive distortions like should-thinking, labeling, catastrophizing and things like that. It’s unnecessary anxiety, the unnecessary elevation of your stress chemicals.

Again, one of the tools is that as you understand these cognitive distortions, they become irrelevant, so then we need that alertness to do your job, you have so much more energy. The other thing is since you’re not bringing up energy, unnecessary anxiety, I have plenty of energy in high school, whereas that nervous energy. I probably have three times as much energy now as I did in high school because I’m not burning it up all the time.

That focused force speaks to me because when your attention is not focused and your awareness is not probably in the present moment and you’re living in the past with stories or you’re anxious about the future, then there is no focus for us. I think that’s why so many people with pain and anxiety struggle with fatigue as well. The candle is burning at both ends constantly. From a physiological level, cortisol and other stress hormones are constantly pumping your system and helping with that focused force is a way to take back your energy. When you can take back that energy, then you’re like, “It’s incredible that I’m getting older, but as I’m getting smarter and wiser, I’m able to use my resources in more concise and useful ways.”

If you learn how to do it because if you don’t learn, it gets worse as you get older. One metaphor is driving your car down the freeway in second gear is going to break down. You got to mentally and physically break down. It’s the same thing. The body translates your environment into safety versus threat. There are over 30 different symptoms created by the ongoing threat. There are multiple physical symptoms, multiple mental symptoms, but it’s all the same thing. It’s all your body’s response to the environment and again, sustaining your nervous system versus the circumstances. That’s where the action is at, is that interaction is right there.

I’ve been talking to David Hanscom, MD. He has two books out. His first book was Back in Control. His second book is Do You Really Need Spine Surgery? Both are excellent resources, whether you’re someone with low back spinal pain or if you’re a practitioner looking to learn more about David’s unique perspective and his life experience as well. David, can you tell everyone how they can learn more about you and follow you?

Let me tell you about this rendition of what’s going on. I may have watched well over 1,500 patients go pain-free and chronic pain is not considered solvable and it is. There’s a new rendition or evolution of the project called the DOC Journey, the Direct Your Own Care Journey. You can access it at TheDOCJourney.com. It’s a package of services, which includes a set of lessons, which gives you a sequence of things you can do going from A to Z. It has twice-a-week group sessions, which is very powerful and healing. We’ve had a wonderful time with this. There are teaching videos and webinars. There’s access to questions being answered. There’s also an app. What we’re excited about by understanding chronic pain better and presenting it more clearly in group interaction, we’re seeing people getting better much faster.

It’s been a long time coming and it will continue to evolve. It’s called the DOC Journey. It’s a static concept. It’s not 1, 2 and 3 and your fixed mode. The final thing I’ll say is that, remember we talked about how people get bounced around and get discouraged? Why would my process work? It’s not about belief. Start with your disbelief. This is not about pretending things are good. It’s not about believing in David Hanscom, MD or Joe Tatta. It’s about just digging into who you are and connecting to who you are that you start changing your brain. It’s a step-wise process that had been consistently effective. What I like about your work is you’ve got it so concise. We’re now done with the DOC Journey. We’ve got it much more concise. Your goal and my goal are both to get this energy out into the world somehow and there’s a lot of work to do. I’m excited to be aware of your work and it is good stuff.

It’s always nice to connect with you. As David mentioned, you can find out more information on that website, the DOC Journey. That’s www.TheDOCJourney.com. I want to thank David for being with us on the show. Make sure to share this episode with your friends, family, and any practitioners interested in chronic pain anxiety and if they’re interested in learning to know if they need spine surgery or not. We’ll see you on the next episode.

Important Links:

• David Hanscom, MD
• Radical Relief
• Back in Control
• Do You Really Need Spine Surgery?
• Feeling Great
• @DrDavidHanscom – Twitter
• @DavidHanscom – Facebook
• www.TheDOCJourney.com

About David Hanscom, MD

David Hanscom is an orthopedic spine surgeon whose practice focused on patients with failed back surgeries. He quit his practice in Seattle, WA to present his insights into solving chronic pain, which evolved from his own battle with it. The second edition of his book is, Back in Control: A Surgeon’s Roadmap Out of Chronic Pain.

His website, www.backincontrol.com presents an action plan and his most recent program, “The DOC Journey” guides patients more clearly through the complexities of solving chronic pain. It can be accessed at www.thedocjourney.com. It includes weekly group sessions that have been a powerful addition to the healing process.

His latest book is, Do You Really Spine Surgery? – Take Control with a Surgeon’s Advice. It is intended for health care providers and patients alike to make a clear and informed decision about undergoing spinal surgery.